Hello, welcome to Just Answer. I will do my best to answer your questions and help Scallywag. Is she on any other medications besides the Metacam and Tramadol?
Ok, thank you. Any chance she has had bloodwork and x-rays performed recently? Either way, it does sound like your veterinarian feels she is pretty healthy for her age.
The history of change in the past week can be due to a number of things, and considering a few things I would focus on a few areas.
no she has not had any blood tests performed nor has she had x rays done.
One condition that might be causing her to have a head tilt and be unsteady on her feet is called Vestibular Disease. This is more prevalent in older dogs and causes problems with their balance. Most of these patients present with head tilt, unable to stand, nystagmus (eyes moving rapidly back and forth), and sometimes vomiting and rolling over and over.
A veterinarian would need to examine her to confirm the diagnosis, and the disease is usually self-limiting - this means that she will get better in 2-4 weeks without any medication. Occasionally there will be a permanent head tilt, but most cases recover back to their normal condition.
Another consideration is that she has had a stroke, as you suggested.
her seems to be okay but seems to have to focus quite hard as if she seems to be going blind.
This is a bit harder to confirm, and there is a chance she will have more strokes if that is the case. Ideally, she would need to have bloodwork, a blood pressure and ECG checked, and even discussing with a Cardiologist to see if this is the cause. If so, there are medications to help alleviate future strokes, but you wouldn't want to use them unless it really is a stroke condition.
thanks for your help I will make an appointment to see the vetarian
Finally, there is a possibility that she has developed a brain tumor, and quite a bit of her history and current symptoms support this. Again, she would need to be examined by a vet to confirm or deny this, and many times we have to do advanced imaging (MRI or CT scan) to verify and locate the mass, which then gives you treatment options and a prognosis.
Best of luck to you and Scallywag!