Patient with previous vestibular disease

[lehughes]

Hi Laurie, I recently saw a 12 year old hound that had a previous bout of vestibular disease of unknown cause about 1 year ago. She did have a residual head tilt but the vestibular disease appeared to be resolved otherwise. She also had CP deficits in both pelvic limbs and mild ataxia. Primary vet did not have radiographs, CT or MRI. She spent the day with us in rehab and we did only 2 minutes in UWTM, 2 sessions of cavalettis at a slow walk, laser and acupuncture. A short 5 minute walk outside. We only did 1 sit to stand because that seemed to be difficult for her. We did one rocker and wobble board with her as well. She was normal when she left my office but later that evening developed worsening vestibular signs. I am hoping we did not do anything to exacerbate her signs. I am wondering if you have seen this happen before. I also would like to know if you feel it would be best not to do wobble board or rocker with this type of history. Obviously, I would never do this with a patient that had acute vestibular disease. We work with a lot of geriatrics, so we have had other patients with a history of vestibular disease that has resovled and they did not have any problems when we used wobble or rocker board in a gentle manner.The dog was highly anxious when she was with us for the day and one of my concerns is the possibility of a vascular event due to stress. Thanks for your thoughts, B.

[lehughes]

Hello B.! Ciao from Italy!

So, I think you are beating yourself up for no reason!
It is known that once a dog (or person) has a vestibular episode, they are more prone to having another episode.
The reason for the ‘idiopathic’ geriatric vestibulitis is that the otolith comes loose from over the hair folicles of the utricle or saccule, and the reason they come loose is that they are a bit osteoporotic to begin with… which is what makes a dog more prone to this happening again.

So, I don’t think that this had anything to do with what you did. It could have been just bad timing, or perhaps, as you said, the dog was very anxious being away from home for the day, and perhaps that set off the issue.

From what you described… nothing you did would have caused this!

And actually, working on the rocker board is exactly what I would do with a chronic / late stage / past vestibular incident… As it would work on developing other balance pathways, but would in no means cause it.

To cause it one of the otoliths would have to travel UP into one of the semicircular canals. So unless your were spinning the dog or rolling it around repetitively, or took it on a carnival ride… you didn’t cause this.

But I know how crappy and guilty you will be feeling, just the same.

My Canadian solution would be to phone and check up on the dog, apologize that this event occurred (apologies in Canada do not imply guilt… just a statement of empathy… there is actually a law about it!), and explain to the owner all that I have explained to you. If they want the dog to return for some therapy (which I think would be good), it might be best if the owner was there and it was not a ‘drop off’ client - so the dog is not stressing for the whole day.

All the best! Chin up!

Laurie