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Dr. Kara
Dr. Kara, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 14829
Experience:  Over 20 years of experience as a veterinarian.
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My nine year old male Lhasa Apso has been acting very

Customer Question

My nine year old male Lhasa Apso has been acting very disoriented, not eating and unable to keep his balance. Our regular vet is not opened today and I wanted advice about waiting one day or going to an emergency 24-hour clinic?
Submitted: 1 year ago.
Category: Dog Veterinary
Expert:  Dr. Kara replied 1 year ago.

Hello, my name is***** and I have over 20 years of experience as a veterinarian. I am so sorry to hear about Rudy's sudden loss of balance, weakness, agitation, whimpering, and lack of appetite.

Is his head tilted to one side?
When he walks is he circling or leaning to one side?
Does he have rhythmic back and forth or circular eye movement? (like this dog : http://www.youtube.com/watch?v=NaB7OJRLVQ4 )
Does he have an ear infection or has he had one recently?

Because his symptoms came on suddenly he may be suffering from vestibular disease. Episodes can come on very suddenly.

Vestibular disease is a disturbance in the balance system. It can be due to a problem in the middle ear or along the pathways that send information from the middle ear to the brain or in the brain itself. Dogs with vestibular disease feel like they have just stepped off a merry-go-round, very dizzy and nauseous and the more they try to move the worse they feel, so they may refuse to try and move or get very upset because they cannot move properly and wander and be unable to settle.
There can be several causes of vestibular disease. They range from very benign causes such as idiopathic (meaning we don't know the cause but they resolve on their own with supportive care) to middle ear infections or polyps, brain infections (bacterial, fungal or viral) or even a primary brain lesion such as a blood clot, bleeding or a tumor.
If we cannot identify a cause then we will often treat the patient symptomatically (antinausea drugs, anti-inflammatories and antibiotics) as most dogs do get better with supportive care.

Prognosis if this is caused by a lesion outside the brain is very good in most cases.

We can check bloodwork to make sure organ failure or low thyroid hormone are not the cause of his symptoms.

At home you can give Gravol also known as Dramamine (dimenhydranate) to control nausea. The dose is 4mg to 8mg per pound of body weight every 8 hours. Side effects are mild sleepiness and dry mouth.
Or you can try Benadryl (diphenhydramine) at 1mg per pound of body weight orally every 8 hours. Side effects are sedation and dry mouth as well.
To stimulate his appetite start a bland diet of 1/3 boiled, lean hamburger (or boiled, white, skinless chicken), all fats and juices drained off the meat, mixed with 2/3 boiled, plain white rice. Feed several small meals a day.
To help with nausea you can also give her an acid reducer. At home you can give either:
1)Pepcid ac (famotidine) at ¼ of a 10mg tablet per 5 to 10 pounds of body weight every 12 hours
OR
2)Prilosec (omeprazole) at ¼ of a 10mg tablet per 5 to 10 pounds of body weight every 24 hours
These are acid reducers and may settle his stomach so he can eat. They are quite safe and can be used days if necessary to help him feel better.

If he is getting very nauseous such that he cannot eat or is vomiting all that he eats he should see a veterinarian promptly to treat his nausea with injectable medication and fluids to treat his dehydration.

If you can get him to eat and drink and he isn't vomiting, and you see that he has an ear infection (redness to the ear, ear discharge or odor) then he can wait until tomorrow to see his veterinarian.
If there are no signs of an ear infection and after a week’s time there is no improvement or he is worse then he needs further diagnostics to try and identify the cause. Serious central nervous system (the brain) causes are more likely and thus prognosis is much more guarded.
Things such as an MRI or spinal tap are indicated at that point.
If he is not improving a referral to a neurologist is best as they can perform this advanced testing.
Please see this link if you would like to read more about vestibular disease: http://www.petside.com/condition/dog/vestibular-disease-canine

At this point I think your ability to get him to eat and drink should determine whether he needs emergency care today. If he hasn't eaten for several days and you cannot force anything in, he is vomiting, or has a seizure then he needs to be examined today.

If you can get him to eat and drink without vomiting and his neurologic signs aren't progressing (no seizures, responds appropriately to his name and will interact with you) then tomorrow is fine.
Please let me know if you have any further questions.