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Shea Cox
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Idiopathic or “Old Dog” Vestibular Disease
Vestibular signs in dogs are often incorrectly referred to as a stroke

A fairly common reason for a veterinary visit is the concern that an older dog has had a stroke, when he suddenly starts walking like a drunken sailor with his head tilted. I know of other cases, where these sorts of symptoms are assumed to be a brain tumor and the dog is euthanized—maybe unnecessarily. (The condition plays a role in the new Hallmark movie, Duke.)

Well, I want to shed some light on a much more common and less concerning cause of these and other disturbing signs, something known as idiopathic vestibular disease, in case it is something you ever experience with your own geriatric dog.

Idiopathic (meaning unknown cause, think: idiot) vestibular disease is a syndrome that looks really, really bad, but usually gets better all on its own with little or no treatment.

The vestibular system
The vestibular system is composed of portions of the brain and ear and is responsible for maintaining a sense of balance. When something goes wrong with this system, it’s like being drunk on a rocky boat. Dogs with idiopathic vestibular disease have some combination of the following signs:

These videos show a dog with mild, but very typical, vestibular signs and another dog with more severe signs.

Now for the caveat: These clinical signs are unfortunately not unique, or diagnostic for, idiopathic vestibular disease and other things can cause this same presentation. These can include (yes) a brain tumor, an inner ear infection, inflammatory disease or sudden bleeds into the brain—to name a few. But with that being said, when the symptoms seemingly appear out of nowhere in an older dog, I always recommend a “wait-and-see approach,” treating symptomatically and supportively, as there is a good chance of improvement.

Wait-and-see approach
For a dog showing the above signs, I first discuss the possible causes. Next, I recommend blood work and a blood pressure check to make sure there is no “obvious” disease. I discuss the availability of an MRI to evaluate the inner ear and brain. Although an MRI allows for the best evaluation of disease, it is often not pursued due to cost (about $1,500 here in the Bay Area).

I examine both ear canals, and if an infection is suspected, I discuss antibiotic therapy, as inner ear disease is one of the possible causes of vestibular signs. The inner ear (pictured below) is something you cannot see during an exam because the eardrum obscures the view to the inner ear. The eardrum is like a closed door that sits in front of the middle and inner ear. However, if there is a nasty looking outer ear and an inflamed eardrum, there is a chance that inner ear disease could be present as well.

If the dog’s clinical signs are so severe that they cannot walk, I then recommend supportive care with IV fluids and injectable anti-nausea medications. Urinary catheters are sometimes placed for hygienic reasons. If clinical signs are mild, pets can often be managed at home with over-the-counter meclizine (for the feelings of “motion sickness” they experience). We also provide instructions for general nursing care as well as how to protect from falls.

The conversation ends with discussing a very loose rule of thumb: If there is gradual or complete improvement within 72 hours, it is likely idiopathic vestibular disease and additional diagnostic testing is not necessary. If there is no improvement or progression of signs, it is likely something much more serious, such as a tumor, and an MRI would be recommended to reach a definitive diagnosis. With idiopathic vestibular disease, marked improvement is usually evident in this time frame, with the pet returning to normal in 7 to 14 days (although in some dogs, a head tilt will still persist).

It should also be noted that this is not a painful condition, and my recommendations stem from the fact that euthanasia is a permanent decision, so why not wait and see, giving time a chance? There is a high likelihood that improvement will be seen and the difficult decision of euthanasia can always be made at a later date if there is no improvement or if there is a change in your pet’s quality of life. I feel there is reason to hold out hope and be cautiously optimistic, as idiopathic vestibular disease is the most common form of vestibular disease in dogs. It is the direction I would take if it were my own boy experiencing this.

Please note: There are times, however, when a physical exam points undeniably to a brain tumor, but these neurological exam findings are beyond the scope of discussion, so feel free to ask me any questions.

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Veterinarian Shea Cox has enjoyed an indirect path through her professional life, initially obtaining degrees in fine arts and nursing. She later obtained her veterinary medical degree from Michigan State University in 2001 and has been practicing emergency and critical care medicine solely since that time. In 2006, she joined the ER staff at PETS Referral Center in Berkeley and cannot imagine a more rewarding and fulfilling place to spend her working hours. In her spare time, she loves to paint, wield her green thumb, cook up a storm and sail. Her days are shared with the three loves of her life: her husband Scott and their two Doberman children that curiously occupy opposite ends of the personality spectrum.

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Submitted by PMN | May 21 2014 |

Dear Portland,
Thank you for the excellent description on vestibular syndrome. My GSD (12yrs) has just started showing the signs described. My vet was flammoxed! thanks to your article we were able to identify it and feel confident that she will be with us for some more years. Fluids seem to be the most difficult part. I'll try your syringe therapy.
Thanks once again.
Dr.PMN

Submitted by kristin | August 18 2014 |

My 13 yo gsd is going thru this now. It started yesterday morning. I freaked out at first but then did some research. He's a finicky eater as it is, and has a tough time eating now so I bought canned food, the chuncky kind and added a bunch of water. Hell drink the water first because I'm sure it tastes yummy, then he'll eat the chunks of meat. I do that a couple times til he's had enough. That way he's getting enough fluids and food. Might be worth a try? Good luck.

