My dog has vestibular disease

Re: My dog has vestibular disease

Martin Jones — Thu, 20 Jan 2011 10:57:40 GMT

Careful now, whippersnapper.

Note to all - thyroid function normal and dog progressing well, so likely idiopathic event. I had thought that I knew all there was to know about vestibular events, so it goes to show that there's always someting to learn. One of the best things about this forum, I feel.

Many thanks to all.

Martin

Re: My dog has vestibular disease

Anthony Todd — Thu, 20 Jan 2011 01:04:46 GMT

[quote user="Richard Carter"]Sorry - preds rule. Feels better, prepared to try get up, try to eat.[/quote]

Never in the field of veterinary science was a drug subjected to such conflict by so many, supported by so few, and made so many animals feel better.

Funny how the few supporters can probably remember the war.

Re: My dog has vestibular disease

Catherine Williams — Mon, 17 Jan 2011 09:47:15 GMT

A while back one of our nurses was going through training as a animal physiotherapist. She had to do a study project and her area of investigation was recovery of CVAs/idiopathic vestibular syndromes. I'm going from memory here but I seem to recall that in our practice she found that dogs that received steroids made a better initial recovery but when monitoring their ataxia + demeanour she found that the steroid treated patients deteriorated a little after 3-4days and the dogs who didn't receive steroids then overtook them in speed and degree of recovery. The conclusion was that we stopped giving a little pred or dex to "help" these cases. Possibly not the most rigorous trial as I don't think we ruled out all other disease processes, just our normal work up of the typical older dog vestibular signs case and our case numbers weren't brilliantly high.

A bit of physiotherapy did seem to help, but how much that was helping the vestibular syndrome or how much it helped all the concurrent arthritis etc I'm not sure but I haven't given steroids to idiopathic vestibular dogs since and haven't perceived any more problems than when I was using steroids

Re: My dog has vestibular disease

Julian Earl — Sat, 15 Jan 2011 16:24:18 GMT

Have youtried feeding it a RMB diet? 'Cos that seems to treat everything else so it probably works for this as well.

Sorry. Someone had to.

Please don't throw me off the site Arlo.

Re: My dog has vestibular disease

Christopher Saul — Sat, 15 Jan 2011 08:46:01 GMT

[quote user="Andrew Kent"]Betahistine will work in a significant number of these cases[/quote]

I'll second this Andy; I always use it in suspected idiopathic vestibular syndrome. Seems to work, though that is of course just anecdote......

Re: My dog has vestibular disease

Alex Gough — Fri, 14 Jan 2011 08:32:11 GMT

No problem, I agree that palliative steroids can be invaluable in some neurological diseases, provided the owners arent going for further work up, and understand the downsides.
alex

Re: My dog has vestibular disease

Mark Hedberg — Thu, 13 Jan 2011 22:01:21 GMT

Forgive me; I'm all in favor of responsible steroid use myself - I use them, and use them proudly. The lecture in question I referenced was solely talking about palliative use of steroids in undiagnosed neurological signs.

The lecture I was talking about was by Richard LeCouteur at the London Vet Show about giving steroids to treat neurological signs without a definitive diagnosis at London Vet Show - I did not provide proper context for my comment, for which I apologize.

Cheers,

Mark

Re: My dog has vestibular disease

Richard Fox — Thu, 13 Jan 2011 19:47:21 GMT

My suggestion to use steroids was that I was under the impression that major diagnostics like CSF analysis and MRI were unlikely to be perused by Martin - i.e. didn't want to put his dog through too much and thus was intended as a palliative care Good Luck anyway Martin in what ever you do and hope your dog improves

You might this useful:

http://onlinelibrary.wiley.com/doi/10.1111/j.1939-1676.2006.tb00752.x/abstract

Hypothyroid-Associated Central Vestibular Disease in 10 Dogs: 1999–2005

Re: My dog has vestibular disease

Martin Jones — Thu, 13 Jan 2011 17:58:32 GMT

I think the use of vivitonin is based on that it's unlikely to do harm, but is - at least in theory - potentially helpful. I'll generally explain to clients that there's not much that will do anything, but these may be worth a go in the short term, in case of follow-up vasospasm and anoxic episodes. In the absence of anything more concrete to argue the converse, it's at least something for the owners to feel empowered to do whilst nature takes its course.

