Visiting Veterinarian : Dizzying disorder
Gillespie, a 14-year-old Labrador mix, loves the Vineyard, so his owners didn't think twice about popping the old man in the car for the four-hour trip to their Island home for the holiday. Hey, what Labrador doesn't love a family car ride, followed by turkey, and maybe a run on the beach? Heaven.
Gillie arrived Wednesday feeling fine. He took a walk, even played ball, but by evening he seemed off. He vomited dinner and was having trouble getting up. By Thanksgiving morning, Gillespie couldn't get up at all. "I made a towel sling to help him," his owner explained when I responded to her emergency call, "but his feet just curl under and he can't stand." I get this kind of phone call a lot - big, old, arthritic dogs who can't get up on cold, raw days. Usually by the time they arrive at my office they're walking fine. They're just stiff, achy, and have trouble getting started in the mornings. I can relate.
"Do you have any aspirin in the house?" I asked.
"He takes Rimadyl for arthritis," his owner replied. "I wasn't sure if I should give it this morning."
"Has he vomited again?" I asked. Anti-inflammatory analgesic medication like Rimadyl can exacerbate an upset stomach, but if Gillie's problem was orthopedic rather than gastrointestinal, then he needed pain relief. Since he hadn't vomited again, I suggested they give the Rimadyl, wait an hour, then try again to get Gillie up.
"Make sure he's on a surface with good footing," I advised. "Linoleum or wood are too slippery. Slide him onto rubber-backed throw rugs, or carry him outside. Lift him up, uncurl his feet, place them squarely underneath him. Support his weight for a few minutes as he gets his bearings. His feet may be asleep from having been down for so long. Call me back if he isn't walking in an hour."
"We got him up," the family reported later, "but he's staggering and keeps falling down. He looks, well, dizzy." Ah, dizzy. I know dizzy.
"Is he holding his head tilted to one side?" I asked. The owners were unsure. "Are his eyes flicking back and forth in a rhythmic fashion?" I asked. The owners were unsure. "I suspect he has geriatric vestibular disease," I said. "It's not serious, but it looks scary." His family understandably decided they would feel better if I examined Gillespie and opted to bring him right down.
Geriatric vestibular syndrome is an acute, non-progressive disturbance of the peripheral balance system in old dogs, most likely caused by a problem in the semicircular canals of the inner ear. It occurs most frequently in medium to large breed dogs over the age of eight. Classic signs are a sudden loss of balance, head tilt to one side, and rhythmic flicking of the eyes, called nystagmus. Cats have a similar syndrome, although the feline form is not age-related.
People get it too. It's called benign paroxysmal positional vertigo. I know because my first episode happened years ago while camping. I awoke in a panic in the middle of the night thinking we were having an earthquake, or that our tent had been sucked up into a tornado like Dorothy in "The Wizard of Oz." Since then, I have gotten used to coping with the periodic bouts of dizziness. In fact, I have been experiencing a recurrence this week so I empathized deeply with my patient.
When Gillie arrived, I met them in the parking lot. "Put him down on the ground," I requested as they lifted him out. Wagging his tail, Gillie staggered happily around the yard, his head cocked to the right. "Whoa, big guy," I grabbed his collar and looked into his smiling face. Yup. There was the nystagmus, his eyes darting side to side. The differential diagnosis included middle and inner ear infection, head trauma, and any central nervous system diseases that might affect the balance center, such as tumor or stroke. There was no way to definitively determine if this was geriatric vestibular syndrome, except to rule out other possibilities. Gillie came inside for a full exam. "Temperature normal, heart okay," I went down my checklist, looking in his ears with an otoscope, doing a neurological exam.
"We could run blood work," I offered "but it's usually normal." I glanced at their worried faces. "You could go off to a neurologist, but I really don't think that's necessary. This looks like classic vestibular syndrome. There's no specific treatment other than supportive care. Most dogs get better on their own." They still looked awfully worried. "Here, let me get a text." I pulled out a huge impressive veterinary tome and began reading. "Initial signs can be alarming and incapacitating, but the prognosis for rapid improvement and recovery is excellent."
One hallmark of vestibular syndrome is the sudden onset. Until they acclimate, the dizziness makes dogs feel seasick, hence the initial vomiting and loss of appetite. Many dogs literally spin in circles trying to get the world to stand still. These severe symptoms often resolve in a few days. The head tilt and incoordination persist longer but usually disappear within a month. An occasional dog will have a permanent head tilt, or recurrent episodes.
During the early stages, anti-vomiting drugs or motion sickness medications such as Dramamine or benadryl may be useful. Rarely we may prescribe human medications used for vertigo in people, but all most dogs need is good old-fashioned TLC and tincture of time. "You may need to help him navigate at first, to find his food and water and get outside to relieve himself, but you should see rapid improvement soon." His family reassured, Gillespie went be-bopping out of the office, already looking steadier on his feet. I sat down, a little dizzy myself, thankful for this simple and happy outcome to a holiday emergency.