I jolt awake in the middle of the night to the sound of one of my three dogs throwing up. My first thought is, glad the floors are concrete and easy to clean. The moon provides enough light for me to make my way to the kitchen, where I see Meadow, my 10-year-old Alaskan Malamute, standing with her head slightly lowered, a small pool of yellow vomit on the floor in front of her. Her front legs are splayed wide.
“Oh, Meadow girl, I’m sorry you’re sick …” I murmur as I approach. Before I can reach her, she stumbles and falls hard to the floor, then struggles to stand up. Stumbling like a drunk, she slams to the floor again. What the hell’s going on?
Meadow, who weighs more than 90 pounds, continues trying to stand. I hold onto her collar, using my other hand to steady her. When she falls, she crashes into my legs with all her weight, almost taking me with her. Not wanting to hear that heart-wrenching thud again, I use my body to prevent her from standing. She moves awkwardly, head swaying, fighting my downward pressure.
She finally stops struggling, but is clearly distressed. Her front legs are spread out in front of her, her chest is barely on the floor and all her weight is on her elbows. One of her hind legs is pinned under her hips, the other one extended out to the side. She pants fast and heavily. She can’t possibly be comfortable, but hasn’t let out any cries of pain and resists my attempts to rearrange her legs.
I turn on an overhead light, then lift her face toward mine. I’m confronted with one of the most frightening sights I’ve ever encountered: Meadow’s eyes are darting rapidly from side to side, as though every neuron in her brain is on fire. Almost crying in fear and frustration, I’m completely stymied.
I’m also alone in a house without cell phone reception. Just me and my dogs. The nearest ER vet clinic is three hours away, but I can’t get Meadow into the car without help. “Meadow, look at me.” I sense that she’s trying to focus, that she hears me, but she can’t make her eyes stop moving. “Meadow, you cannot leave me, not now, not here,” I say to her, trying to quell my own fear that she’s dying and there’s nothing I can do prevent it. I have to do something.
Telling Meadow to stay, I quickly dress and drive the quarter-mile to my closest neighbor’s house. Amazingly, despite the hour, they get their vet on the phone. After hearing the pertinent details, the vet makes an instant diagnosis: “She’s having a seizure. It might be the only one she ever has, or she might have more. She may have brain damage, or she may not.” Brain damage? Not good, although at least I can stop worrying that she’ll die tonight. But the eye thing, her inability to stand; it was going on a good 15 minutes before I left to come here, I argue mentally, thinking a seizure should be a quick thing, like the one I’d witnessed in a friend’s dog with epilepsy. “Seizures can last anywhere from a minute to a couple of hours,” the vet informs me, as if reading my mind. “Should I bring her to you tonight?” I ask. “No,” he replies, “there’s nothing to be done. Just watch her so she doesn’t fall down and hurt herself.”
When I get home, Meadow hasn’t moved, and is still exhibiting the same symptoms. I make a bed next to her on the floor and watch, and wait. As the night wears on, Meadow’s eyes finally quit darting, and eventually—around 5 am—she puts her head on the floor and sleeps on her side. I lay with her, stroking her fur, still trying to figure out what’s happening. It just doesn’t fit my idea of a seizure. Then suddenly, I remember: three years earlier, I’d had a sudden case of extreme dizziness, and my own eyes had danced uncontrollably, just like Meadow’s. I had awoken one morning to a world spinning out of control, unable to stand without falling or slamming into walls. Even rolling over in bed made the world heave and lurch. An ER doctor diagnosed vertigo, likely the result of a severe head cold that had affected my inner ear. A drug resolved my symptoms within 20 minutes, although I had to keep taking it for a week.
Can dogs get vertigo? I wonder as I lay there, stroking Meadow’s body. As it turns out, the answer is yes. In dogs, it’s called vestibular disease. Just about any creature with ears and a brain stem can suffer from vestibular disorders.
Vertigo (from the Latin vert(ere) = whirling or turning around) is a type of dizziness, a sense of motion when one is stationary, due to a dysfunction of the vestibular system in the inner ear. It is often associated with nausea and difficulty standing or walking.
“Vertigo is a human description of a feeling; dogs can’t tell us what they’re feeling, so vestibular disease is the term used,” says Beverly Sturges, DVM, associate professor of clinical neurology/neurosurgery at the UC Davis School of Veterinary Medicine.
According to Dr. Sturges, the most frequent cases are referred to as idiopathic or “old dog” vestibular disease because it’s most often seen in older dogs and there’s no obvious cause. “It’s benign; we still have no real understanding why it occurs,” she says. “It’s self-limiting, [requiring] no treatment except supportive care and comforting the dog,” she adds. The second most common cause is infection—especially Rocky Mountain spotted fever—or inflammation.
Dr. Sturges describes two broad categories of vestibular disease: outside the brain, and inside. “When outside the brain, it involves the middle or inner ear and is referred to as peripheral vestibular disease. This type is more treatable, with a better prognosis,” she says, and includes the old-dog syndrome. “Inside the brain means it involves the brain stem and is referred to as central vestibular disease. In small breeds—Maltese, Yorkies, Pugs, Poms—it’s usually caused by a non-infectious inflammation of the brain stem, often referred to as inflammatory brain disease. It occurs mostly in younger dogs [less than] two years of age. In larger breeds, central vestibular disease is usually caused by brain tumors [putting] pressure on the brain stem. Or, sometimes, trauma to the head.” Symptoms of central vestibular disease may be more subtle, with gradual onset.