If there's pathology in the brain, preserving the blood supply would, in most cases, be logical and sensible. By the same token, I'll be using phosphatidylserine, to ensure that the synapses are firing as well as possible. Makes me feel better - and look better in front of the kids - than doing nothing and will be less stressful than a 400-mile round trip for MRI. Probably of more benefit are regular trips outside, providing strong horizontal visual stimulus, bland but appetising food and general TLC. The basket is in front of the fire, somebody is always smoothing her coat and the dog is more likely to die of happiness than vestibular disease.

Thanks for the continuing help.

Re: My dog has vestibular disease

Alex Gough — Thu, 13 Jan 2011 17:35:22 GMT

I dont with Vivitonin any more, there is no evidence it helps. As far as I can work, the rationale for everyone using it that was that these used to be called strokes, and so Vivitonin's blood thinning actions helped cerebral blood flow. As we now know very few of these are strokes (and if they are, about 15% are haemorrhagic rather than infarction), there seems to be much less rationale. Anyone know of any theoretical benefits of Vivitonin in idiopathic vestibular disease?

alex

Re: My dog has vestibular disease

Martin Jones — Thu, 13 Jan 2011 15:31:30 GMT

Okay, lots of useful stuff there. I'm persuaded to look at hypoT, which I really wouldn't have otherwise. Equally, there is now a genuine incontinence and a more persistent left eyelid spasm, so I may start looking at steroids. I haven't started them, for reasons generally in line with Alex's advice - my experience of speculative steroids in these cases have been that it's often impossible to tell whether there is any benefit, and that where they are useful, they should be given at high doses and for a long time: coming off them too quickly, or inadequate dosing intially may cause relapses which are non-recoverable even if treatment is restarted.

The betahistine tip is a brand new one to me, and I'm certainly looking into it. As I'm a locum, I'll get a mate to see whether he can get hold of it; if not, I may well visit Boots. Thanks for that.

All advice gratefully taken on board. There's always something to learn, and certainly it would seem that hypoT might be more significant in these than I'd previously considered. Does anybody else bother with vivitonin at all?

Re: My dog has vestibular disease

Alex Gough — Thu, 13 Jan 2011 15:18:58 GMT

Re: steroids and neurological disease, it is a problem to have a case referred for a neuro work up that has had a "therapeutic trial" of steroids first. It will mask some of the signs, making neurolocalisation harder, but most importantly it has a profound effect on the cell count in CSF, making this test almost useless in many dogs on steroids. Unfortunately, CSF analysis is essential to diagnose the inflammatory brain diseases in most cases, and this can be a huge dilemma if you suspect GME but cant prove it, because you will then, without a defiinitive diagnosis, have to embark on a 6 month course of high dose prednisolone +- cytarabine/cyclosporine/lomustine/azathioprine/insert your immunosuppressive drug of choice, which is not a benign treatment path. And of course it might be lymphoma, which will also be supressed by steroids, in which case you will have reduced its survival chances if the owners would elect chemo.

Where I do think speculative steroids are justified is in cases, as with lymphoma, where further work up/treatment has been offered and declined. As long as the owners are aware of the downsides, then steroids can be wonderful drugs in a number of neuro conditions, and I dont think they should be witheld purely on principle, if there is a suspicion of a steroid responsive disease.

Alex

Re: My dog has vestibular disease

Tamara Vela — Thu, 13 Jan 2011 12:52:09 GMT

Dear colleague,

I have some experience on vestibular syndrome in old dogs, as my 15 year old mixed breed dog, had a very serious one, two years ago. My advice is to eliminate the possibility of brain parasites: neospora, cryptosporidium, toxoplasma....just in case, but it is little likely.

And then (and this is very important), check out HYPOTHIROIDISM!!!.....There is a 10% of hypothiroideous dogs that show only neurological symptoms, no obesity, no hypercholesterolemia or hypertrigliceridemia, no anemia.....that was the case of mine.....

I did T4, TSH AND antitiroglobluline ABs, and I could see that T4 was low, TSH was high, and the antibodies were positive....

Of course he is now on levotiroxine and is doing fine....

My two cents,,....hope this helps,

Tamara.

