Friday, April 22, 2016

Canine Vestibular Disease. Veterinarian advice on the diagnosis,treatment, along with associated costs, and advice from mom.

There are clients and patients I hold very close to my heart. They are extensions of my family and their pets hard times are the instances for my purpose. I try to be there for my clients at every step and through every trip up. I will be the first to admit that at times I cannot dissect the line between caring too much and passionately fighting for them when life appears to be dealing yet another unfair hand. There is incredible injustice in the world, and it seems that the small, the meek and the voiceless always seem to pay the heftiest price.

Seems to be getting worse. This sticky situation I find myself in repeatedly. Frustrating and costing lives everyday. What do I think about it? I think it is unconscionable, and I am going to do everything I can to stop it. It is not that there isn't help available it is that this help is either out of financial ability or out of accessibility. Part of Pawbly's mission is to remove both.

Minnie and Murray, Christmas 2009
This is the story of Murray. A 13 year lab and his incurable textbook bought of idiopathic vestibular disease. It is also a tale of who you see and how this can influence how your pet is treated and thus how much it will cost you..

There are a few not uncommon diseases that pop up out of no where that can scare the be-jeezus out of you. One minute your dog seems perfectly normal and the next they are unable to stand, their eyes are going haywire, and you don't know what is going on or what to do about it.

One of the most common and least dangerous of these is idiopathic vestibular disease (IVD). It is also known as geriatric vestibular disease, old dog vestibular disease, or, idiopathic vestibular syndrome.

This disease can affect both dogs and cats. For sake of completeness this blog will only discuss canine idiopathic vestibular disease. Cats are more difficult to categorize and I believe IVD is far less common and often confused with other diseases.

IVD seems to come on like a freight train. You wake up, you walk into the next room and out of no where your dog cannot stand up, walk, hold its head straight, or stop the violent eye movements that look like a demon has taken possession. It is very scary for everyone. Sudden afflictions cause hysteria. My phone rings and my good friend is incoherently yelling/crying in fear. Like every dedicated pet parent my friend ran immediately to the closest emergency clinic.

Murray 24 hours post initial ER visit 
At our clinic I would have recommend that Murray have the following diagnostics done;

1. Physical examination, with special emphasis on the neurological exam and inner ear (otoscopic) exam. 

2. CBC, chemistry, thyroid panel. With this disease all should be normal.

3. Tick panel. I write this, but I am not opposed to skipping this if the history, lifestyle or environment doesn't coincide.

That boy and his smile... it says it all.

At my clinic this is a $230 ($50 exam, $130 blood work, $50 tick panel) work up. For clients with a tight budget I will reduce the clinical work up to an exam. Veterinary medicine is about using our skills, experience and working with your client to care for their pet. An exhaustive work up is great, if it is possible. BUT this is not a treatable disease. An owner needs to be to given all of the information, all of the options, associated costs, and prognosis for every possible diagnosis. In some cases we save our patients lives by being honest and not running any diagnostics. 



Murray has been a patient of mine for almost a decade. He had his annual exam, geriatric blood work, tick exposure panel and is current on all vaccines and preventatives. He is the model patient with the model parents.  He is a lucky happy boy, but this early morning Murray's eyes were going from side to side in a rapid motion (nystagmus), he couldn't stand, his head was twisted to the side, and he was obviously afraid. His mom reacted to his acute condition the way many of us would. She feared the worst and ran for help. Which is exactly how every parent should react. Unfortunately at the emergency clinic gave an estimate that included all of this;


Not knowing what to do my friend handed over a credit card and walked out the door. When she got to the parking lot she called me. I was concerned to hear that all of the diagnostics we had just run were repeated. I was also perplexed to hear that a 2 day stay was recommended. "This is not a 2 day fix, and at a few hundred dollars a day you are paying someone else to not be able to treat your pet. save yourself the money you don't need to spend."





The first 24-72 hours of this disease can be harrowing and discouraging. 

Most pets cannot stand, do not ambulate, have difficulty eating, or nausea associated with eating and for most clients the idea of this as status quo for days, months or years seem insurmountable and unacceptable. I spend a lot of time talking and reassuring that this state of dysfunction is normal and will pass.
My favorite harness for big dogs who need assistance.
I call it the 'suitcase harness'.

I asked Murray's mom to provide her side of his story.. I think it is incredibly helpful to provide a parents perspective..


Murray and mom.. head tilt (to the left) is obvious.

"So the story starts with ......... Early on a Friday morning Murray got up to go outside and stumbled a bit. He walked really fast out the door to the grass peed and quickly laid down.  I thought he was having a bad arthritis day.....struggling with his hips..... My assumption.  He came back into the house and went right back to bed.  

When fed breakfast he would not get up and kept looking at me with a tilted neck and would not eat and kept staring at the ground.  At about 7:15 he wanted to get up to go out and fell very hard into the wall and door frame.  It scared him and me so much he peed himself.  Then he was so upset he kept trying to get up and was frantic now and was foaming at the mouth.  I got to him as fast as a could and his eye brows and eyeballs were shaking very fast back and forth.  He could not focus or hold his head straight or walk.  I thought he was having a stroke or seizures since his legs were very flailing.  My regular vet clinic did not have a doctor in yet it was only 7:30 am so I rushed him to the emergency vet.  They quickly assessed him and gave him something to calm him down.  (Valium I assume).  They came in about 10 minutes later and gave us the rundown of $ deposit and time to watch over him.  They would draw blood and keep him comfortable.  We should go home and call back at noon to see how he is doing.  They had us sign a release form and they explained that it would cost between $781 and $1515.09 and that we would need to leave a $625 deposit to get started.  Of course we did it because we were so scared and worried for him.  
Upon leaving I consulted my dear veterinary friend she advised me that I could take care of Murray at home with her as support.  We brought him home that evening incurring a $551.80 bill.  We used a t-shirt on him so we could help him walk and hold him up straight.  

