Monday 28 May 2007

She’s got Masticatory Muscle Myositis

Photos of Kiri during her illness and now in remission


It was a Monday evening and Kiri was sitting in her usual place, her bum on the sofa and her front legs draped over Steve’s lap. I turned and looked at the happy couple. Something about Kiri was different. Was there a swelling around her eye? Maybe not! Tuesday evening and she’s sitting once again in the same place. Today there was no doubt - something was different. Her face seemed puffy and swollen and she seemed reluctant to open her mouth.
By Wednesday morning her face was so badly swollen that she had no stop and indeed from a side profile she looked more like a Borzoi than a GSD. Though she managed every last crumb of her breakfast she seemed to be having difficulty opening her jaw and she was coughing whilst eating.(Let me point out at this stage that the meaning of life for Kiri is food; she would have sucked it up through a straw if necessary)
The vet’s earliest available appointment was for early afternoon and initially the young vet seemed baffled at the symptoms. Kiri’s temperature was normal, her colour was good and her eyes bright and healthy, but by now she showed signs of distress if any one tried to open her mouth and the swelling on her face was hot and painful. There was also a strange smell on her breath. The vet reckoned that there was a possibility of a foreign body in her mouth or throat and suggested an X-ray. Because she had eaten that morning she was given a “rimadyl” injection and an appointment was made for the next day.
Kiri looked pretty much the same on Thursday morning, though she objected loudly to being left in her cage as the rest of her family had breakfast!
A different vet called us into the consulting room and offered me an alternative diagnosis; possibly Kiri had suffered a severe allergic reaction to something, or it could be a condition called “Masticatory Muscle Myositis” (MMM). They could proceed with
X-rays or give her a large dose of steroids and wait for 24hrs to see if there was any improvement. Convinced this was an allergic reaction I decided to wait.
By Friday morning the swelling on Kiri’s face had reduced dramatically and she looked almost her usual self; there was just a slight dip on her temple that bothered me somewhat. The vet suggested this could be a reaction to the high dose of steroids, but felt it necessary to give her another injection and tablets to carry us over the weekend. With an appointment made for Monday we set off home.
This was not the weekend I had been expecting. Kiri spent the entire time on a chair in the computer room and when I finally managed to encourage her into the living room she sat behind the sofa. She was quiet and distant and the only time she showed any enthusiasm was when she heard the rattle of dinner bowls! By Sunday night there was a drastic change to Kiri’s face. At the time it appeared as if the swelling had gone down but hadn’t known when to stop, giving her head a skull-like appearance, and by now the front of her mouth would not open more than an inch or so. (But yes she could still eat).
When I took her to the surgery on Monday I felt sick with worry. What on earth was going on with Kiri? She was then taken in for X-rays on her throat and mouth to see if there was anything untoward causing the problem but nothing had been found.
The diagnosis following this visit to the vets was MMM. (Chronic form) They hadn’t even been able to open Kiri’s mouth under anaesthetic. They informed me that it is an immune mediated disease found in many large breeds of dogs, but especially GSD’s. Then why had I never heard of it, and what can be done about it?
Kiri was prescribed a course of steroids, starting with 60mg to be reduced over the next 6mths. I was also told to provide her with bones and chew sticks as physiotherapy for her jaw. As MMM is a disease that only goes into remission and never really goes away long term use of steroids may be a necessity. (But I am looking for alternative medicines). After the 6mth course we will have an important decision to make. If we take her off the steroids we could risk her having another episode and apparently each one increases in its severity. But I don’t relish the thought of putting a 5yr old bitch on steroids, with all their side affects, for the rest of her life.
Over the next week Kiri’s face deteriorated, the condition affected the muscle behind her eyes giving them a sunken look and I suppose due to the pressure on the tear ducts, her eyes where also weeping. On a good note after spending a day on a chew stick about the size of a stick of rock (normally would have been demolished within an hour), there was a drastic improvement in the mobility of her jaw. We continue daily to provide her with something to chew. As regards to eating, throughout these last few weeks Kiri has never stopped eating. I realise this could have been the downfall of many a dog as at times she did find it difficult. A less food-orientated dog may not have made the effort and long term not obtained enough nourishment to maintain his strength.
Kiri is responding well to treatment to date though on the advice of a specialist 10 days after starting her steroids the dose was cut in half. This was because she was losing muscle tone on her limbs and it was felt that the steroids themselves were causing this problem. We always had a bit of trouble with Kiri’s weight; much to my husband’s disapproval I affectionately called her “fatty.” Now she seems only half the dog she was and though she has eaten well throughout these past few week she has lost about 6kg in weight, or maybe partly muscle.
This chapter is by no means closed; we have to take each day as it comes. There has been a lot of stress and tears in this house over the last few weeks, partly due to the “not knowing.” On our part we have to learn to accept that our lovely girl doesn’t look the same any more; we will get use to the new face that greets us daily; after all the dog behind the face is still the one we love so much. For Kiri herself, well, we just want her to feel well and be happy. At least she won’t go into the bathroom in the morning, look in the mirror and ask “why?” We are the ones doing that!
May I also take the opportunity to thank all of the people who have helped us throughout this; without their friendship and support this would have been much harder. Kiri would also like to thank everyone who turned up with bones and chews; she really doesn’t mind if they keep on coming!!!!!