Well, 72 hours into this ordeal, I'd say that she is about the same. It's been over 24 hours since I took her to the vet. He's treating her for an ear infection although he could not actually diagnose it due to wax in her ears. He was unable to see her eardrums. My brother thought he should have cleaned out her ears instead of making an assumption. I am not sure how easy that would be given the ninety-degree angle.
She still staggers and stumbles. She falls. Her head tilts to the right. She can be very determined to navigate the steps and such. She's eating slightly less than half her normal food (1/2 c. 2x daily). The vet gave her a shot, some amoxicilin and NSAD along with an ointment to dissolve the wax. I dunno. I am not too keen on leaving her alone for long periods of time though she seems to be doing fine.
Ok, so now we know something. She has a right head tilt and the wobbly gait is called ataxia. This all means her symptoms are probably coming from her vestibular system. Part of the vestibular system is in the inner ear and part is in the brain. Sometimes a neurologist can tell for sure where the problem is by performing a neurologic exam, but sometimes it cannot be determined for sure from the exam. It can also be hard to perform a good ear exam if the dog has vestibular signs, because the dog feels dizzy and the vet can make that feeling much worse by manipulating the head position. Then the dog can start to panic and flail. Sometimes in that scenario, one would need a sedative or anesthesia for really look deep in the ear canal to visualize the ear drum. However, an inner ear infection is an infection on the other size of the ear drum from the external ear canal. You can't necessarily just see signs of an infection by looking with an otoscope.
Considering that the symptoms came on very suddenly, there are really two top considerations in your dog's case: 1. A vascular accident (ie a stroke) or 2. Old dog vestibular syndrome.
Most of the time in dogs we don't know for sure why a stroke occurs, but sometimes it occurs secondary to a bleeding disorder, atherosclerosis (the main cause of which in dogs is low thyroid function), urinary protein loss (with loss of an anti-clot blood protein called antithrombin III), and high pressure (sometimes a primary problem, sometimes secondary to an endocrine disease called Cushing's disease, sometime secondary to renal disease, sometimes secondary to heart disease). Therefore, she should have her bloodwork checked (CBC, chemistry panel, and urinalysis), thyroid testing, blood pressure check, and chest xrays. The good news if that there is a stroke, most dogs will make a good recovery with time and sometimes a course of prednisone (a steroid) to decrease edema in the surrounding brain tissue.
More common than a stroke is Old Dog Vestibular syndrome. This is a self limiting disease of unknown cause, usually improves or resolves without treatment.
An inner ear infection is certainly possible, but typically symptoms would not come on as instantanously as you describe. It is also possible that there is a more ominous disease such as a brain tumor or encephalitis that had a sudden change like hemorrhage to account for the onset of symptoms that you saw.
Other than the tests as described above, a brain/inner ear MRI and possibly a spinal tap or myringotomy (procedure in which fluid is removed from the inner ear by inserting a needle across the ear drum) are indicated. To have the MRI/spinal tap/myringotomy procedure, she would need to be anesthetized. If you wanted to go this route, you'd go see the neurologist at Purdue and they would organize it. If you do not want to proceed with anesthetized tests, it is very reasonable to treat with steroids or NSAIDs (steroids more effective in my experience), antibiotics and possibly an anti-nausea/anti motion-sickness medication such as meclazine.
I would encourage you to hang in there with her. Try to give her at least a week or two. If she has old dog vestibular syndrome or had a stroke, you may be very surprised at how well she does in the long run. With both of these diseases, you should not see her get any worse, so if that happens you have to be very concerned that something else is going on (like a brain tumor).
Good luck and let us know how things turn out with her.
H
