Vestibular signs from neck problems

[Guest guest]

Hi guys

I have a client who is a nurse and her aged dog was in for UWT exercise

last week. The following night she started with vestibular signs, was

taken to the E clinic - her ears appeared normal. Signs resolved in 12

hours.

This client is convinced that the dog having her head looking up the

whole time in the treadmill caused the signs. Has anyone heard of this?

I am skeptical but am trying not to be too defensive.

The dog's primary problem is lumbar weakness and I have seen her for 3

months with good success (balance exercises etc. ). I have treated the

dog with chiropractic before and not encountered many neck problems.

Any suggestions?

Thanks

Tomlinson (vet)

[Guest guest]

Rarely, new joint movement in the upper cervicals can cause an animal to have to reorient its upper cervical righting mechanisms. More probably, this dog had a bout with idiopathic vestibular syndrome for which there is supposedly no known etiology. My opinion about the cause of vestibular syndrome is that an otolith has become dislodged, and has landed on some different set of sensory hairs in the saccule of the inner ear and the nervous system just has to figure the new information out to determine where down is. Hence the almost constant recovery from this sometimes frightening and possibly nausea causing condition. I have found that if the rest of the neck is well adjusted, and the animal is kept still, and preferably sternal, that they recover more quickly than average. Dogs may be affected for a few hours to several weeks and may have relapses; though they seem to recover more quickly each time if it is in the same ear. I have seen it occur after especially hard play sessions or very long runs, or after a fall, even without an apparent blow to the head. I have also had an old dog or two have it after an especially long sleep! Judith M. Shoemaker, DVMAlways Helpful Veterinary Services305 Nottingham RoadNottingham, PA 19362ph fax info@... www.judithshoemaker.com

To: VetRehab From: drjulia@...Date: Mon, 17 Dec 2007 20:41:34 +0000Subject: Vestibular signs from neck problems

Hi guysI have a client who is a nurse and her aged dog was in for UWT exercise last week. The following night she started with vestibular signs, was taken to the E clinic - her ears appeared normal. Signs resolved in 12 hours. This client is convinced that the dog having her head looking up the whole time in the treadmill caused the signs. Has anyone heard of this? I am skeptical but am trying not to be too defensive. The dog's primary problem is lumbar weakness and I have seen her for 3 months with good success (balance exercises etc. ). I have treated the dog with chiropractic before and not encountered many neck problems. Any suggestions?Thanks Tomlinson (vet) Get the power of Windows + Web with the new Windows Live. Get it now!

[Guest guest]

Being in C.C. and EM med for years before going GP and rehab I have seen a multitude of vestibular dogs and rarely cats. They seem to do very well with an injection of diphenhydramine and started orally on Meclizine. With this most have not required hospitalization and some thatwere too dizzy to walk on arrival were able to walkout of the clinic within an hour.

Vestibular signs from neck problems

Hi guys

I have a client who is a nurse and her aged dog was in for UWT exercise

last week. The following night she started with vestibular signs, was

taken to the E clinic - her ears appeared normal. Signs resolved in 12

hours.

This client is convinced that the dog having her head looking up the

whole time in the treadmill caused the signs. Has anyone heard of this?

I am skeptical but am trying not to be too defensive.

The dog's primary problem is lumbar weakness and I have seen her for 3

months with good success (balance exercises etc. ). I have treated the

dog with chiropractic before and not encountered many neck problems.

Any suggestions?

Thanks

Tomlinson (vet)

Get the power of Windows + Web with the new Windows Live. Get it now!

More new features than ever. Check out the new AOL Mail!

[Guest guest]

Just playing Devil's advocate. How do you know that this technique is

working vs animals just getting better as they usually do?

