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This guide helps you triage; it does not replace your veterinarian's exam. A pet losing balance is seen the same day. When in doubt, call us at 514 223-1197.
Go now: the signs that cannot wait
Any single one of these is enough. You do not have to tick several, and you do not have to decide which is worst. Do not wait to see if it passes, do not wait for morning: go to the clinic or to the nearest emergency centre, and call on the way so we can expect you. Here, what makes it a leave-now is almost never the head tilt itself: it is what comes with it.
- He cannot get up at all, or he keeps rolling to one side and cannot stop, or he has been lying on his side for hours without being able to right himself.
- His awareness has changed. He is less awake than usual, he no longer answers to his name, he stares at nothing, or he pushes the top of his head into a wall, a corner, or a piece of furniture and stays there. That last one is not a sulking pet: it is a sign in its own right.
- He is seizing, shaking all over, or collapsing with a loss of consciousness, even briefly. Our guide on seizures covers what to do during one, and also says that several events look like a seizure without being one: film it and let us decide.
- His legs will not carry him, he is dragging one, he cannot hold himself up at the back, or the weakness clearly affects one side of the body only.
- He is breathing fast at rest, with effort, with his belly heaving on every breath, or with his neck stretched forward. Pale, grey or bluish gums confirm the emergency, but they are a late sign: do not wait to see them before you leave.
- He is vomiting non-stop and keeping nothing down, to the point of not being able to eat at all, or he can no longer swallow.
- He is diabetic and on insulin. Call us before the next injection, even in the evening, even if it is due in an hour. Do not decide on your own to give the dose or to skip it. An unsteady walk and a loss of balance are among the signs of low blood sugar, and our insulin guide already names them: in him, this picture is handled in minutes, not hours.
- He may have swallowed, licked, or been given something: cannabis, antifreeze, a human medication, a leftover prescription, a mushroom from the yard, a plant, a household product. And for a cat: a dog flea product, even a small amount, even by rubbing against a freshly treated dog. Do not make him vomit, and bring the packaging or a piece of the plant.
- It happened after an impact: a fall, a car, a fight, a knock to the head, a sudden grab by the collar.
- His nose is bleeding, or one of his ears is bleeding, or you can see blood in the canal.
- He has lost his sight at the same time: he is bumping into things, hesitating in the dark, no longer following your hand, or both pupils stay wide in a lit room. In an aging cat, a sudden loss of sight together with a loss of balance is the picture of blood pressure that has become dangerous, and it is an absolute emergency: every minute counts to preserve vision.
- It is getting worse hour by hour instead of settling, or it started climbing again after a period of improvement.
- He is a puppy or a kitten. Everything moves faster in him, and the timing on this page does not apply: we call now.
One is enough
You do not have to work out which of these matters most. If one of them speaks to you, go. If you are unsure, call anyway: triage is our job, not yours. Outside our hours a 24/7 emergency centre answers, and describing the situation on the phone commits you to nothing.
These signs say when to leave, not what it is
Do not try to read a diagnosis out of this list, and do not conclude anything from what you cannot find in it. It does one job: deciding whether you leave now or leave today. What tells these pictures apart from one another is found on the exam table, not in a living room.
And if none of this sounds like your pet?
That is the commonest situation, and it is good news. It does not mean tomorrow morning. A head tilt, eyes moving on their own, a drunken walk: that gets examined the same day. Call us and say it is a balance problem. The rest of this page was written for you, and it starts with the question you just typed.
If you are thinking poison, the first steps are elsewhere
The first steps by product are in our guide to toxic foods and plants, and the chocolate calculator answers the commonest question. If we are closed, the emergency page and the list of 24/7 centres tell you where to go.
"Did he have a stroke?"
We start here, because that is the phrase you put in the search bar, or the one somebody said out loud in the room ten minutes ago. The honest answer comes in three parts, and you need all three.
Yes, it really does look like one
The resemblance is not your imagination. A head tilted to one side, eyes drifting on their own, one side of the face drooping, a walk that veers off, a sudden collapse in someone elderly: that is almost exactly how a human stroke is described. The word came to you because it is the only word you have for this scene. That is normal, and it is not ignorance.