Submitted by Anonymous | May 1 2012 |

I wish I would have found this site earlier! We just put out Lady to sleep after presenting with exactly these signs. I am devestated and don't know why my vet advised euthanasia if this was a possible scenario. She only had I either symptom-loss of badder and bowel control. Is that symptom ever part of this syndrome?

Thank you for your article!

Submitted by Shea Cox DVM | June 7 2012 |

Hi Anonymous~ I am sorry for my delayed response as I am just seeing these comments today. And I am so sorry to hear of your loss. It is unfortunately very difficult for me to say one way or the other~ what I can say, is that loss of bladder and bowel control often happens during a seizure, and seizures can come from brain tumors. Vestibular disease doesn't generally present with sudden loss of bowel/bladder control. My heart goes out to you~ it is such a difficult thing to lose a pet and best friend.

Submitted by Dana | May 2 2012 |

Thank you for this article. I have had a few clients and friends dealing with this in the last few months(including myself with my old guy). Good information and I have shared it! Thanks again!

Submitted by Shea Cox DVM | June 7 2012 |

Thank you, Dana! I really appreciate the feedback and glad it has helped you and others. I hope your "old guy" is doing well!

Submitted by Lab Lover | May 22 2012 |

Thank you so much for this article. I took my 12 year old yellow lab to the vet this morning thinking she had a stroke. It was a very sudden onset of symptoms. At 7:30am she ate breakfast normally, although we noticed she did have a tiny bit of trouble walking, but nothing major. 15 minutes later she couldn't stand, her head was tilted and her eyes were spinning in circles.

We immediately took her in and the vet mentioned old dog vestibular disease. I had never heard of it, so when I came home, I looked it up. My guess is this is what she is suffering from. She is at the vet getting fluid and antibiotics to make her comfortable for now. I hope, hope, hope, this is all it is and not the suspected tumor. I will wait and see if she improves or gets worse over the next few days.

This article makes me feel a little better about her condition. Thank you.

Submitted by Shea Cox DVM | June 7 2012 |

Thank you for sharing your experience and I am glad to hear this made you feel a little better after reading :). I am seeing these comments late, so I hope that she has continued to improve since your post. Improvement over time is definitely one of the hallmarks of the disease, and I hope this is what she has experienced~ keep me posted! :)

Submitted by Lab Lover | June 18 2012 |

It turns out this is exactly what my dog was experiencing. After 4 hours at the vet on fluids and antibiotics, the Vet called and said he had never seen a dog respond so quickly to medical treatment. She was up and moving around and I was able to see her that night. They did keep her overnight as a precaution, and she came home the next day on antibiotics. The only lingering side affect was her right eye was not dilating properly. At a check-up a week later, it had improved. Its been a month since this all happened, and she is back to her old self. A very scary experience, but thankfully one that ended positively. Thanks again for posting this article. It did help calm me down after the Vet had mentioned it could be a brain tumor.

Submitted by Joe | July 22 2014 |

We have Leo, a 19 year old(yes19) Italian
Greyhound. Last winter he had head tilt
couldn't stand or walk, eyes twitching. This
lasted for two days, and he slowly got back
To 100%. He still has some head tilt, worse
some days. A few days ago, he started having
the same symptoms reoccur, and he is slowly
starting to get back to normal. Very sad to see
him go through this, but Vet said it's common
and he is not in any pain.

Submitted by Mishi | May 31 2012 |

Thank you for posting this article, until today I'd never heard of this affliction. I woke up this morning to find my 16 year old dog vomiting, unable to walk/stand, tilting her head, and her eyes darting all over the place. My first thought was either a stroke or poisoning of some sort. The boyfriend and I rushed her to the Vet and were given old dog vestibular syndrome as the prognosis. After discussing options, we decided on an injection to help with the nasea and brought her home to follow the "wait and see" approach. She has already started drinking water unassisted if presented the water dish, but still has no interest in food. This article has been very comforting and reaffirmed my decision to give the old gal more time to recover. Hopefully, she'll be as good as ever in a few weeks and able to again run around the pasture with the chickens.

Submitted by Shea Cox DVM | June 7 2012 |

Hi Mishi! I am so glad to hear this blog has offered some reassurance and help! I am glad to hear she is making baby steps, and hope she continues to do so. Let me know when she gets back to chasing chickens! :)

Submitted by Martha | June 2 2012 |

My 11 year old lab/chow mix just presented with these symptoms last night. The head tilt, drooling on that side and imbalance on the front leg on that side. No eye jiggling, but vet said this am that there was no nystagmus in her right eye, it does retract and the other one is fine. Appetite and drinking are good and gets around pretty good. She did vomit at the vet office but that's the only time. Vet gave prednisone and drew blood for labs and will check back Monday. I hope this is all it is and not a tumor or something like that.:(. Her symptoms dont seem that severe right now, and came out of nowhere last night. Thoughts?

