Cora’s Vestibular Disease, Part 2

Read Part 1 here.

Last Sunday (August 16), we got home from a day away to find Cora not quite herself—she didn’t seem certain that it was us coming in the door, and she was a little unsteady on her feet. I also noticed her head tilt was worse than usual. Because of our experience with her vestibular disease in January, I knew what to look for, so I got her in good light and, sure enough, saw the nystagmus (rapid eye movement), which was diagonal again. It was then that I realized her head tilt was to the left, not to the right as usual.

She really wanted to join us on the walk but wasn't able to walk much, so she rode.

She really wanted to join us on the walk but wasn’t able to walk much, so she rode.

She saw the vet the next day, and vestibular disease was confirmed. However, this time, there was no sign of an ear infection, which was more worrisome to the vet. It was suggested we see how her symptoms changed over the next few days. The following day, as last time, she was moving in circles in the backyard. Over the next several days, new symptoms that were different from before appeared gradually—confusion about how to get out of the house; Parkinson’s-like movements when eating, drinking, or sniffing the ground; and circling that she seemed unable to stop.

By Friday, the vet recommended a consultation with a neurologist and possibly an MRI.

We got in to see Dr. Campbell at Toronto Veterinary Emergency Hospital on Monday. Cora was doing so much better by then, and I honestly expected him to send us home with no further investigation. But he found that she was painful in her neck. With only slight pressure, her neck spasmed. His concern was a tumour on her brain stem because neck pain is common with that. The MRI was booked for the next day. When he learned that our vet had removed a pellet from her cheek a couple years ago, he said he’d do X-rays first to be certain there wasn’t any other metal in her head.

Cora's head had to be shaved for the spinal tap. It looks as though she had three needles there.

Cora’s head had to be shaved for the spinal tap. It looks as though she had three needles there.

Sure enough, she has another pellet embedded deep in the tissue of her neck (no wonder she is so wary of people!); however, the vet felt it was deep enough to make the MRI safe to do. Cora’s neurologist was in emergency surgery during her MRI, so the radiologist on staff looked at her results, and I got a call at 3:05 p.m. telling me that her brain and ears were normal, so they were also going to MRI her neck and do a spinal tap. I was thrilled to get the news that nothing showed up in her brain (well, except a brain).

However, then when I met with the neurologist at 5:30 p.m., he started by telling me they’d found something small at the base of her brain stem, the site he’d expected to find something, based on the vestibular symptoms. I was confused and told him about the call I’d received. It turns out that the nodule or whatever it is is SO small that the radiologist didn’t see it until the neurologist pointed it out. They can’t be sure of what it is or whether it’s cancerous, though, so we don’t actually know much more than we did. He said we’ll have to judge the prognosis simply by Cora’s clinical symptoms over time.

So it wasn’t exactly the news we were hoping for, but it’s also not nearly as bad as we feared. There isn’t a definitive sign of brain cancer (woohoo!). The spinal tap results we’ve received thus far have been “normal,” but we’re waiting on the pathologist to look at the cells in her spinal fluid to be certain.

The head tilt to the left is just as cute as her head tilt to the right was. :)

The head tilt to the left is just as cute as her head tilt to the right was. :)

The best part of the call from the neurologist yesterday was his pronouncement of the diagnosis “geriatric idiopathic vestibular disease.” Idiopathic means “unknown cause,” so he’s not relating it to the tumour. (The second best part of the call is his assurance that our insurance company will cover the cost, which was substantial, and if it doesn’t, he’ll follow up with whoever he needs to talk to to get coverage!) Cora received amazing care at TVEH, with both her neurologist and vet tech recognizing just how sweet a dog she is. Both were saddened by the pellet in her neck, and as I left there Wednesday, the vet tech pet Cora’s bald head and said to me, “This girl really melts my heart.” Really, how could she not?

If we’re to judge by Cora’s clinical appearance, I’d say she’s healthy. Since Friday, she’s continually improved, walking straighter, not shaking as much when her head is down, and seeming much less confused. Whereas I thought maybe her head would at last be straight, which it hasn’t been since her first vestibular episode, it seems the left-leaning tilt may remain, and that’s okay. After all, it’s just as cute as her right tilt was.

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