# mmm help please



## Rott lover (Jan 2, 2015)

is there anyone who can help with mmm questions on here


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## rona (Aug 18, 2011)

There should be someone who could help with virtually any question you'd like to ask


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## Rott lover (Jan 2, 2015)

I have a 4 year old rott named oliver and he has just been diagnosed with mmm.he is about 120 lbs and has been put on 50 mg of prednisone twice daily.He went in on tuesday and had to be put under and had xrays and teeth cleaning done.Since he came back from the vet he can hardly open his mouth but when he went in he could open it a couple of inches.He has also been really skittish and jumpy since he came back.His muscles have all sunken in on his cheeks and head.I have read many storys of dogs making great progress but how long does it take?It has been 3 days and he still seems worse off than when he went in.Any help would be very gratefull.


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## Rott lover (Jan 2, 2015)

Thank you rona


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## rona (Aug 18, 2011)

I can't help with this but hopefully someone will be able to help. It may take a while for the right person to see your post, so please check back over the next few days and hopefully you can get some help


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## Rott lover (Jan 2, 2015)

Thank you for the encouragement.This situation just has me so frustrated and infuriated all at the same time.


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## Rott lover (Jan 2, 2015)

I have done a lot of research on this myself and it seems that the dosing may be very light and i am really frustrated that my baby is not even close to the same as when he went in.


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## rona (Aug 18, 2011)

Rott lover said:


> Thank you for the encouragement.This situation just has me so frustrated and infuriated all at the same time.


It must be upsetting to. We have a vet that posts on here so I will give them a link to this thread


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## Rott lover (Jan 2, 2015)

Thank you very much Rona


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## Rott lover (Jan 2, 2015)

Yesterday i reached over to pet him and as soon as my hand touched him he fliched and cowered away from me.That is not how my baby reacted to me before this.What is even more frustrating is it seems his mouth is much worse since we took him in.


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## rottiepointerhouse (Feb 9, 2014)

Sorry to hear about Oliver. I have no idea what MMM is - could you explain please?


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> is there anyone who can help with mmm questions on here


Im assuming you mean Masticatory Muscle Myositis. It involves Inflammation of the muscles in the case of MMM it effects the head and jaws. I know its one of the auto immune diseases. The body starts for some reason not to recognise the muscles of the head and jaws as its own, and starts to produce antibodies, which then attack the muscles and cause pain, it then causes loss of the muscles making it hard for the dog to open its mouth and eat or drink.

Myositis can affect other muscles or groups, but in MMM I believe there is a blood test to look for antibodies to confirm it is MMM.

Because the case is the immune system getting confused and over reacting and producing these antibodies against its own muscles, then the treatment is immuno suppressants to suppress the immune system and stop it doing it.
Like other auto immune diseases often the first choice is steroids like prednisolone although there are other immuno suppressant medications. Sometimes they can eventually be weaned off the medication but not always.

Like most auto immune conditions immuno suppressants will work, but it can sometimes take a good while before it seems to be getting better and in fact can seem to get worse before it gets better, it can I believe take a good few weeks, because those antibodies have to be stopped and it will take awhile before it gets rid of them and stops them attacking the muscle.

Its something I know about but not in great detail as I have a dog with another form of auto immune disease, but if you have any questions I cant answer I would be only to happy to help you with some research and see what I can find out for you.


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## Ceiling Kitty (Mar 7, 2010)

Progress with MMM isn't always fast. I would normally expect a response within 1-2 weeks of starting steroids, by which I mean the jaw starting to open a little more and pain to start decreasing.

These dogs often look worse before they look better, because the steroids control any residual swelling in the muscles and they seem to 'sink in' even more. Often, the muscle atrophy never resolves and many dogs always have poor muscling on their head following an episode of MMM.

Generally, where there is a response, steroid therapy has to continue for at least six months. Stopping too soon is a common cause of relapse (although this can happen anyway due to the nature of the disease). 

If you think the dose needs changing, speak to the vet about it. High immunosuppressive doses are usually given at first, tapering once there is a response. Obviously the severity of side effects is greater with higher doses.

Is he on any pain relief? It might be worth talking to the vet about this as well, as some adjunctive pain relief may help him feel more comfortable while the steroids are getting to work. He may feel worse after his procedure because they will have had to open his mouth and manipulate his jaw for the X-rays and dental work.

For cases that don't respond to prednisolone alone, azathioprine is a common plan B.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> I have a 4 year old rott named oliver and he has just been diagnosed with mmm.he is about 120 lbs and has been put on 50 mg of prednisone twice daily.He went in on tuesday and had to be put under and had xrays and teeth cleaning done.Since he came back from the vet he can hardly open his mouth but when he went in he could open it a couple of inches.He has also been really skittish and jumpy since he came back.His muscles have all sunken in on his cheeks and head.I have read many storys of dogs making great progress but how long does it take?It has been 3 days and he still seems worse off than when he went in.Any help would be very gratefull.


Had not read this far down so just answered your first post.

Really you should discuss any queries with your vet, however I did find this which looks like a reliable source on the Diagnosis and treatment of MMM

TREATMENT
A favorable outcome in masticatory muscle myositis
necessitates early accurate diagnosis and appropriate
therapy. Treatment is centered on aggressive immunosuppression,
which is generally achieved by corticosteroid
administration. The cornerstone of therapy is
prednisone at 2 mg/kg PO bid during the acute phase.
This dose should be maintained until maximum jaw
function has been regained and CK levels have returned
to normal. At that time, prednisone can be slowly
tapered to the lowest every-other-day dose that abates

If he is 120lbs then that would be 54.5 Kgs so if the dose according to the above is 2mg per Kg then that would be 109mg
not sure if that is once a day or could possibly be twice. Maybe show your vet the link especially the treatment part and see what he thinks?

If you haven't seen the whole article it looks like a very informative one so may be worth reading through.

http://vetneuromuscular.ucsd.edu/publications/melmed.pdf


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## Ceiling Kitty (Mar 7, 2010)

Sled dog hotel said:


> Had not read this far down so just answered your first post.
> 
> Really you should discuss any queries with your vet, however I did find this which looks like a reliable source on the Diagnosis and treatment of MMM
> 
> ...


^^^ But don't change your dog's dose without speaking to your vet first.


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## Rott lover (Jan 2, 2015)

Sled dog..That would be correct.When we first took him in he could at least open his mouth a couple of inches.Now he only opens it a half inch or so.It has been one week since he whent in and there hasn't been much improvement since.I can tell that the swelling has gone down since i was doing a neck and jaw massage and his cheeks and muscles are actually loose for the first time in months.I have talked to my normal vet and he has talked about pain meds as well.we just wanted to give him a little time for the steroids to work.He does seem to be in pain but the drooling has finally subsided.I was thinking the steroids were going to be more like lightning in a bottle with immediate results but i have not seen anything more than half baby steps.As i stated after one week he is not even as good as he was before we took him to have him checked out.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> Sled dog..That would be correct.When we first took him in he could at least open his mouth a couple of inches.Now he only opens it a half inch or so.It has been one week since he whent in and there hasn't been much improvement since.I can tell that the swelling has gone down since i was doing a neck and jaw massage and his cheeks and muscles are actually loose for the first time in months.I have talked to my normal vet and he has talked about pain meds as well.we just wanted to give him a little time for the steroids to work.He does seem to be in pain but the drooling has finally subsided.I was thinking the steroids were going to be more like lightning in a bottle with immediate results but i have not seen anything more than half baby steps.As i stated after one week he is not even as good as he was before we took him to have him checked out.


Maybe have a word with the vet and check the dose, because according to that link on diagnosis and treatment, the weight/medication ratio fits but Im unsure if it should be twice a day, ie 100mg x 2, from what you have said he is on 50mg x 2 daily.

I know you do have to be careful with steroid dosing in most circumstances, but with the auto immune conditions it does have to be more aggressive then with other general use. Im sure I read somewhere to when I was checking for you, that over steroid use can cause muscle wasting, which is not what you want, so I should imagine its a finite balancing act, so they should never be altered or discontinued without veterinary supervision. Just maybe double check with him for your own peace of mind. It is though not something that has an instant reaction and turn around, the treatment is a relatively slow process.


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## Sled dog hotel (Aug 11, 2010)

Forgot to add in case you missed it shoshannah replied too, after my post and she is a veterinary surgeon, so if you did skip the post double check above.