Submitted by Shea Cox DVM | June 7 2012 |

Hi Martha~ it sounds like you are hopefully dealing with a case of vestibular disease, especially the way you are describing her symptoms (mild) and improvements. With vestibular disease, the signs generally come on just like you describe- out of nowhere. I hope she continues to make strides and gets back to her normal self soon :)

Submitted by dale | June 3 2012 |

My Shiht-zu 11 years, Tony has been diagnosed with this. It has been 4 weeks. He did show some improvement at day 5 but got worse and now is trying again to improve. We are hand feeding and watering. Also having to hold him up to do his business. He also crys at night, we have left a night light on, I read they get confused in darkness from being dizzy. I wonder if he is also getting frustrated since he can no long fetch his ball or walk around. We are holding out since everything I have read said to give it time. I wonder to myself when the time will be, these sites say he is not in pain, but being stuck to his cushion bed and not being able to get around must not be very satisfying to him either.

Submitted by Shea Cox DVM | June 7 2012 |

Hi Dale~ I would expect that by 4 weeks he should be showing steady improvement. If symptoms persist or progress, we get concerned of a more central disease (brain tumor), but it is difficult to say without knowing or seeing your boy. With brain disease, pets can get a change in their behavior, and vocalizing is often one of the signs. And you are right~ quality of life is so very important and it is difficult to make such decisions. I hope he continues to improve for you.

Submitted by Lisa | November 21 2012 |

My 14 yr old greyhound sharpie mix female (baby girl) dog suddenly seemed to have a really bad dream. I was awaken by her paddling in her sleep and she got up and kept ramming her head in the wall until I stopped her. Then she was falling down and paced until she got her bearings. She's always been prone to ear infections and had 2 hemotomas and tubes put in her left ear. the next morning I was out watering the plants and found 2 of my dining chairs on the floor. I immediately thought she had another bad dream but was thinking maybe she had an ear infection and was showing signs of degenerative disease, cause she has been becoming hard of hearing and she's been wetting her bed in her sleep. We took her to the vet and put on k-brovet. She didn't take it well, we only managed to give her 2 500mg in the evening and 2 in the morning. At this point stil not sure if she really had a seizure just a really bad dream. She panthed all day and wasn't interested in food or water and didn't take any naps. We stopped the k-brovet and spoke with the vet.

The following Saturday (this past weekend) we witnessed her having a seizure where she foamed at the mouth and defecated and urinated a mild episode followed 2 hours later which led to another after 3 hours. It seemed to occur when she would get into a deep sleep. 2-3 hours went by and nothing; so we thought the worst was over. We brought her upstairs to bed only to find ourselves waking to another seizure after 4 hours. We contacted the Animal Hospital, the person we spoke to advised us to monitor her; as long as between episodes she was bouncing back to her normal self and bring her in after 7 a.m. that there was nothing they could do more since we already did bloodwork last Saturday. She had another at 3 in the morning and bounced back again.

Then at 5 a.m. she had a minor one episode then panthed for an hour. Since began to not be interested in drinking water or food out of the bowl since. We figured she was so tired and just wanted to rest.

She's had a couple minor episodes later that morning but just wanted to go back to sleep. None since but it has been a scary horrible 36 hrs (about 8 total).

We are on the third day giving her water and food with a syringe. The vet said she may have a brain tumor. She's getting up from the ground on her own and she was always a girl who had anxiety quivers. She seems to have it when we take her outside like she's scared. She still refuses to eat sold food or drink from the bowl. She urinates on her own.

This occured several times until the last two seizure episodes she seemed so exhausted and panthed and not interested in water or food from her dish or walk the back yard to gain her bearings anymore. She's so scared now.

She hasn't had anymore seizure episodes only last night she panthed for an hour before she went to bed and her nose was warm.

Do you suspect it could be a brain tumor as well, this came on all of a sudden. She has always been such a mellow but skidish girl and would usually have anxiety quivers when it's closer to fireworks season or when she's scared. It's her personality.

Should I request for antibiotics and watch and see if she does have a bad case of inner ear infection? She face planted after the night of her initial bad dream and the day after. Now she seems only week in the legs while standing, quivering outside after we carry her to encourage her to urinate. Otherwise she lies down a lot nowadays and not interested to go go right away.

We are trying to feed her water and liquefied food with a syringe.

Submitted by Cath | June 5 2012 |

I am writing this absolutely devastated as my 14 year old German Shepherd girl developed these symptoms last Thursday. I called the vet who suggested a wait and see approach. Friday saw some improvement and Saturday even more. She was able to eat if hand fed and drink from her water bowl when brought to her. She was able to walk outside in the garden, on a leash, to do her business. She was very unsteady with a head tilt but seemed fine in herself. Saturday she was able to walk without assistance, albeit unsteadily, around the house and the eye flicking had stopped. Sunday saw a marked decline and from 6pm Sunday tea time she would not move. Her head tilt was much worse and she could barely lift her head. She was able to lick food off my hand but had to be given water through a syringe. I slept next to her every night from Thursday, never left her side. Monday (yesterday) there was no improvement. She had remained laid in the same position now for 16 hours and had peed where she lay. I gently cleaned her up and was so worried I called the vet to see her. He gently stood her up but she could not support her own weight and her front right paw was bent underneath her. She was panting and very distressed. I thought I would be given medication and was in complete shock when he suggested euthanasia. He said he thought something more serious was going on as she had markedly declined since Thursday. She died in my arms. After reading this I am now worrying in case I should have given her more time. I would have been quite happy to nurse her at home until she got better. I am so devastated and feel like I have let her down.

