Dog stroke/vestibular syndrome--UPDATE!

[SarahandSam]

In the continuing saga of What Is Wrong This Week With My Old Dog… pretty sure she’s had a stroke or is having a vestibular syndrome episode. We were in Minnesota having a great old time last week and noticed about Monday or so that she was having periods of cocking her head funny and staggering/walking in circles a little bit. But then she’d be back to normal again and has been eating and drinking normally. She also would have periods when she didn’t want to open her good eye (her left eye has limited tear production and she gets eye drops twice a day) much–seemed squinty. Again, otherwise acting normal.

Last night I got home from the barn and when I came in, she was sniffing and wagging and looking around expectantly for me in the exact opposite direction of where I was standing. Took her forever to realize where I was. Again, eating and drinking normally, going outside normally, got her treats out of her puzzle game… but she also was squinting the good eye (which looked a little rolled back in her head), cocking her head, unsteady with walking, lying down frequently and abruptly, not wanting to put her head down completely, and generally seeming sort of lethargic and confused. Except where treats were concerned.

The almighty Internets says there’s not much the vet can do except try to diagnose the underlying problem, which is what the past couple thousand dollars have been trying to do, unsuccessfully… any advice or thoughts would be appreciated. She’s been seeming a little confused for months now in general, and flinches a lot. The vet thinks everything is pain related, so she’s done gabapentin, Metacam, now Rimadyl, and acupuncture, and dog seems more energetic and happy but still flinching and having the “senior moments,” though last night was much more confused than her usual moments of “wait, is this the right side of the door?” She seems better this morning, at least sleeping comfortably and more alert/aware…

[maybedog]

My experiences with vestibular syndrome have been more of a sudden acute onset. Flailing to get up, severe nystagmus, circling & unsteady gait etc. All gradually improving day to day. The only meds we give are for nausea, steroids can mask more severe underlying issues. A brain tumor can also cause vestibular syndrome symptoms. I am dealing with that now with a 16yr old Sheba. Just waiting for her to let us know when it’s time. The asymmetrical eye issue you have is usually not indicative of vestibular syndrome. Have you had radiographs or CT scan of her head? One thing that concerns me with your dog is the use of 2 NSAIDS. We don’t usually mix Rimadyl with Metacam. Good Luck and sending jingles.

[ezduzit]

Possible calcium deficiency?

[SquishTheBunny]

I would assume its not a stroke, or vestibular if its not continuous. Its possible there are continuous mini-strokes, but usually there is an underlying cause to multiple strokes.

In an older dog, brain/inner ear/sinus tumors are more common but before you get too scared most of them are slow growing compared to other cancerous tumors. There are oral medications to help with the inflammation which is likely causing the symptoms.

I would ask your vet for a referral to a neurologist - you can always go in saying you are not wanting to do MRI/invasive testing but would like to try a suitable anti-inflammatory IF they feel the cause is likely to be a tumor.

Another thing high on the list is glaucoma. It can cause pain and vision loss which would account for a headtilt and strange vision - however, like strokes and vestibular its not common for it to wax and wane like inflammation in the brain or a tumor invading the frontal sinuses.

[summerhorse]

[QUOTE=maybedog;7105842]
My experiences with vestibular syndrome have been more of a sudden acute onset. Flailing to get up, severe nystagmus, circling & unsteady gait etc. All gradually improving day to day. The only meds we give are for nausea, steroids can mask more severe underlying issues. A brain tumor can also cause vestibular syndrome symptoms. I am dealing with that now with a 16yr old Sheba. Just waiting for her to let us know when it’s time. The asymmetrical eye issue you have is usually not indicative of vestibular syndrome. Have you had radiographs or CT scan of her head? One thing that concerns me with your dog is the use of 2 NSAIDS. We don’t usually mix Rimadyl with Metacam. Good Luck and sending jingles.[/QUOTE]

This was my experience also. I was able to treat the symptoms for a week with a tiny bit of improvement and then she crashed.

[Foxtrot_s]

You are a wonderful owner. Our daschie had vestibular syndrome and the vet just said to give him ‘tincture of time’ and he did recover slowly. The thing he had that you don’t mention is eye movement, flicking from side to side.

