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Dr. Kara
Dr. Kara, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 16879
Experience:  Over 20 years of experience as a veterinarian.
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My dog stopped eating and was falling over. We took her to

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My dog stopped eating and was falling over. We took her to the vet and they gave us 3 medications to give her. They said she had an inner ear infection that threw her equilibrium off, making her dizzy and nauseous (hence the not eating). The vet said she should start eating again the next day. She started eating a little but now about a week on the medicines, she stopped eating again and is having trouble walking again.
JA: I'm sorry to hear that. This sounds like it might be serious. I'll let the Veterinarian know what's going on ASAP. Is there anything else the Veterinarian should be aware of about your dog?
Customer: She's going back to the vet today for xrays. Other than that, I don't think so.

Hello, I'm Dr. Kara. I have over 20 years of experience as a veterinarian and I'd like to help. Please give me a moment to review your concerns.

Customer: replied 4 months ago.
I just remembered something, she was vomiting a lot right before she stopped eating the first time.

I am sorry to hear that your pup is again not eating, and having trouble standing and walking.

Is her head tilted to the right or left?

When she tries to walk is she circling or leaning to one side or walking very slowly with a wide stance and then leaning and falling over?

Does she have rhythmic back and forth or circular eye movement?

(like this dog : http://www.youtube.com/watch?v=NaB7OJRLVQ4 ).

If the answer to these questions is yes then she may have vestibular disease. Vestibular disease is a malfunction of the balance system, either a problem in the inner ear itself or in the nerves that take information to the brain or in the brain itself. Episodes often come on suddenly.

With vestibular disease she can get very dizzy and as such have trouble with coordinated movement. They will often fall or lean to one side.

It makes sense that she was initially vomiting a lot before she stopped eating because she was likely very, very dizzy.

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 (anti-nausea drugs, anti-inflammatories and possibly antibiotics if an ear infection is a concern) as most dogs do get better with supportive care. It sounds like is what was done for your girl, and she initially responded but has now regressed.

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

We may check bloodwork to make sure organ failure or low thyroid hormone are not the cause of her symptoms. Since she isn't improving then blood tests should be done to make sure all is well internally. In dogs that have signs of an inner ear infection we may take radiographs of the skull to check the bones of the inner ear for signs of a mass, or thickening or fluid in the ear. Some cases require that we make a hole in the ear drum to drain the infection and culture the fluids to make sure we are treating the infection with the right medications. In some cases surgery is needed to debride the infection or in some cases we need to perform an ear ablation to remove the infection or a tumor.

Is she still taking any medications to help with her being off balance?

At home you can give Gravol also known as Dramamine (dimenhydranate) to control nausea, which is also used for carsickness. 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 only, do not use products with acetaminophen or decongestants as they are toxic for dogs) at 1mg to 2mg per pound of body weight orally every 8 hours. Side effects are sedation and dry mouth as well.

To stimulate her appetite start a bland diet of 1/3 boiled, lean hamburger (or boiled, white skinless chicken), all fats and juices drained off mixed with 2/3 boiled, plain white rice. Add warmed low salt chicken or beef broth to get additional fluids into her and make the food more palatable. Feed several small meals a day.

You may need to hand feed her and offer her water or ice cubes to lick as she may have difficulty negotiating eating and drinking on her own.

If she still won't eat even after medication to decrease her dizziness and offering a bland diet then to help with nausea at home you can give either:

1) Pepcid ac (famotidine) at a dose of one 10mg tablet per 20 to 40 pounds of body weight every 12 hours

OR

2) Prilosec (omeprazole) at a dose of one half of a 20mg tablet per 20 to 40 pounds of body weight every 24 hours

These are acid reducers and should help her feel a little less nauseous. They are quite safe and can be used for several days if necessary.

If she starts vomiting or refuses to eat for a couple days she may need hospitalization for supportive care, fluids and injectable medication for nausea.