But in dogs and cats, it usually is not that
In our two species, this picture is overwhelmingly produced by a disturbance in the system that manages balance, not by a blocked vessel in the brain. That disturbance is called vestibular syndrome. Our fiches on it already say this in these words: a stroke is possible, but it is less common, and only a veterinary exam can tell the two apart.
And "probably not a stroke" does not mean "nothing at all"
- One. "Probably" is not "certainly". That word describes what happens most often to a great many animals. It does not describe yours, who is lying on your kitchen floor.
- Two. Several of the other possible explanations are more urgent than a stroke would be, and several of them are treatable. That is the exact opposite of the reflex we import from human medicine.
The human reflex that costs a night
In human medicine, everyone has retained two things about stroke: that it is serious, and that the window is very short. In a pet owner, those two ideas produce two opposite reactions, and both are wrong. Some panic to the point of not deciding anything. Others conclude that the window has already closed, that there is nothing to be done, and that it can wait for morning. In your pet, what is in front of you is far more often something that gets treated or that resolves by itself, and the exam that will tell you which is short, done on an awake animal, and available today.
What the word stroke is hiding
In everyday speech, "stroke" covers just about anything that happens suddenly and involves the brain. Genuine cerebrovascular events do occur in dogs and cats, and they are often the visible part of something else in the body: blood pressure that has climbed too high, tired kidneys, an overactive thyroid in a cat, a clotting problem, a heart problem. In others we look and find nothing underneath, and that is an answer too. That is why, when the exam does point that way, the search carries on outside the head. Naming what sits underneath is what changes the outcome, and it is what our feline hyperthyroidism fiche already says.
Did you just watch this happen?
Call us, describe it, and on the call we will tell you whether you leave now or we see you today. Outside our hours, a 24/7 emergency centre answers.
For the condition itself
The timeline, the treatment and the outlook belong to our two full fiches. Read them after you have called, not before.
Both sentences are true at once
Here are the two sentences. They look like they contradict each other, and both of them are correct. Holding both at the same time is the one genuinely useful thing this page has to teach you.
The two sentences
- One. In an older dog, the commonest cause of this picture is benign: it arrives all at once, it looks dreadful, it is not painful, and it settles by itself. In cats the same thing exists, at any age.
- Two. An infection deep in the ear, blood pressure that has become dangerous, a poisoning, and a problem in the brain itself all produce, seen from your living room, exactly the same scene.
Why that is not a contradiction
The first sentence is about a great many animals. The second is about yours. A frequency describes a population; it does not identify a patient. Between the two sits exactly one thing, and it is an exam. That is not a cautious formula: it is the only operation that turns a statistic into information about your dog.
The reassuring diagnosis is a diagnosis of exclusion
Here is the point that settles the question, and it is simpler than it sounds. The benign form has no test that confirms it. There is nothing to find in the blood, nothing on an X-ray, nothing to see down the ear. It is confirmed in two ways, and neither is available on your sofa: by the absence of any other cause once they have been looked for, and by the animal recovering on his own afterwards. That is what "diagnosis of exclusion" means, and it is written in plain sight on both our fiches.
Which means: to conclude that this is the benign one, the others have to have been ruled out first. At home tonight, you have ruled out nothing. Not through any lack of ability: because the things that rule them out cannot be seen from the outside.
What cannot be seen from the outside
What separates these causes from one another are things that get measured, not things that get noticed: which way the eye movement runs when the head is moved into particular positions, how a paw resets itself when it is gently turned over, each nerve of the face taken one at a time, alertness judged by someone who sees it every week, the look of the canal down an otoscope, blood pressure, bloodwork. None of that is visible from a sofa, and none of it requires hurting your pet.
There is no home test, and this page will not give you one
Online you will find tables headed "peripheral versus central". They exist, we publish one ourselves on our fiches, and they genuinely earn their place: they are reading grids for an exam, not questionnaires for an owner. Every line on one comes from a maneuver performed by someone who does it weekly. And even in those hands the lines overlap: horizontal eye movement, the kind associated with the reassuring form, turns up in the central form as well, and finding nothing in the "central" column is not enough to rule it out. That is why the grid is read alongside the rest of the exam, never on its own.