Honestly, I say this gently, there comes a time when no amount of vet visits can turn back the clock and there is a certain point when making the pet as comfortable as possible and taking care of them generally is the best course of action.

[SquishTheBunny]

Jingles for your pup, sounds like your dog is very well loved.

[SarahandSam]

maybe, it’s just Rimadyl–it was gabapentin and then adding the Metacam, but I didn’t feel that the Metacam was doing much and it was more expensive than the Rimadyl, so we switched to Rimadyl once the Metacam ran out. Seems to be helping a bit more than the Metacam did. Also trying coconut oil.

Squish, it’s interesting that you said sinuses… the same side as the bad eye, she tends to get a lot of snot built up in that nostril, but the other is always clear. Do tumors tend to affect one side like that? I’ve been really worried about the possibility of a brain tumor for a while, but the vets seem so convinced that all her nervous reactions (the flinching, unsteadiness, etc.) were pain-related. She’s had just about every test except a CT or MRI… I have been a little scared to even suggest that to the vet because I am so certain it’s going to find something, and I don’t think there’s much we could do at that point with a dog who’s at least 13 years old. But if anti-inflammatories could at least help or slow the growth, that’s good to know–I’ll give the vet a call.

Fortunately her heart is good and she’s otherwise very healthy, according to all the bloodwork… but I am completely out of money at this point, exhausted by all the testing we’ve done, and still frustrated that I don’t know exactly what’s wrong and how to magically make it better. Sigh. This dog’s my baby, and she’s the sweetest thing on earth–just want to be able to keep her happy and pain free as long as possible.

[CVPeg]

@Foxtrot's;7106677

Our daschie had vestibular syndrome and the vet just said to give him ‘tincture of time’ and he did recover slowly. The thing he had that you don’t mention is eye movement, flicking from side to side.

This - one of my Labbies had vestibular, and the pupils darting back and forth were, I believe, a definitive symptom. And mine did recover well in time. Believe she got it when she was 11, and lived another couple of years. Just had to help her up and down (towel under the belly to help her stand, and steady her when she walked). It lasted a week or two, then was pretty much fine afterwards.

Good luck to you - hope you can figure things out without too much more drama. Am guessing you also know the Rimadyl has warnings about liver issues. My older Irish Wolfhound showing signs of slowing down this week, and I’m wondering if it will be safe for her in the future.

[Foxtrot_s]

IIIIIIIIIIIIF you think it is cancer, our lab was given some pills from the vet
(can’t remember the name) that slowed the growth and she did get quite
good quality of life thereafter, until that fateful day when we just KNEW.

13 is quite aged for a larger dog.

[BuddyRoo]

I’ve got nothing but jingles. ((hugs))

[Beckham03]

I ditto going to the neurologist and being up front about not wanting to do MRI/CT, etc. They do different types of exams and look for different signs then a general practitioner. They may be able to give you a better indication of what is going on.

The Vestibular/Stroke dogs I see usually have an acute onset of symptoms and start to improve very quickly with supportive care. Bloodwork doesn’t always show signs of what is going on, cancer, etc.

Big hugs for you. I know this is hard.

[SquishTheBunny]

[QUOTE=SarahandSam;7107017]
maybe, it’s just Rimadyl–it was gabapentin and then adding the Metacam, but I didn’t feel that the Metacam was doing much and it was more expensive than the Rimadyl, so we switched to Rimadyl once the Metacam ran out. Seems to be helping a bit more than the Metacam did. Also trying coconut oil.

Squish, it’s interesting that you said sinuses… the same side as the bad eye, she tends to get a lot of snot built up in that nostril, but the other is always clear. Do tumors tend to affect one side like that? I’ve been really worried about the possibility of a brain tumor for a while, but the vets seem so convinced that all her nervous reactions (the flinching, unsteadiness, etc.) were pain-related. She’s had just about every test except a CT or MRI… I have been a little scared to even suggest that to the vet because I am so certain it’s going to find something, and I don’t think there’s much we could do at that point with a dog who’s at least 13 years old. But if anti-inflammatories could at least help or slow the growth, that’s good to know–I’ll give the vet a call.

