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one year old (samet)..his back legs started to give..neurological…

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hello, i have a one year...
hello,

i have a one year old (Samet). about three weeks ago, his back legs started to give up on him, he was not able to walk, or get down to eat and so on. i took him to vet, and they said he looked fine, it might be a neurological thing. they gave him some fluids (he was dehydrated because he wasn't eating)and the next day he was much better. vet also gave metacam to promote healing. in the following days, he started to get worse, stopped eating and drinking altogether and all of his legs gave up. he was not able to walk at all, he was just lying on the floor. i took him to a bigger animal hospital. he is there for two days now and they say there is a neurological problem, the signals the brain sends cannot be received by muscles. they said they tried a medicine which seems to promote his mobility but since he cannot live on drugs, they are searching for a permanent cure. they are gonna check if he has tumor in abdomen. if that does not work either, they seem to be hopeless, which makes me hopeless too. do you have any idea?any suggestions?thank you
Submitted: 8 years ago.Category: Veterinary
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6/24/2010
Veterinarian: DrLucy, Veterinarian replied 8 years ago
DrLucy
DrLucy, Veterinarian
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Satisfied Customers: 618
Experience: Almost 30 yr as a practicing small animal vet.; experience in gen.medicine, surgery, emerg/crit.care
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It sounds like a very upsetting situation. I will do whatever I can to help you sort through the information. Can you tell me whether they think the problem is in the spinal cord or elsewhere in the nervous system? Are there any lab results you could post? What is the name of the medication that has been helping his mobility?
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Customer reply replied 8 years ago
Hello,

the diagnosis is "myastenia gravis" and they gave a pill "mestinon" (i give 1/8 of 10 mg tablet)there is no sign of tumor from the xrays. he is much better now, walking, eating and even jumping!he is rather weak but i think it is because he couldnt eat for so long. do you have any further suggestions for a better life quality or faster recovery (if it is possible to have 100% recovery)
Veterinarian: DrLucy, Veterinarian replied 8 years ago
It is great news that there is no tumor on X-rays. I assume that they were looking for a Thymoma in the chest (not just an abdominal tumor), because the prognosis with myasthenia gravis that is associated with Thymoma is much worse than the type that is caused by myasthenia that is caused by a malfunctioning immune system (attacking the place where the nerve controls muscle activity). The second type is the type that your cat probably has---This is good. Although there may be a good bit of medication adjustment, he should have a good quality of life. Usually prednisolone (or prednisone) is part of the treatment regimen. If his case is not being managed by a neurology specialist or internal medicine specialist (even if their input is in the "background," assisting your own vet), I would suggest at least a consult with one. Fortunately, cats generally have very few side effects from prednisolone (prednisone), unlike humans and dogs. Sometimes, Mestinon is not even needed. However, since he is already on it, that is not a problem. The good news is that he may be able to be weaned off, eventually.

As far as your specific request about additional suggestions, I would discuss adding prednisolone with your vet. The only other suggestion I might make is to make sure to keep him on the lean side during his life. There are two reasons for this. One is that there is less weight to carry around if his muscles are on the weak side. Another is to decrease his risk of diabetes, which is higher in overweight cats. If he does get diabetes and has to be on long-term predisolone (or other corticosteroid), it makes diabetes much more difficult to manage.

I have included some reading material for you, and some links to helpful web pages.

This is a link to an owner-education article from the VeterinaryPartner.com site (which has a wealth of other client information, too). => http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=1544

If you don't mind sorting through medical terminology, the following information should be both informative and encouraging.

Here is a copy of a case report summary of a cat with myasthenia gravis. Note the last paragraph ("Outcome"). You should be encouraged by this cat's response.

=> Acquired immune-mediated myasthenia gravis in a cat
J Small Anim Pract 30[9]:511-516 Sep'89 Case Reports 25 Refs
P. A. Cuddon Dept of Med Sci, School of Vet Med,XXXXXW, Univ of Wisconsin, Madison, WI 53706

-Case report of a 4 year old castrated male Somali cat.

HISTORY/CLINICAL SIGNS included progressive lameness of the forelimbs, weakness, stiffness, tremors, ventroflexion of the neck, retching, dysphagia, weight loss, decreased responses to external stimuli, increased lung sounds, fever, and partially prolapsed third eyelids.
NEUROLOGIC EXAM revealed decreased conscious proprioception and postural reactions in all 4 legs, decreased withdrawal reflexes in the forelimbs, inability to blink eyelids, absence of vocalization, and normal tendon responses and pain sensation.

LABORATORY FINDINGS revealed lymphopenia and hyperproteinemia. Blood chemistries, FeLV test, coronavirus and toxoplasma titers were normal/negative. The serum acetylcholine receptor antibody titer was increased ie., 8.0 nmol/L [normal < 0.3 nmol/L].