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## Rott lover (Jan 2, 2015)

Sled Dog thank ou very much for the article i will be printing that for further study


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## Rott lover (Jan 2, 2015)

sled dog.I have been checking and talking back and forth with my normal vet and he was telling me that they usually start around half to see where that puts things.As i was saying the swelling seems to be down but there is not much progess with him opening his mouth.My normal vet has said that will come when two things have been reighned in hand in hand and that is the swelling and the pain.So i think the swelling is under control and brought down so now i think we need to work on the pain side of things.He doesnt seem to be in a lot of pain most of the time but oliver has always been very stowic in that way.


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## Rott lover (Jan 2, 2015)

also yesterday was the first day he seemed to be in good spirits.He ran out and met me at the door and did his sit pretty for me to give him lovins and was playing a little bit as well.I was very happy about that because all he has done is lay around since i got him home from the other vet.


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## Rott lover (Jan 2, 2015)

At this point i am just trying to arm myself with as much information as i possably can.I know since his muscles are still being used and they are loosened up that the prognosis is much better than some as this means that he has a greater chance for full recovery as long as we can keep things on a forward path.i am just concerned that the forward path is supposed to be moving faster than it is.However from what i am learning is this path is made of baby steps and not leaps and bounds.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> At this point i am just trying to arm myself with as much information as i possably can.I know since his muscles are still being used and they are loosened up that the prognosis is much better than some as this means that he has a greater chance for full recovery as long as we can keep things on a forward path.i am just concerned that the forward path is supposed to be moving faster than it is.However from what i am learning is this path is made of baby steps and not leaps and bounds.


If he is improving and a lot happier then it looks like everything is going in the right direction I would have thought. It seems its well documented that its not a quick turn around, so any progress as you say in the right direction must only be good. If the dose wasn't doing its job then in theory at least you wouldn't be seeing progress at all, or it would be worse thinking logically.


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## Sled dog hotel (Aug 11, 2010)

Just been checking to see if I can find you anything else. I did manage to find this by a RCVS and European specialist in veterinary neurology. Its about all sort of conditions full link is below but MMM is mentioned. Ive copied and pasted the bit on MMM to save you searching but the full link is at the bottom.

Masticatory muscle myositis
Masticatory muscle myositis (MMM) is an auto-immune, focal inflammatory myopathy with clinical
signs restricted to the muscles of mastication (masseter, temporalis, pterygoid and rostral
digastricus) which are innervated by the mandibular branch of the trigeminal nerve. Masticatory
muscles contain a unique muscle fiber type (type 2M) that differs both histochemically and
biochemically from fiber type present in limb muscles (types 1A and 2A). Biopsies of dogs with
MMM are characterised by intense multifocal lymphocytic and plasmacytic perivascular
infiltration, occasional eosinophils, necrosis and phagocytosis of type 2M myofibers. Circulating
auto-antibodies against masticatory muscle type 2M fibers (fiber type-specific auto-antibodies)
can be detected in more than 80% of dogs with MMM and are the basis of serology testing for
this condition. Despite many hypotheses proposed to explain the formation of auto-antibodies
directed specifically against type 2M fibers including molecular mimicry, the primary initiating
factor to this auto-immune disorder is unknown.
The most common clinical signs associated with MMM are inability to open the jaw, jaw pain, and
masticatory muscle atrophy. Some dogs may present with pyrexia, mandibular
lymphadenopathy, trismus, swollen and painful masticatory muscles, and bilateral exophthalmos
from swelling of the pterygoid muscles during the acute phase of the condition. Many owners
however do not recognise a problem until the chronic phase when marked muscle atrophy and
enophthalmos because of atrophied pterygoid muscles are present.
MMM can be seen in any breed of dog with no apparent gender predilection. The average age of
onset is 3 years, although dogs as young as 4 months of age with MMM have been reported.
Diagnosis can be confirmed by detection of significant levels of anti-type 2M muscle fiber
antibodies in the serum of suspected dogs. False negative results may occur if corticosteroids
have been administered before sampling. Serum creatinine kinase (CK) levels are modestly
elevated in some dogs in the acute phase of MMM. EMG can help to confirm the selective
involvement of masticatory muscles and differentiate MMM from polymyositis. However, EMG
may be normal in dogs with end-stage disease because of severe fibrosis and myofiber depletion.
Evaluation of muscle biopsy taken from the masticatory muscles can also provide diagnostic
confirmation of the disease as well as prognostic information by determining the stage of the
disease.
Immunosuppressive doses of corticosteroids (prednisolone 1 to 2 mg/kg every 12 hours orally)
comprises the cornerstone of treatment of MMM. This dose should be maintained until jaw
function and serum CK level (when initially elevated) have both returned to normal. Dosage of
prednisolone is then slowly decreased over a few months to the lowest every-other day dose that
keeps the clinical signs at bay. Other immuno-suppressive agents such as azathioprine (1 to 2
mg/kg every 24 hours orally) are indicated in dogs that failed to respond to corticosteroids
treatment or that relapse when the dose is tapered. Short-term prognosis is usually good
however many dogs that are treated for insufficient period of time will experience relapses. Lifelong
treatment is occasionally necessary. The prognosis of dogs in the more chronic phase of
the disease (gradual replacement of myofibers by fibrous tissue) is guarded. Persistent muscle
atrophy is a common manifestation of the disease.

http://www.veterinarywebinars.com/assets/NSK_Session2_Notes.pdf


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## Rott lover (Jan 2, 2015)

Thank you so very much sled dog.I am very gratefull for all the info and help in this.I have just been so frustrated about all this since noone really had any answers for me.You have helped to ease my mind a little as to what to expect and knowing at leas what is coming in the road ahead.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> Thank you so very much sled dog.I am very gratefull for all the info and help in this.I have just been so frustrated about all this since noone really had any answers for me.You have helped to ease my mind a little as to what to expect and knowing at leas what is coming in the road ahead.


Your very welcome. Not the same condition, but Ive been in the position when my dogs are ill, in pain, and your are not sure what to do or what might be going on and worried sick. Im glad its been of some help at least. Keep us updated how your both doing. x


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## Rott lover (Jan 2, 2015)

I will do that,Well,I will let you know how he is comining along I will be a mess and a wreck until he can actually use his mouth.


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## Rott lover (Jan 2, 2015)

It has been a while since i posted a reply so i thought i would give everyone an update.Oliver is finally able to open his mouth a little again.I have seen his fangs actually clear each other.He is using his tounge again and he even licked his own nose for the first time in a while.So progress is being made it is just going slowly.I wish it would go faster so we can reduce him a little on the pills.He starts panting very quickly and he seems to be losing weight even though he seems to be eating like a horse.He is eating twice to three times what he used to.he is also having accidents in the house.I know that is from the steroids.One thing that still bugs me is that when he starts panting he wont open his mouth he just raises his cheeks and it sounds horrable.I know he can open his mouth at least a little but he just wont when he pants.The vet said we will keep him on 50 mg prednesolone as long as there is any kind of progress for at least a month and we will work from there.He origionally said he wanted to keep him on this dosage untill he could open his mouth completely as normal.Does this seem right?that seems like a very high dosage to keep him on for a very long time.just wondering.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> It has been a while since i posted a reply so i thought i would give everyone an update.Oliver is finally able to open his mouth a little again.I have seen his fangs actually clear each other.He is using his tounge again and he even licked his own nose for the first time in a while.So progress is being made it is just going slowly.I wish it would go faster so we can reduce him a little on the pills.He starts panting very quickly and he seems to be losing weight even though he seems to be eating like a horse.He is eating twice to three times what he used to.he is also having accidents in the house.I know that is from the steroids.One thing that still bugs me is that when he starts panting he wont open his mouth he just raises his cheeks and it sounds horrable.I know he can open his mouth at least a little but he just wont when he pants.The vet said we will keep him on 50 mg prednesolone as long as there is any kind of progress for at least a month and we will work from there.He origionally said he wanted to keep him on this dosage untill he could open his mouth completely as normal.Does this seem right?that seems like a very high dosage to keep him on for a very long time.just wondering.


As you say they are all the rotten side effects that you get with steroid medication unfortunately, Ive had the same when any of mine have been on steroids, especially the drinking and peeing excessively and the increased appetite. I had a cushings dog too where they produce too much natural steroid and the symptoms are the same.

According to that first link I gave you and copied and pasted the treatment regime.

