Ten years ago I was camping with my family at Nickerson State Park on the Cape. I love camping there. The kettle ponds are beautiful. There are no bears. We pitched our tents (one for me and the girls, a pup tent for my snoring husband), including my latest luxury — a massive air mattress. That night, after roasting frankfurters and marshmallows over the fire, I went to sleep in comfort. At 2 am, I woke in a panic. What was happening? Everything was moving, spinning, chaos. Earthquake! I had to save the kids! As I pulled myself upright and fumbled for the lantern, the whirling world began to slow and eventually came to a halt. I had just experienced my first bout of benign paroxysmal positional vertigo (BPPV).
BPPV is one of the most common causes of vertigo in people, manifest as brief episodes of mild to intense dizziness. It occurs most frequently in women over 50, but can affect all ages and genders. What is thought to happen is tiny crystals in the inner ear that help orient the head’s position related to gravity get dislodged and move into the semicircular canals. This throws the balance system off kilter, so head positions that normally wouldn’t bother you suddenly make you feel dizzy. Although BPPV can be brought on by head trauma or damage to the inner ear, most cases occur spontaneously. What does this have to do with veterinary medicine? Read on.
A Friday evening in June. Tiber, a hefty 12-year-old Maine Coon cat, is suddenly unable to stand. I heard him crying plaintively in the background when his owner called. The rapid onset and severity of symptoms led Tiber’s mom to think this was something bad. Really bad. She didn’t want him to suffer. Was it time to say goodby? In May, I was asked the same question by the family of Franny, a 13-year-old Labrador retriever. Despite lifelong orthopedic issues, Franny had generally been mobile enough to have a good quality of life. But early that morning, suddenly she couldn’t stand up, falling over repeatedly, holding her head tilted to one side. Like Tiber’s mom, Franny’s owners couldn’t bear the idea of her suffering. Was it time to let go?
“Idiopathic vestibular syndrome,” a common balance disorder of dogs and cats, is similar, though not identical, to BPPV in people. Like in humans, older animals are affected most frequently. Like my “earthquake,” onset of signs is rapid, often developing in under an hour. Symptoms include head tilt, rhythmic back-and-forth eye motion called nystagmus, and incoordination. Some animals walk in circles. Others cannot even stand. It’s pretty dramatic, so owners often jump to the conclusion that their pet has had a life-threatening “stroke,” but idiopathic vestibular syndrome is basically benign. Unlike people, who tend to get repeated symptoms over time, idiopathic vestibular disease in dogs and cats usually presents as a single episode. Pets generally improve significantly in a day or two. Most return to normal within a few weeks and the problem rarely recurs. Some may be left with a mild head tilt or slight incoordination, but these residual effects are rarely a big problem.
I convinced Franny’s owners to take her outside onto the grass, where the footing was better. There, the old Lab started to get her “sea legs.” Vestibular syndrome feels a bit like riding the Woods Hole on a rough day. Many animals actually act seasick, refusing to eat, even vomiting, because the dizziness can lead to nausea. Franny, being a Labrador, continued to eat despite everything, and was walking better within days. Not Tiber. He couldn’t sit up, let alone stand, and despite eating on the first day, soon stopped taking food altogether. Could it be something else? Something more serious?
Diagnosis of idiopathic vestibular syndrome is based on consistent history, clinical signs, and ruling out other diseases causing similar symptoms, such as ear infection, brain tumor, or stroke. Tiber’s ears looked fine. No indication of infection. Eardrums intact and normal. Evaluation for tumor or stroke would require referral for MRI, but if it was idiopathic vestibular syndrome, he should eventually get better. His mom opted to keep him at my clinic where we could provide supportive care, and see what happened. There is no specific treatment except “Tincture of Time.” People with BPPV sometimes use a physical therapy procedure called the “Epley maneuver” that theoretically moves the crystals out of the semicircular canals, but no one has figured out an “Epley maneuver” for dogs and cats. Their ear anatomy differs from ours, besides which we don’t really know if idiopathic vestibular syndrome has the same underlying cause as BBPV.
What about antinausea or antimotion medications? They can be used, but animals often experience a rebound effect once you stop, so I usually advise owners to simply wait and let the pet’s brain adjust without drugs. Even so, after a few days with Tiber still unable to sit up and not eating, I decided to try antinausea medication. The next day he was a little better, but still wouldn’t eat. The day after that, I gave an oral appetite stimulant. He was able to pull himself into a sternal position, but still wouldn’t eat. The day after that, he sat up, but couldn’t stand. I gave an intravenous appetite stimulant and, finally, he ate.
It took Tiber two weeks from the onset of his illness until he was able to walk enough to be ready to go home. There he will stay safely ensconced in a cozy room while we see how much he continues to improve. Me? When we returned home from the wilds of Brewster, I consulted my doctor, who confirmed the diagnosis of BPPV. I realized we had pitched the tent on a barely noticeable downhill incline. Perhaps sleeping head downwards, combined with the subtle fluctuations of that fancy new air mattress, had dislodged my “crystals.” In any case, I know just how Franny and Tiber felt.