Applied from a living room, it produces a false conclusion, and a false conclusion produces a night of waiting. So let us say it plainly: this page will give you no way to settle this yourself, because there is none, and pretending otherwise would be the most harmful thing we could publish here.
What the good news still means
It means the odds are on your side, and that is worth something when you are frightened. It means the appointment you are about to book is often a reassuring appointment. And it means that if this is the benign form, your pet needs a few days of careful nursing and patience, not heavy treatment. That good news is real. It becomes yours the day somebody has looked.
Film it now, before you leave
This is the one thing on this page that cannot wait for the appointment, and it is also the most useful thing you can do in the next five minutes. What you film now may not be there any more by the time we see him.
Why it makes a difference
- The eye movement is the first thing to go. Nystagmus, those fast involuntary eye movements, usually settles before anything else does, and it is often the sign that has already gone by the time we see him. It is also the one that carries the most information. Filmed tonight, it can still be watched later in the week.
- Your pet does not perform the scene again at the clinic. The car ride, the stress, the table: many animals arrive quite different from how they were at home, sometimes stiffer, sometimes frankly better. What you saw in the kitchen will not necessarily repeat itself in three hours.
- A video beats a description, and that is not an opinion. Our seizure guide already says it: several events look alike, the best tool for telling them apart is a video, film it and let us decide. The sentence holds here word for word.
- It works twice. Once for the appointment. Once again later, as a point of comparison, if the picture changes or if it improves.
What we want to see, in order
- His face close upwell lit, for fifteen to thirty seconds, phone propped or held steady. The eyes above all. No flash: the ceiling light or a lamp off to the side is plenty.
- His head and his whole bodyfrom the front and then from the side, leaving him alone. We want the posture he takes by himself, not the one you put him in.
- A few steps, if he takes them himselfDo not push him, do not pull him, do not walk him down a step for the video. If your video is of an animal lying still, that is a good video too: it is information.
- A shot of the room, including the floorThe rug, the slippery boards, the step, the stairs. It lets us tell you what to make safe first.
Write this down too, it is gold on the phone
- The exact time you noticed it.
- What he was doing just before: sleeping, eating, playing, coming back from a walk, out of the bath, home from an appointment or an anesthetic.
- Whether it has changed since, and in which direction.
- Which side the head tilts to, and which way he circles if he circles.
- Everything that has gone into him these last few days: medications, ear drops, flea product, a household product, a plant, cannabis, a human medication, a new food. Say it straight, cannabis included: it does not change how you are received, you are not reported, and it lets us treat him faster. Our poisons guide already puts it that way.
- His known conditions, his current medications, and the time of the last dose.
What not to film
Safety comes before footage. Never film at the top of stairs, at the edge of a pool, on a balcony or on a counter. And do not stage anything for the video: do not spin him, do not move his head, do not wave a hand in front of his eyes, do not try any test you read somewhere else. None of those will teach you anything, all of them increase the nausea and the fear, and a disoriented animal who feels forced can bite or scratch, including one who never has. He will not be doing it at you: he simply will not understand what is coming towards him.
Say so when you book
"I have a video." That sentence often changes the order of things before you are even sitting in the waiting room. Keep the original on the phone, and bring the phone.
Film it, then call
Say it is a balance problem, and say you have a video. If we are closed, a 24/7 emergency centre answers.
What produces exactly this scene, and why it cannot be untangled from outside
Here is what the vet is going to look for. It is not a checklist, it is the plan for the appointment. It is here so you understand what is about to happen, not so you can skip it. Read it the way you read a game plan, not the way you take a quiz.
A balance problem with no cause found
Idiopathic vestibular disease. This is the commonest one. In dogs it mostly affects seniors, so much so that it is usually called old dog vestibular disease. In cats it turns up at any age. It arrives all at once, it looks alarming, it clears up by itself, and it is the one that can only be named after every other has been looked for.
An infection deep in the ear
Otitis media or interna. The organ of balance sits right there, behind the eardrum. That is the branch in the next section, and it is the one where an owner can make things worse without meaning to.
Blood pressure that has climbed too high
Hypertension. Silent, common in aging cats whose kidneys or thyroid are struggling, it damages the small vessels of the eyes, the brain and the kidneys. We measure it at the clinic, in dogs as well as cats, on an awake animal and without a needle, and it is treatable. Our senior guide already says so.
