Vestibular Disease in Dogs: the ESSENTIAL guide
First published October 2018, updated 31st January 2019
If you have an old dog who has suddenly started to stumble and act drunk, developed a head tilt or even can’t get up then there is a real chance they are suffering from a condition known as vestibular disease. In dogs this can come on very quickly and the symptoms can appear very dramatic.
Is vestibular disease as serious as it appears though? What is the treatment and recovery time? Keep reading as I answer all these questions and more!
What causes vestibular disease in dogs
Let’s start with what vestibular disease actually is and the known causes of this condition. The name of the disease reflects the involvement of the vestibular system, the group of structures and nerves that are responsible for balance, found next to the middle ear and relaying information about which way is up to the brain. As well as balance, the vestibular system also helps with the control of posture and keeping the body (and head) horizontal or at least know which way up is!
There are lots of potential causes of vestibular disease. Some will affect young dogs, others just old dogs. Some causes are very rare and others much more common.
Causes of vestibular disease in dogs
Thiamine (vitamin B1) deficiency
Brain bleed or clot (stroke)
Hormone abnormalities (hypothyroidism)
Middle ear infection
Thankfully, the vast majority of old dogs that develop vestibular disease are suffering from the idiopathic form. Idiopathic simply means we don’t yet know why it happens or what the cause is but this cause is so common that the condition is also known as old-dog vestibular disease.
This disease can affect all old dogs, of any breed and any gender. It can also affect cats but this is very rare.
Vestibular disease vs stroke in old dogs
We are all aware of the signs of stroke in people and the devastating effect that is can have. It is pretty common for worried owners to believe that their old dog has suffered a similar catastrophic stroke.
It used to be thought that dogs didn’t actually get strokes. With MRI scans now being available we know that this isn’t true and they actually can suffer from a stroke, also known as a cerebro-vascular accident (CVA).
While they can be due to a bleed within the brain, most are actually due to a blood vessel becoming blocked, either due to a blood clot or other form of embolism, cutting off the blood supply to part of the brain. Very often, a dog who suffers a stroke will be suffering from a condition that makes blood clot development more likely, such as Cushing’s disease, cancer or heart disease.
Unfortunately the signs of stroke and those of idiopathic vestibular disease can be almost identical. History, examination and testing though may very well give a clue as to which is the more likely diagnosis.
In reality, true strokes are much less common in dogs and the prognosis for vestibular disease is normally much better as I’ll discuss in a bit.
Symptoms of vestibular disease
As you can imagine, the symptoms of vestibular disease in dogs relate to a loss of balance and not knowing which way is up. It might even appear like your dog is drunk or sea-sick. Let’s break down the symptoms you might see in your dog and then discuss them in more detail.
Main symptoms of dog vestibular disease:
Leaning to one side.
Wide based stance
Drooling + vomiting
Signs of other nerve dysfunction
Inability to stand
The severity of signs seen can vary a lot. Some dogs may only develop a slight head tilt, holding one side of their head lower than the other, while others will have their head almost 90 degrees to normal and be completely unable to stand.
Along with a head tilt, affected dogs will having something known as nystagmus. This is a flicking of the eyes, typically from side to side, with them moving quickly in one direction and more slowly returning the other way.
As I’ve mentioned, the degree of wobbliness can really vary. It might just be a subtle stumble or dragging of a leg. Instead it could be a complete inability to stand up. To compensate for this instability, you might find that your dog spreads they legs further apart than normal to try and prevent falling or they may lean against a fall for support.
Walking in circles (always in the same direction), falling over and rolling are all other symptoms that might be seen as a result of a loss of balance and reflect a vestibular system that is not working properly.
You might also see your dog drooling, appearing nauseous or actually vomiting. In effect your dog has developed motion sickness and if you have ever had vertigo I’m sure you’ll sympathize with what your dog is going through! Finally, if there is a different cause of your dogs vestibular signs there may also be other symptoms your dog displays that are not typical of old-dog vestibular disease.
How is vestibular disease diagnosed
Because vestibular disease can be caused by a large number of different underlying conditions, a number of tests may be needed to reach a diagnosis. Idiopathic vestibular disease itself is a diagnosis of exclusion. This means that all of the other causes need to be ruled out before a specific diagnosis can be made.
A detailed history is absolutely vital, as is a complete physical examination. Blood and urine testing are generally the first tests to be run.
Depending on the results and the clinical picture imaging might be next. Xrays can show the presence of middle ear disease, either infection or a mass, but can not give any indication into the presence of abnormalities within the brain itself. Only CT or MRI scans can do this but the obvious problems with this are both availability and cost.