Cheers

--

Jeff Bowra DVM

Certified Canine Rehabilitation Practitioner

26841 Fraser Highway

Aldergrove, BC, Canada

[Guest guest]

Jeff

I agree with you-this disease is self limiting and with time, these dogs improve providied no other disorder causing vestib signs

Re: Vestibular signs from neck problems

Just playing Devil's advocate. How do you know that this technique isworking vs animals just getting better as they usually do?Cheers-- Jeff Bowra DVMCertified Canine Rehabilitation Practitioner26841 Fraser HighwayAldergrove, BC, Canada

[Guest guest]

Indeed they are frequently self limiting, however the technique apparently gives instantaneous results. I am investigating, as ANY extension in the time that one feels NAUSEA is a humane issue. I hope you have never had to experience vestibular nausea, I have, and find severe pain of any variety to be preferable. Hopefully we can find some new techniques to help.Judith M. Shoemaker, DVMAlways Helpful Veterinary Services305 Nottingham RoadNottingham, PA 19362ph fax info@... www.judithshoemaker.com

To: VetRehab From: rfreedman@...Date: Tue, 29 Jan 2008 17:10:06 -0500Subject: Re: Vestibular signs from neck problems

Jeff

I agree with you-this disease is self limiting and with time, these dogs improve providied no other disorder causing vestib signs

Re: Vestibular signs from neck problems

Just playing Devil's advocate. How do you know that this technique isworking vs animals just getting better as they usually do?Cheers-- Jeff Bowra DVMCertified Canine Rehabilitation Practitioner26841 Fraser HighwayAldergrove, BC, Canada

Shed those extra pounds with MSN and The Biggest Loser! Learn more.

[Guest guest]

Fair enough guys, and this has been one of the things that I

have questioned in the past as well. From what I’ve seen ( a

limited amount mind you), they do respond very quickly as Judith has remarked

in another e-mail. The dog we most recently treated was carried in and

could not ambulate. He had been down this way for 2-3 days. We

performed the Dix-Halpike and the rest of the ‘turns’. His

nystagmus diminished (slowed in rate) and he was able to walk around the

room/office after his treatment. On his next treatment a couple of days

later he had minimal nystagmus, was self ambulating and just a small head

tilt. If he had not had immediate improvement, I might be equally sceptical.

It is certainly worth a try – as the sooner that dizziness can be

resolved the better – for the comfort of the animal and caregivers too.

Laurie

From: VetRehab

[mailto:VetRehab ] On Behalf Of rfreedman

Sent: Tuesday, January 29, 2008 3:10 PM

To: VetRehab

Subject: Re: Vestibular signs from neck problems

Jeff

I

agree with you-this disease is self limiting and with time, these dogs improve

providied no other disorder causing vestib signs

-----

Original Message -----

From: Jeff Bowra

To: VetRehab

Sent: Tuesday, January 29,

2008 4:10 PM

Subject: Re:

Vestibular signs from neck problems

Just playing Devil's advocate. How do you know that this technique is

working vs animals just getting better as they usually do?

Cheers

--

Jeff Bowra DVM

Certified Canine Rehabilitation Practitioner

26841 Fraser Highway

Aldergrove, BC, Canada

No virus found in this incoming message.

Checked by AVG Free Edition.

Version: 7.5.516 / Virus Database: 269.19.15/1249 - Release Date: 1/29/2008

9:51 AM

No virus found in this outgoing message.

Checked by AVG Free Edition.

Version: 7.5.516 / Virus Database: 269.19.15/1249 - Release Date: 1/29/2008 9:51 AM

[Guest guest]

Hi All...

I have a friend/client who goes to another vet practice, his dog was

recently diagnosed with vestibular dx. I accidently deleted the email

with the link provided info about the Canalith repositioning... Can

whomever sent that post please resend it.. Thanks Kim

[Guest guest]

Hi ,

We had best results with starting the animal in a sitting

position and then we brought him straight backwards onto his back with the head

in the appropriate position. It was a 2 – 3 man job.

Laurie

From: VetRehab

[mailto:VetRehab ] On Behalf Of skimsu@...

Sent: Wednesday, January 30, 2008 6:04 PM

To: VetRehab

Subject: Re: Vestibular signs from neck problems

Interesting, So how do you start the animal sitting or on

their back?

karen kowalski rn, dvm cincinnati

Start the year off right. Easy

ways to stay in shape in the new year.

No virus found in this incoming message.