Submitted by Deanna | June 6 2012 |

Cath, I'm so sorry for your loss, and in such a stressful, confusing way, too. I've done a lot of reading on grieving over the loss of a pet, and your feelings of guilt and disappointment are very common. Just know that your animal trusted you, and knew you were doing the best you could with the information you had. Sometimes the vet just feels or knows something that's hard to communicate, and perhaps you felt it, too, which is why you made that decision in that moment. Try not to be so hard on yourself, as I don't think your wonderful dog would want you to be unhappy.

Submitted by Shea Cox DVM | June 7 2012 |

Hi Cath~ First off, let me relay my heartfelt sympathies for your loss. I don't think there are many things more difficult than that experience. And secondly, it sounds like the difficult decision of helping her pass peacefully was the right one, as heart wrenching as it is to make. I mentioned in the blog, "There are times, however, when a physical exam points undeniably to a brain tumor, but these neurological exam findings are beyond the scope of discussion." I bring this up because it sounds like she had such an underlying problem. The way you described her return of clinical signs, the progression of her signs, and especially the knuckling of her right paw under her, all point to a tumor in her brain. And I want you to know that I am not saying these things to ease your heart- I, myself, would have made the exact same decision as you based on what you have shared. You did not let her down in the least- you were by her side, sharing your love for her, and letting her pass in as peaceful a way as possible. I hope this helps in some small way. In understanding, Shea Cox.

Submitted by J | June 8 2012 |

Hi Cath, My story mirrors yours very cloesely, except I still have my 14 year od Belgian sheep dog with me.10 months ago she develpoed vestibular syndrome. very severly. I too layed next to her side for 5 days. She could not stand on her own. She peed where she layed too. I gently cleaned her as well. I had to feed her water thru a syringe, and made a slurry of food home cooked meats, organ meats, probiotics, electrolytes. I was certain she would not recover, but never lost hope. it was touch & go. Slowly she recovered, but still has a head tilt and wants to spin/walk. I don't mind these changes. I'm just greatful that I still have her. I'm writing to express that you absoluty did everything within your power to help her. I don't believe in a wait and see approach. I've found much success with homeopathy. I used gelsinium, traumeel, pusattlia remedies. for the inflamation & nausea. i firmly believe that these helped speed her recovery. after all if inflamation causes this symdrome, why not try to alleviate it? Ive also discovered slippery elm bark helps with nausea and upset stomach along with ginger. I continue to use homeopathic remedies for her other health concerns. I know the pain of the loss of a beloved pet is devasting. I just lost my 19 yer old Cat, 3 weeks later our 10 month old kitten snuck out and was hit by a car. they lay to rest in my back yard. Our Dear Belgian is clearly morning their loss, I wish I could find a remedy to help ease the devasting loss of those so dear to us. maybe just knowing that others share in your loss and that you are not alone helps?

Submitted by Anonymous | December 1 2012 |

I have an almost 5 years old St. Bernard. In the Past few days he has been having trouble with his motions, bad stomach. Today when we woke up we got to see his shit in the house (which never happens), turns out he is not able to move much and has been shivering/shaking(not out of cold) with long breaths with constant trembling. He is not able to lift his body, and can't be taken to the Vet as he is huge to carry... I'm really worried, thinking either he has got a stroke or may be paralysis. Any suggestions as to what actually is going on with him?

Submitted by jackie hannum | February 26 2014 |

id be worried about bloat, with a big dog, if he seems
uncomfortable, or paces you must get him to
vet stat!! is his stomach distented? seem bigger
than normal? if so get to hospital please

Submitted by Anonymous | June 11 2012 |

We are going thorugh this with our Cocker Max. We have him on Antibo.and Pred. we are seeing improvement, but still have to lift him and some times he gets going and out side to do his business,he stands for a while and eats and drinks out of his bowl and some times on a plate easer. Our vet did not metion Old Dog Sbyndrome. We are going to watch for about a week or two. I guess if his bad days are more than his good it is time. A tough dicissoion to make. So sorry for your loss, all dogs go to heaven, and we meet them later.
Hugs

Submitted by Anonymous | June 19 2012 |

I want to cry as I am going through this right now. My shihtzu is 17 and it is hard to watch her. I aboutt has only been 24 hours since she started antibiotics for this Ivd. Do you think i should give her more time before deciding about euthenasia?

Submitted by Scott | July 25 2012 |

Cath, first as a many pet owner, doing this for other reasons, understand your pain.