Other tests that might be considered are sampling of the fluid around the brain and spine (known as CSF) and sampling of any fluid within the middle ear. Additional, specific blood tests may also be needed to rule out potential conditions when there is a suspicion they might be responsible.
Referral to a neurologist and advanced, expensive imaging will not be needed in the majority of dogs. Those dogs that are older and showing the appropriate sudden onset symptoms, where there is no evidence of middle ear disease or other disease and where there is no history of trauma or potential for drug toxicity could quite appropriately have a presumptive diagnosis of old dog vestibular disease.
Response to treatment is the final factor in diagnosis. If a dog is not progressing as expected then the diagnosis should be re-evaluated.
Vestibular disease treatment
In reality, time is the biggest treatment of this condition. Time and supportive care.
This might include anti-sickness medication, IV fluids, supportive bedding with regular turning for patients who can’t get up and anti-anxiety or sedative medication if a dog appears to be becoming distressed by their situation.
Anti-inflammatory drugs in the form of NSAIDs or steroids may be given in the first instance, although whether these make any difference or not is not clear.
The bottom line is that, because we don’t know the cause of this idiopathic disease there is not specific treatment targeting the problem directly. Instead, we rely on good supportive nursing care and time. In a dog who is only mildly affected, TLC at home may be all that is prescribed.
Home care tips for your dog
Let's jump into my 5 home-care tips for treating old dog vestibular disease:
Avoid skin damage
Maintain hydration and food intake
Work with your vet
Home treatment tip number one is to help your old dog avoid injuries. When they're disorientated and stumbling around, it's very easy for them to become injured. To prevent this from happening, we can do a number of things.
Stop your dog lying down or having access to areas with slippery floors. This could be tiles, linoleum, bare wood, whatever. One way to get around this if that is all you have in your house is to put a rug or runner down in the area your dog likes to be. It's important though to make sure that the underside has a non-slip grippy surface so it's not sliding around when your dog walks on it. If that happens it could make injury even more likely. Just keeping them on carpeted areas to make sure that they're not going to slip and fall over is clearly a simple solution if available.
A non-slip floor will also help them get extra purchased when they're trying to stand up. This in something a lot of seniors can struggle with at the best of times, especially it their arthritis (something that’s really common in senior dogs), but will be even more of a struggle while they're a little bit unsteady on their legs.
If your dog is really unsteady than actually helping and supporting them can make a huge difference. What you can do is actually put a harness on your dog to help with this. While some harnesses are appropriate for keeping on all the time, others are better just to slip on when you're going to take your dog out to go to the toilet. For example I really liked the ones by Julius K9 which are very robust and have an excellent handle (as well as coming in all sizes and colors!).
You can help your dog get to their feet in the first place and then continue to hold this handle to help support them while they're getting outside and while going to the toilets as well.
For those old dogs that are really struggling with mobility, as well as having that handle on the harness you can sling a towel or sheet under the tummy just in front of your dog’s back legs to provide just a little bit of extra support and stability. This is manageable with one person but having a second pair of hands will definitely help, especially if you have a larger dog!
Avoid skin damage
Next up is to prevent pressure sores and urine or fecal scolding. So often, a dog who is suffering from vestibular disease spends a lot of time lying in a single spot. They're sleeping a lot, they really not wanting to move, and this can be a perfect recipe for developing pressure sores. These can then be quite challenging to treat in some cases and will simply add to your dogs distress.
The other skin problem is getting really sore, inflamed skin around their back-end and back legs. A dog who is struggling to move freely will often have accidents, they're wetting themselves and the urine is sitting next to the skin.
There are simple ways to help prevent both of these skin problems in dogs with vestibular disease.
In the first case we should try and encourage our dogs to get around and move a little bit more, within reason. We don't want to force them to do more than they are able to do, or if they get upset by being encouraged to move.
If a dog is not moving then rotating them from side to side every few hours is important. Also making sure that they've got really nice soft, comfortable bedding is vital as well. A memory foam bed is perfect for this and is an ideal bed for any older dog to take pressure off painful joints. They even come with waterproof covers to make clean-up super simple.This will massively reduce any pressure build up over the bony bits out seniors often have.
As well as keeping the bedding soft, keeping it as clean and dry as possible is clearly of huge importance. If your dog does have an accident then change it straight away. Also bathing them and drying them well is key to prevent urine scald.
If though you do find that your dog is developing urine scald, you need to clean and dry your dog well and then use a barrier cream like Sudacrem to help protect the skin from further damage. Clipping the fur can help with this and bandaging the tail is also a good way to help keep a dog clean.