TREATMENT
A favorable outcome in masticatory muscle myositis
necessitates early accurate diagnosis and appropriate
therapy. Treatment is centered on aggressive immunosuppression,
which is generally achieved by corticosteroid
administration. The cornerstone of therapy is
prednisone at 2 mg/kg PO bid during the acute phase.
This dose should be maintained until maximum jaw
function has been regained and CK levels have returned
to normal. At that time, prednisone can be slowly
tapered to the lowest every-other-day dose that abates

seems to say that the dose should be maintained until maximum jaw function has been returned, which I would assume its back to normal or as fully normal as you are likely to get.

The second link I gave you and C&P the relevant bit on MMM as it covered other conditions too to save you hunting on the full Link says.

Immunosuppressive doses of corticosteroids (prednisolone 1 to 2 mg/kg every 12 hours orally)
comprises the cornerstone of treatment of MMM. This dose should be maintained until jaw
function and serum CK level (when initially elevated) have both returned to normal. Dosage of
prednisolone is then slowly decreased over a few months to the lowest every-other day dose that
keeps the clinical signs at bay. Other immuno-suppressive agents such as azathioprine (1 to 2
mg/kg every 24 hours orally) are indicated in dogs that failed to respond to corticosteroids
treatment or that relapse when the dose is tapered. Short-term prognosis is usually good
however many dogs that are treated for insufficient period of time will experience relapses. Lifelong
treatment is occasionally necessary. The prognosis of dogs in the more chronic phase of
the disease (gradual replacement of myofibers by fibrous tissue) is guarded. Persistent muscle
atrophy is a common manifestation of the disease.

Again seems to confirm that the dose should be maintained until jaw function
is normal and then they should be gradually decreased and tapered off.

There are other Immuno suppressant drugs that can be used its mentioned in both if the steroids don't seem to be working. I think there may be more then one something called Azathioprine is one that is mentioned if you read above.
Not sure what the side effects of that are should be easy enough to check.
Obviously its something you would have to speak to your vet about.

The only other thing I can think of, is maybe ask for a referral to a specialist in MMM and auto immune diseases for a second opinion, you can ask for one and if he is insured your insurance should cover it I would have thought.


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## Sled dog hotel (Aug 11, 2010)

The following links are on Azathioprine, they may not be the best in the world but it should give you some information about the medication.

01 Azathioprine (Imuran) - VeterinaryPartner.com - a VIN company!

Azathioprine | VCA Animal Hospitals

http://www.forestlodgevets.com/drug_information_leaflets/Azathioprine.pdf

At least it gives you 3 and something to cross reference on.


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## Rott lover (Jan 2, 2015)

Thank you for the info sled.I reread all the info you sent me before and saw that as well.I just feel bad for him.He doesnt want to do anything except lay around and do nothing.He wont play with anything and i am afraid to get the laser light out for fear he will hurt himself.I talked to the vet about the dosage and he said he wants to leave his dosage at 50 mg twice a day since there is forward progress and it will minimize the stress on him as well.I just hate that he is getting skinny so i guess i am just going to have to feed him alot more.The vet said that it is normal from the prednesolone since it supercharges his system.I guess i am just wishing things would happen faster than what they are.I did see him yawn last night and that was the first i had seen in a long time.That made me happy.As i said before he is now opening his mouth a good inch and even sometimes two inches and he is able to use his tounge again.Thank you for all your help and your reassurence in all this.This is just alot to go through.Feel free to expess any thoughts and thanks again.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> Thank you for the info sled.I reread all the info you sent me before and saw that as well.I just feel bad for him.He doesnt want to do anything except lay around and do nothing.He wont play with anything and i am afraid to get the laser light out for fear he will hurt himself.I talked to the vet about the dosage and he said he wants to leave his dosage at 50 mg twice a day since there is forward progress and it will minimize the stress on him as well.I just hate that he is getting skinny so i guess i am just going to have to feed him alot more.The vet said that it is normal from the prednesolone since it supercharges his system.I guess i am just wishing things would happen faster than what they are.I did see him yawn last night and that was the first i had seen in a long time.That made me happy.As i said before he is now opening his mouth a good inch and even sometimes two inches and he is able to use his tounge again.Thank you for all your help and your reassurence in all this.This is just alot to go through.Feel free to expess any thoughts and thanks again.


Glad that you are beginning to see more progress all be it slower then you would like. It must be so hard and you must be so anxious. Im hoping that maybe now the steroids are getting on top of things more the upward progress will begin to be a bit quicker now.

I know you do have to be careful with steroid use as I mentioned before when I was trying to sort out some decent reliable links for you, Im pretty certain I read that if you over do the steroids especially it can cause the muscles to weaken and waste more.

Keep us updated on how he is doing.


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## Rott lover (Jan 2, 2015)

I have to say this weekend brought on some very good results and also some highlighted side effects as well.I was giving him his rice and hamburger in his big bowl with his soft food on top and he is opening his mouth about halfway and the best part is when he was done he actually licked his nose and lips clean.Then he went and tanked out his water bowl.I noticed that he gets really overworked very easily which is why he doesnt want to do anything at all.I opened the window just a crack to let some fresh air in the house and oliver came right over and layed under that window the entire time it was open.We left the window open long after we were cold since it seemed he was really enjoying it.It seemed to slow his breathing down quite a bit and also seemed to let him fall into a deep sleep.The first time in a while i have seen him fall asleep and start snoring.Usually he wont lay anywhere for more than 15 to 20 min.Then he will get up and move and the cycle starts all over again.I took alot of time to try to get him to play this weekend and i saw that the want was there and you could tell that he really wanted to but he was just too physically tired.I did this with several things at several different times throughout the weekend with the same results.It really makes me sad that he has the want to play but is just too tired to do so.Also both sat and sun he ate more than i had ever seen him eat.
One thing that really does bother me is when he starts panting he wont open his mouth much at all.He opens his mouth just a little and raises his cheecks up and basically pants through his teeth.I know he can open his mouth but he doesnt do it when he pants.I know it is not pain related.I have given him pain pills during the day and it hasnt made any difference in any of his mouth actions.This i would take as a good thing meaning there is no pain there.Now he just has to work the muscles to get them working stretched out and to realize he can use them again.
Thank you for listening to my going on about this just trying to put it all out there and keep myself sane.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> I have to say this weekend brought on some very good results and also some highlighted side effects as well.I was giving him his rice and hamburger in his big bowl with his soft food on top and he is opening his mouth about halfway and the best part is when he was done he actually licked his nose and lips clean.Then he went and tanked out his water bowl.I noticed that he gets really overworked very easily which is why he doesnt want to do anything at all.I opened the window just a crack to let some fresh air in the house and oliver came right over and layed under that window the entire time it was open.We left the window open long after we were cold since it seemed he was really enjoying it.It seemed to slow his breathing down quite a bit and also seemed to let him fall into a deep sleep.The first time in a while i have seen him fall asleep and start snoring.Usually he wont lay anywhere for more than 15 to 20 min.Then he will get up and move and the cycle starts all over again.I took alot of time to try to get him to play this weekend and i saw that the want was there and you could tell that he really wanted to but he was just too physically tired.I did this with several things at several different times throughout the weekend with the same results.It really makes me sad that he has the want to play but is just too tired to do so.Also both sat and sun he ate more than i had ever seen him eat.
> One thing that really does bother me is when he starts panting he wont open his mouth much at all.He opens his mouth just a little and raises his cheecks up and basically pants through his teeth.I know he can open his mouth but he doesnt do it when he pants.I know it is not pain related.I have given him pain pills during the day and it hasnt made any difference in any of his mouth actions.This i would take as a good thing meaning there is no pain there.Now he just has to work the muscles to get them working stretched out and to realize he can use them again.
> Thank you for listening to my going on about this just trying to put it all out there and keep myself sane.


Steroids can make them pant more and will usually make them hungry so eat more too. Good news that he seems to be able to a lot more movement wise with his mouth.The steroids make them drink more too.

The only real way a dog too cool down is to pant and draw air over the mucos membranes and tounge this, then cools the blood down, but then its got to circulate through the body, so cooling isn't a quick process.

You can get cooling pads for dogs in the summer, wonder if he is getting hot and cant cool himself down at the moment and his uncomfortable one of those may help? 
Amazon.co.uk: dog cooling mat
Other then that if you have a fan maybe that may help. The only thing I would say is maybe check with the vet that cold or cold air wont cause discomfort to the jaws or pain with the muscles. It may be OK, but often when you have muscle pain or stiffness just generally cold can sometimes make it worse, although having said that my osteopath tells me to use cold packs on my back when the muscles tense up to help.