Something he swallowed, licked, or had put on his skin
A poisoning. Cannabis, antifreeze, a human medication, a leftover prescription, a dog flea product used on a cat: several of these produce exactly an animal who staggers and looks lost. It is also the cause that resolves fastest when it is named early.
A problem in the brain itself
The central form. Inflammation, a tumor, a stroke. Rarer than the ones above, more serious, and the one that calls for advanced brain imaging, which is done on referral.
Something else that looks like a balance problem without being one
Weak hind legs, back pain or a slipped disc, a cardiac faint (a syncope), a focal seizure, low blood sugar in a diabetic pet, a sudden loss of sight. From the outside, all of those can read as "he cannot stand up". It is one of the reasons the exam starts by locating before it starts naming.
A seizure, or a balance episode?
This is the commonest mix-up, and it is a fair one: from a living room the two look alike. Our seizure guide already publishes the marker: during a balance problem the animal stays conscious the whole way through, he hears you, his eyes follow you, he tries to get up. During a seizure he is not there.
That marker only works in one direction: if he lost consciousness, even for seconds, that is the red block at the top of this page and you leave now. It does NOT work the other way: "he stayed conscious" does not buy you until morning, because a seizure can also look like nothing more than a balance problem. And if you cannot say which of the two you just watched, that is exactly why we ask for the video.
What is specific to dogs
- The old dog form is the classic script: a dog who was perfectly fine an hour ago, now lying on his side with his head tilted, unable to get up. How abruptly it starts is part of the picture and is not, in itself, a bad sign.
- A sluggish thyroid, hypothyroidism, is among the causes to look for in dogs. It is found with a blood test, and it is treated.
- Some products put into an ear can reach hearing or balance when they pass behind a damaged eardrum, sometimes permanently. That is written on our ear medication guide, and it is the bridge into the next section.
- A dog with repeat ear infections starts this list several steps ahead: in him, the ear is the first hypothesis, not the last.
- A dog just back from traveling, or living where ticks are abundant, opens one extra and uncommon line of enquiry: an infectious or inflammatory cause inside the brain. Our fiches name it with that same contextual qualifier, and not otherwise.
What is specific to cats
- The idiopathic form is not reserved for old cats. Unlike dogs, it happens at any age, and a seasonal increase is often noted in summer and late summer. That is written on our feline fiche. A four-year-old cat who topples over is therefore not automatically a more worrying case than a fourteen-year-old.
- Hypertension is the cause never to forget in an aging cat, because it is silent right up until the day it is not. A cat who loses his balance AND starts bumping into things, with both pupils staying wide in a lit room, is an emergency: our hyperthyroidism fiche already puts it in exactly those terms.
- A polyp in the ear or the back of the throat is a classic cause in young cats. We look for it during the ear exam, sometimes under sedation because it hides behind the eardrum or behind the soft palate, and it is removed.
- A kitten who has always wobbled, who trembles as he aims for his bowl and plants his legs wide to stay standing, is a different story: that is a cerebellar problem, often present from birth, which does not get worse and which a great many cats live with perfectly happily. It is told apart on the exam, not by eye, and it is a distinction vets make routinely.
- A cat who has also stopped eating has a second clock running. In cats, refusing food quickly becomes a problem in its own right, and our dedicated page explains why. Mention it on the phone: it changes the timing.
And why all of it looks the same at home
Because from the outside you only ever see one thing: the report that the balance system files with the rest of the body about where down is. Anything that disturbs that circuit, anywhere from the inner ear to the brainstem, produces the same wrong report. Your pet is not telling you where the problem is; he is telling you that the report is wrong. Finding where the circuit is disturbed is the whole job of the exam, and it is precisely the part that cannot be done at a distance.
If it is the ear: put nothing in it
This is the one branch on this page where an owner can, without meaning to and in ten seconds, make things permanently worse. That is why it has its own section, and why it comes down to a single instruction.
Why the ear and balance are the same subject
The organ of balance is not next to the ear: it is inside it, right at the back, behind the eardrum and behind the middle ear. The nerve that drives the muscles of the face runs through the same place. That is why an infection reaching that level can produce a head tilt, a zigzag walk, a lip drooping on one side, an ear that hangs, an eye that no longer closes fully.