In some cases when the patient worsens she may need 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 she 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.marvistavet.com/vestibular-disease.pml

Please let me know if you have any further questions

Customer: replied 4 months ago.
She's laying on her side with her legs out (which the vet said indicates her stomach hurts). She has trouble getting up from laying, she has trouble keeping her back legs from slipping out from under her. The falling, thay was her back legs just giving out on her.She's drinking lots of water, just not eating.The vet gave us Ketoconazole, Cephalexin, and Prednisone for her.She's going back to the vet today for xrays and we're taking a stool sample (if we can get one).

Is she normally a dog that likes to curl up and sleep on her abdomen?

If so her stretched out position may indeed indicate abdominal pain, and her reluctance to put pressure on her abdomen. She may also have trouble keeping herself balanced to sleep on her abdomen if her balance system is off.

Does she have a head tilt (holding her head tilted to one side)? If not perhaps her issue isn't really vestibular disease but simply being very, very weak and uncomfortable.

How did they diagnose an inner ear infection? Swollen, red, ear drum or ruptured ear drum with discharge? Or was that a presumptive diagnosis based upon her symptoms of nausea and weakness/falling?

She may be drinking a lot because of the steroids she was prescribed. Those should have helped her appetite too, so I am concerned that hasn't improved.

Are her gums very pale pink, white or a normal nice bubblegum pink color?

I think at this point given her poor response to treatment bloodwork and abdominal radiographs are needed, especially if she does not have a head tilt and she seems more weak then off balance.

Customer: replied 4 months ago.
She usually lays on her stomach with her legs underneath her.She was drinking constantly before we got her to the vet. The drinking increased when she stopped eating.I haven't noticed a head tilt but I'll watch her when I get home.
Customer: replied 4 months ago.
The ears, they said it was blocked down in. She gets ear infections a lot but normally she shakes her head when she has one. And you can usually smell them. She wasn't shaking her hear nor could we smell anything. So I was surprised.

I see, so I suspect that her ears were full of wax/debris such that they couldn't really see her ear drums and based upon that, and her previous history of ear infections, a reasonable thought was that this was related to an inner ear infection.

Given her poor response to treatment that thought process needs to be re-evaluated. Her changes with her ears may not be the problem behind her symptoms.

Her increased drinking even before the steroids, loss of appetite, reluctance to place pressure on her abdomen by laying on as she usually would, and weakness may indicate a mass in her abdomen, internal bleeding or internal organ failure. If she is not spayed a uterine infection (pyometra) is possible too.

As I mentioned I think it is time for blood work, and radiographs or an ultrasound of her abdomen.

Customer: replied 4 months ago.
They did blood work when we took her to the vet last Friday. They came out to the parking lot and drew blood in case she had anything that could have been contagious to the other animals in the clinic.
Customer: replied 4 months ago.
But like I said, we are going back today for X-rays and who knows what else. I just worry that it might be some type of cancer. I had a dog when I was very young who kind of had the same issues. It turned out she had cancer and we had to have her put down.

I too am worried about an abdominal tumor/cancer, especially given her normal blood results.

I would also want to make sure that the blood tests included a thyroid profile. It is rare but hypothyroidism can lead to neurologic signs and weakness.

Customer: replied 4 months ago.
I just wanted to let you know that my dog had to be put to sleep. When they took x-rays comma she was full of tumors.
Customer: replied 4 months ago.
Thank you so much for all of your input. I appreciate it.

My deepest condolences on your loss. I know that her diagnosis was along what you were suspicious of, but I understand that it was still difficult to hear and hard to say good-bye. You made the kindest decision for her, but I know that she will be very missed and that it was a hard day for you and your family. My thoughts are with you, take care and thank you for taking the time to let me know.

Dr. Kara and other Dog Veterinary Specialists are ready to help you
Hi,

I'm just following up on our conversation about your pet. How is everything going?

Dr. Kara