A fairly common reason for a veterinary visit is the concern that an older dog has had a stroke, when he suddenly starts walking like a drunken sailor with his head tilted. I know of other cases, where these sorts of symptoms are assumed to be a brain tumor and the dog is euthanized—maybe unnecessarily. (The condition plays a role in the new Hallmark movie, Duke.)

Well, I want to shed some light on a much more common and less concerning cause of these and other disturbing signs, something known as idiopathic vestibular disease, in case it is something you ever experience with your own geriatric dog.

Idiopathic (meaning unknown cause, think: idiot) vestibular disease is a syndrome that looks really, really bad, but usually gets better all on its own with little or no treatment.

The vestibular system
The vestibular system is composed of portions of the brain and ear and is responsible for maintaining a sense of balance. When something goes wrong with this system, it’s like being drunk on a rocky boat. Dogs with idiopathic vestibular disease have some combination of the following signs:

• A head tilt,
• An unsteady gait, loss of balance, or falling over,
• Circling in one direction,
• Eyes rapidly moving from side to side, known as nystagmus,
• Sudden vomiting.

These videos show a dog with mild, but very typical, vestibular signs and another dog with more severe signs.

Now for the caveat: These clinical signs are unfortunately not unique, or diagnostic for, idiopathic vestibular disease and other things can cause this same presentation. These can include (yes) a brain tumor, an inner ear infection, inflammatory disease or sudden bleeds into the brain—to name a few. But with that being said, when the symptoms seemingly appear out of nowhere in an older dog, I always recommend a “wait-and-see approach,” treating symptomatically and supportively, as there is a good chance of improvement.

Wait-and-see approach
For a dog showing the above signs, I first discuss the possible causes. Next, I recommend blood work and a blood pressure check to make sure there is no “obvious” disease. I discuss the availability of an MRI to evaluate the inner ear and brain. Although an MRI allows for the best evaluation of disease, it is often not pursued due to cost (about $1,500 here in the Bay Area).

I examine both ear canals, and if an infection is suspected, I discuss antibiotic therapy, as inner ear disease is one of the possible causes of vestibular signs. The inner ear (pictured below) is something you cannot see during an exam because the eardrum obscures the view to the inner ear. The eardrum is like a closed door that sits in front of the middle and inner ear. However, if there is a nasty looking outer ear and an inflamed eardrum, there is a chance that inner ear disease could be present as well.

If the dog’s clinical signs are so severe that they cannot walk, I then recommend supportive care with IV fluids and injectable anti-nausea medications. Urinary catheters are sometimes placed for hygienic reasons. If clinical signs are mild, pets can often be managed at home with over-the-counter meclizine (for the feelings of “motion sickness” they experience). We also provide instructions for general nursing care as well as how to protect from falls.

The conversation ends with discussing a very loose rule of thumb: If there is gradual or complete improvement within 72 hours, it is likely idiopathic vestibular disease and additional diagnostic testing is not necessary. If there is no improvement or progression of signs, it is likely something much more serious, such as a tumor, and an MRI would be recommended to reach a definitive diagnosis. With idiopathic vestibular disease, marked improvement is usually evident in this time frame, with the pet returning to normal in 7 to 14 days (although in some dogs, a head tilt will still persist).

It should also be noted that this is not a painful condition, and my recommendations stem from the fact that euthanasia is a permanent decision, so why not wait and see, giving time a chance? There is a high likelihood that improvement will be seen and the difficult decision of euthanasia can always be made at a later date if there is no improvement or if there is a change in your pet’s quality of life. I feel there is reason to hold out hope and be cautiously optimistic, as idiopathic vestibular disease is the most common form of vestibular disease in dogs. It is the direction I would take if it were my own boy experiencing this.

Please note: There are times, however, when a physical exam points undeniably to a brain tumor, but these neurological exam findings are beyond the scope of discussion, so feel free to ask me any questions.

Bayer makes two different flea control products that can easily be confused with one another, leading to potentially lethal complications in our feline family members. Advantage has formulations approved for both dogs and cats, while the product Advantix is intended for use in dogs only. Advantix causes permethrin toxicity in cats, which is a common emergency I see, especially during the spring and summer months, when fleas are at their peak of peskiness. 