Maybe when there is food and because of his increased hunger, he opens his mouth more without thinking a sort of an involuntary thing if that makes sense? With the panting though maybe there is a bit of association still with the previous pain he may have had, and he is still a bit wary about it.

Hopefully now you are seeing a lot more movement it wont be too long now before he is a lot more comfortable and relaxed again. I think once they have the movement back then they will hopefully start to try to reduce the steroid dose a bit gradually, and that should make him feel better.

Your very welcome btw, off load all you want and when you need too, sometimes it does help and its often better then sitting there with it all going round in your head.


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## Rott lover (Jan 2, 2015)

That would actually make a lot of sense.On friday night we had bw3 for dinner and the wife gave him a fairly large boneless wing off the fork.He took it and didnt even think about it.The surprising part it when he took it he grabbed it and actually chewed it in the back teeth .That amazed me to see.When he eats his kibbles he usually doesnt crunch many of the kibbles but i think that might be because the kibbles are really small so it is probably easier for him to just swallow them.Just a thought but maybe i should get him some bigger kibble food and see if i can get him to start chewing on his kibbles.I know for hamburger and rice there really is not any chewing required.Just opening of the mouth to get it in and swallowing it.What are your thoughts.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> That would actually make a lot of sense.On friday night we had bw3 for dinner and the wife gave him a fairly large boneless wing off the fork.He took it and didnt even think about it.The surprising part it when he took it he grabbed it and actually chewed it in the back teeth .That amazed me to see.When he eats his kibbles he usually doesnt crunch many of the kibbles but i think that might be because the kibbles are really small so it is probably easier for him to just swallow them.Just a thought but maybe i should get him some bigger kibble food and see if i can get him to start chewing on his kibbles.I know for hamburger and rice there really is not any chewing required.Just opening of the mouth to get it in and swallowing it.What are your thoughts.


One of mines a right Diva and I have to change her food and rotate it on a regular basis. Ive actually just tried a new Natures menu dried, There is a complete one, that has baked chunks containing oats, fruit and vegetables, and also you get cubes of freeze dried raw meat in it too. You can also get the Mighty mixer that is just the baked crunchy bit containing oats and the fruit and veg and you can add what meat you want yourself. These love it, and they are quite big chunks too.
Ive been giving her the complete for breakfast, and using the mixer and raw meat for evening meals, they said you can mix it with raw, and haven't had any problems with upset stomachs. I know if the kibble is small sometimes especially as in his case his probably ravenous with the steroids they can tend to inhale them and swallow without it touching the side, Ive got one whos a dustbin and would eat anything and madam who I have to change foods as I said on a rotation basis. As long as you think he can chew harder or crunchy stuff safely now I should imagine something like that would be OK. James wellbeloved used to do big kibble chunks too for large breeds, Ive used those in the past.

New seriously meaty Country Hunter raw dog food | Natures Menu


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## Rott lover (Jan 2, 2015)

right i just think maybe the bigger chunks will force him into chewing before swallowing making him use those muscles and making him realize he can do it with out pain


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## Sled dog hotel (Aug 11, 2010)

Out of curiosity I have just had a check to see if any sort of physio theraphy 
or something like massage is recommended once you start to see an improvement that may help. I managed to find this.

Therapy

Therapy for acute and chronic cases of MMM consists of immunosuppression with corticosteroids. In the acute cases, oral prednisone at 1mg/kg to 2mg/kg twice daily is given until the jaw function returns to normal. Physical therapy should be started as soon as possible in an attempt to normalise the masticatory muscles tone and to increase the jaw opening. Encouraging the dog to play with tennis balls or chew rawhide is recommended. Most dogs cannot eat properly and food should be blended to a consistency for licking. In most cases, a rapid clinical improvement is seen. Once the jaw function returns to normal, the prednisone dose is gradually tapered down and is maintained for four to six months.

Masticatory muscle myositis in dogs - Publications - Vetsonline.com

It mentions encouraging chewing on a few other sites too. Im wondering if something like a stuffed Kong might help too.

The only thing you would need I would suspect with trying him with something like bigger Kibble is that he is ready for it, and will be able to chew it without it getting stuck or him coughing and choking and your not trying it too soon.


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## Rott lover (Jan 2, 2015)

also it might help to start working those muscles and building them back up.


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## Rott lover (Jan 2, 2015)

I was thinking of trying to mix it in with his smaller kibbles to see if he will attempt it and if he does not want them i know he will just nose them out lol.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> also it might help to start working those muscles and building them back up.


According to the above link I found as well as others it does seem to say that encouraging chewing and using their mouths does help. The sooner he is better enough to use them and the more he can I would think the better. Lack of use muscles can waste quickly. I remember when my daughter broke her arm and it was in plaster for six weeks and the lack of muscle in the arm was pretty astounding.


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## Rott lover (Jan 2, 2015)

i am waiting for my vet to call me so i will discuss this with him to see what he thinks


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## Rott lover (Jan 2, 2015)

i think once his dosage is lowered a little to get him back to normal and wanting to do things and play so he has some energy it will be alot easier to do and to get him munching on his bone again.Right now the prednisolone has him just completely wiped out.I do massage his muscles on a daily basis and he just melts into my lap.That in itself is funny considering how big he is.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> i think once his dosage is lowered a little to get him back to normal and wanting to do things and play so he has some energy it will be alot easier to do and to get him munching on his bone again.Right now the prednisolone has him just completely wiped out.I do massage his muscles on a daily basis and he just melts into my lap.That in itself is funny considering how big he is.


Have you tried Tellington touch? There is a short video explaining it and a demo.






If you are interested and have longer to kill there is also a seminar on it.


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## Rott lover (Jan 2, 2015)

i will watch both when i get home


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## Rott lover (Jan 2, 2015)

So i talked to the vet today and he is going to do some research and see what he can find.He thinks oliver is having adverse affects to the prednisolone and it might be affecting his whole body.He said we might need to come in for some bloodwork to see what is going on but it sounds like we may need to ween him off the pred fairly quickly or at least drop the dosage.He said there are several different meds we can give him which i know is true.I told him about the fact that he wont do anything and seems completely wiped out at all times.He said that is very concerning since he knows oliver is a very very active boy.He said he will get back to me tomorrow so i guess we will see tomorrow.


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## Rott lover (Jan 2, 2015)

also i weighed him last night and in about 1 week he has lost about 25 lbs.He is really skinny as a rail now.All his ribs and bones and spine are sticking out but he is eating like a horse.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> So i talked to the vet today and he is going to do some research and see what he can find.He thinks oliver is having adverse affects to the prednisolone and it might be affecting his whole body.He said we might need to come in for some bloodwork to see what is going on but it sounds like we may need to ween him off the pred fairly quickly or at least drop the dosage.He said there are several different meds we can give him which i know is true.I told him about the fact that he wont do anything and seems completely wiped out at all times.He said that is very concerning since he knows oliver is a very very active boy.He said he will get back to me tomorrow so i guess we will see tomorrow.





Rott lover said:


> also i weighed him last night and in about 1 week he has lost about 25 lbs.He is really skinny as a rail now.All his ribs and bones and spine are sticking out but he is eating like a horse.


How did the vet diagnose the MMM? I know there is a specific antibody test for MMM the 2M antibody titre test. That though has to be given I believe before any drugs are given as I think they can throw the tests off. Did they do this, and did they take any other bloods etc?

There is MMM which affects the head and jaws, but there is also other forms of myositis too and ones that effect the skeletal muscles.

Steroids can have adverse effects and can cause iantrogenic cushings which means veterinary induced. I know one members dog, who was given steroids for another condition steroid responsive meningitis had terrible symptoms until they started to reduce the dose.


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## Sled dog hotel (Aug 11, 2010)

On doing some checking MMM seems to be auto immune only, ie the body makes antibodies against its on Masticatory muscle. There is the acute phase where there is pain and the dog cant open or use its jaws. then you get the chronic stage where there is muscle atrophy (loss of muscle) apart from this though, there is no other neurologic or physical abnormalities. 
It seems that the diagnosis consists of complete blood count and chemistry profile including a Creatinine Kinase.



> DIFFERENTIALS AND DIAGNOSTIC TESTS
> Initial diagnostic testing should include a complete blood count and
> serum chemistry profile, including a creatine kinase (CK) level. Biochemical
> changes that have been documented in patients with masticatory muscle
> ...