Eating and drinking
It's obviously important that they stay hydrated. It's also important, if we can, to try and ensure that they're getting enough calories on-board. The body is in a recovery mode and they're going to need their calories.
When it comes to encouraging them to drink, we can put ice cubes in the water bowl. You can also put unflavored ice cubes in, or just flavoring. So that could be low salt stock cubes, you really want to avoid anything with a high salt content. Or you could boil up some chicken or vegetables and use that broth to add flavor to the water.
We also need to offer this water to them regularly. Remember, your dog might not be wanting to get up. They might be really reluctant even to reach not very far to try and get to that water. So just taking it to them and then to encourage them to drink is vital.
As far as feeding goes, start by choosing something that you know your dog likes, something strong tasting or strong smelling food. You can also hand feed it, so have your dog either lick it off your finger or take it out of your hand and again offering it to your dog, taking it to your dog because they might be hungry, but they might again be really reluctant to get up and actually go to their food bowl.
Tip number four is to try and prevent anxiety. It can be a very anxious time for your dog. They're not understanding why they're struggling, why they're stumbling around, why they can't get up. Remember too that for your dog with vestibular disease the world seems to be spinning!
Reducing anxiety starts with simply spend time with your dog. Be there to reassure them. You don't have to spend all your time stroking or patting them obviously, but just your presence being there, talking to them in a gentle voice will reassurance can make a big difference.
Next, if your dog is able, consider using some kind of food treat or food toy.
So that could be a kong, it could be a licki pad, it could be a food puzzles. Now obviously if a dog is badly affected then they're not going to be able to benefit from these more challenging situations. That said, it could definitely be good mental stimulation for those dogs that aren't too badly affected or who are well on their way to recovery.
Finally, if your dog is getting anxious then consider anti-anxiety supplements or medication. That could be something like the supplement Zylkene. It could be Adaptyl, or dog appeasing pheromone, that comes in a color form or as a plugin diffuser.
You could also consider something a lot of people are recommending at the moment, CBD oil. Now cbd oil isn't the be all and end all. There's a lot that we don't know about it. But if it’s something you’re looking into make sure you check out my guide to the evidence behind CBD oil in dogs, and with any form of supplement of medication consult your vet.
Work with your vet
You need to be sure that your dog does have idiopathic vestibular disease or old dog vestibular disease. There are a number of other conditions that can cause very similar symptoms. As an extreme it could be a brain tumor so you definitely want to make sure that you're treating your dog for the right thing.
Your dog may also need other medications. For example, if they are feeling really nauseous or vomiting they might need treatment to stop that so that they then feel like eating and drinking.
It may also be that your dog has other conditions that need to be addressed or they are already under treatment for. It's important that you work with your vet to make sure that you’re able to give the appropriate treatment that your dog needs for all their conditions.
You need to have a chat about what's important to your dog. Both from a vestibular disease point of view, but also what's going on with that general health and you know, being older adults frequently, there are other things going on.
And then finally, if your dog really is severely affected, if you're struggling, then the veterinary hospital might definitely be the best place for them. You know there'll be looked after by a team of nurses or techs who are fantastic at caring for patients in situations like old dogs with vestibular disease. Your dog may need intravenous fluids to stop them being dehydrated. They may need other care and attention.
Hospitalization is definitely something to consider if you're struggling, even if your vet is happy for you to try and look after your dog at home. You need to be honest with yourself about whether it is something you’ll be able to cope with. Looking after any dog with reduced mobility is challenging, even more so if your dog is big and heavy. Sometimes the veterinary hospital is the best place for them.
Prognosis and recovery time
As you might have guessed by now, the actual prognosis for dogs suffering from vestibular disease is generally really good. Most will go on to make a full recovery. Some will be left with a permanent head tilt but they will otherwise adapt really well and be able to live a full, happy life.
It is important that we give our pets enough time to recover. It is all too easy to see a dog that seems to be suffering from really severe, upsetting symptoms and make the irreversible decision to euthanize.
We need to give them time. The general course of disease is that the symptoms are at their worse 24-48 hours after they start. Some dogs will then recover as rapidly as the disease started. For others the recovery time will be longer, instead taking more like 7-10 days before a significant improvement is seen and 2-3 weeks before they are back to normal.
The most common symptom to remain is a head tilt, and this may remain a constant feature. Even in this case our dogs are amazing at adapting and will be able to run and exercise without a problem and with no impact on their quality of life.
In my personal experience, most dogs will show significant improvement after only a few days and will recover fully.