What exactly is the difference?
Advantage is a topical solution that can be applied to either your dog or cat’s skin once per month for flea prevention, and it contains the active ingredient imidacloprid.

Advantix is also a topical solution for the treatment and prevention of fleas, ticks, biting flies, mosquitoes and lice on dogs. The product’s active ingredients are imidacloprid and permethrin. It is the addition of permethrin to the recipe that makes the deadly difference.

Dogs can metabolize permethrin effectively, resulting in a safe product for them. However, cats cannot metabolize this ingredient, and will suffer from toxic effects if exposed. Cats are exposed to Advantix in a variety of ways, including direct application, close contact with a dog who has been treated within 48 hours, or if they have groomed a doggy pal’s fur after an application.

What are the symptoms?
Symptoms in cats will generally manifest within a few hours, but it can take up to three days following Advantix exposure or application. Symptoms include tremors and twitching (sometimes just the ear tips), hyperexcitability, drooling, depression, loss of coordination, vomiting, seizures, loss of appetite and, potentially, death, if not treated. One of the major concerns is an extreme elevation in body temperature from the continuous muscle activity due to tremoring.

What is the treatment?
Treatment consists of decontamination of the skin with a bath, tremor and/or seizure control and supportive care. Medications are given as needed by an intravenous injection to control these clinical signs. General supportive care takes the form of intravenous fluids to keep the cat hydrated, as well as vital-sign monitoring and providing a safe environment so the cat does not harm him or herself during the period of incoordination and disorientation. Clinical signs of tremors generally last for 12 to 24 hours but may persist for up to 48 to 72 hours.

Prognosis for recovery is excellent with early treatment.

Prevention tips
If you share your home with both dogs and cats, it is not advisable that you treat your dog’s parasites with Advantix mainly because accidents can occur. I often hear a distressed owner say that they “accidentally” applied the wrong one, so I feel that it is best just to take that risk out of the equation, especially when there are so many other flea control options available.

If you do use canine Advantix in a home with cats, apply the medicine to your dog while your cat does not have access to the area or to the dog and allow for the medicine to fully absorb into your dog’s skin—when you can no longer visibly see the oily medication on the fur—before allowing your cat back into the same room. I have treated cats that were obsessive groomers and decided the fur between “their” dog’s shoulder blades needed to be cleaned.

And lastly, always double-check labels and read all the fine print; you can even have someone just “double-check you” as another safety precaution.

Diarrhea. Boy, do I see lots of this, and when I say “lots,” I mean lots. In fact, on some shifts, it feels like that’s all I see. One of the common causes of diarrhea in dogs worldwide is giardia, a ubiquitous single-celled protozoan parasite. Giardiasis is transmitted by a fecal-oral route, meaning that the parasite is swallowed in food and water (think: puddles, lakes and streams) contaminated with feces. Note: Your pet does not have to eat feces to get the parasite!

Infection can be present without symptoms, but when signs are present, the most common one we see is large volumes of watery feces, oftentimes with blood and mucus. Weight loss, decreased appetite and vomiting can occur as well.

How is the diagnosis made?
Diagnosis is often made by evaluating fecal material under a microscope. However, this little parasite can be difficult to find. So, in addition, we use a nifty “snap test,” adding some stool to a solution that gives us a positive or negative result (like a pregnancy test for poop). This test is very sensitive to the presence of giardia.

How does one treat this parasite?
Generally, easily and inexpensively, provided your dog doesn’t get so ill that he or she needs IV fluids or hospitalization. The little puppy pictured is named Rascal, and he was hospitalized due to an infection with giardia. His diarrhea came on fast and furious, and because teeny puppies don’t have much “wiggle room” when it comes to bodily reserve, it caused a critical drop in his blood sugar. He required more intensive hospitalization, and made a full recovery.

Giardiasis is generally treated with an inexpensive antibiotic called Metronidazole (Flagyl) that is readily available. In small puppies, such as Rascal, or dogs sensitive to this antibiotic, a dewormer known as Panacur can be used instead for five to ten days.

How do I prevent it?
This best way to help prevent infection is to keep your dog from drinking from puddles, lakes, streams or other sources of stagnant water. I know, this can be difficult.