So from that it looks like if the blood tests are done as part of the initial diagnosis things can show up to support the MMM, however with MMM the test for the antibodies is conclusive by all accounts. Its an American site obviously, but the 2M antibody test was also confirmed on a site from a veterinary specialists in the UK too as the diagnostic for MMM.

The above does mention Polymyosistis I did a quick check so far on the Merck Manual which is only the Pet Health edition so limited as regards info but it does say.



> Polymyositis
> 
> Polymyositis is an inflammatory muscle disorder in adult dogs that affects the entire body. It may be associated with immune-mediated disorders such as lupus erythematosus or myasthenia gravis. The condition can have a sudden onset, or it may be recurring and progressive. Signs include depression, lack of energy, weakness, weight loss, lameness, muscle tenderness or pain, and wasting away of muscle. Corticosteroids are generally recommended for treatment; however, other drugs that suppress the immune system may also be used. The outlook for recovery is favorable, although signs sometimes reappear.


Muscle Disorders in Dogs: Bone, Joint, and Muscle Disorders of Dogs: The Merck Manual for Pet Health

It seems that where MMM is confined to the Masticatory muscles only Polymyosotis according to that so far affects the entire body and gives other symptoms where MMM alone doesn't. MMM also can be diagnosed with the 2M titre test where the Poly form cant. Therefore if he has the other symptons, then something else has to be going on its either got to be other steroids or not confined just to MMM from what I can make out.

It is of course just a suggestion or maybe a possibility.


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## Sled dog hotel (Aug 11, 2010)

I just had a dig about to explore some thoughts/theory to see if MMM was known to come along with any other conditions, that may explain his other symptoms, putting aside for a moment that it could be purely the reaction to the steroids. I managed to find a review of 200 cases on canine Inflammatory Myopathies which include things like MMM, Polymyositis etc.

There is amongst other things something on there called over lap syndrome where apparently some dogs in the study which was done from Muscle biopsy
(another diagnostic for Myositis) had a combined diagnosis even of Polymyosits and MMM, so it seems you can even have both together amongst other things. MMM can also come alongside other auto immune or immune mediated problems too, and although MMM is auto immune in itself or alone, you can get other causes of Myositis in its other forms as well as the Polymyositis, infectious causes it seems amongst others. Although the treatment for MMM and other auto immune and immune mediated diseases is usually steroids or other immunosupressants, other causes would probably need other forms of treatment as they wouldn't work.

All pure theory and suggestion of course, but could possibly perhaps explain things.

Its getting late and Im getting a bit cross eyed and punchy now but I will link you to the study as said it was on a total of 200 dogs of varying breeds, Rottie btw way was included in the breeds too. I know you said the vet was in the process of doing some research anyway, so it may be of some use.

http://vetneuro.com/Portals/124/Forms/Evans Myopthies.pdf

See how you go with this or if it might be some help, hopefully the vet and more diagnosics will get to the bottom of it.

Next step maybe otherwise, would be too look at specific health problems known in the rotweiller and see if there are any conditions that may explain his illness or part of it.


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## poppy2714 (Nov 13, 2014)

Its good to hear that things are starting to turn around and he can open his mouth a bit more! We all worry about them when they aren't well!


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## Rott lover (Jan 2, 2015)

Wow sled I am so glad you are around.You are just a welth of knowledge and research.I should explain a little better and see what you think of this.When all this started was about four months agliver was starting to have trouble chewing on his bone.We simply thought that he had hurt himself on the bone.We didnt think much of it.After a bit of time he just stopped chewing on the bone all together.Thats when we becamee worried.At about the same time we noticed that he was chewing on one side of his mouth.SO we thought it was a bad tooth.We took him in and had jus a quick look at his teeth but found nothing wrong.fast forward about a month and the howling started with the wierd neck and head spasms.He would go to try to grab something and he would jerk his head up and sideways(which we now know was from the pain in his jaw).His head had just started to sink a tiny bit when we went to have the xrays done.As for his body he never had any issues untill he got put on the steroids.all through all of this he was always happy chipper and as playful as ever.Then when he got put under for the xrays is when all this started.he was completely out of it when we got him back from the vet who did the xray and all the blood work.They were the ones that started him on the pred.With in a week he was back to being normal and somewhat playful again and i could see the hollows in his head getting bigger.(the swelling was going down and making things look worse)However,About half way through the second week his breathing took on a very fast pace even while sleeping.It sounds like he is on the verge of panting even while he is sleeping.His heart rate started to go off the charts and he is very hot to the touch.at this time is when everything started to go down the tubes so to speak.No matter how much he ate he was losing weight and he got less and less playfull and wanted to do nothing but sleep.Doing anything gets him panting like crazy.
This is why i think it is from the pred as does the vet.The only thing that has changed in this is the pred.
All the bloodwork was done when he went in for the xrays and there was an elevated aspect of the blood that i dont remember that the vet said is very good indicator that he has mmm.The thing that threw everyone was that it started on one side and then moved to the other.
I dont know if any of this helps you but it helped me just typing it all out.I feel so lost and helpless in all this.It has been 4 weeks since the xrays and pred was started.Wow i cant believe it has been that long.I guess time gets away from you in these situations.
Again THANK YOU so very much.


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## Rott lover (Jan 2, 2015)

Now i know why you were crosseyed.That is alot of info to try to decypher at one time.After reading it all(man do i have a headach)None of the other issues quite fit with what is happening.I did find something that does kind of fit however.Cushings disease fits almost every aspect of what he is going through.I did some investigating on the side effects of pred as well and found that between the pred and cushings he is exhibiting every single side effect that they have listed.


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## Rott lover (Jan 2, 2015)

My vet just got back to me and he is thinking it could be pred induced cushings.I am taking him in tonight to get blood work done.so i guess we will see what happens when i get the results back.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> Wow sled I am so glad you are around.You are just a welth of knowledge and research.I should explain a little better and see what you think of this.When all this started was about four months agliver was starting to have trouble chewing on his bone.We simply thought that he had hurt himself on the bone.We didnt think much of it.After a bit of time he just stopped chewing on the bone all together.Thats when we becamee worried.At about the same time we noticed that he was chewing on one side of his mouth.SO we thought it was a bad tooth.We took him in and had jus a quick look at his teeth but found nothing wrong.fast forward about a month and the howling started with the wierd neck and head spasms.He would go to try to grab something and he would jerk his head up and sideways(which we now know was from the pain in his jaw).His head had just started to sink a tiny bit when we went to have the xrays done.As for his body he never had any issues untill he got put on the steroids.all through all of this he was always happy chipper and as playful as ever.Then when he got put under for the xrays is when all this started.he was completely out of it when we got him back from the vet who did the xray and all the blood work.They were the ones that started him on the pred.With in a week he was back to being normal and somewhat playful again and i could see the hollows in his head getting bigger.(the swelling was going down and making things look worse)However,About half way through the second week his breathing took on a very fast pace even while sleeping.It sounds like he is on the verge of panting even while he is sleeping.His heart rate started to go off the charts and he is very hot to the touch.at this time is when everything started to go down the tubes so to speak.No matter how much he ate he was losing weight and he got less and less playfull and wanted to do nothing but sleep.Doing anything gets him panting like crazy.
> This is why i think it is from the pred as does the vet.The only thing that has changed in this is the pred.
> All the bloodwork was done when he went in for the xrays and there was an elevated aspect of the blood that i dont remember that the vet said is very good indicator that he has mmm.The thing that threw everyone was that it started on one side and then moved to the other.
> I dont know if any of this helps you but it helped me just typing it all out.I feel so lost and helpless in all this.It has been 4 weeks since the xrays and pred was started.Wow i cant believe it has been that long.I guess time gets away from you in these situations.
> Again THANK YOU so very much.


You do get the acute phase of MMM which is when the pain starts and the trouble with the jaws, it then goes to the chronic stage where you start to get loss of the muscle too. Something called Creatinine Kinase does raise so don't know if that what they were talking about. However according to the diagnosis creatinine Kinase elevates in the acute stage but then it can go down again and return to normal or almost normal in the chronic stage. It seems that you can use it as an indicator, but with MMM the test seems to be that 2M antibody test to confirm as that is specific to MMM apparently with other forms of Myosotis, it doesn't show up. Although going from memory on that case history of 200 dogs, I believe they said that with the combined or what they called the overlap scenario where a number of dogs that had MMM and the Poly form the antibodies did show up. Not knowing what they did, ie if they did both the CBC and bio chemistry including the Creatinine Kinase and the 2M antibody test that's specific to MMM.