My mixed dog, Arfy, been told by vet 7.5 years ago when saving him from the adopted brought back twice reason for the "shot". He is something Akita. Others have said "some wolf". I don't know either was but we love him. Friday will be three weeks since he woke us up, as many, thinking seizure or stroke. 1100 later, diagnosed hour away vet ER. Immediately said IVD. Never heard of it he was 70% and in the last 36, seems to have regressed back to a week ago. Putting our precious daily joys down comes to our mind, we are scared, we are too close to be objective.

I am not sure how long this will take, as long as I can see that smile, that tail wag, the vet continues to assure us, we will, as you had to make the awful choice of thinking of your baby, I will make that decision. I do not think you were and us either, what is best for our pets, just harder to make this tough decision.

I am a 53 yr old man, not to macho to admit I cried reading your story.

Scott

Submitted by Paula | December 12 2012 |

Dear Cath,
I am so sorry for your experience and am full of tears! I had to respond to let you know that as my beloved shihtzu is now going through this if not for the vet telling me to wait it out, I would have put her down. The signs alone had me panic stricken since it seemed like a stroke and so unlike Cricket's normal behavior. She is 16 and the best friend anyone could ever want or need and I couldn't tell what was happening but didn't want her in pain. I depended on the vet to guide us. Honestly, I was way too emotional to make any decision since I thought she was dying and was devasted. Even people in the vets office were devasted when they saw her and tried to be comforting to us.

Again, I am so sorry for your pain but understand how the decision was made. Your little lady is now in Heaven and having a ball without despair. You will see her again! Blessings to you Cath.

Submitted by Tamara Miner | May 26 2013 |

Dear Cath-
It takes a lot of LOVE to let go. Think about the wonderful time (forever) in eternal summerland you have gifted your dog with. She will be waiting for you!

Submitted by Senga Thorpe | June 8 2012 |

Hi, my 13+yr old had to be rushed to the vets on New Years day 1012. the vet i saw suggested a stroke. the condition got worse when we got back home and eventually Clova was completly of her legs. My own vet came to see her two days later. i asked him what was the diff to tis 'stroke' and vestibulars. he told me this IS vestibulars. and also that it is one of the few occassions that he goes out to a house to pts a pet and then advised wait and see. my bitch had the VD severly and after a week my vet said we need to have a think now what we do. i told him i wanted to wait and see for longer as with each day there was slight improvement. the most distressing was my bitch being unable to stand and toilet, she would store it for about 17hrs, get v stressed, puffing and panting then the floods came. after two weeks she was up on her wobbly legs. i know i may not have her much longer as she now has Laryngyal paralasis, but i have had extra time and appreciate that time. Clova celbrated her 14th birthday 7 wks ago!

Submitted by Don | June 18 2012 |

My 13 year old german shepard/chow mix had an episode last night right after he ate. Eyes darting, drooling, some whining, unable to stand, falling over to one side when we did help him up. We thought he must be having a seizure or stroke so we took him right to the emergency room. Once there, the staff evaluated him and thought that he has vestibular disease. His symptoms vanished as quickly as they had come. When we left the clinic he was able to walk on his own and even climb into the car with very little difficulty. 3 hours later he was still fine, no eye movement, no listing to one side. The clinic had given us meclizine to give to him. I gave him a pill, brought him into the bedroom, and we went to sleep. About 1 am he started vomiting every hour on the hour until 5 am and his eye movement returned. It has been 16 hours since then and his eyes are still moving on their own. He can stand up on his own but not very well, his head leans to the right quite a bit, he will take food and water from his bowl if I hold it under his nose. He still wags his tail and smiles at me when I come in the room so I know he feels pretty good. I just wish his eyes would stop! Any suggestions would be greatly appreciated.

Submitted by Shea Cox DVM | June 21 2012 |

Hi Don~ I'm so sorry to hear about your baby :( It is tough to have to go through these experiences... by now, I would expect him to be getting slowly better. The difficult thing with these signs, is that every pet can present differently, take completely different paths towards improvement or decline, and can have any one of many underlying causes going on that all give you the same clinical picture. For example, sudden onset of signs, rapid improvement, and then return of signs again can indicate a small bleed in the brain; but on the other side, it could also mean simple exacerbation of vestibular disease. At this time, the focus is mainly on comfort measures, safety, and nursing care. You can give Meclizine 25 mg once daily for several days in a row without harm. Keeping him in a darkened, low stimulus room can help with the spinning (and subsequent vomiting). It can take a while for the nystagmus (eye movement) to resolve, but that is usually one of the first things to go away. I'd be concerned if this is still present, and if so, you should follow up with his vet. I am glad to hear his tail is wagging and he is happy... it is emotionally frustrating to have to 'wait and see' what progresses or improves, and I wish you both the best. Keep us posted.