Checked by AVG Free Edition.

Version: 7.5.516 / Virus Database: 269.19.15/1249 - Release Date: 1/29/2008

9:51 AM

No virus found in this outgoing message.

Checked by AVG Free Edition.

Version: 7.5.516 / Virus Database: 269.19.15/1249 - Release Date: 1/29/2008 9:51 AM

[Guest guest]

Am posting my off list communication with re the vestibular treatment. If others are interested in collaborating on a clinical study or in compiling case studies perhaps we could get together. I thought her case example was quite interesting.

Judith M. Shoemaker, DVMAlways Helpful Veterinary Services305 Nottingham RoadNottingham, PA 19362ph fax info@... www.judithshoemaker.com

From: dizzydogs@...To: judithshoemaker@...Subject: RE: Vestibular signs from neck problemsDate: Wed, 30 Jan 2008 21:26:45 -0600

You are welcome to post them if you think there is value or interest. I agree that the more involved, the more numbers and the reliable the information- that is great. Thanks. CCC

From: Judith Shoemaker Sent: Tuesday, January 29, 2008 4:29 PMTo: ; 'Ann-Margret 'Subject: RE: Vestibular signs from neck problems

Dear , Could we post these two letters on the list? I believe there might be some interest in others collaborating as the incidence of this problem is so spotty that it might take a few of us to come up with enough to make some legitimate numbers within a reasonable period of time. I am going to paraphrase you in response to a recent post. Looking forward to working with you.Judith M. Shoemaker, DVMAlways Helpful Veterinary Services305 Nottingham RoadNottingham, PA 19362ph fax info@... www.judithshoemaker.com

From: dizzydogs@...To: judithshoemaker@...; ann-margretmorgan@...Subject: RE: Vestibular signs from neck problemsDate: Tue, 29 Jan 2008 02:14:36 -0600

The larger the animal, the more difficult it is to do the positional testing and treatment but I have treated dogs up to about 100#. The first dog I treated with vestibular disease was about to be euthanized because it hadn’t eaten or drank in 8 days and had been hospitalized twice for fluids and forced feedings but owners could not continue to afford to do that. So we tried the repositioning maneuver and 10 minutes later the dog was eating ravenously and was fine thereafter. Another dog that had been recumbent for several days at the emergency hospital was treated at 10pm and taken home still recumbent and the owner went to sleep on the sofa with her next to her on floor and woke up a couple hours later and the dog was gone – she couldn’t find the dog anywhere and went upstairs to alert her husband and the dog was sleeping in the bed upstairs with him – she had climbed flight of steps and jumped in bed – no further problems. The results are quite remarkable with people and animals. I have had BPPV four times myself and it is an awful feeling so if there is anything I can do to help ease the symptoms for dogs and the burden for the owners, I am passionate about it.

By positioning the head (and hence the ear) in 4 different positions, one can determine which canal is involved and then depending on which ear and which canal, there is an associated maneuver to relocate the crystal. It can be tricky to get the animals (and people) to cooperate with this as the positions invoke the symptoms which are so undesireable. I have not done any formal research but have tracked the cases I have seen and there was an article in the APTA orthopedic journal animal rehab section – I could send you a copy. I feel that it would be beneficial to have research to verify its success and to perfect the positioning – I do the testing and maneuvers simulating how we do it in people – the vestibular systems are the same but I am not certain of the orientation of the canals in their ears which would certainly effect the repositioning.

The possibility of helping more animals by collaborating is very exciting to me. Thank you for your response and I would love to discuss further. Cauley

From: Judith Shoemaker Sent: Monday, January 28, 2008 11:31 PMTo: dizzydogs@...Subject: RE: Vestibular signs from neck problems

Dear , Thank you for your insights into the vestibular problem. I am very interested in learning more about this repositioning/reprogramming technique. I have just intuitively treated the ones with resting nystagmus with rest and other things and the others with just aided activity, but I'd like to be more precise!! What kind of research would you like to see done? Perhaps, I can help. Best Regards,Judith M. Shoemaker, DVMAlways Helpful Veterinary Services305 Nottingham RoadNottingham, PA 19362ph fax info@... www.judithshoemaker.com

To: VetRehab From: ann-margret@...

