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Dr. Kara
Dr. Kara, Veterinarian
Category: Dog
Satisfied Customers: 17111
Experience:  Over 20 years of experience as a veterinarian.
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My dog is struggling to walk he is falling to the left with

Resolved Question:

My dog is struggling to walk he is falling to the left with his back end .he was fine this morning .he doesn't seem to be in any pain but he just keeps laying in his bed now .can you give me a reason for this .he is 12 .
Submitted: 3 years ago.
Category: Dog
Expert:  Dr. Kara replied 3 years ago.
Hello, my name is***** and I have over 20 years of experience as a veterinarian.
I am so sorry to hear about Oscar falling to his left and being reluctant to move.
Is his head tilted?
When he tries to walk is he circling or leaning to one side?
Does he 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 he 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 he can get very dizzy and as such have trouble with coordinated movement. They will often fall or lean to one side.
Does he have a history of an ear infection?
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 (antinausea drugs, anti-inflammatories and possibly antibiotics if an ear infection is a concern) as most dogs do get better with supportive care. 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 his symptoms. If he isn't improving in 3 to 5 days then blood tests should be done to make sure all is well internally.
At home you can give Gravol also known as Dramamine (dimenhydranate) to control nausea, which is also used for carsickness. The dose is 8mg to 16mg per kilogram of body weight every 8 hours. Side effects are mild sleepiness and dry mouth.
Or you can try Benedryl (diphenhydramine) at 2mg to 4mg per kilogram of body weight orally every 8 hours. Side effects are sedation and dry mouth as well.
To stimulate his 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. Feed several small meals a day.
You may need to hand feed him and offer him water or ice cubes to lick as he may have difficulty negotiating eating and drinking on his own.
If he still won't eat even after medication to decrease his dizziness and offering a bland diet then to help with nausea at home you can give either:
1) Pepcid ac (famotidine) at ¼ of a 10mg tablet per 2 to 5 kilograms of body weight every 12 hours
OR
2) Prilosec (omeprazole) at ¼ of a 10mg tablet per 2 to 5 kilograms of body weight every 24 hours
These are acid reducers and should help him feel a little less nauseous.
If he starts vomiting or refuses to eat for a couple days he may need hospitalization for supportive care, fluids and injectable medication for nausea.
If after a week's time there is no improvement or he is worse then he needs 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 he 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.petside.com/condition/dog/vestibular-disease-canine
Please let me know if you have any further questions.
Customer: replied 3 years ago.

He is eating fine and just wants to sleep but I have noticed over the past few weeks he has been a bit wobbly on his back end . do you think it is his age ?

Expert:  Dr. Kara replied 3 years ago.
Thanks, ***** ***** is only affecting his rear end and been a slowly progressive change rather then sudden, he is eating fine without a head tilt, nystagmus (rhythmic eye motions) or nausea then vestibular disease is less likely.
At his age I would be concerned about arthritis, either spinal or hip, intervertebral disc disease (soft cushions between the spinal vertebrae slipping up and putting pressure on his spinal cord) or a myelopathy which is nerve degeneration which is not painful but they lose function.
Arthritis and intervertebral disc disease can be helped with a combination of a glucosamine/chondroitin product (examples are Dasuquin or Cosequin) and an omega 3 fatty acid (like 3V Caps or Derm Caps). I recommend an omega 3 fatty acid dose based upon the EPA portion (eicosapentanoic acid) of the supplement as if we do that the rest of the supplement will be properly balanced. Give him 20mg to 40mg of EPA per kilogram of body weight per day. For example a 12 kilogram pound dog could take 240mg to 480mg of EPA per day.
Omega 3's and glucosamine/chondroitins work synergistically and improve cartilage health and joint fluid quality and quantity as well as reducing inflammation. They can take several weeks to see full improvement but some dogs do very well with them alone. They are available over the counter.
Another option is a product called Duralactin. This is an anti-inflammatory product derived from milk proteins and it also has omega 3 fatty acids incorporated into it which can be very helpful. See this link for further information: http://www.duralactin.com/products_canine.htm
If those medications are not enough his veterinarian can prescribe drugs that are more potent. Veterinary drugs we can add include a nonsteroidal like Metacam, Deramaxx, Previcox or Rimadyl. If those aren't enough we can add another drug in the opiod family called Tramadol and/or another drug called Gabapentin.
Myelopathy is very difficult to diagnose, the only sure way is to biopsy the spinal cord, which we cannot do when they are alive, so we rule everything else out and are left with that as a diagnosis. There are no effective therapies for true myelopathy, they progress no matter what we do.
Please let me know if you have any further questions.
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