Submitted by Zeke's Mom | July 7 2012 |

Last September, my 6 year old sheltie/Australian Shepherd mix began barking episodes ..for 10 mins, two to three times a day..In October, after medicating, my Vet Said she believed, based on her educated intuition and 30 years experience, that Little Zeke has a brain tumour...( I must include here that he developed a paralysis(partial) on right legs when he was 2 years old...acupuncture reduced the severity but he has limping with clubbing sometimes in the right front leg.).Vet believes the old injury and these barking episodes may be related...Now, eight months later, he is on a cocktail of supplements, pheno and prednisone(every other day)..but he still barks..and it's an anxious bark, staring at nothing...The curious part is that the bark episodes (142 times in 30 mins -sometimes only 10 barks) are within an hour to one and half hours of eating..the other thing, is that if I stroke him, pet him, barks stop! If I stop, he resumes this mindless barking.. I tried for one month an experiment recommended by vet, of NOT touching him at all..the barks continued..so rather that leave him in what appears to be a fearful state, I stroke him, to calm him. At 6 years(when it began) is he a senior dog ? I must note here that he is although a little subdued still has a good life for about 70% of his days...Anyhelp out there ?

Submitted by Anonymous | September 8 2012 |

My approximately 11 year old dog started the barking episodes in the last few months, usually after eating. I really didn't relate that to anything, and didn't mention it to the vet. when I took her this past week. She started the head tilt and stumbling on Sunday so I took her to the vet. Her eyes were moving rapidly to the side, so he concluded that she had vestibular disease. He seemed to think it was not ear-related, but now I wonder. She is blind, but has been able to sniff her way around. Now she just runs into everything, and I have to carry her outside. He seemed to think she would get over this in 3 days to 2 weeks, but I really wonder.

Have you learned anything else about your dog? I hate seeing my dog like this. She sleeps much of the time, but I would like to know if she is in pain or just frustrated because her balance is very unstable.

Submitted by Scott | July 25 2012 |

Dr. Cox,

I came here to ask, cried my eyes out about Cath's decision

Arfy, male, 9 years. Bam, 3 am wake up, he is left, stiff, certainly trying to understand it himself. First thoughts as many, seizure or stroke. He was so bad, it could have been seen as a broken back. Freaked, rushed to vet ER hour away, first look, check, then eyes and immediately said vestibular disease, explained it using the human vertigo times ten.

Arfys improvement has been much slower. Starting last week, he could manage drunk, left side tilt, everything crashes and leans left.. Up until late Monday night, he was even able to sorta take his position to poop, with some stumbling. Continues to pee with a four legs down stand pee. Noticeable Tuesday, he went south a bit. Instead of running somewhat straight with a left lean, he really started floating to the left, so bad, makes a half moon if you will trying to get right, as he is flowing 10 yards to then head a bit straight.

Reading what you posted here, I think the MRI or CT are in order. Money is not the object, my kids cost me more and I love my dogs more. ;) I read you say tumor possible in the brain. If this, I assume a qualified radiologist report would be clear enough to know operate or not operate?

Thank you Dr. Cox

Submitted by Shea Cox DVM | July 25 2012 |

Hi Scott~ I hope I am replying at a time where this still helps (I'm sorry, but I am not alerted as to when a new comment is made, otherwise I would have replied sooner)... First off, please let me offer my heartfelt empathy for the difficult situation your family is experiencing. The next step would be to consult a neurologist, who would perform advanced imaging; the neurologist and radiologist would then evaluate the images to see if a tumor or other problem is present. The neurologist generally oversees the MRI/CT while the pet is anesthetized, and from there, it can be determined which modality would work best based on the images that are interpreted by the radiologist. So, yes, moving forward with a neurologist consult and advanced imaging would be the next steps. I hope this helps answer your question, and again, my thoughts are with you and Arfy.

Submitted by Anonymous | July 30 2012 |

With the exception of 'vomiting', my 19+ y/o mix breed dog has all the symptoms, at first, I thought he was unable to walk due to hip dysplasia[even tho I make sure he takes a glucosamine tablet daily]. When he defecated inside due to inability to walk down one step, I panicked, we have a vet appt first thing tomorrow, hopefully[& prayerfully] it will be something simple like vestibular disease...please send response.
Thank you for being there, I'll keep you posted

Submitted by Shea Cox DVM | August 29 2012 |

Hi Anonymous~ I hope your appointment turned out well; I am just seeing this response now but sending thoughts that you had a happy outcome. Please do keep us posted.

Submitted by Susan | August 17 2012 |

Our 7 yr old shih tzh, Lexi, first got the vestibular symptoms on June 30th. Shd had
the head tilt and could hardly walk but never got sick. The vet prescribed antibiotics and
prednisone and she got back to normal within a few days. About 3 weeks later, the same symptoms
Re-occurred. Antibiotics again for a month....gets better and now about 3-4 weeks later, head tilt iz bCk.
She is able to get around, use the bathroom, eat, etc but seems tired. We thought we are dealing w/ vestibular disease but now we are being referred to. Neurologist cor an MRI. Lexi keeps shaking her head and scratching at her ears like they are bothering her. Dont mind paying for mri but shouldnt a
blood rest reveal if we are dealing w/ something else other than vestibular? Coulx this re-occurrence be a brain tumor ?