Hello

I wanted to respond to Dr. Shoemaker's email.

I am sorry this has taken so long.

I work with a Physical Therapist, Cauley who treats vestibular dz in people.

She has treated some dogs and a rabbit with vestibular dz, and has had some success

I am posting her reply and would like to ask if any other PT's have any experience with this treatment or have tried it on animals. It may be an option for some animals to correct vestibular signs.

Any input is welcome.

Ann-Margret DVM

I am posting her reply.

I agree with Dr. Shoemaker’s opinion that there is a high probability that a crystal has become dislodged from the prolonged positioning (for unknown reasoning). This is a common occurrence with humans – accounts for 85% of vertigo/vestibular disease in humans – called BPPV – benign paroxysmal positional vertigo. I specialize in vestibular rehab in humans (and have also treated dogs, cats, rabbit). The vestibular system is virtually the same for all. In people we are highly successful (over 90% in 1 session and almost 100% in a few) in relocating the crystal back into the vestibule where it belongs. We have been very successful in treating it in animals too but more research is needed. There is a Canalith repositioning maneuver to relocate the crystal once it is determined which canal it has been dislodged into – this is done by putting the person or animal in various positions and observing the nystagmus. Depending upon which ear and canal, there are different repositioning maneuvers.

People and animals will recover or improve over time without such treatment by the brain learning to ignore messages from the dislodged crystal. However there is high reoccurrence because if the crystal moves within the semicircular canal, the brain has to again accommodate. The more activity a dog has during that time, the quicker it will accommodate. But if it is a neuritis or labrynthitis, the dog will have resting nystagmus for the first 48-72 hours and resting for the first several days is recommended. It is important to determine what is the cause of the vestibular syndrome in order to treat it effectively.

Cauley, Physical Therapist

dizzydogswi (DOT) rr.com

Judith Shoemaker <judithshoemakerhotmail> wrote:

Rarely, new joint movement in the upper cervicals can cause an animal to have to reorient its upper cervical righting mechanisms. More probably, this dog had a bout with idiopathic vestibular syndrome for which there is supposedly no known etiology. My opinion about the cause of vestibular syndrome is that an otolith has become dislodged, and has landed on some different set of sensory hairs in the saccule of the inner ear and the nervous system just has to figure the new information out to determine where down is. Hence the almost constant recovery from this sometimes frightening and possibly nausea causing condition. I have found that if the rest of the neck is well adjusted, and the animal is kept still, and preferably sternal, that they recover more quickly than average. Dogs may be affected for a few hours to several weeks and may have relapses; though they seem to recover more quickly each time if it is in the same ear. I have seen it occur after especially hard play sessions or very long runs, or after a fall, even without an apparent blow to the head. I have also had an old dog or two have it after an especially long sleep! Judith M. Shoemaker, DVMAlways Helpful Veterinary Services305 Nottingham RoadNottingham, PA 19362ph fax infojudithshoemaker www.judithshoemaker.com

To: VetRehab From: drjuliatcrehabDate: Mon, 17 Dec 2007 20:41:34 +0000Subject: Vestibular signs from neck problems

Hi guysI have a client who is a nurse and her aged dog was in for UWT exercise last week. The following night she started with vestibular signs, was taken to the E clinic - her ears appeared normal. Signs resolved in 12 hours. This client is convinced that the dog having her head looking up the whole time in the treadmill caused the signs. Has anyone heard of this? I am skeptical but am trying not to be too defensive. The dog's primary problem is lumbar weakness and I have seen her for 3 months with good success (balance exercises etc. ). I have treated the dog with chiropractic before and not encountered many neck problems. Any suggestions?Thanks Tomlinson (vet)

Get the power of Windows + Web with the new Windows Live. Get it now!

Shed those extra pounds with MSN and The Biggest Loser! Learn more.

Connect and share in new ways with Windows Live. Get it now!Need to know the score, the latest news, or you need your Hotmail®-get your "fix". Check it out.