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Ask Dr. Michael Salkin Your Own Question

Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Veterinary
Satisfied Customers: 12698
Experience:  University of California at Davis graduate veterinarian with 42 years of experience.
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Almost two weeks ago my 12 year old pit bull experienced three

Customer Question

Almost two weeks ago my 12 year old pit bull experienced three grand mal seizures in 12 hours. She has since then had an MRI and spinal tap. The spinal tap came back normal however, the MRI showed two brain lesions. She is currently taking 90 mg of phenobarbital daily as well, as 0.75 mg of Dexamethasone two times a day. In addition, she has also been in kidney failure for three years. The other day my husband noticed her cheeks looked slightly sunken in. This evening I noticed how severely sunken in her face looks. We are both very concerned as this seems to have come out of no where. Any help would be greatly appreciated! Thank you in advance for your time and consideration.
Submitted: 1 year ago.
Category: Veterinary
Expert:  Dr. Michael Salkin replied 1 year ago.
Aloha! You're speaking with Dr. Michael Salkin
I'm sorry to hear of this with your Pit Bull. You've described a syndrome called facial muscle wasting - atrophy of the muscles of mastication, mainly the temporal and masseter muscles.

There are quite a few etiologies for this syndrome. There are idiopathic (unknown cause) etiologies such as trigeminal neuropathy (cranial nerve V disorder); infectious etiologies such as toxoplasmosis and neosporosis - both rare; immune-mediated etiologies such as systemic lupus erythematosus, idiopathic polymyositis, and masseter muscle myositis; iatrogenic etiologies such as glucocorticoid administration (her dexamethasone?!); metabolic etiologies such as Cushing's disease and cardiac cachexia (wasting); neoplasia (malignancy) - which is an important consideration because two brain lesions have been seen; and disuse atrophy due to TMJ problems (unlikely in this case).

By the principle of Occam's Razor we should incriminate the brain lesions but a careful physical exam - particularly a neurologic exam - is necessary to clarify why facial muscle wasting has occurred. It would be prudent to ask her neurologist if the lesions seen in her brain are in areas where her facial muscles might be affected.

Please respond with further questions or concerns if you wish.
Customer: replied 1 year ago.
Thank you for your prompt and very thorough reply.

The MRI showed a focal lesion within the left frontal lobe of the brain, with a smaller focal lesion affecting the caudal vermis on the right. Could the location of the aforementioned lesions be consistent with what you are describing?
Expert:  Dr. Michael Salkin replied 1 year ago.
No, I wouldn't expect so. The caudal vermis of the cerebellum is involved with posture and locomotion. The frontal lobes are involved with motor functions and higher order functions such as reasoning, planning, and memory. Once lesions expand, however, the pressure exerted on other parts of the brain can confound our understanding.

Her presentation is going to be a challenge to clarify. Many of the etiologies I mentioned are treated with corticosteroids such as dexamethasone! Please continue our conversation if you wish.
Customer: replied 1 year ago.
Thanks again for your input and expertise.

I will consult with her regular vet and neurologist as soon as possible.
Expert:  Dr. Michael Salkin replied 1 year ago.
Sounds good. I'm going to check back with you in a few days for an update. Feel free to return to our conversation - even after rating - prior to my contacting you if you wish.
Dr. Michael Salkin, Veterinarian
Category: Veterinary
Satisfied Customers: 12698
Experience: University of California at Davis graduate veterinarian with 42 years of experience.
Dr. Michael Salkin and 3 other Veterinary Specialists are ready to help you
Expert:  Dr. Michael Salkin replied 1 year ago.
Thank you for your kind accept. I appreciate it. I'll speak to you soon.

Please disregard the info request.
Expert:  Dr. Michael Salkin replied 1 year ago.
May I have an update, please?
Customer: replied 1 year ago.
Thanks for checking in. We took our dog to our regular vet last Thursday. He was perplexed by the facial atrophy but suggested it may be due to pressure on a nerve. He didn't seem to think it was a result of the steroid because it happened so fast. He also ran a full CBC which showed significantly raised liver levels. Surprising since she's only been on the pb for just under two weeks. He was anxious for us to meet with the neurologist.
Well we met with the neurologist today. She thought the facial atrophy was due to the dexamethasone. She has cut her dose of the demo to once daily and suggested that we may consider halting that dose again in a week. Our dog has also lost 3.5 lbs in the last two weeks. We are waiting for the results of the pb levels. Our primary vet would like to cut the pb dose to 75 mg a day but the neurologist believes we should stick with 90 mg a day.
The dog does not appear to be in any pain and has quite an appetite and drinks lots of water. She doesn't want to play or go for walks. We worry about her happiness and struggle daily with the decision weather or not to put her down. How do you know when it's time to say goodbye?
Thanks in advance
Expert:  Dr. Michael Salkin replied 1 year ago.
Thank you for the update. I would listen to the specialist. I hold them in high regard.

I predicate the decision to euthanize on my patient's quality of life. If they're not having fun anymore - if they can't do the things they used to do - they become anxious and depressed. Dogs don't have any conception of lifespan and so there's no fear in that regard. They are emotional, however, and their response to illness and incapacitation is an important clue for me when I discuss their prognosis and how to move forward. There's no denying that the decision to let go is difficult. It should be but when my owners have been kind to their pets all their pet's life, the final kindness should be considered when it's appropriate to do so.

Please continue our conversation if you wish.

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