From what you say though symptoms wise it did follow the MMM pattern, and he seemed to be responding to the preds.

Naturally occurring cushings disease is an adrenal problem either a pituitary cause (most about 85% in dogs is pituatary) the other is what they call adrenal dependant cushings. The body for one of these two reasons starts to produce too much cortisol. you and I and dogs need cortisol to survive, there is actually another condition where you can go the other way called addisons disease where you don't make enough. Ive actually got low cortisol and have to take hydrocortisone to make up my levels, as I don't reach the levels and mine doesn't chuck out enough when Im under physical or mental stress, I had a dog with proper cushings too. As said before there is also whats known as iantrogenic cushings disease which means that's its veterinary medicine induced. So you get all the symptoms of real cushings, this though usually resolves again once off the meds or they are reduced. I think I mentioned a members dog had this when they had been on high dose steroids for steroid responsive meningitis for a good while. The symptoms did abate once the drugs were reduced and slowly tapered off.

It could be then from what you have said that his problems are all from the preds.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> My vet just got back to me and he is thinking it could be pred induced cushings.I am taking him in tonight to get blood work done.so i guess we will see what happens when i get the results back.


Looks like we cross posted again, while I was answering your other two posts.


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## Rott lover (Jan 2, 2015)

Lol,Sled yes we did again.It is ok at least we keep going right?


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## Rott lover (Jan 2, 2015)

The vet said he can test for this and even if he is positive then there are a couple of meds we can give him to get him back on track without doing anything with the pred or we can ween him off and start the other meds as well.I guess we will see when the blood comes back and see what we got when we get to that point.He had mentioned as well a whole body mytosis or muscle issues.But now that he has all the symptoms and seeing the report on the blood work from the other vet he doest think that is possable.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> Lol,Sled yes we did again.It is ok at least we keep going right?


I hope the blood tests his going to run will give you a clearer picture and it is just the preds. Could well be by the sounds of it. I know it then means the juggling with either reducing the dose but not too much and too soon, in case of a relapse and maybe even using one of the other immunosuppressant meds instead, but at least if it us Iantrogenic cushings you can reverse it.

I know with steroids you cant just stop them and they do have to be reduced and tapered off. You have to do it this way, because taking steroids with a normally functioning adrenal system and especially stopping them quickly before the adrenals have a chance to get back into their normal production and pattern you can get adrenal insufficiency, meaning that the dog can go the other way too low cortisol addisons.

Special precautions for use in animals

Pharmacologically-active dose levels may lead to atrophy of the adrenal cortex, resulting in adrenal insufficiency. This may become apparent particularly after withdrawal of corticosteroid treatment.

Adrenal insufficiency may be minimised by institution of alternate-day therapy if practical. The dosage should be reduced and withdrawn gradually to avoid precipitation of adrenal insufficiency.

NOAH Compendium of Animal Medicines: Prednidale Tablets - Clinical particulars

Obviously with auto immune conditions and things like MMM you have to use higher dose daily aggressive treatment.


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## Rott lover (Jan 2, 2015)

You are right on the money with that one sled.We can wean him off the pred slowly abut we can also start with the other meds as well.He also told me there is a med we can give him with the pred that will reduce this problem and wont affect the pred as well


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## Rott lover (Jan 2, 2015)

and according to all i have read he should be on the heavy dose untill he regains full movement and use of his jaws and mouth.Then he can be decreased slowly but must remain on it for 6 months for best chances of keeping it from reaccuring


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> The vet said he can test for this and even if he is positive then there are a couple of meds we can give him to get him back on track without doing anything with the pred or we can ween him off and start the other meds as well.I guess we will see when the blood comes back and see what we got when we get to that point.He had mentioned as well a whole body mytosis or muscle issues.But now that he has all the symptoms and seeing the report on the blood work from the other vet he doest think that is possable.


Oh there are more meds that you can use for sure, several in fact, they are listed in some of those links that I gave you.

On the 200 case thing of the canine myopathies I found it is possible to have more then one as I said. The main tests for diagnosis according to everything I have found seems to be certain things that can show up on complete blood counts and the biochemistry and things like that creatinine Kinase I mentioned that can by all accounts be an indicator of MMM at least, but then the actual diagnostic confirmation wise seems to be that specific 2M antibody test as regards to MMM, and for the other types of myositis including the poly one that affects the whole body the test for that seems to be muscle biopsy that is diagnostic as there isn't an antibody test.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> You are right on the money with that one sled.We can wean him off the pred slowly abut we can also start with the other meds as well.He also told me there is a med we can give him with the pred that will reduce this problem and wont affect the pred as well


I remembered reading you can use a combined theraphy if needed I had a feeling the Azathioprine is one of them, double checked back and it seems you can. Although there are still more that you can use not sure about combining them though

corticosteroid
therapy alone can result in masticatory muscle
atrophy. If the side effects of prednisone therapy cannot
be tolerated, alternative immunosuppressive agents may
be used.
Azathioprine is another immunosuppressive drug
that can be considered in addition to traditional
corticosteroid therapy. Although azathioprine is generally
not included in the initial therapy for masticatory
muscle myositis, it can be used in conjunction with
prednisone in patients that are unable to tolerate the
side effects of corticosteroids or are refractory to prednisone
therapy alone.

There is more on the full link its one of the ones I gave you before

http://vetneuromuscular.ucsd.edu/publications/melmed.pdf


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## Rott lover (Jan 2, 2015)

So with all the research i had been doing i realized a couple of things.1 is that with pred you run the risk of ending up in a diebetic type of situation in some cases.I know from experience that when your blood sugar runs rampent you start to lose a ton of weight.I was feeding oliver about 4 cups of rice a night plus some hamburger and soft food all mixed in.Well rice turns to sugar when digested.So i made a new batch of hamburger with just a little rice that i am putting into 2 big double hand fulls of Science diet lamb meal dry kibble with a rachel ray soft treat food and add a cup of water and stir it all up.Before he was pooping a ton and everytime i let him out.Since i started doing the new food he has gone back to his normal amount and times of pooping.
2 is i didnt give him all of his meds yesterday morning.he is normally getting 50 mg of pred and i only gave him 40.Last night when i got home he was actually active and met me at the door.His breathing was also almost back to normal.Then last night when i gave him his preds at night within an hour or so his breathing was the super fast almost panting while laying there.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> So with all the research i had been doing i realized a couple of things.1 is that with pred you run the risk of ending up in a diebetic type of situation in some cases.I know from experience that when your blood sugar runs rampent you start to lose a ton of weight.I was feeding oliver about 4 cups of rice a night plus some hamburger and soft food all mixed in.Well rice turns to sugar when digested.So i made a new batch of hamburger with just a little rice that i am putting into 2 big double hand fulls of Science diet lamb meal dry kibble with a rachel ray soft treat food and add a cup of water and stir it all up.Before he was pooping a ton and everytime i let him out.Since i started doing the new food he has gone back to his normal amount and times of pooping.
> 2 is i didnt give him all of his meds yesterday morning.he is normally getting 50 mg of pred and i only gave him 40.Last night when i got home he was actually active and met me at the door.His breathing was also almost back to normal.Then last night when i gave him his preds at night within an hour or so his breathing was the super fast almost panting while laying there.


I know with cushings where the body produces too much cortisol on blood tests you usually get increased glucose on the blood tests, cholesterol usually goes up too along with liver enzymes AP and ALT.

Have you had any results back yet, it does look suspicious it may well be the preds his on, but you should really talk to the vet before decreasing any and what too.


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## Rott lover (Jan 2, 2015)

So i just got a call from the vet and we need to drop his pred immediately in half starting tonight.The vet said his levels are off the charts.I guess he is really sensitive to the pred.I asked if it was safe to do a drop like that and he said it would be ok since he is getting dropped to half dose and staying there.He said we have to just keep an eye on his MMM to make sure we have forward progress and if not then we need to switch meds but for right now he should be ok with as sensitive as his system is to the pred.


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## Rott lover (Jan 2, 2015)

also sled you were right on.His alt and ap were waaaaaaay high in his words but his glucose and his cholesteral were only slightly elevated.so now i hope oliver can have a comfortable weekend and come back to his normal habits as well.


