Old Dogs and Vestibulitis

Mrs. Johnson sounded sad on the telephone. ‘Cara has had a stroke’, she told me. “ She is fourteen years old, and I am afraid that the time has come…….”

Cara was a golden cocker spaniel who I knew very well and I discussed the case in more detail with Mrs. Johnson. She told me that Cara had been very healthy, and behaving normally until a few hours previously. She had been sleeping during the afternoon. She had then stood up, vomited once, and she had started to stagger around the room. She was now lying down, unable to stand up, and her eyes looked strange. Mrs. Johnson explained that she had always been clear that she did not want Cara to suffer at the end of her life. As she said this, she burst into tears, and between sobs, she told me that she didn’t want Cara to go, but she couldn’t see any other way. I asked her to bring Cara down to the hospital at once. I would examine Cara, we would discuss her condition, and then we would try to make the best decision.

Animal Medical Conditions

There are many medical conditions that occur across all the species. For example, every animal, from mouse to man, can be affected by itchy skin, dental problems, heart disease, and cancer. Each species has its own variation of a disease, and part of the challenge for a vet is to be aware of those differences. A medical doctor has one species of humans to deal with, whereas vets need to be very familiar with twenty species or more.

Pet owners naturally compare the diseases of their pets with conditions that they are familiar with in humans. Sometimes they are correct. A cat with cystitis shows very similar symptoms to a human with the same disease. At other times, the comparison is not valid, and an owner can jump to the wrong conclusion. Cara’s apparent “stroke” was a classic example.

Vet Examination

When Cara arrived at our hospital, she had to be carried from the car. She was lifted onto the consulting table, and she lay still, looking confused. When I examined her, the most obvious abnormality was a dramatic flicking of her eyes, from side to side. This is a symptom known as “nystagmus”. It is a common sign, indicating a focus of disease within the skull. Affected animals cannot stop this flicking of their eyes, and so they experience a bizarre sensation of dizziness and disorientation. The rest of Cara’s symptoms could be explained by the eye-flicking.  Her strange head tilt and the panicky staggering around the room were directly related to the fact that she was trying to regain her balance. Unfortunately, despite her best efforts, she was unable to make her world return to normal.

Mrs. Johnson watched me carefully as I completed my examination of Cara, and she told me what she was thinking.

“Cara has had a stroke, hasn’t she? I don’t want her to struggle if she has no quality of life. Should we just let her go now?”

I settled Cara into a propped-up position in her dog basket so that she was comfortable, and then I turned to her owner.

“It may not be nearly as bad as it looks” I told her.

Vestibular Apparatus

“Dogs can suffer from strokes like humans, but they are exceptionally rare, and Cara has not had a stroke. A stroke involves disruption of the blood supply to part of the brain, but Cara has no specific sign of brain damage. Cara’s balance is controlled by delicate structures in her inner ear, known as the vestibular apparatus. After carefully examining her, I have been able to localise her problem to that part of her nervous system. At the moment, she must be feeling as if she is trying to stand on a beach ball, but the rest of her nervous system seems to be normal.” 

Mrs. Johnson looked surprised. “But surely without her system of balance, she cannot live a normal life?”

Vestibular Syndrome

“You are right. If the damage was permanent, it would not be fair to carry on. However, the good news is that the most common disease to cause these symptoms is known as the ‘Vestibular Syndrome’. This is a very common condition that particularly affects older dogs. Although the symptoms can be dramatic and frightening, most dogs make a full recovery.”

“But what causes it to happen, and can you be certain that she will get better?” Mrs. Johnson asked.

I explained that the condition was still a bit of a mystery. Many vets still refer to the condition as a ‘stroke’, because it occurs in elderly dogs, and it has superficial similarities to minor strokes affecting older humans. Despite much research, involving CAT scans of the inner ears of affected dogs, the precise cause of the condition has not been identified. 

Treatment For Vestibular Syndrome

“We know that the inner ear develops a sudden onset inflammation, but we do not know why,” I explained. “We also know that with simple treatment, including drugs to calm down the area of inflammation, most patients return completely to normal after two or three days. Some dogs are left with a slight head tilt, but they are able to live normal lives. A few cases do not respond to treatment, and there is a small chance that if Cara has not improved within 48 hours, it may still be necessary to consider euthanasia. However, we will make sure that she is comfortable for those two days, and it is much more likely that she will get better.” 

Cara stayed with us for three days, and she made a dramatic recovery. Mrs. Johnson was delighted when she came in to collect her. I was so sure that I was going to say goodbye to her “ she told me. 

Cara’s ‘stroke’ happened two years ago. Mrs. Johnson is still dreading the final goodbye, but fortunately, Cara is still in excellent health. That last goodbye may not happen for a long time yet!