Re: My dog has vestibular disease

Bob Russell — Thu, 13 Jan 2011 10:57:18 GMT

Unless the owners are keen for advanced imaging I am a fan of anti-emetics and steroids. Used to give Co-trims but don't now. Seems to have made no difference removing the antibacterials.

Re: My dog has vestibular disease

Richard Carter — Thu, 13 Jan 2011 09:33:32 GMT

Sorry - preds rule. Feels better, prepared to try get up, try to eat. Probably one of these cases where takes 4 days on treatment or 4 days without treatment but with my own dog 14y.o. springer and numerous clients start at a/infl doses and drop to eod by 10 days. Perhaps it may be just co-incidence that any underlying arthritis is being treated at the same time...

Re: My dog has vestibular disease

Richard Fox — Thu, 13 Jan 2011 08:56:38 GMT

Could some of these cases have low T4 due to CNS issues rather than the CNS issues being due to low T4 i.e. Hypothalamic axis disruption? I would use steroids myself - my sisters dog had the same but then started to have cluster fits and futher CNS and PNS deficits and eventually took its toll

Re: My dog has vestibular disease

Andrew Kent — Thu, 13 Jan 2011 00:05:51 GMT

Betahistine will work in a significant number of these cases - it is a human anti-vertigo drug which seems to stabilise semi-circular canals. Nobody knows exactly how but is used by neurologists for idiopathic vestibular episodes. Dose is an 8mg tablet once or twice daily in average sized dog. Plenty of info on VIN if you have access, or speak to Geoff Skeritt at Chestergates who introduced it to the UK.

Andy

Re: My dog has vestibular disease

Mark Holmes — Wed, 12 Jan 2011 23:41:26 GMT

[quote user="Mark Hedberg"]

There was a lovely lecture at the London Vet Show about preds and neurological signs...the professor in question didn't like prescribing them without a definite diagnosis. :p

[/quote] But then RVC don't advocate an ex lap without a definative diagnosis and teach that all castrates should be done by scrotal ablation !

Re: My dog has vestibular disease

Mark Hedberg — Wed, 12 Jan 2011 23:32:28 GMT

There was a lovely lecture at the London Vet Show about preds and neurological signs...the professor in question didn't like prescribing them without a definite diagnosis. :p

Re: My dog has vestibular disease

Michael Woodhouse — Wed, 12 Jan 2011 23:16:47 GMT

What's wrong with steroids? I tried various things and found the steroids made them better faster.

Re: My dog has vestibular disease

Mark Holmes — Wed, 12 Jan 2011 23:10:37 GMT

I have diagnosed hypoT in some of these dogs. Before I am accused of over diagnosis low T4 high TSH! With no other classical Hypo T signs so I would definately check. Also check ears and bulla rads. Last dog with vestibular symptoms had chronic OM. No external signs but very marked ostitis of the Typamic bulla

Re: My dog has vestibular disease

Mary Thomson — Wed, 12 Jan 2011 22:30:03 GMT

I've also used Stemetil in these cases

Re: My dog has vestibular disease

Martin Jones — Wed, 12 Jan 2011 22:17:32 GMT

Incontinence now seems to be becoming an issue - never like that sofa anyway - and I'm leaning towards central issues. No limb proprioceptive deficits, but we'll see what the morning brings. No problems with appetite ayway - and about the least likely candidate for hypoT you ever saw. I think we'll go onto aktivait or some kind of phosphatidylserine source tomorrow as well, but I've got to be honest, right now I feel a little useless. Neighbour's dog is doing well, though.

Thanks for the comments.

Re: My dog has vestibular disease

Sandra Milburn — Wed, 12 Jan 2011 20:30:41 GMT

I have prescribed Stemetil for it at times, especially if really ataxic. Have heard about 'Serc' (another human drug) having been used,apparently with good results, but haven't dispensed it and dosages seem to be empirical.

Re: My dog has vestibular disease

Julian Earl — Wed, 12 Jan 2011 19:48:46 GMT

Check for hypothyroidism as that (according to some authorities) can be associated with vestibular disease. If it is idiopathic then no treatment will make a difference although Cerenia at travel sickness doses should in theory make her feel a lot better. But she needs checking for proprioreceptive defects, cranial nerve deficits and other signs of central vestibular disease as the underlying differentials are different to those for peripheral VS of course.