Submitted by Shea Cox DVM | August 29 2012 |

Hi Susan~ an MRI is the best way to evaluate what is going on from what you describe, and it will help "cut to the chase" so to speak. An MRI can help evaluate for inner ear disease (that you cannot see on an exam) as well as any problems with the brain tissue. With that said, a blood test will be part of the work up (not just the MRI).

Contrary to popular understanding, a blood test can not tell you if you are "dealing with something else." I often hear people say that "the blood test didn't reveal any cancer," when in fact, there are not any specific blood tests for cancer screening (like in people, such as a prostate cancer screen).

What a blood test can tell you, is general organ function; i.e., the kidneys and liver are healthy, the electrolytes are normal, etc.

To further illustrate the "frustration" of a single test, if you see an increase in white blood cell levels, that doesn't necessarily mean an infection like you would think... i can also mean inflammation, certain types of cancer (again, NOT a diagnosis for cancer or screening, but a piece of a big, big puzzle), or sometimes even stress.

Unfortunately, there are very few diseases in medicine (human or animals) where one test gives you an answer. Oftentimes, the more important thing a single test can reveal, is, what it is NOT going on.

When I am explaining the need for various diagnostics to a pet parent, I use the analogy of a literal puzzle, and each diagnostic gives us one piece of the puzzle. The more "pieces" of the puzzle we can lay down on the table, the clear the picture (diagnosis) becomes.

I hope this helps! Good wishes to Lexi and your family.

Submitted by Anonymous | September 13 2012 |

Hi!
My dog has a very similar thing at the moment! Did you get any further investigations?
I notice they are about a monthly occurrence? Out of interest, this doesn't coincide with flea treatments does it?
My Frenchie has had this hind leg lameness 3 times now 2of which were just after the flea treatment. My vet told me it would not be the cause at all.
So would be interest to find out how your pup is doing now and if you found the cause?
Ta!
Graham

Submitted by Jo carroll | August 9 2013 |

Hi Shea,
My very fit 17 yr old Welsh Collie awoke yesterday with bi lateral nystagmus, head tilt, urinery incontinence overnight and was very unsteady. She is mildly epileptic, suffering from focal fits for the past 12 years and having a full Grand Mal fit about 6 weeks ago. She had two further Grand Mal fits yesterday afternoon lasting only 5-10 seconds in total. Overnight she has slept soundly by my side with no further fits.
Today her nystagmus has reduced, her gait is stronger, steadier and she is walking in strait lines. She is sill swerving but it's so much better than yesterday. She still has head tilt but has eaten and drank water, wags her tail from recognition when we are near her and seems settled.
If a dog is already epileptic could the past two fits have come from that or does it I'll indicate a probable brain tumour? She has improved so much in 24 hrs- would she have done if she h a brain tumour? My vet, I can tell, thinks we are delaying the euthanasure selfishly, but I do not think she is in pain and she seems happy and content albeit obviously very dizzy. We have meds today to help h wih her sea sickness symptoms. Can you advise? Could he fits be a red
herring and could she have vestibular disease and also have fits from her epilepsy? Could h epilepsy have caused vestibular disease?
Many thanks and great site!

Submitted by Nick Abbott | November 6 2013 |

Graham, In my experiance 3 out of 3 is not a coincidence , may be just that the connection has not yet been made
Nick

Submitted by Anonymous | August 22 2012 |

Hi Dr. Cox,

Do you see dogs who have repeat episodes of IVD?
I have a 15+ year old german-shepard mix who I adopted 3 years ago. She had her first "episode" 2 1/2 years ago and presented with classic signs of IVD (head tilt, falling, nystagmus, etc.) the only odd thing is she recovered within 2 hours. Same thing happened 3 months later, then 6 months later, etc. She has always recovered within hours and has no symptoms in between episodes.
My vet started her on asprin and plavix (maybe she is having strokes?). Now, 7 months later, she's having an episode that has been going on for 2 days (again, classic signs of vestibular) but this time for a longer duration.

Any thoughts? Brain tumor? (would symptoms dissapear in between episodes for such long periods of time?). Focal seizures? Odd version of IVD?

Thank you for your comments,

Submitted by Shea Cox DVM | August 29 2012 |

Hi Anonymous~ Yes, dogs can have repeated episodes of vestibular disease, and I have seen dogs that recover quickly (just as you experienced). Some reports state that these rapidly presenting and resolving episodes are due to sudden bleeds in the brain but the jury is still out as far as a definitive answer for this. This may be why your vet prescribed the aspirin/plavix.

A brain tumor (unfortunately) has to be considered due to the recurrence of the signs and her age, breed. And to answer your question, yes, symptoms can disappear between episodes. An MRI is the only way to tell what it happening.

