Visiting Vet: Mystery staggering

A full history is essential for successful treatment.

Shoes is a happy, healthy, 2-year-old Labrador retriever. Late one evening in January, she was sleeping contentedly in her chair, then decided to hop down. When she reached the floor, her owners immediately noticed something was wrong. Shoes’ hind end was wobbly and uncoordinated. She staggered about for a few minutes, her family becoming increasingly concerned, but then, just as quickly, Shoes snapped out of it, returning to normal. Three hours later, it happened again. 

The next day the family brought Shoes to the veterinarians on call for emergencies. The doctors asked questions, trying to determine whether Shoes might have ingested something that could have caused this episode. There was no known exposure to antifreeze. Antifreeze tastes good and is highly toxic, leading to acute kidney failure that is usually fatal. There was no known exposure to rat poison. There are multiple kinds of rodenticides that, depending on the type, may cause anything from life-threatening hemorrhage to fatal neurological damage. Sugar-free gum or candy containing the artificial sweetener xylitol can cause hypoglycemia in dogs, which can present as staggering, but Shoes hadn’t eaten anything with xylitol. She hadn’t eaten raisins, which in some cases can cause kidney failure. She had no exposure to marijuana or other drugs.

The most important part of a doctor’s evaluation of a sick patient is getting a thorough history — especially when the doctor is a veterinarian and the patient is an animal who cannot tell us herself how she is feeling, what happened, or if she ate something she shouldn’t have. The emergency veterinarians did a very thorough job exploring possible causes of Shoes’ late-night lack of coordination, but were unable to find an explanation. In a dog of her age, there also was the possibility that this was an early sign of some congenital neurological problem, like idiopathic epilepsy. In any case, Shoes seemed perfectly fine now. Her physical exam and blood tests were all essentially normal. The family was advised to keep a close eye on her and, if the episodes recurred, to try to get a video and consider evaluation by a neurologist.

One month later, Shoes had another episode. The history was exactly the same. It happened late in the evening. Once again Shoes got down from the chair where she had been sleeping. Once again she staggered around a bit, then quickly returned to normal. Once again the veterinarian (this time it was me) could not find anything amiss on physical exam the next morning.

History, history, history. I told Shoes’ owners my stories. There was Jalapeño, the dog who started vomiting at home one evening, then came to me on emergency a few hours later, semicomatose, trembling all over. I could not determine the source of the problem, but treated symptomatically with intravenous fluids and anticonvulsants. He recovered, going home the following day, without a definitive diagnosis. Several weeks later, the same thing happened. A month later, a third episode. “I think Jalapeño is getting into something outside that is making him sick,” I told his owner. There is a condition veterinarians call “garbage toxicity” or “garbage intoxication,” which lumps together everything that may happen when a dog gets into the trash or compost and eats a bunch of nasty, rotten stuff. Signs vary depending on exactly what is in the disgusting goop eaten. 

At first Jalapeño’s owners did not believe my presumptive diagnosis. They often let him out unattended at night. Their home was in a rural part of the Island, so they felt he was safe, and they never found any overt evidence that he had raided a dumpster or compost pile. But by the third episode, they were really tired of seeing me late at night and paying emergency fees. I asked them to do an experiment. “Don’t let him outside unattended,” I requested. “Never. Ever. Especially at night. ” Reluctantly they agreed.

I didn’t see Jalapeño back for a long time. But then one evening, there he was again, on emergency, vomiting, tremors, signs of “intoxication.” The owners acknowledged that, after all these months without any episodes, just that evening they had decided to let him outside unattended again. And look what happened. The family was now convinced that Jalapeño was causing his own illness by repeatedly ingesting something bad outside. 

History. History. History. The most frustrating cases are the dogs who ingest drugs but whose owners are not forthcoming with the information about what products might have been in the environment. With the legalization of marijuana, people are better about telling their veterinarian about exposure to weed or edibles, but sometimes it’s the teenage kids who have the THC-containing products, and their parents are unaware. Even when the drugs involved are completely legal, sometimes an owner is embarrassed about medications such as antidepressants, antipsychotics, antianxiety, or even prescription pain medications. Seriously, no judgment. All your veterinarian wants is to get the necessary information to help your dog. 

I reviewed Shoes’ history again, asking about garbage, compost, mushrooms, anything. I have seen several cases of staggering dogs who ingested wild mushrooms outside. Mushroom ingestion can cause a wide variety of signs, depending on the type, but as identification of an ingested mushroom is not likely to happen, I follow the adage in my favorite toxicology text which simply says “treat the patient, not the mushroom.” In other words, provide symptomatic care based on, well, the symptoms. 

In the end, we still don’t know what caused Shoes’ episodes. It is theoretically possible she ingested mushrooms or moldy mulch in the yard. To be on the safe side, her family will supervise her carefully outside, and will try to video any future occurrences. We still can’t rule out primary neurological problems like epilepsy. It might even be a musculoskeletal problem — something as simple as her legs falling asleep, or back spasms. If only Shoes could talk! Instead, her family must talk for her, answering all the questions we veterinarians can come up with, to try to discover the cause.