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## Rott lover (Jan 2, 2015)

I swear it is always something


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> So i just got a call from the vet and we need to drop his pred immediately in half starting tonight.The vet said his levels are off the charts.I guess he is really sensitive to the pred.I asked if it was safe to do a drop like that and he said it would be ok since he is getting dropped to half dose and staying there.He said we have to just keep an eye on his MMM to make sure we have forward progress and if not then we need to switch meds but for right now he should be ok with as sensitive as his system is to the pred.





Rott lover said:


> also sled you were right on.His alt and ap were waaaaaaay high in his words but his glucose and his cholesteral were only slightly elevated.so now i hope oliver can have a comfortable weekend and come back to his normal habits as well.


If its iantrogenic cushings brought on by the meds it should be reversed as they are brought down. Like you said as regards to the physical symptoms his getting from them that seemed to stop pretty quickly when you gave him a lower dose the other evening. My Daisy who was a cushings dogs, levels were high in the beginning, thats how I sussed what her problem could be when she had some pre op blood tests. It was the results of the liver enzymes on her bloods, plus some symptoms she was having when I researched more in cushings, it was something I knew a bit about but not in full detail, Hers actually affected her coat too, she didn't moult the hair was dead, and from a previous op the hair didn't grow back when she was shaved. She had been diagnosed with hypo thyroid previously but when the coat didn't improve which it should have if just hypo thyroid, and together with the other symptoms that begin to appear and the levels on the pre op blood test it was a bit too suspicious, the ACTH stim test which is the test for Cushings, was done and bingo thats what she had. She had the proper cushings though so had to take meds to stop it. Iantrogenic medicine induced should right itself with the change in preds.

Hoe you start to see the difference in his symptoms, in fact you already KNOW there is a difference from what you said the other night. Let me know how hw is doing.


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## Rott lover (Jan 2, 2015)

Hey sled.
So this was my weekend.Oliver seemed much more like himself this weekend and the breathing slowed quite a bit.I would not say he is back to normal but he is better.That is about all the good that came of this weekend.
The bad news is that he had the exreme diarrea since friday.He has blood coming off the end of his penis and his jaw muscles are all hard and he is drooling like crazy and having trouble eating again.
I have to get the poops to stop.I had to rent a steam cleaner after friday night and i am glad i kept it for sunday.We actually put down a painters tarp to save my sanity.I thought about giving him amodiam but i was afraid of drug interactions.
As for the blood it is only a drop or two when he first starts peeing and once in a while when he is just laying there.He doest seem to be having any troubles or any difficulty with peeing.Right now it is really dark but i think that is from all the liquid poop he has had for the last 3 days.
Last of all I need to get him off the preds all together and get him on the other meds to help his jaws.He is at 30 mg of pred twice a day and he is still haveing adverse reactions to it.His breathing is still fast and he still looks for cool places to lay in the house.Although he is more spunky he just still is not right.At the same time the dose is too low to do his jaws any good.
So in all it was another weekend spent crying wishing i could do something.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> Hey sled.
> So this was my weekend.Oliver seemed much more like himself this weekend and the breathing slowed quite a bit.I would not say he is back to normal but he is better.That is about all the good that came of this weekend.
> The bad news is that he had the exreme diarrea since friday.He has blood coming off the end of his penis and his jaw muscles are all hard and he is drooling like crazy and having trouble eating again.
> I have to get the poops to stop.I had to rent a steam cleaner after friday night and i am glad i kept it for sunday.We actually put down a painters tarp to save my sanity.I thought about giving him amodiam but i was afraid of drug interactions.
> ...


Did you tell the vet about the blood, in all honesty I would be concerned with the blood more then the diarrhoea, even if its only a drop, Urine should really be clear/clearish and a lighter yellow to amber sort of colour. If its darker yellow then it can be because its concentrated or they are dehydrated I think.
If he has had running diarrhoea and losing fluids quicker then they are going in and being absorbed that may be a possible cause, but how dark and what colour is it, Im just wondering if he has blood in the urine making it dark. You can get blood in the urine with infections, but really if he is passing blood and the urine is dark and any colour other then yellow like red, orange or blackish then it should be investigated. Has the vets done urinalysis, the dip sticks can tell so much but you can usually tell a lot more if you spin the urine and look at the sediment.

If he was mine I would be concerned about it and want it checked out it doesn't sound right. Its a worry too of course that decreasing the preds are helping with some of the symptoms but the fact that there seems to be a relapse with the MMM is worrying.

Have you thought of asking for an urgent specialist referral, with someone who deals with auto immune and Myosotis type diseases? If you are insured then you would be covered or should be.


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## Sled dog hotel (Aug 11, 2010)

One thing that I have just remembered Daisy my cushings dog was prone to getting urinary tract infections, because of cushings and cortisol levels it does leave them open to any kind of infection including as mentioned UTIs.

I double checked and high dose steroid use and longer term use does the same thing urinary tract and other infections are common. You do as said often get blood in the urine with UTIs and kidney infections, UTIs if not treated can become kidney infections too so are then even more serious.

With kidney infections they do tend to pee more, often drink more, can sometimes run a temperature too, trouble is of course as the preds cause excessive drinking peeing, panting, etc etc anyway practically the same symptoms then if he had an infection urinary tract or otherwise then it would be hard to pick up on symptoms as they could so easily be put down to the preds.

One thing I remembered too, was that Daisy along with her regular ACTH monitoring tests for her drugs also had to have other regular blood tests too to monitor general health and organ function, I remembered too after one of those was glucose as diabetes can be common with untreated and treated cushings disease. Ive checked on steroid use and apparently steroids if a dog is on the border line for diabetes mellitus it can tip the balance.

Steroid use can cause digestive upset and diarrhoea and stomach ulceration, as said though it can also cause the dog to be open to infection, so I am wondering if he has got some infection on top that's causing the problems.


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## Rott lover (Jan 2, 2015)

So the vet finally called me late last night.He got me three different prescriptions.He got me one to clear up the poops.One to clear up the urinary/bladder infection and the aza(cant remember the rest) to replace the pred.We dropped him down to 20 mg twice a day on the pred and the aza is at 75 mg once daily.I got him started on all of them last night.When we went to bed last night we were sitting on the floor with him and his breathing was almost normal.He was more relaxed than i had seen him in a long time.I was even getting him to growl and grumble.It had been a long time since i had heard him play growl.This morning was even better.He jumped up on the couch with authority and even went belly up.So of course since it has been since before all this started since he had done that i had to take full advantage of that.Also the best part was i had nothing to clean up this morning.I have seen more improvement in the last 12 hours than i had seen in the last month.I think we might finally be on the right track.That would be nice.I will give any updates as they come.


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## Rott lover (Jan 2, 2015)

Unfortunantly i do not have insurence for him.So this is all out of pocket.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> So the vet finally called me late last night.He got me three different prescriptions.He got me one to clear up the poops.One to clear up the urinary/bladder infection and the aza(cant remember the rest) to replace the pred.We dropped him down to 20 mg twice a day on the pred and the aza is at 75 mg once daily.I got him started on all of them last night.When we went to bed last night we were sitting on the floor with him and his breathing was almost normal.He was more relaxed than i had seen him in a long time.I was even getting him to growl and grumble.It had been a long time since i had heard him play growl.This morning was even better.He jumped up on the couch with authority and even went belly up.So of course since it has been since before all this started since he had done that i had to take full advantage of that.Also the best part was i had nothing to clean up this morning.I have seen more improvement in the last 12 hours than i had seen in the last month.I think we might finally be on the right track.That would be nice.I will give any updates as they come.


So relieved he seems so much better and the vet thinks its an infection too that will be OK with the meds. Brilliant he seems so much better in himself as well as physically.

I know what you mean about it being a strain when they are not insured, my youngest two are but my old girl who I lost at over 16 in June last year never was, and her meds for the last few years of her life for the cushings alone were about £75 a month, that's with out bloods and the blood tests and meds for her other ailments.

When you say your vet gave you a prescription, do you mean that you are getting a prescription but you get the drugs on line from a reputable vet pharmacy? If you don't then you can get a prescription from your vet and get them yourself. There is a charge for the script, which you would have to ask him how much he charges, but even with that its often a very good saving still getting them on line. You of course have to be careful, Ive used one called vet medic for years and got stuff from their stands at shows, there are others too that forum members use and could probably recommend so you could shop around for best prices.

The one I get them from is Pet Medicine, Vet Prescriptions & Pet Food Cheaper Than Your Vet you could have a look on there and see how much they are. They are pretty good if you phone them too if you cant see it on the website.