RADIOGRAPHIC FINDINGS revealed bronchopneumonia. Fluoroscopy revealed prolonged swallowing reflex and no primary esophageal contractions and partial oronasopharyngeal reflux.

PHARMACOLOGIC TESTING. Edrophonium chloride [Tensilon : Roche] at 2.5 mg IV after exercise and collapse resulted in a return of the ability to blink, vocalize, and raise its head 30 minutes postinjection.

ELECTROPHYSIOLOGY. See article for results.

BIOPSY FINDINGS. Muscle biopsies revealed the presence of immune complexes at the neuromuscular junction using immunohistochemical techniques.

TREATMENT consisted of cephalexin [Keflex : Lilly] at 12.5 mg/kg PO tid for bronchopneumonia; pyridostigmine bromide [Mestinon : Roche] at 2 mg/kg PO bid for 10 days; and prednisone at 1.5 mg/kg PO bid.

OUTCOME. Marked improvement was seen after 2 days of therapy and signs of weakness had resolved after 10 days. Reduction of the prednisone to 2 mg/kg PO sid after 1 month of therapy resulted in a severe recurrence of clinical signs of myasthenia gravis requiring pyridostigmine bromide at 0.5 mg IV bid [IV dose is markedly lower than oral dose due to poor bioavailability orally--based on humans] and dexamethasone at 2 mg/kg IV bid before any response to therapy was seen. Once the cat responded, the original oral therapy was started with pyridostigmine being discontinued after 3 weeks and the prednisolone dose gradually decreased after 2.5 months and discontinued 1.5 years after initial diagnosis. No further recurrence of clinical signs have been seen for 2 years after stopping the medication.


Here is a link to a page that lists diagnostic tests for neuromuscular diseases, in genera (in case you are interested): http://vetneuromuscular.ucsd.edu/cases/2009/March09.html

Also from UC San Diego:
http://vetneuromuscular.ucsd.edu/publications/factors.pdf
http://vetneuromuscular.ucsd.edu/publications/mg2.pdf

=======================

I hope this helps. It is wonderful that you have already gotten a diagnosis. That's 90% of the battle. I am glad that he has responded well so far. It is likely that it will take a little time to regain all his muscle strength. Please let me know if you have questions. I would be happy to help.
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Customer reply replied 8 years ago
thank you for your help. one more question: he looks quite unhappy and uninterested in the toys he used to love. i don't know how to cheer him up, he looks so unhappy. do you think it is because his situation?or the medication is keeping him down?
Veterinarian: DrLucy, Veterinarian replied 8 years ago

I would hesitate to assume that he is unhappy in the sense that we humans get unhappy. If he is tired or weak, he might not want to play with toys until he gets all his strength back, but that does not mean that he is unhappy. I think that if he were seriously distressed, he would be hiding. If he is willing to stay where his humans are hanging out, then I would interpret that as being fairly content.

 

By the way, is he on prednisolone or some other corticosteroid? (e.g. dexamethasone)

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Customer reply replied 8 years ago
no, he only takes mestinon. I havent consulted to a neurology specialist yet, but i will do that. he is on his cushion, curled up and sleeping now, he is not hiding. he is just really still, not reacting to his toys. but maybe he is just tired and needs time.
Veterinarian: DrLucy, Veterinarian replied 8 years ago
Because myasthenia gravis is such an unusual disease in cats is such an unusual disease, I do not want to insist on a particular treatment, especially since I am not a neurologist, myself. However, my understanding is that those cases of feline myasthenia gravis that are not related to thymoma are generally due to immune-mediated disease. Therefore, the best chance of successful treatment includes starting on immune-suppressive doses of corticosteroids. I wonder if adding one of these drugs to the Mestinon would make him feel better. It's worth asking your current vet. I hope you get an appointment soon with the neurologist. If you need help finding one in your area, let me know, because all board certified specialists in the U.S. are listed.
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Customer reply replied 8 years ago
Thank you for all your help but i don't live in the States, i am in Sweden. Now time will show how it goes, plus all my effort!your answers were very helpful, thank you!
Veterinarian: DrLucy, Veterinarian replied 8 years ago
That's right! I forgot. I am sure that they have a similar list in Sweden, too. If you need any more information, I will make sure I get it for you, because I have access to some neurologists.
DrLucy
DrLucy, Veterinarian
Category: Veterinary
Satisfied Customers: 618
Experience: Almost 30 yr as a practicing small animal vet.; experience in gen.medicine, surgery, emerg/crit.care
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Customer reply replied 8 years ago
Hello, it is me again!Samet has been really good the last week but he is starting to get worse again. can he create some kind of resistance to the medicine?
Veterinarian: DrLucy, Veterinarian replied 8 years ago
My understanding is that treatment for the immune-mediated (i.e. autoimmune) form of myasthenia gravis is more a matter of finding the combination that works best. If Samet has not been on an immune suppressant (like prednisolone), then simply the Mestinon will not be enough to hold him. It's quite like the kind of resistance that bacteria get with antibiotics. He needs to have an additional drug. What is he on now......still just the Mestinon?
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Customer reply replied 8 years ago
yes he is still on Mestinon only. I will take him to the hospital tomorrow and ask for this drug. thank you
Veterinarian: DrLucy, Veterinarian replied 8 years ago
Here is a suggestion: You might want to tell your vet that a vet-acquaintance of yours said that there is some information on www.vin.com about treating myasthenia gravis in cats, when it is not due to a thymoma (which they have ruled out). If your vet does not have a subscription to VIN, I will post some other references which have treatment recommendations. I am concerned that, if you just go to your vet and ask for prednisolone or prednisone, they may get defensive.