Dog park puddles carry a higher risk than, say, fresh rainwater pooled in a birdbath or fountain. Remember, giardia is transmitted by a fecal-oral route, and what better place to have concentrated levels of feces than a dog park, especially when some pet parents are not diligent about removing their doggy’s waste. Think of it this way: If a dog infected with giardia defecates on the grass, and the rain creates a puddle of water in grass, your dog is essentially drinking a giardia martini.

It may also be advisable to treat other animals in the same household while treating the infected, symptomatic pet. There is a vaccine available for giardia in dogs, but most veterinarians don’t recommend it unless your dog is at really high risk or is one of those pets who gets giardiasis frequently.

Don’t forget: People can get giardia too. Younger children are at a higher risk as hands often find their way to mouths during outside playtime (grass can be contaminated with giardia cysts as well). And those adorable doggy kisses we love so much? Let’s just say that it is easier to accidentally ingest one of those little cysts than you might think.

There are also environmental control measures that can be taken to prevent reinfection. People should be vigilant in clearing fecal material from the environment. If your pet has been diagnosed with giardia, it is often recommended that you wash as many areas of your environment as possible, followed by disinfection with a solution of bleach diluted in water (another measure that is easier said than done).

As with anything medical, there is no one clinical sign that equals a definitive disease, and diarrhea happens to be of the most common clinical signs of any disease process. Because of this, if your pet has diarrhea that persists beyond 24 hours, or is very sudden and severe, a veterinary exam is in order.

And, on that note, I’ll leave you with this closing mantra: No drinka da puddle, no snout in da bay. Pick up poop in da yard, quickly throw it away!

Not long ago an adorable Dachshund-mix puppy named Sunny was brought into my ER because he was having trouble breathing and was coughing up blood. A quick blood test determined that he had eaten rat poison. A blood transfusion was required to save his life. He made a full recovery.

The need for blood or plasma transfusions is a frequent occurrence in our referral hospital, and can be crucial in many situations including trauma, immune diseases, blood-loss during surgery or, as in the case of Sunny, for eating rat bait.

When a lifesaving transfusion is recommended, the natural question by worried pet parents is, “Where do you get this from?” People are generally surprised when I answer, that just like for us people, there are canine blood banks.

Canine blood banks
Veterinary blood banks are a fairly new concept, developed during the past 10 to 20 years, and there are essentially two kinds: collection centers using volunteer dogs and centers that house and care for their own group of donor dogs who live on the grounds of the blood bank.

Community-based donor programs rely on volunteers to bring in their pets for blood donation. There are several veterinary schools that participate in this kind of program, including University of California, Davis, School of Veterinary Medicine. Incentives to volunteers can include free annual health exams and blood work, heartworm prevention and food. Some programs even offer a return gift of blood at no cost if the donor ever needs it during his or her lifetime.

Animal Blood Resources is an example of the second type of blood bank. It obtains donors through partnerships with rescue groups, providing a working solution for unwanted adult dogs and cats.

These donors are given a temporary home where they can frolic and play, including getting trained for agility! Additionally, there is a force of volunteers who groom, cuddle, walk and play with them. After one year of providing their lifesaving service, every animal is adopted into a permanent home in great health and well socialized.

Could your dog donate?
Donor dogs must be between one- to six-years-old, weigh at least 55 pounds and be free of any medications. Prior to becoming a donor, all dogs are screened for infectious diseases and are given a full veterinary exam to ensure that only healthy dogs enter a donation program.

Next, their blood type is determined. Dogs have six major (but up to 13 different) blood types. The preferred donor is antigen 1.1 negative. In the dog world, they are considered “universal donors” and are similar to type-O universal human donors.

Donor dogs can “roll up their fur sleeves” every 2 to 3 months, but this varies by blood bank. Sedation is not needed—just plenty of head rubs and treats. The blood draw takes about 10 minutes.

A single donation can be used to save up to four lives, because the blood can be separated into two components, red blood cells and plasma.

People understand how important it is to donate blood, and the same holds true for our pets. In the case of canine donations, one dog can give the gift of life to many others. One more reason to add to my list of why dogs are my heroes.

Interested in having your dog become a donor or adopting a retired donor? If you live in California, contact the University of California, Davis, Veterinary Medical Teaching Hospital at (530) 752-1393. Or ask your veterinarian or local shelter.