And if one eye does not look the same
Look at both his eyes side by side, without touching anything. If, on the side his head tilts towards, the pupil is smaller than the other one, the upper lid droops a little, the eye looks sunken and the third eyelid comes up in the corner: that is not the same thing as a drooping face, and it is not the loss of sight in the red block either, where BOTH pupils stay wide. That set of signs has a name, Horner syndrome. It is not painful and it is not an emergency in itself. It matters for a different reason: it is one of the signs that tilts the exam towards the middle or inner ear, and one of the signs the benign form does not produce. Say so on the phone, take a photo of it, and draw no conclusion of your own: this sign changes what we look for, it does not change the fact that we see you today.
Nothing goes into that ear
Not the drops left over from a past ear infection. Not the other pet's. Not a cleaner bought at the pet store. No peroxide, no alcohol, no vinegar, no oil, no water, no cotton swabs.
A pet already tilting his head is exactly the one whose eardrum is most likely to be damaged. And some products that are safe in a closed canal are not remotely safe on the other side of it: they can reach hearing or balance, sometimes permanently.
That is word for word what our two hands-on guides already publish, and nothing here softens it by a comma.
And do not clean it either
Our ear-cleaning guide is unambiguous: you never clean a painful or discharging ear, and a head tilt is precisely one of the signs that mean call rather than clean. There is nothing for you to prepare before coming in. A dirty ear tells us as much as a clean one, often more.
If ear treatment is already under way
Stop it and call us. Our ear medication guide already publishes this instruction without hedging: a head that stays tilted, a loss of balance, eyes flicking on their own, one side of the face drooping, or hearing that drops suddenly are signs to stop the treatment and call without waiting. Do not finish the box out of diligence.
What we look at, and why it sometimes needs sedation
Seeing the bottom of the canal takes an otoscope and a clean canal. In an animal in pain, or whose canal is too full, that is not always possible on the first pass: we clean it at the clinic instead, and then reassess. An image may also be needed to see what is happening on the floor below, and your veterinarian will tell you whether that is done here or elsewhere. It is an extra step, and it is worth it.
The technique and the warnings live elsewhere
For dogs, our full fiche on otitis externa explains why an ear infection is almost always the visible symptom of something else, and what a third episode in a year changes. For both species, the two hands-on guides carry the technique, the products and the signs that mean stop. This page repeats none of the three: it defers to them.
What the exam decides, and why it is so often reassuring
A lot of people put off the appointment because they picture a machine, an anesthetic, a big production. The first appointment is none of that. It is above all an examination done with hands and eyes, on an awake animal, on the table, while you are standing there. Here is exactly what happens.
- We listen to you, and we watch your videoThe history does half the work: sudden or gradual, what changed in the house, treatments under way, the ears, a trip, access to the garage or the garden.
- The examination that locates the problemFrom the outside it looks like nothing much, and yet it is the part that decides. We watch how he holds himself and how he moves, we gently turn a paw over to see whether he puts it back himself, we follow his eyes, we test the nerves of the face one at a time, we judge how alert he is. Those maneuvers, and not the scene in your kitchen, are what tell us which level of the circuit the problem sits at. None of it is painful, and none of it needs sedation.
- The earWe look down the canal with an otoscope, and we take a sample if one is needed. This is the step that rules the previous section's branch in or out. It is also the only step of the appointment that sometimes needs sedation, when the ear is too sore or the canal too full to see the bottom: we tell you before, never after.
- Blood pressureWe check blood pressure here, in dogs as well as cats, on an awake animal, with no needle and no anesthesia: a cuff, a quiet room, several readings averaged together. It is not automatic at every visit; we do it when the picture calls for it, and it belongs in the workup of a pet who is getting older, in both species. The reading needs a few quiet minutes before the first measurement. If the pressure is running high, we explain what it means for your animal, we build a treatment plan with you, and we schedule a follow-up check to track it.
- Blood and urine, depending on the pictureWe are looking for the general causes that are treatable: kidneys, thyroid, sugar, a liver upset, an infection.
- And if the picture calls for it, imagingRadiographs are done here. An image of the brain, a CT or an MRI, is not done here: that is a referral to an equipped colleague, and we tell you so plainly on the day rather than leaving you waiting.