Here are some good VIN web pages:

http://www.vin.com/Members/boards/discussionviewer.aspx?DocumentId=3200643 ;
http://www.vin.com/Members/Associate/Associate.plx?DiseaseId=1018 ;
http://www.vin.com/Members/boards/discussionviewer.aspx?DocumentId=3353926 .

Here are some references to Myasthenia Gravis in cats
:

1) Shelton GD, Ho M, Kass PH: Risk factors for acquired myasthenia gravis in cats: 105 cases (1986-1998). J Am Vet Med Assoc 2000 Vol 216 (1) pp. 55-57.
2) Shell LG: A review of feline neuromuscular diseases. Vet Med 1998 Vol 93 (6) pp. 565-574.
3) Shelton GD: Myasthenia gravis and disorders of neuromuscular transmission. Vet Clin North Am Small Anim Pract 2002 Vol 32 (1) pp. 189-206.
4) LeCouteur RA: Disorders of the peripheral nerves. New York, Churchill Livingstone 1988 pp. 299-318.
5) Joseph RJ, Carrillo JM, Lennon VA: Myasthenia gravis in the cat. J Vet Int Med 1988 Vol 2 (2) pp. 75-79.
6) St. John LM: Pyridostigmine. Compend Contin Educ Pract Vet 2002 Vol 24 (2) pp. 92-94.
7) Ducoté JM, Dewey CW, Coates JR: Clinical forms of acquired myasthenia gravis in cats. Compend Contin Educ Pract Vet 1999 Vol 21 (5) pp. 440-448.
8) J Small Anim Pract 30[9]:511-516 Sep'89 Case Reports 25 Refs; Acquired immune-mediated myasthenia gravis in a cat



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Veterinarian: DrLucy, Veterinarian replied 8 years ago
Here are two neurologists in Sweden who are board certified by the European Society of Veteriinary Neurology:

Sweden

Dr Karin Hultin Jaederlund [email protected]
Dr Sofie Van Meervenne [email protected]

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Customer reply replied 8 years ago
Hi again!
So Samet was at the hospital again for a check up. he is getting worse sometimes and acting like a normal cat for the rest. vets say it is a matter of dosage and the neurologist didnt want to start corticosteroids right away because it is a rather strong medicine. so we will see with dosage now, if we can keep him stable with a higher dose of mestinon. now he is still taking 1/4 of a tablet but if he gets worse we are going to increase it to 1/2. on the 21st, they will call how he is doing and according to the situation we are going to follow a path. but Samet is eating, drinking and peeing by himself. he was playing yesterday. so i hope he will get better with this dose.
Veterinarian: DrLucy, Veterinarian replied 8 years ago
Thanks for the update. As long as a neurologist things that it's OK to hold off on the steroids, I am happy with that. I am glad that they are monitoring him carefully.
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Customer reply replied 8 years ago
Hello again!

here are the news: the test results from the States arrived and they are negative, he does not have MG. vet suggested we start prednisolone. before they sent the blood sample to the states, they told us there might be a tumor in his brain and that is the cause of this situation but they dont know. it seems noone knows. we are waiting. if it is an auto-immune disease then i presume prednisolone would help,if not, i dont know what we do next.
Veterinarian: DrLucy, Veterinarian replied 8 years ago
That's odd. Short of doing a brain scan, there is probably not a good way of ruling out the brain tumor possibility. Prednisolone, at immune suppressive doses, helps most auto-immune diseases, but there are some that have to be treated with other drugs. I am curious to know which tests originally indicated myasthenia gravis and what the more recent tests were (the ones sent to the States) that came back negative. It certainly seems like prednisolone treatment would be the way to go. I hope it helps. Thank you very much for the update.
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Customer reply replied 7 years ago
Hello!