If your dog is not recovering as expected then the diagnosis should be revisited if possible. This might mean repeating some tests, running new ones and even referral to a neurologist for assessment alongside advanced brain imaging with an MRI scan. This might be out of reach for you but it would certainly offer your dog with the best chance of an alternative diagnosis and successful treatment.
Buddy and Dan’s Story
A friend of mine, Dan from the Youtube channel Parent Pacifier, had his family dog go through an episode of old dog vestibular disease. Along with his family, he went through a lot of worry and uncertainty and I’m really grateful to him for sharing his story with you here:
“Hi, I'm Dan from the parent pacifier YouTube channel and I want to thank Dr Alex for having me on Our Pets Health to talk to you about the story of my dog Buddy and his bout with vestibular syndrome, also known as old dog syndrome or doggy vertigo.
On a Sunday morning in February 2018, my dog Bud was with my parents and he started to fall down a little bit. He's 13 years old, cavalier cocker spaniel and he's had some knee problems, so we assumed that it was probably a knee issue. Our normal vet was closed so we took them to another one that we've been to before and they gave him a shot because he looked completely normal of course at that time.
So then fast forward a couple of hours in that day and he started tripping again. He started falling down, his head was a little tilted and he didn't look like himself. He was having a hard time. That night he had fallen asleep on the couch, like he normally does, and about an hour into being asleep, he got up, jumped off the couch and then fell down and could not get up.
You could tell he was really disoriented. He was looking all over the place when you called him. He really couldn’t tell where you were calling him from. His legs were completely stiff and he urinated himself.
We knew we needed to take him to the vet. So we called the closest vet that was 24 hours, also another one that we don't normally use. Immediately the veterinarian knew it was vertigo, that is was vestibular syndrome.
And it made so much sense because he looked like he was seasick. He just was stiff with those paws trying to hold on to anything that would keep him still, and his head was tilted. And actually you could see it with his eyes. The vet had showed us that his eyes would jump up and then slowly come down, jump up and slowly come down. And that was happening throughout this time. And so they had to keep him overnight that night and we would hear the next day how he had progressed.
Well that Monday around 2:00 PM, we heard back that nothing had happening and he was actually still exactly the same. So we decided to let them keep him overnight another night.
That Tuesday afternoon again, no progress, still exactly the same, laying down, not getting up.
And that's where the vet said, “well, you know, he's 13, he's, he's lived a good life, but we'll have to at some point make a decision on what we're going to do” because it was getting really expensive to keep him overnight there. We also had to have him in an IV drip because he wasn't eating. So it was a difficult situation to be in.
So we're trying to think through what that family decision would be on that Wednesday. But around noon I was doing some research because I really wasn't ready to give up and found an article or a blog that had talked about another person who had the same experience. They had a dog very similar to buddy and around 13 years old and had vestibular syndrome and was in it for like four days. But on the fifth day the dog got up.
They were ready to go to a neurologist and all those are things that we just don't have the money for, to take him to a neurologist to find out potentially what could it be causing the problem. This is anything from an earache all the way up to cancer on the brain. And at 13, what are we going to do? Have surgery and spent all this money when he might not make it through.
So I was looking at it and thinking maybe just one more night, right? One more night if we need to. I'm not ready to jump on that decision but we had to make it as a family.
But at 2:00 PM we got the call from the vet that he actually stood up and that was awesome. We really wanted to hear that. So we went to the vet that night to go see how he was and we were able to make our decision. He was walking around and moving. His head was still tilted. He still looked a little disoriented, but he was up and walking around, which was a huge difference from where he was Sunday night and throughout the beginning of the week.
So we decided to take him home and he actually ate at home. He didn't want to eat at the vet, he refused to take anything even from our hands at the vet's office. But the second we were back home, he was eating. He actually ate some chicken right away. It took only a couple of days and he was pretty much back to normal and now he doesn't even look like he has had to deal with that vestibular disease.
It was really encouraging to read what others had been through so I hope that this can encourage you if you're currently dealing with vestibular syndrome or vertigo with your dog. I'd love to have conversations with you in the comments below.
That's our story and here he is today, a 13, almost 14 years old, and normal and healthy. It was rough because it looked really bad but ultimately he was able to come out of it and we're glad we didn't make any other final decisions that week.”
Thanks so much to Dan for sharing his challenging story with us all. Like he said, let us all know your experience with this disease in the comments below to help support anyone looking for information in the future.
If you have an old dog and are wondering what else you need to think about to make sure they are looked after as well as possible so they stay happy, comfortable and actively engaged in family life then make sure you also check out my article all about caring for senior dogs.
Our Pets Health: because they’re family