I hope this helps, please keep us posted. My thoughts are with you; it's hard on the heart to see our babies go through this. And, as an aside, my hat goes off to you for opening your home to an older dog! Those that adopt geriatric pups have a special place in my heart :)

Submitted by Melissa | September 12 2012 |

Hello Dr. Cox,

About a month ago my 8 yr old shitzu Myles was in a car accident one week before we were scheduled to fly back to the US from living overseas for 2 yrs. I fortunately did not witness it but was on site of the accident just as it had happened. Surprisingly, he survived the accident and the vets went above and beyond to save him. We quickly realized he'd been hit in the head but the swelling went down fast enough that the vets believed there was a very good chance for a full recovery. But they had to remove both eyes as they were causing him more harm than good. He's flown home last weekend and seems to be perking up. But what we are left with is not just blindness but a very considerable head tilt. He stands up from time to time as if to try and get from point A to B but only ends up walking in circles. I really don't know what to do. I've not taken him to our vet here because I just want to give him some time to just be home for a while to just rest. He's eating well (his jaw was broken but seems to be healing fine). He always waits to be put outside to use the restroom. He certainly responds positively to our voices and touch. We've had a little tail wagging and barking at the door. Just no improvement on the walking. Do you think there is any chance he might someday be able to get around? I know, loaded question. Just thought in case you had ever known of a dog in this situation. Blind and with the head tilt is a tough combination. Any words of wisdom would be appreciated. Thanks.

Submitted by theresa | September 14 2012 |

Dr Cox I have a chihuahua, the vet thinks he is 12 years old. Two weeks ago he woke me with a yelp at 5am. He had his head turned to his left. We thought he had a crick in his neck. He has walking eating peeing pooping like always but had the head tilt. We thought he had a stroke. He got better then a week later had to take him to the vet because he would bark and it sounded like a painful bark it did not sound like his usual bark. I thought his ear was painful or itchy because when I would rub his ear he would push it down on my hand. The vet gave him clavamox for 1 week and said he has an ear infection very deep down. Also gave him a shot dexamethasone. Other than the head tilt you wouldn't have known anything was wrong with him. But 2 days later all he wants to do is eat and sleep. But now he gets up and will step backwards 2 or 3 steps and lay back down. He knows where he wants to go but has lost some ability to get there sometimes. If he thinks he is going to get some food he always manages to get there but it is hard for him. About a year ago I think he made have had a seizure because for about 10 minutes he was laying down head up but shaking not responding to my voice. It hasn't happened again to my knowledge. Does this sound like vestibular disease to you and if so will he have setbacks? I have read a lot on this but every dog is different. He has not vomited or does not have the eye movements. He does squat to pee. Your opinion means a lot to me sounds like you know a lot on the subject. We are leaning on putting him down as we don't have money for xrays and mri. We love him like our child but dont want him to suffer. Do you have any suggestions on what I can expect if it is a tumor. Thank you

Submitted by Ashley | October 16 2012 |

I too have a chihuahua and my dog is having identical issues. I'm freaking out looking for answers. Have you figured anything out since posting this? Any info helps! Thank you!

Submitted by Stacey | September 24 2012 |

Hi Dr. Cox,
Thank you for the great article. I was so frightened when my dog displayed the symptoms described in your article. My Vet suspected Vestibular disease, which I had never heard of. I immediately did some research online and thankfully came upon your article. It put my mind at ease to see that in all likelihood, this is what my dog has. One thing I have not seen discussed in your article or any of the comments is the absence of an appetite. My dog has never been a ravenous eater, but usually eats both breakfast and dinner. It's been six days since she's had the symptoms of Vestibular disease and she has still not eaten on her own. She spent two days at the hospital receiving IV fluids. Since then, it has been three days in which I've had to force feed her. I am mixing Pedialyte with baby food from a jar and squirting it into her mouth. She'll eat about two small jars a day but only if I force her. She has no interest in dry dog food, wet dog food, beef, chicken, etc. I managed to get her to eat a few small scraps of chicken last night but that's all. She seems to be keeping the food I manage to get in her down. But I'm very concerned that she won't eat on her own. Is this to be expected?

Thank you!
Stacey

Submitted by Cara | October 2 2012 |

Hello, our 14 year old Golden Retriever was diagnosed with Vestibular Disease yesterday afternoon. We brought her home from the vet and she hasn't been able to walk since. Her back legs stick straight out and when we try to assist her to stand or go outside, her front legs shoot out and she "faceplants" into the ground. She is on antiobiotics and drops for an ear infection and an anti-nausea medicine. Is the absolute lack of use of her legs a common symptom of vestibular disease? Most sites/info. lists staggering, trouble walking, circling, etc. but NOT the complete inability to use legs.

Thank you

Submitted by Anonymous | October 3 2012 |

Hi Cara,

I'm not an expert, but my dog (a 15 year old german sheperd mix) had very similar symptoms (inability to use her legs, doing faceplants, etc.) Her symptoms went on for almost 5 days before she started making any improvement. Now, 4 weeks later, she's doing MUCH better. Have you tried using a towel as a sling to hold her legs up? If you put the towel towards her midsection it might help keep her back legs up and prevent faceplants.
My dog was struggling so much that she partially tore her cranial cruciate ligament (canine version of an ACL).. have you checked to see if her knees are swollen at all?
My thoughts are with you!

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