I just want to tell that Samet is really good. he takes one tablet of prednisolone every two days and 3/4 mestinon 3 times a day. it is quite a lot of medicine, but he looks perfectly good, eats like he never ate before and plays cheerfully!tahnk you very much for all you attention!
Veterinarian: DrLucy, Veterinarian replied 7 years ago
That is great to hear. I am so glad!
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Customer reply replied 7 years ago
Hello DrLucy, it is me again. Samet has gotten very bad in just one day!I have moved into a new apartment and I was busy with cleaning/packing, etc. and I did not give the prescribed amount of medicine to him. (i was strict on prednisolone -once every two days-but I sometimes gave two times or sometimes one time of 3/4 mestinon tablet instead of the prescribed 3 times a day. I also thought maybe he could live with 2 times a days and not take that many pills everyday) yesterday i left home, he was ok, i got back home he was walking in a crooked way, as if he had a hunch back of some kind..I don't know what to do. If it goes like that we are going to reach the toxicity limit of mestinon and he wont be able to take it anymore. maybe increasing prednisolone would work..what do you suggest?do you suggest we increase mestinon to 1 tabletX3 times a day or try a little with 3/4x3 times a day and if it does not work, we talk to his vet? Thank you.
Veterinarian: DrLucy, Veterinarian replied 7 years ago
I would highly recommend talking to his vet, who may be able to adjust his doses more effectively. Until then, however, I would increase his prednisolone to 5 mg daily. As far as Mestinon goes, you should be able to give it twice a day--The typical dose is 2 mg per kg body weight. I am not sure how much he weighs or what the tablet strength is, but I am figuring he would need approximately 6 - 7 mg per dose, for flare-ups. Again, however, check with his vet. There might be other adjustments that need to be made. Please let me know how everything goes.
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Customer reply replied 7 years ago
Hello. Our vet has not returned us yet. My search on the web leads me to the decision of increasing Prednisolone. Samet weighs around 5 kilos and mestinon tablet is 10 mg. So he gets 22.5 mg a day. Prednisolone tablet is 2.5 mg and he takes it every two days. He took one yesterday. Instead of increasing mestinon to 30 mg a day, I will give a whole tablet of Prednisolone every two days as prescribed and a half tablet in between. Do you think I can give more? I dont want to overdose him.
Veterinarian: DrLucy, Veterinarian replied 7 years ago
I would not increase his Mestinon any further, but you can safely increase his prednisolone dose. He could get 3 tablets (total of 7.5 mg) daily. He should be able to stay on this dose for at least a week or two before tapering it. Good luck.
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Customer reply replied 7 years ago
Hello!
I have not been to the vet yet, i have an appointment for the 1st of november but Samet has already gotten better. I think moving in a new place caused stress on him and therefore increasing prednisolone (i gave 1 tablet each day for 5 days) helped him to overcome the stress. He is much better now. i still give 3/4 mestinon x3 times a day and i am back to 1 prednisolone every two days. he is really good. thank you for your support!
Veterinarian: DrLucy, Veterinarian replied 7 years ago
That is good news. I am so glad that he is better.
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Customer reply replied 7 years ago
Hello Dr. Lucy,

It has been some time since i havent upgraded you with Samet's situation. He has been fine. now he is 2 years old, taking his meds, although we reduced the dosage of mestinon to twice a day from 3 times a day. he eats and drinks fine, he poops and pees perfectly. he threw up hairballs a few times recently but i guess it is normal. there is actually something that bothers me. that is, sometimes, especially after he drinks water, he gags, retches and hacks as if he wants to throw up, maybe a hairball, but nothing comes out. do you think it might be something important?

thank you very much,

Celen and Samet.
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Hello, my pet rabbit has a head tilt, i hav taking him to the vet and she thougth at firstit was an ear infection and gave him baytril. He since then was showing signs, unsteady on his feet abd rollin… read more
Dr. G.
Dr. G.
DVM
711 satisfied customers
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Disclaimer: Information in questions, answers, and other posts on this site ("Posts") comes from individual users, not JustAnswer; JustAnswer is not responsible for Posts. Posts are for general information, are not intended to substitute for informed professional advice (medical, legal, veterinary, financial, etc.), or to establish a professional-client relationship. The site and services are provided "as is" with no warranty or representations by JustAnswer regarding the qualifications of Experts. To see what credentials have been verified by a third-party service, please click on the "Verified" symbol in some Experts' profiles. JustAnswer is not intended or designed for EMERGENCY questions which should be directed immediately by telephone or in-person to qualified professionals.

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