Fortunately her heart is good and she’s otherwise very healthy, according to all the bloodwork… but I am completely out of money at this point, exhausted by all the testing we’ve done, and still frustrated that I don’t know exactly what’s wrong and how to magically make it better. Sigh. This dog’s my baby, and she’s the sweetest thing on earth–just want to be able to keep her happy and pain free as long as possible.[/QUOTE]

Glad to hear she is otherwise ok. Without scanning your dog, there is really no way to tell. However, I do about 5+ CT’s per week on dogs with nasal discharge/head swellings. Often times yes it is tumor, and the nasal discharge starts when the the tumor has reached a stage where it has really invaded the sinuses and destroyed the turbinates. Tumors which grow thrugh the frontal sinus can grow into the brain. 95% of cases we diagnose have unilateral nasal discharge, not from both nostrils.

Unfortunately the only way to diagnose is a CT or MRI. CT’s are generally cheaper and much faster. MRI’s are suggested if they think primary lesion or any intracranial swelling is brain related.

If the eye is bulging and rolling back, I would bet something behind it is putting pressure on it.

If a CT is not in your budget, sometimes a radiograph can give you an answer. While its not as detailed, it can maybe tell you if there is something there.

CT’s are great if you are thinking tooth root abscess causing the symptoms vs. tumor, as its far more detailed.

If you are looking at palliative treatment, I would first have a referral figure out WHAT are you likely dealing with (brain, sinus, nothing of the above) and start a suitable palliative treatment plan. Its up to your general practice vet to figure out if your dog is best to see internal medicine (ie. nasal/sinus disease) vs. neurologist (ie. intracranial disease). With a bulging eye, and nasal discharge I would persoanlly start with the medicine service. While metacam and gabapentin may be controlling pain, a more potent anti-tumor medication may give you better results (depending what it is). IF it’s a tumor (not saying it is!) there are many different palliative routes you can take. Some tumors are very slow growing and responsive to treatments. And who knows, maybe its something completely different!!!

Continued jingles for your dog!!

[Foxtrot_s]

Nice, practical post.

[SquishTheBunny]

OP - my brothers cat has a brain tumor, likely meningioma. She has had it at least for a year now, and opted for no treatment as her signs were minimal and not painful. She is now blind, circling and having difficulty using the litterbox. Tomorrow we are letting her go. Of course I am sad, however, we were happy that we had a year with her.

I hope for your sake, you can feel the same way about your dog when the time comes…whether its now or a year from now. Diagnostics are great if money is unlimited, but for the majority of us its not. Sounds like you have given your dog a great life so far, and within reasonable means it sounds like you are willing to give him the best quality of life possible. If you can (because he sounds happy in his life right now), talk to your vet or a specialist about maintenance within your budget. It will make you feel better knowing you are doing SOMETHING, but will also not put you in debt and will allow you to control the quality of life your dog is getting

[Foxtrot_s]

nice, kind, practical post.

[SarahandSam]

Thanks hugely for all the advice and insight, folks.

[SarahandSam]

Update

After seeming normal since Saturday, Sylvia woke up this morning again looking lethargic, miserable, unsteady, etc., and this time had a lot of discharge around her bad eye (she has had limited tear production in that eye for years) and shrieking in pain if you came anywhere near her head. Rushed her in to the vet; this vet saw a corneal ulcer and sent me to the opthalmologist, who deduced that the ulcer had ruptured. She’s on gabapentin again, plus an antibiotic, and tomorrow she’s having surgery to remove the eye, since she’s had so many issues with it for so long. I’m sad that she’ll be losing the eye, and freaked about the surgery (not to mention the cost of the surgery), but very glad at least that now we have an explanation and plan of action!

[SquishTheBunny]

Well that’s probably the best news you could expect!!! That’s great its something fairly easily treatable and not life threatening!!!

Don’t worry about the surgery, enucleations are pretty routine and have very very very few side effects. Usually within a day dogs are completely back to normal (sans 1 eye!). Sure the cost is up there, but if pain from the ulcer was truly the only thing causing her all this discomfort then you have an easy fix!

Jingles for your dog and so happy to hear the good news!

[BuddyRoo]

Jingles for your pup. I hope she gets some relief! Glad you all figured out what the root cause is/was. Hope surgery and recovery go well. Most dogs seem to take it all in stride w/o many challenges at all (in my experience). You may have to make a few adjustments initially at home and w/ your routine, but here’s to an easy transition!