Disclaimer: There may be context provided in the lecture that is not addressed in the answer to these questions. Paper links have been provided where possible/applicable. I linked to the publisher’s site to avoid any copyright issues. Some papers may be behind paywalls, though I try to use mostly open-access journals. Finally, many of these comments are opinions or thoughts based on experience in my situation; your patient’s situation may not apply to all comments. I try to link sources to questions about doses. It is recommended that you consider rechecking all doses prior.

What is your preferred first medication for idiopathic epilepsy?

a. It depends. (I know, not the answer you wanted). That being said, if I want control and I want it now - I’m going to lean on the proven efficacy of phenobarbital. For example, a dog with clusters or multiple seizures in a short time - phenobarbital is likely going to be my go-to in that situation. See the handout above!

If owners declined referral for otitis media. Is it rational to use clindamycin or convenia as antibiotics for treatment?

a. I do think it is rational, especially if you have any secondary evidence to support your presumptive diagnosis OR have a history of otits externa. There was a great article talking about cats with invasion of otitis media into the calvarium and why they liked clindamycin for cats -> Click Here for Article

Do you always treat a presumptive vascular event?

a. I guess it depends on what you mean by treating. If it is a vascular event, looking to see if there is a primary cause is actually my first go to and if identified, then yes, I will always treat that condition. A vascular event without any known etiology, only with supportive care, as steroids don’t hasten the recovery of vascular events or even idiopathic vestibular conditions.

Do you feel the Epley maneuver is helpful in treating idiopathic vestibular disease?

a. I have tried it a few times with zero success. I think some of this may be that not all vestibular diseases are the same and that we don’t know if idiopathic vestibular disease is one or multiple conditions that represent an umbrella of various conditions. That doesn’t mean I am against it; I just haven’t been able to get it to work; that being said, I also don’t hear about it working from many people either. I would LOVE to hear if others are having different experiences!

 For anyone wondering what the Epley Maneuver is or the proposed theory as to why it may help: -> Click Here

BPPV is a human issue with calcium crystals being dislodged and causing vertigo. I was curious if this is a differential in pets with vestibular signs. Thanks!

a. This is a theory that has been discussed in veterinary medicine and I think there is some support for it! Now, which animals have this or another cause. . . differentiating that has proven more difficult in practice. It may not be the same etiology, but there are reports of calcified otoliths in dogs, but the association with clinical disease is where some is lacking.

What’s the timeframe where you’d call a second vestibular event a relapse (so more concerning for something else going on) vs. just a second vestib episode?

a. Anytime a dog has multiple in a short time frame (within a week or so) or progression of even a single issue past 24-48 hours, both situations are going to raise my concern and suspicion, but it doesn’t guarantee that there is something insidious going on - but it makes me want to look closer. I wouldn’t be as concerned if an older dog has two with six months between them, especially if there is rapid recovery each time. I had one dog that appeared to have them like once a week, and we did EVERYTHING and couldn’t find anything as to the underlying etiology, so again, it doesn’t mean they will have something more serious, but it raises the concern for it it makes me want to go looking more! The other takeaway is that sometimes things may be going on at a microscopic level that we can’t appreciate very well on MRI or imaging, which can be additionally frustrating for everyone (and every pet) involved.

Do you recommend supplementing thiamine to all vestibular cats?

I don’t do this as a matter of routine personally; however, if I have one that is on a weird diet (like a cooked fish diet) or is blind and vestibular, then my suspicion will rise and then would supplement it.

Disclaimer: There may be context provided in the lecture not addressed in the answer to these questions. Paper links have been provided where possible/applicable. I linked to the publisher’s site to avoid any copyright issues. Some papers may be behind paywalls, though I try to use mostly open-access journals. Finally, many of these comments are opinions or thoughts based on experience in my situation; your patient’s situation may not apply to all comments. I try to link sources to questions about doses. It is recommended that you consider rechecking all doses prior.