That frightening eye-darting I saw in Meadow? It’s called nystagmus, a rapid, involuntary eye movement, side to side or, less frequently, up and down. “Nystagmus is not seen in all cases, but [it] is common,” says Dr. Sturges. “It lessens as the dog gets used to the sensation. Nystagmus can be profound in old-dog vestibular disease; a few days, or perhaps one to two weeks later, it’s almost always gone. It’s a reliable symptom: if there’s nystagmus, it’s vestibular disease and not usually a seizure. But you can see a drunken gait—ataxia—and other symptoms without nystagmus and it could still be vestibular disease.”
Diagnosis is based on a description of symptoms, or better yet, actual observation of symptoms. When appropriate, a vet will do a CT scan or an MRI to see if there are tumors or brain swelling. The type of nystagmus observed (horizontal versus vertical) and the direction of the dog’s head tilt (another common symptom) can help a neurologist differentiate between peripheral and central vestibular disease. Other issues involving the inner ear, or ear infection, will be ruled out if symptoms persist.
Treating central vestibular disease in dogs depends on the type and cause. “We’re pretty good now at removing tumors from the brain stem,” says Dr. Sturges. “If there’s inflammation and fluid, that can be drained surgically if necessary. We can prescribe antibiotics or an antifungal. When a vascular cause is suspected—a temporary or permanent lack of blood supply—vestibular issues usually get better on their own,” she says. “Toxins are another possibility. Metronidazole [Flagyl] and a few other medicines can cause toxicity, including vestibular disease; taking the dog off the drug and substituting another can resolve it.”
A sudden onset of acute symptoms and an absence of other physical findings usually mean peripheral vestibular disease. You and your vet may elect to wait a few days to see if improvement occurs before doing extensive diagnostics. After some online research, this was the choice I made for Meadow. Some vets will prescribe corticosteroids to reduce swelling and antibiotics just in case the cause is inside the brain. Ultimately, the final diagnosis of old-dog vestibular disease is made by the self-limiting nature of the symptoms. According to Dr. Sturges, 5 to 10 percent of dogs who experience this problem may have additional episodes.
Unfortunately, like Meadow, many dogs with vestibular disease are initially misdiagnosed as having seizures. In some instances, unable to afford expensive diagnostics or consult a neurologist, the distressed owners put the dog down, fearing he or she has suffered brain damage and won’t recover, or will suffer repeated seizures in the future. “That’s sad,” says Dr. Sturges. “There’s no reason to put them down. We don’t often see brain damage in dogs. A seriously long seizure could cause damage, but don’t jump to euthanize, even in cases of seizure,” she emphasizes.
Granted, sudden onset of vestibular disease can look like a seizure; the two are often hard to distinguish. “A neurologist could maybe tell the difference,” says Dr. Sturges. “An EEG to measure brain electricity and some other tests could help differentiate. But actually seeing the episode is the best way to diagnose. A video—everyone has cameras and video-cams these days—would be very helpful.”
For those who have never experienced vertigo, let me assure you: it’s sudden, overwhelming and incredibly frightening. You don’t know what’s happening, or why, and your brain seems disconnected from your body. Dogs must experience similar fear. And it can be dangerous, depending on when and where it occurs. Both Meadow and I were lucky; we were safely at home and our falls didn’t cause injury. Growing up in a family of aviators, I remember hearing whispered talk among pilots about vertigo, how deadly it can be during flight; it was the one thing they seemed to fear. Then, I couldn’t understand how simply being dizzy could cause a pilot to lose control of an airplane. Now I do. In fact, vertigo is thought to be the most likely reason the private airplane piloted by John F. Kennedy, Jr., and carrying his wife and sister-in-law crashed into the ocean off Martha’s Vineyard in 1999, killing all three. With vertigo, you literally don’t know up from down. Remember white-knuckle rides on that spinning playground equipment? When you tried to get off, you’d stumble and fall to the ground, head still whirling. That’s vertigo light. The real thing is more intense, longer lasting and much scarier.
Meadow and I eventually fall asleep. Around 7 am, I’m awakened by movement. I open my eyes to see Meadow sitting up. “Meadow! Good girl!” I say excitedly. This is progress; this is huge. “Do you want to go outside?” Before I finish the sentence, Meadow is leaning forward to get her hind legs underneath her. Helping her up, I usher her unsteadily toward the door. Out in the yard, she immediately pees and poops. I’ve never before been so excited about normal bodily functions. We head back into the house, where she goes straight to her normal sleeping spot beside my bed. Her gait is wobbly, but she’s moving under her own power. As she settles down, we both heave a huge sigh of relief.
Within a few days, Meadow’s gait is back to normal. She doesn’t have the lingering head tilt common with vestibular disease, but displayed every other symptom. Follow-up blood work discloses that she’s hypothyroid, a possible cause of vestibular disease.
After the dust settled, I shared my experience with friends. Many had similar stories involving taking their dog to a veterinary emergency clinic. One – a vet – has seen several cases in her clinic. Sharing our stories can help prepare us in the event our dogs – especially our old dogs – suffer a sudden episode, making it less scary. Seek medical treatment when appropriate, but if a diagnosis doesn’t ring true, trust your own observations and get another opinion. You know your dog better than anyone.
An online search of “vestibular disease in dogs” and “nystagmus” brings up YouTube videos of dogs showing classic symptoms such as head tilt, drunken gait (ataxia) and nystagmus. The videos are hard to watch, but being aware of the symptoms of vestibular disease could save you a night of fear and stress, or help you notice warning signs of central vestibular disease, allowing early intervention and an increased likelihood of a good outcome for your dog.[This article first appeared in The Bark, Issue 68: Jan/Feb 2012, and is reprinted here by permission. Cover photo: Wikimedia Commons.]