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Tuesday 17 September 2019

Symptoms of vestibulitis are dramatic and misunderstood

Pete Wedderburn

PATCH, A fourteen year old Springer Spaniel, had been for his usual morning walk and had been lying resting.

All of a sudden, he started to behave bizarrely. He tried to stand up, but kept falling onto his side. At first his owners thought that he was just lame on one leg, but it soon became obvious that it was much more generalised: he couldn't walk at all.

He lay in one spot, staring into the distance, with his eyes flicking from side to side, and his head held at an odd angle. His owners feared the worst. Patch was an old animal, and they thought he'd had a stroke. They thought that they'd have to make that dreaded decision to carry out euthanasia.

Patch had to be carried in to my clinic that afternoon. He was still unable to walk and he was holding his head tilted to the left. His eyes flicked rapidly from side to side, making the same sort of movements that a human's eyes would make if they were looking at the scenery passing while sitting on a train. I carried out a brief neurological examination, as well as checking other aspects of Patch's health. His owners looked on, expecting me to pronounce serious news, with the worst possible outcome.

Fortunately, Patch was suffering from a condition that's common in older dogs, and far less serious than it looks: an upset of the balance system in the middle ear, known as "vestibulitis".

This condition used to be known as a "stroke", and some people still refer to it as this. In fact, the brain itself is completely unaffected. Techniques such as MRI scans have allowed a much better understanding of what's going on inside the skull of affected animals. The delicate system of sensors and nerve connections in the middle ear develops sudden onset inflammation, and stops working properly. The cause is still unknown.

The signs of vestibulitis are so dramatic that many people mistakenly believe that their pet has reached the end of their days. In fact, most dogs go on to make a full recovery. It's important to visit the vet, because there are other diseases that can look similar, including genuine strokes and brain tumours. Once vestibulitis has been confirmed, it's generally a case of giving antiinflammatory medication and plenty of rest. Some dogs need to be fed by hand, because they're unable to balance well enough to eat on their own. Rarely, the signs are so dramatic that euthanasia does need to be considered, but most animals make a steady recovery over five to seven days.

I gave Patch the standard treatment, and saw him again a few days later: he was almost completely back to normal.

Coincidentally, on the same day, an eighteen year old cat called Tilly was brought to see me: again, her owner believed that she had suffered from a stroke, and she expected that euthanasia would be the obvious decision.

Before examining Tilly, I listened carefully as her owner explained the background to her problem. Despite her great age, Tilly still enjoys an active life with a regular routine. After waking up and having breakfast, she goes out into the garden for a walk. She has a favourite sleeping spot, in a box in the greenhouse, and she snoozes there for a few hours before going for another amble around the garden.

She had walked out to her greenhouse bed as usual on this day, but an hour later, her owner saw her on a step in the garden, looking strange. She was swaying from side to side, and her head was moving rapidly from right to left, as if she was looking at something. Then when she tried to walk, she stumbled and fell over. Again, it seemed as if there had been a major internal crisis, and Tilly was rushed to the vet.

As with Patch, I carried out a detailed examination, and my conclusion was the same: Tilly was suffering from vestibulitis. This is less common in cats than in dogs, which made me more suspicious about some other possible underlying cause. At eighteen, Tilly is the "extreme geriatric" bracket, making her prone to many conditions. We decided to carry out a comprehensive screen for the more common problems that can affect older cats.

First, I measured her blood pressure. High blood pressure is often undetected in elderly cats, but once diagnosed, it can be easily treated with a daily tablet. In this instance, Tilly's blood pressure was normal.

I then sent a blood sample off to the laboratory, for a general health screen. There are half a dozen common treatable illnesses affecting older cats, such as an overactive thyroid gland, kidney disease and others. Once a diagnosis has been made, simple treatment can often be given that improves an animal's health and extends the length of their life.

The blood test results showed that Tilly has been suffering from a low grade liver infection. This would not directly cause the episode of vestibulitis, but it would have made her feel run down and tired. She's now being treated with a long course of antibiotics.

Like Patch, Tilly has recovered fully from her dizzy spells. It's too early to say how well her liver disease will respond to treatment, but with luck, she'll do well.

Patch and Tilly are living examples of the truth of that well-known saying: "There's life in the old dog (or cat) yet".

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