Nystagmus is when your pet's eyes 'flicker' (for a video see my FB page https://www.facebook.com/acupawsuk/). There are several different types of nystagmus - Horizontal (sideways), Vertical (up and down), or rotational (looks like your pet's eyes are rolling). Nystagmus is often accompanied by other symptoms such as not being able to get up or walk, being very unsteady and walking as if 'drunk' (ataxia), falling over, head tilt to one side, one sided facial paralysis (one side of face drooping), circling when walking, and vomiting/nausea. When this happens it is very distressing for both pet and owner. Imagine your eyes were constantly moving from one side to the other - you would feel pretty sick and distressed.
WHAT CAN CAUSE NYSTAGMUS?
There are several different causes of nystagmus which include a central nervous system lesion (Brain tumour or cyst), inner or middle ear problem (ie infection or tumour), and idiopathic vestibular disease. There is a saying in medicine 'common things are common' so in this blog post we will concentrate on vestibular disease.
WHAT IS VESTIBULAR DISEASE?
Vestibular disease is often described as ‘sudden non-progressive, disturbance in balance’ and is one of the most common neurological conditions in dogs but is rare in cats. It most commonly affects older dogs. Vestibular disease can be central (involving the brainstem) or peripheral (involving the vestibular system, in the inner ear). Sometimes no obvious cause can be found, this is called idiopathic vestibular disease (this is the most common type).
HOW IS VESTIBULAR DISEASE TREATED?
Treatment will depend on the cause for example if a middle or inner ear infection is diagnosed antibiotics will be one of the treatments used. If idiopathic vestibular disease is suspected the treatment is often supportive. It might involve giving an anti-nausea injection or tablets if your pet is being sick or feeling nauseous. If you pet is unable to keep food or fluids down they might need to be given intravenous fluids. Care at home is a very important part of recovery.
WHAT IS THE OUTLOOK?
Again this depends on the cause of the problem. For idiopathic vestibular disease the outlook is usually quite good despite the dramatic symptoms, most dogs make a full or good recovery. However once a dog has had one vestibular attack they can be prone to having them in the future.
WHAT SHOULD I DO IF I THINK MY DOG HAS VESTIBULAR DISEASE?
Firstly don't panic and keep calm, the more distressed you are the more distressed your pet will become. Make sure they are safe, if they are struggling to get up and/or are falling over make sure they are on a soft floor (you can put blankets or duvets down for added protection). Make sure there are no corners or edges they they might hurt themselves on, if they are upstairs block off the stairs so that they can't fall down them. Stay with them to make sure they don't hurt themselves, they will also be reassured by your presence. As soon as you can call your GP vet and arrange a consultation so that a cause can be identified and appropriate treatment given.
HOW CAN I CARE FOR MY DOG IF IT HAS BEEN DIAGNOSED WITH IDIOPATHIC VESTIBULAR DISEASE?
Once your dog has been diagnosed, treated for any acute symptoms (such as nausea or dehydration), and been discharged from your GP vet you will need to care for them at home. Keeping them safe from falls etc is very important (see above). If they are able to get up and move around by themselves they might struggle with slippery flooring (such as wood, laminate, or tiled floors). In this case placing non slip runners or rugs over these slippery floors can really help them move around. If they are struggling to get up and move around you might need to bring food and water to them, offering little and often is usually best. You might need to hand feed them at first, if they won't eat their normal food try cooking a little chicken, fish, or other meat depending on their tastes, often something slightly warm with a nice smell will help stimulate their appetite. If they turn their head away from the food, don't persist too much just try again in 30 mins or so. If your dog will not eat or drink you will need to contact your GP vet for advice. Your dog might not be able to get up or walk far by itself so you might need to carry them outside and support them so that they can pass urine or faeces, for larger dogs a sling or special harness might help. They may pass urine or faeces in the house or their bed, don't get cross with them or scold them as this isn't their fault. Lots of love and cuddles are an essential part of the recovery treatment! Reassurance is also essential, remember they will have lost a lot of confidence in their own abilities. Take things slowly, reassure, support, and encourage them as they gradually build up their strength.
WHAT ELSE MIGHT HELP MY DOG?
There are lots of things that can help recovery and also help to reduce the severity and/or frequency of future attacks of idiopathic vestibular disease. For example acupuncture, physiotherapy, specific supplements, herbs, and homeopathic remedies. A consultation with a holistic vet can help to decide what is the best way forward for your dog.