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Dr. Gary
Dr. Gary, Dog Veterinarian
Category: Dog
Satisfied Customers: 19759
Experience:  DVM, Emergency Veterinarian; BS (Physiology) Michigan State Univ
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I have a GSD who has seen 3 vets in the last 3 days. One is

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I have a GSD who has seen 3 vets in the last 3 days. One is a specialist and the 3rd vet was visited for a second opinion. The dog has very obvious temporal muscle atrophy mostly on the left side, although the muscle on the right side may have been impacted to an extet. That is not so obvious. He does not have any jaw pain. Although about six weeks ago I called his usual vet when he showed signs of excessive drooling after trying to lap water, and he had some difficulty in eating a denta stick and getting his mince meat into his mouth. The vet at the time suggested he may have received some sort of chemical burn which impacted on the back of his throat. He told me to observe for a few days. The obvious symptoms disappeared quite quickly. But six weeks later we are looking at a dog whose head looks caved in on one side, this has happened very quickly. Neither of the vets he has seen have wanted to put him on any treatment. I wont say why..... and I was interested to get really what is a fourth opinion. They say that it is unlikely that the muscles will recover and they say that his longevity should not be impacted by this.
Hello, I'm Dr Gary. I've been practicing veterinary medicine since 2007. I look forward to helping with your questions/ concerns.

It sounds like you're seeing a condition called MMM (masticatory muscle myositis). This is an auto-immune disease that we can see in dogs. Typically it occurs on both sides, but it can be one sided. We will often also see pain when opening the mouth and a clenched jaw. I think the reason you're not seeing these classic signs is because it's only on one side. If it were both sides, he would have the more classic look.

The diagnosis is made with muscle biopsies. I would have this done if you can. We then treat with immuno-suppressant meds as this is an auto-immune disease. I would put him on steroids (Prednisone) + another immuno-suppressant like Imuran (Azathioprine) if needed.

I hope this helps, let me know if you have any other questions.

Dr. Gary and 3 other Dog Specialists are ready to help you
Customer: replied 3 years ago.

Drug treatment was not considered as an option for him. MMM was discussed although as you mentioned he is not classic because his atrophy is not bilateral and his jaw has not been impacted. The general assumption by the vets is that his body is in recovery mode, although the damage has been done. It appears that the acute phase was missed and that is when the drugs would have been most effective. Would you also agree that treating him now with the drugs you have mentioned would not be effective as the condition has moved from acute to chronic?

I would want the biopsies to know for sure whether meds will help. If all of the muscle has turned to scar tissue, then steroids may not help. If there is still an active phase, then we can still benefit. It's hard to make that determination without the muscle biopsy and microscopic exam.
Customer: replied 3 years ago.

Thankyou Dr Gary, I must say that I tend to agree with you, and I am confused as to why the biopsy was not considered an option. Although we are in Australia and the specialist vet, (who is a member of the American Veterinary Association) said that testing for this is only done in the US and it would take 2 to 3 weeks for the results to be returned. Maybe it has something to do with the delay and the disease moving on in that time. Even so, at least then we would then know for sure what his problem is. Cost was no issue for me and the vets here knew that.

Last question if I may. If this is a recurrent episode, as I mentioned I first called the vet 6 weeks ago and his concerning symptoms disappeared in a short time and were not diagnosed as MMM. Without seeing the dog I realize it is probably hard to say, but knowing what I have told you would you consider this latest episode as acute? You have been very helpful, thankyou.

I think we're probably past the acute stage at this point, but I would think there can still be some benefit from steroids now. I would get the samples sent out and then start steroids in the mean time. I think that would give you the best chance of recovering.
Customer: replied 3 years ago.

Thanks Gary... your answers have prompted me to seek another opinion and Kaiser is now having further tests and CT scans! Without your advice I may not have continued to push this as I have! I am very happy with the service.

Good, I'm glad he's getting the care he needs. Best of luck.