Q: I have a senior dog with immune-mediated hemolytic anemia that your wife, Dr. Mims, nursed back to health. She is a 13-year-old terrier mix and she completely collapsed the other day.
I thought for sure she was on her way to the Promised Land. But thanks to the vet and a sharp vet tech at the emergency animal hospital of North Charleston, I was wrong.
They told me to get some meclizine and monitor her closely. Sure enough, she is doing much better, though still a bit wobbly. You might want to inform other owners of senior dogs about this disease.
A: Your experience reminds me (Perry Jameson) of a patient in the ICU at the University of Georgia I treated while doing my internal medicine residency. She was an older golden retriever hospitalized for some early kidney issues. She was responding to our therapy and we all thought ready to go home.
Suddenly, my pager went off calling me to the ICU. As I rushed into the room, the nurses stated she was having a seizure. It certainly looked like a seizure to me as she was thrashing all four legs violently while her head was turned to one side.
Fortunately, when an ICU emergency occurs, everyone is notified, so as I was trying to figure out what to do the neurology professor slowly walked up to her kennel door. He stood there observing her for about 15 seconds and then surprisingly announced to everyone that this was not a seizure but a severe case of vertigo.
I was a first-year resident so no way was I going to contradict what he said, but I quietly had my doubts. He had several students gently remove her and place her on a soft mat on the floor. Here, we could all see that she was attempting to roll to one side. Her head was also rotated in the direction she was trying to roll. He pointed out to all of us how her eyes were quickly moving back and forth.
These were not symptoms of a seizure but instead a severe case of vertigo. She felt like she was spinning and this caused her to roll, rotate her head and the quick eye movement.
He called it “Old Dog Vestibular Disease” and confidently stated she would start improving within hours to several days. We administered some Valium to calm her and started the meclizine, as you did.
As with your dog, she recovered rapidly. When I arrived the next morning, she was able to stand and go outside. Besides her slight head tilt and mild ataxia, she was close to normal. Within 48 hours of the episode, we sent her home; Mom and Dad reported to me a week later she had completely recovered.
The vestibular system is a part of the nervous system responsible to help us, and our pets, balance and walk normally. It maintains the position of the eyes and body, so head orientation and eye movements are all affected by a disturbance anywhere in the system.
The system is divided into peripheral and central. A simple way to think of the difference is that central disease affects the brain and brain stem while peripheral diseases affect the inner ear or nerves connecting it to the brainstem.
It is important to differentiate between the two locations, as centrally located diseases usually carry a worse prognosis. A complete neurologic examination will often allow us to differentiate the two.
The most common peripheral vestibular diseases are an inner ear infection, idiopathic vestibular disease (also called old dog vestibular disease), toxins, congenital vestibular disease, tumors and trauma.
Causes of central vestibular disease are tumors, inflammation or infection, hypothyroidism and toxins.
Head tilt to the affected side, ataxia, nystagmus (fast twitching of the eyes), strabismus (abnormal eye position), falling or rolling to the affected side, nausea, vomiting and anorexia are all symptoms of vestibular disease.
If your pet has signs of vestibular disease, the first thing to have done is a neurologic examination to help differentiate central from peripheral location. Be honest about all medications your pet is on. A thorough ear examination is always performed to determine if an outer ear infection has spread deeper. A complete physical examination looks for systemic disease like infection, tumors and hormonal diseases.
Hypothyroidism and vector-borne diseases can be tested for in blood samples. An MRI can provide detailed pictures of the brain, middle ear and inner ear looking for diseases in these areas. Cerebrospinal fluid may be obtained to look for inflammation of the brain or brain stem.
There are multiple causes for abnormalities of the balance center in dogs and cats and a thorough physical and neurologic exam can help differentiate.
Despite being an older dog like my patient and your dog, it may not be a terminal problem but could be a condition that, with a few days of TLC, they can recover from completely.