What actually gets decided at this appointment
Not necessarily the name of the disease, and that has to be said honestly. What gets decided is something else, and it is already a great deal: whether this can wait, whether there is something treatable to treat today, whether the picture justifies going to look inside the head, and what to do at home tonight. Those are exactly the four things you cannot decide on your own.
Often we reassure you, and that is not a figure of speech
In a good number of the older dogs and cats brought in for this picture, the exam finds no other cause. We treat the discomfort, we explain what to do at home, and the animal improves over the days that follow. We write that here because it is true, and because it is precisely the outcome nobody can hand themselves at home. The appointment is not only there to find a problem: very often, it is there to give you your evening back.
What we do here, and what we refer
We do the full examination here, the ear exam, the blood and urine work, the blood pressure, the radiographs, the supportive treatment and the follow-up. This is a general practice, and most of these situations are handled here from start to finish. What gets referred, we say straight out: advanced brain imaging and the opinion of a veterinarian who specializes in neurology. That is not a failure, it is the right equipment for that particular case. And one thing worth knowing before you need it: we have no emergency service outside our opening hours. Evenings, nights and holidays mean a 24/7 emergency centre.
Say so when you book
One sentence is enough: "it is a balance problem". Add that you have a video if you do. That is what lets us understand straight away what we are dealing with.
Is your pet staggering or tilting his head?
Book an appointment, saying it is a balance problem, and mention if you have a video. If it started today, call rather than write.
Give no home medications
On this page the temptation is not pain: a balance disturbance does not hurt. The temptation is the nausea. Your pet is queasy, disoriented and frightened, and there is something in the cabinet. There are two reasons to give him none of it, and the second one belongs to this situation alone.
Acetaminophen (Tylenol)
Fatal to cats, even a single tablet. There is no safe dose. If your cat swallowed any, it is an immediate emergency. In dogs, it damages the liver.
Ibuprofen (Advil, Motrin), naproxen (Aleve), aspirin
Digestive ulcers and kidney damage, in dogs as well as cats, sometimes on a single dose. Cats are even more sensitive to them than dogs. Never a human anti-inflammatory, for any reason.
Gravol, human anti-nausea pills, Benadryl
Never without direction, and here there is one more reason: anything that sedates or fogs him changes precisely what the vet is about to assess, his alertness and the movement of his eyes. You would not be settling him, you would be erasing the exam.
Leftover prescriptions and the other pet's medication
Same apparent problem, same weight, same household: none of that is ever enough. What relieves a dog can kill a cat, and a dose calculated for another patient is not a dose.
Anything that goes into an ear
That is section 6, and it is the one rule on this page with no exception. A pet already tilting his head is exactly the one whose eardrum is most likely to be damaged.
A pet settled blind
It is not that everything is poison. It is that the time and the place are wrong. Nausea is treatable, and quickly, but it is a clinic decision: it is made once we know what we are treating. A pet settled blind is a cause that keeps advancing while you reassure yourself. Tonight, your job is not to treat him, it is to bring him to us.
The next few hours: what helps, what hurts
These are for getting through the next few hours without your pet hurting himself, and without the fear rising, in him or in you. None of them is a treatment, and above all none of them is a test: if they settle him, good; if they change nothing, the appointment stands exactly as it was.
What helps
- The floor, right now. A pet losing his balance does not get hurt by tilting his head, he gets hurt by falling. Block the stairs, keep him away from landings, balconies, the bathtub and sharp-cornered furniture. For a cat: close off anything high, and bring the litter box, the food and the water down to the floor he is on.
- A small, quiet, padded space. Not the whole house. One room or a pen, rolled blankets along the walls, non-slip mats over slippery boards. A pet who can no longer bang into things stops being afraid to move, and that alone is a lot.
- Do not move the furniture. Right now he is navigating from memory, and that memory is his best tool. Our fiches already say it: keep the layout as it was.
- Turn the lights and the noise down, and leave a night light on to help him orient himself.
- Leave water and food where he can reach them, on the floor. Stable bowls, flat on the ground, near a wall so he can lean. Wet food, gently warmed: it smells stronger, so it is easier to find when you no longer know which way is down.
