Integrative Pet Vet column: The dog with the crooked head
Integrative Pet Vet
When you get home from work you notice that your elderly dog is not at the door to greet you. She is lying half in her dog bed and half out. There is vomit on the floor. Her head is tilted to the right and she seems disoriented. She is unable to stand or walk on her own and her eyes are darting side to side. When you offer her food and water she refuses.
This is an alarming change from her normal playful greeting and how she was in the morning when you last saw her.
The likely explanation is that your dog is experiencing an episode of old dog vestibular disease (ODV). This has also been referred to as idiopathic vestibular disease because the cause is unknown. It represents about 39 percent of peripheral vestibular disease dog patients. It has a very rapid and often dramatic onset. ODV is generally seen in middle age or older dogs.
Signs that a dog is experiencing ODV include loss of balance, severe disorientation, staggering walk, head tilt and rapid eye movements. They are often nauseous and experience vomiting in the first 24 hours. Nausea and loss of appetite may continue for several days. Generally, the signs of illness stabilize quickly. The rapid eye movements return to normal after a few days and the staggering gait resolves over three to six weeks; although these times can vary along with the severity. Nursing care is essential, especially early while the dog is adjusting to the changes in signals from the vestibular system. Some dogs may benefit from anti-nausea medications.
This group of signs makes sense when the function of the vestibular system is considered. The vestibular system provides important information from the inner ear about body position that is used to coordinate position of the head and body relative to gravity so that balance can be maintained.
Imagine how you feel when you have been on an amusement ride or spun in a circle and you are dizzy, disoriented, having trouble standing, and may even be vomiting. Dogs with ODV look like they are having the same experience because of the vestibular signaling that is similar to what we experience on these amusement rides. This vestibular signaling creates a sensation of disorientation, inability to stand steady, nausea and even vomiting.
Not all old dogs with a head tilt and unsteady gait have ODV. There are other causes for the signs associated with vestibular disease including middle or inner ear infection, brain tumor, stroke and medication side effects. Diagnosis of ODV will involve a complete history and examination including evaluation of the ear canal.
Depending on the examination findings and on how the problem resolves over the first few days, additional testing may be needed. Additional evaluation may include blood testing, X-rays of the head and full neurological evaluation. Each of the potential causes for signs associated with the vestibular system has a different treatment and prognosis, which can make this further testing essential in some situations.
For dogs with ODV, treatment is supportive while the dog adjusts to the initial disorientation. This includes controlling the nausea, assisting with going outside to eliminate, encouraging feeding, and providing a well padded area to lie on until the disorientation begins to resolve and mobility returns. Hospitalization with intravenous fluids may be needed for those that are severely affected and when vomiting continues to occur. The use of anti-inflammatory drugs does not seem to improve the problem. The herb ginger has potential benefits for these dogs because of its ability to reduce nausea and dizziness.
If you have questions about ODV, please contact your veterinarian.
Ron Carsten, DVM, PhD, CVA, CCRT was one of the first veterinarians in Colorado to use the integrative approach, has lectured widely to veterinarians, and has been a pioneer in the therapeutic use of food concentrates to manage clinical problems. He is also the founder of Colorado Animal Rescue (CARE). In addition to his Doctor of Veterinary Medicine, he holds a PhD in Cell and Molecular Biology and is a Certified Veterinary Acupuncturist and Certified Canine Rehabilitation Therapist. He practices integrative veterinary medicine in Glenwood Springs.