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My shih Tzu's head is tilted. OUr local vet isn't sure

My shih Tzu's head...

My shih Tzu's head is tilted. OUr local vet isn't sure what's going on. I wondered if it could be a stroke. He walks wobbley.

Veterinarian's Assistant: I'll do all I can to help. Have you looked to see if there is a wound on their foot?

There is no wound on the foot.

Veterinarian's Assistant: What is the Shih Tzu's name and age?

Marvin. He'll be 15 next month.

Veterinarian's Assistant: How old is Marvin?

14

Veterinarian's Assistant: Is there anything else the Veterinarian should be aware of about Marvin?

He recently recovered from an eye infection and an ear infection. Ok

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Answered in 3 minutes by:
2/14/2018
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 34,313
Experience: University of California at Davis graduate veterinarian with 45 years of experience
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You're speaking to Dr. Michael Salkin. Welcome to JustAnswer. I'm currently typing up my reply. Please be patient. This may take a few minutes.

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I'm sorry to hear of this with Marvin. A head tilt and ataxia ("drunken sailor") are two of the symptoms pathognomonic (specifically indicative) of vestibular (balance) disorders. Nystagmus (eyes flicking back and forth) is the third most common. Marvin's vet needs to clarify if the idiopathic ("old dog") vestibular disorder has arisen (most common), a peripheral vestibular disorder involving his inner/middle ear(s)/otitis interna/otitis media) is present (an important consideration because Marvin has a history of ear infection), or a more serious central vestibular disorder involving his cerebellum or brainstem exists such as a stroke or tumor in or affecting those areas. Testing can be quite involved necessitating CT or MRI imaging neither of which may be appropriate at Marvin's advanced age. My initial approach would be a complete neurologic exam and careful examination of Marvin's ears looking for tell-tale signs of middle ear infection - a discolored or bulging typanum (eardrum), for example. Please respond with further questions or concerns if you wish.

Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 34,313
Experience: University of California at Davis graduate veterinarian with 45 years of experience
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Customer reply replied 4 months ago
It's like his head is attached wrong?
Because of his age, I haven't taken him for an MRI etc. I think it would be too stressful for him. He's peeing and eating.....so I'll just keep carrying him outside and back. He walks wobbley. Thank you very much. He's taking 2 Long Dan Xie Gan 0.5 g twice a day and
Prednisolone 5 mg twice a day. Does that sound reasonable?.

I understand. You're quite welcome. Prednisolone hasn't been found to be of value for the idiopathic vestibular disorder and would make an infection worse and so I don't recommend its use. I'm not familiar with the Chinese herb. Thank you for your kind accept. I appreciate it. I regret that my state board of veterinary examiners doesn't allow me to speak to customers by phone in this venue but other experts in this category may be able to assist you in this regard. Please let me know if you'd like another expert to do so and I'll opt out of this conversation. Please stay in the conversation if you wish.

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Customer reply replied 4 months ago
Thank you very much. Maybe I'll take him to another vet. His vet is Korean. they are well respected in this area (new jersey), but maybe another vet will have some suggestion that might help.
I'm signing off now. God bless you for your contribution to us.

It's my pleasure. I can't set a follow-up in this venue so please return to our conversation - even after rating - with an update at your convenience. You can bookmark this page for ease of return.

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Dr. Michael Salkin
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