Day 2 severe head tilt and labored walking and acute eye shaking.  

Day 3 we got a suitcase harness with a handle on the back to help him walk.  

Day 4 still with a head tilt no eye shaking andwalking a tad better. 

Day 7 noticeably better gait.  

Day 12 less severe head tilt and almost normal walking.  

Day 20 only a barely noticeable head tilt.....he pulls away from us and does not want help walking.  From the start we had to acclimate to his changing needs.  We kept his bed in the center of the house and moved all the furniture to around the walls so he would have clear walking paths.  We had to barricade the stairs so we had the peace of mind that he could not fall down the stairs.  We put runner rugs from the door to his bed and to the food dish and water bowl so he would not have slipping issues.  We installed a carpeted ramp outside our house to get off the deck.  He struggles sometimes but he tries hard every day to keep his schedule and his normal routine."


Murray about 3 weeks post ER visit.
His head tilt is almost completely resolved.
Here is why Murray's diagnosis of IVD makes sense;
1. Murray is an older dog. This is a disease of predominantly older dogs.

2. Murray's signs evolved very quickly.

3. Murray fit the billet of IVD. He recently had a full senior blood work done, is current on preventatives, and up to date on all recommended vaccines. He was fit as a fiddle a month ago.

Here is my advice should you suddenly find your dog with a head tilt, nystagmus, unable to stand and ataxic (wobbly walk or stand). Head to the vet. After an examination ask the vet what their first rule out diagnosis is. If they say IVD discuss which diagnostics are needed and which you can afford. Go from there. I  have some difficulty justifying spending money on diagnostics for diseases that are both unlikely and not treatable. Talk about your pets work up and treatment plan. If possible ask your primary care veterinarian for their help before handing over the credit card.
And, of course,Stay calm, always stay calm.


After Murray went home he needed the following;
1. A safety harness to help ambulate. Murray is a big dog. A sturdy harness to help keep him from falling over. He also needed help to stand and go to the bathroom. 

2. He was prescribed an anti-nausea medication (available over the counter) and sent home to rest. If your dog is nauseous and vomiting talk to your vet about an injectable 24 hour anti-nausea medication. In severe cases fluid therapy can help.

3. Assist your pet at all times needed.

4. Block off stairs and keep doors to adjacent rooms closed.

5. Baby proof your house for a little while.

6. Frequent trips outside to urinate and defecate. Often IVD patients do not defecate for the first 24-48 hours.

7. Hand feed four times a day. Smaller more frequent meals with help maintain adequate caloric intake and decrease the nausea.


Most dogs take days to weeks to recover. Some always have a head tilt, but ambulation should steadily improve and resolve over days.


Minnie, Gannon, and Murray at their annual exam three years ago

If your pet needs immediate help please ask your vet first. They are your pets best source for the most accurate answers and help your pet needs. If you would like to learn more about this disease, how to care for your dog with this disease, or have a pet related question please join us at Pawbly.com. Pawbly is a free open platform to help educate, empower and inspire pet parents around the world.

If you would like to meet me or become a patient of ours please come visit me at Jarrettsville Veterinary Center in Jarrettsville Maryland. I will do my best to help... but be warned I get emotionally attached. I cannot help myself.

If you end up at the vets office and feel that you cannot afford the care your vet recommends please speak up. Ask for help. Stay calm, and get your pet out alive with you.

I am also on Twitter, yelling into the void.. @FreePetAdvice.

Be well everyone!

7 comments:

  1. Excellent post. Want to thank you for the time you put in to educate us rather ignorant laymen. :)

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    1. Hello Roberta,
      I hope that you found this blog helpful,, and not speaking down to our readers? (PS I dont think any of them are ignorant??) I hope it doesnt come across this way.. ;(
      thank you for reading and adding your thoughts.
      Krista

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  2. I can not tell you how grateful I am for your Blog. I am only in day 1.5 of my first experience with vestibular --- needless to say I am a basket case but your post has helped so much. I raced to out Vet yesterday at the onset and her advice and information was identical to yours, Krista. My husband is out of the Country on work --- and so I'm a single parent of Max at the moment. I have found many articles on Vestibular disease --- but yours was the first to incorporate a real life scenario and a realistic, detailed timeline of recovery. I just ordered via Amazon overnight Max's very first 'suitcase' harness --- thank you for this wonderful, insightful practical blog. TJ

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    Replies
    1. Hello !
      Thank you for the kind words. I hope that your pup does well and is back to finding four feet confidently and comfortably on the ground. In most cases they are significantly better within a week or two.
      I wish you both the very best of luck!
      XOXO to you and Max.. ;-)

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  3. My dog is 3 years old and had her booster vaccinations on Saturday however Sunday well taken her work a walk I noticed her head was tilt. Today she can barely stand it's got so bad and her eyes are flickering like she is spinning. The vets are going to contact the manarfactuers of the vaccines to see if they will pay for MRI Scan. Keep hearing they do get better but will they way she developed hers make a difference?

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    Replies
    1. Hello,
      If this is vestibular disease, then, yes, they typically improve within a few days. I hope that she is ok. best of luck, please let us know

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