- Help him up, with the right hold. A towel or a sling under the belly for a big dog, both hands for a small dog or a cat. Our guide on a pet who cannot get up shows the technique and how to protect your own back.
- Take him out in a harness, on a short lead, on grass. Not the sidewalk, not the ice, not the steps, not the usual walk.
- Write down what you see, morning and evening. Two dated lines, or ten seconds of video: is he steadier, is he eating, is he drinking, is he urinating. How it moves over a few days is itself information the vet will use.
- Stay with him more than usual. He is disoriented and frightened, and that fear is part of what you can actually relieve tonight.
What hurts
- Do not fast him. No "I will give his stomach a rest until morning". The reflex comes from the vomiting pages, and it has no business here. A pet losing his balance is already struggling to find his bowl: taking away his food and water is the exact opposite of what he needs. In cats, not eating quickly becomes a problem in its own right.
- Do not force-feed him and do not syringe anything into him. A nauseated, disoriented animal who struggles can inhale the food. You offer, you do not impose. If he is not eating, it is not on you to force it: tell us, because that is information and sometimes a prescription.
- No household medications, and that is the section just above. No Gravol, no human anti-inflammatory, no human painkiller, no leftover prescription, no medication belonging to the other pet.
- Nothing in the ear. That is section 6, and it is the one rule on this page with no exception.
- Do not make him walk to see whether he can. It is not a test, and every failed attempt is another fall.
- Do not spin him, do not move his head, do not wave a hand in front of his eyes. None of it will teach you anything, and all of it increases the nausea.
- Do not leave him alone anywhere high, outdoors unsupervised, or alone with the other pets in the house while he is unsteady. A disoriented animal gets knocked over, and he can also bite because he no longer understands what is approaching him.
- Do not wait to see whether it passes overnight. This page has no watch-and-wait window to offer you, because there is not one: it is today.
Make no final decision during the acute phase
Both our fiches publish this already, and after the red flags it may be the most important sentence on this page. The first day is the worst one. An animal rolling on the floor, vomiting, unable to get up and not quite recognizing you looks like an ending, and a great many people think about it within the first few hours.
If that thought crosses your mind, tell us on the phone. It is not a sentence that shocks us and it is not a sentence we judge: it is one we hear often on the first day, and the first day is exactly the worst moment to act on it. Many of these animals are markedly better within a few days, including the ones left with a slight head tilt they get along with perfectly well.
Get your call ready (2 minutes)
- When exactly, and has it changed since?
- Which way does the head tilt, and which way does he circle?
- Can he get up on his own? Is he rolling over?
- Are his eyes moving on their own? Do you have a video?
- Does one of his eyes look different from the other: a smaller pupil, a drooping lid, the third eyelid coming up?
- Is he eating, is he drinking, is he vomiting?
- Does he respond when you call him?
- Has he had an ear infection, ear treatment, a flea product, a new medication, a recent anesthetic? Could he have swallowed something?
- His known conditions, his current medications, and the time of the last dose.
Frequently asked questions
The questions we hear most on the phone, and the one people do not always dare to ask.
Did my dog have a stroke?
It is evening and you are closed. Do I wait until morning?
I have been told it is old dog vestibular disease. Does that mean it is nothing?
He is queasy and off his food. Should I fast him? Should I syringe-feed him?
Can I give him Gravol for the nausea?
He has had a head tilt for weeks. Will it stay? And can it come back?
One side of his face has dropped and his eye will not close. Are they connected?
Is he in pain?
He has been circling and seeming lost for weeks, mostly at night. Is this the same thing?
Also worth reading
Honest triage, in one paragraph
He cannot get up, his awareness has changed, he is seizing, his legs will not carry him, he is breathing badly, he is diabetic, he may have swallowed something, it happened after an impact: go now. A head tilt, eyes moving on their own, a drunken walk and nothing else: that is today, not tomorrow morning. And until then, film him, leave food and water within his reach, and put nothing in his ear. The good news is real; it becomes yours the day somebody has looked.
He is staggering, and you are hesitating to bother us?
Do not hesitate any longer: hesitating to call is already a reason to call. We triage it together, and if an appointment is all it takes, we will tell you straight away. Say it is a balance problem, and tell us if you have a video.