nystagmus

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.

Cora’s Vestibular Disease, Part 1

I haven’t had much time to post here in the past year, but last week I got a terrible reminder of one of the reasons I started this blog in the first place—to have a record of issues we go through with the dogs.

One morning at the end of January this year, Cora scared the bejeezus out of us by being, well, spaghetti-like. She was unable to stand, and whenever she tried, she just fell down, limp as could be. She had the will to walk and do everything her brothers were doing, and she still wagged her tail, but she seemingly had no control over her body. We thought she was having a stroke. It was terribly frightening!

Fortunately, the symptoms began the day that one of our vets was to come to our house to give Dusty acupuncture for a cruciate ligament tear we were treating through conservative management (another blog post I should’ve written). The vet examined Cora off the record, suggesting we get her to the clinic for a full “official” exam, and pointed out her nystagmus—the darting of her eyes. He felt fairly certain Cora had geriatric vestibular disease. The word disease in the name knifed fear into my heart—would she live out her days unable to control her body? He then told me that when his dog had it, it lasted about two weeks and resolved itself. Phew!

Vestibular disease, I learned through many Facebook friends whose dogs had gone through it, is not all that uncommon in senior dogs, and, more important, it’s not a death knell. Essentially, it’s an episode of vertigo. Cora was dizzy, as evidenced by her eye movements (nystagmus), which in her case started out as diagonal, not back and forth or up and down, and through her poor sense of balance. Most often, vestibular disease is considered idiopathic, meaning that there’s no known cause—it’s just age related.

However, because Cora has had ear infections on and off since we adopted her, the vet assumed an ear infection could be causing her symptoms, and sure enough, examination showed inflammation (despite regular ear cleanings!), so she prescribed two weeks’ worth of antibiotics.

Cora’s condition worsened a bit on the second or third day, when she started circling in the backyard. Our vet was a little worried by this because vestibular symptoms should only start improving after the first day. The circling happened on and off for a couple more days. But we waited it out because other things were normalizing—her nystagmus wasn’t noticeable to the naked eye, she was able to walk around the block, and she wasn’t vomiting or avoiding food (quite the opposite, as usual).

Cora rocking the head tilt.

Cora rocking the head tilt.

By the time she finished the antibiotics, Cora seemed mostly back to normal. She was safely jumping onto and off of furniture, going on our long walks and keeping up, and being as energetic and kooky as usual. Two main symptoms remained: her head tilt, which the vet had warned might never go away, and a bit of a lazy eye—both on the right side.

Then a day or two after she finished the antibiotics, Cora’s symptoms worsened again. I don’t remember exactly what was going on, but the vet decided to put her on antibiotics for another four or six weeks.

Once that course of antibiotics was done, Cora was back to normal (yay!), except for the head tilt and the lazy eye, both very cute qualities, we think. 🙂

And then in August …