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Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 29787
Experience:  University of California at Davis graduate veterinarian with 45 years of experience
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My dog has been diagnosed with Neuritis about a year ago but

Customer Question

My dog has been diagnosed with Neuritis about a year ago but I think it may be MMM as he has just started to have slack jaw and not able to chew as usual (plus dribbling which he never did before) plus muscle atrophy.
Submitted: 1 year ago.
Category: Dog Veterinary
Expert:  Dr. Michael Salkin replied 1 year ago.

Trigeminal neuritis results in a dropped jaw and failure to be able to close the mouth. MMM results in an inability to open the mouth. One disorder doesn't preclude the other, however. I'm sorry to hear of this with Marely. His facial muscle atrophy can have quite a few differential etiologies - a neuropathy such as bilateral denervation of the mandibular branch of the trigeminal nerves, infectious, immune-mediated, metabolic, neoplastic, and disuse atrophy. Is Marley under the care of a specialist veterinary neurologist? Please clarify MMR for me.

Customer: replied 1 year ago.
Thank you for your response. Marley has been for an MMR with a neurologist and they said there was no obvious tumour, but they could see a shadow of something. So they said they will treat is as though it was neuritis and gave me those 3 medicines. They appeared to help him a lot and when the 3 month course ran out we left it as the muscle appeared to have filled out his head again. After a few months off the medication, Marley's head has progressively got so bad he "scratches" the dipped muscles by pressing really hard into my leg, my elbow, the corner of tables, the wall, the stairs, the floor even. The past week his jaw is slack and he dribbles when drinking. When chewing on a dental stick he takes 10 x as long and foams at the mouth. He is generally very happy in himself except for the scratching which is becoming nearly constant. I have started him back on the course of these three meds again today, although I am concerned the slack jaw is a new symptom possibly changing his diagnosis? He also has one very diluted pupil. I'd like to send a photo:
Expert:  Dr. Michael Salkin replied 1 year ago.

Thank you for the additional information. I believe that there's an immune-mediated polyneuritis that has responded to the immunosuppressive cyclosporin + prednisolone. A trigeminal (cranial nerve V) neuropathy is manifesting at this time but other cranial nerves may be involved as well. For example, the hypoglossal nerve (cranial nerve XII) which innervates his tongue and the oculomotor nerve (cranial nerve III) which innervates his pupil. Starting up his medications is, indeed, prudent again.

Please continue our conversation if you wish. He's still a handsome boy.

Customer: replied 1 year ago.
I like to think so! So do you feel like these medications are the right ones for him to continue on and there's nothing else we should be looking into? I wouldn't want to make this worse by giving him the wrong treatment. Also, do you think the slack jaw and pressing his head on everything will improve shortly?
Expert:  Dr. Michael Salkin replied 1 year ago.

At this point repeating the MRI might be of value. He responded well to those drug previously; it makes sense to see if the same drugs still are effective. If so, I would expect his trigeminal nerve neuropathy symptoms (jaw drop/head pressing as a response to the discomfort of inflammation?) to abate. I don't know long that will take or if it's possible. I can think good thoughts for Marley, however.

I can't set a follow-up in this venue so please return to our conversation - even after rating - with an update at your convenience.

Expert:  Dr. Michael Salkin replied 1 year ago.
Hi Danielle,
I'm just following up on our conversation about Marley. How is everything going?
Dr. Michael Salkin