Is it Azathioprine his given you? Im guessing it is by the Aza..... its the one we were discussing the other day that you seem to be able to use with steroids too if it is and seems the next favourite to the preds alone.

Really hoping he has turned the corner now and onwards and upwards.


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## Rott lover (Jan 2, 2015)

For most of the meds my vet just gives me the pills on the spot.If he doesnt carry them then i go to a normal pharmacy.Like the azathioprine,I went to cvs pharmacy and they gave me a discount as well.i got a 30 day supply for less than 40 dollars.They used the people discount card and got me a pretty good discount.so i cant argue too much.
I dont know that he has turned the corner yet but the wheels are headed in the right direction.This is a relief in itself.He was up and active and even greeted me at the door last night when i got home.I was so happy.I cant wait to get home and see my little man tonight.I still have a few messes to clean up from before that i didnt see but this morning there was no mess and he didnt go this morning.Maybe we can get him back on track with his normal schedual again.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> For most of the meds my vet just gives me the pills on the spot.If he doesnt carry them then i go to a normal pharmacy.Like the azathioprine,I went to cvs pharmacy and they gave me a discount as well.i got a 30 day supply for less than 40 dollars.They used the people discount card and got me a pretty good discount.so i cant argue too much.
> I dont know that he has turned the corner yet but the wheels are headed in the right direction.This is a relief in itself.He was up and active and even greeted me at the door last night when i got home.I was so happy.I cant wait to get home and see my little man tonight.I still have a few messes to clean up from before that i didnt see but this morning there was no mess and he didnt go this morning.Maybe we can get him back on track with his normal schedual again.


That's really good news improving and a much happier dog is in the right direction. I just realised your not in the UK, sorry, Its a UK based forum, and although we do have members from all over I often forget.


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## Rott lover (Jan 2, 2015)

It is ok sled


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## Doggiedelight (Jan 27, 2015)

Just had a quick read through this thread, I dont know anything about mmmor cushings but Just wanted to wish your pooch a good recovery, sounds like its been a long road, hope now he is off the pred that this new drug doesnt give his adverse reactions and he can lead a healthy life once once and be able to eat and pant normally


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## Rott lover (Jan 2, 2015)

Thank you doggiedelight,He wont be off the preds for a while.He has to stay at the 20 mg for about a week then we can drop him to 10 mg for about a week then to 5 mg.It is a slow process but he is on the other med at full dose and he is taking to it well so far.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> Thank you doggiedelight,He wont be off the preds for a while.He has to stay at the 20 mg for about a week then we can drop him to 10 mg for about a week then to 5 mg.It is a slow process but he is on the other med at full dose and he is taking to it well so far.


Glad that he is doing well so far on the new meds.


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## Rott lover (Jan 2, 2015)

I had something funny happen last night with oliver.I got home to a no poop no pee house which was very nice so i could get olivers dinner together early.His dinner consists of 2 big handfuls of dry kibble,a few spoonfuls of hamburger and rice and half a wet treat with a cup of water.I went and grabbed his bown and put the dry kibble in it and before i could do much of anything else he shoved his head in the bowl and ate almost all of his dry kibble before i could add anything else.
another thing that does bother me is when he eats his dinner he opens his mouth pretty far.I would say on average of an inch or so.Some times i have seen him open it more than 2 inches.however when he gets to panting he wont hardly open it at all.other things bother me as well.Such as when he is swallowing he does this weird thing while swallowing where you can hear everything moving in his mouth to swallow but his mouth never opens.
I would love to see what is going on in there but after his ordeal he wont let us near his mouth and i refuse to try to pry his mouth open at this point.
I don't want to cause any undo stress on his mouth right now so i just left wondering.Like say if he eats his dry kibble he will hardly open his mouth to eat it but when we give him his dinner he will open it plenty.
Any ideas?


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> I had something funny happen last night with oliver.I got home to a no poop no pee house which was very nice so i could get olivers dinner together early.His dinner consists of 2 big handfuls of dry kibble,a few spoonfuls of hamburger and rice and half a wet treat with a cup of water.I went and grabbed his bown and put the dry kibble in it and before i could do much of anything else he shoved his head in the bowl and ate almost all of his dry kibble before i could add anything else.
> another thing that does bother me is when he eats his dinner he opens his mouth pretty far.I would say on average of an inch or so.Some times i have seen him open it more than 2 inches.however when he gets to panting he wont hardly open it at all.other things bother me as well.Such as when he is swallowing he does this weird thing while swallowing where you can hear everything moving in his mouth to swallow but his mouth never opens.
> I would love to see what is going on in there but after his ordeal he wont let us near his mouth and i refuse to try to pry his mouth open at this point.
> I don't want to cause any undo stress on his mouth right now so i just left wondering.Like say if he eats his dry kibble he will hardly open his mouth to eat it but when we give him his dinner he will open it plenty.
> Any ideas?


I still think it might be an element of certain things and movements might be associated with pain when it was at its worst still. Dogs do learn by association and remember things. There is a Yorkie near me, one day he was in the garden, the owner heard a yelp and he was running towards the back door. She didn't see what happened apart from that. The dog thereafter wouldn't go in the garden at all, wouldn't go past the back door. She had to put his lead on and walk him for every required toilet trip as well as his normal walks, he would shake if she tried to get him out into the garden. This went on for a good few weeks, before he must have decided it was OK again to go out.
Can only assume by the yelp and flight it was something painful and he associated the garden with the pain and experience for awhile. So that's what may be happening with yours perhaps. It may be that when his hungry, considering too, that his been on steroids that stimulate the appetite and make them ravenous (don't know if the new drug does?) then maybe at times the hunger and a dogs urges to eat overrides it.

Another thought Ive just had with the panting too and what they actually do jaw position wise when they pant, is that the mouth is open pretty wide its also in a fixed position not really moving. Not wanting to bang on about my ailments which are considerable , but I went through a phase where my jaw would lock which wasn't much fun and hurt like hell apart from the fact it was pretty scary, and it always happened when I did things like yawn or open my mouth too wide. Mine also hurts like hell when Im in the dentists and have to sit with it in one position and open for too long too. If you try it yourself, with your mouth in different positions less open and more open, moving and not moving it seems that muscles in the jaws come into play more too at times. also different movements and varying degrees of position put cause strain on jaw and muscles more then others. So maybe as he has lost muscle due to the MMM or at the moment. and still probably has a certain amount of restriction or movement, that's playing a part too, and he is just doing things that make what he needs to do the easiest and most comfortable for now.

When you say he doesn't open his mouth but you can hear the food moving about and then he swallows, is he swallowing OK? and doesn't look like his finding the actual swallowing and getting the food down in itself a problem?
If he is swallowing fine, at the moment I wouldn't be stressing about it in all honesty.


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## Rott lover (Jan 2, 2015)

Thank you sled you might be onto something there.Yes he swallows fine from what i can tell.It isn't with food that i hear it it is when he swallowing his slime(drool or saliva).When he is eating there is no problem in swallowing.I guess i will have to wait until we get his muscles all working again.For right now he is eating plenty and slowly putting the weight back on and drinking plenty.Day by day he is coming back to normal.The more we drop his pred the more back to normal he becomes.I now know why he never recovered from going to get the xrays done.Ever since that he was on the preds.hopefully we can get him back to normal soon and then we can work on getting his jaws back to normal.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> Thank you sled you might be onto something there.Yes he swallows fine from what i can tell.It isn't with food that i hear it it is when he swallowing his slime(drool or saliva).When he is eating there is no problem in swallowing.I guess i will have to wait until we get his muscles all working again.For right now he is eating plenty and slowly putting the weight back on and drinking plenty.Day by day he is coming back to normal.The more we drop his pred the more back to normal he becomes.I now know why he never recovered from going to get the xrays done.Ever since that he was on the preds.hopefully we can get him back to normal soon and then we can work on getting his jaws back to normal.


I know its been a goodwhile now since it started, and for you with all the worrying it probably feels a lot longer still. From you recent updates though it sounds like there is good progress now. Hopefully the new drugs will give even better results and maybe even quicker now, and without the awful side effects that were making him so poorly he sounds like a much happier boy too and a lot more himself from what you say.


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## Rott lover (Jan 2, 2015)

So the word for Monday is good.Oliver is doing good.Not great,But better than before.He is finally starting to put some weight back on.His breathing is a lot closer to normal.He doesn't have any blood in his urine.His muscles in his cheeks and head are starting to loosen up quite a bit.He is also using his tongue a lot more and starting to articulate his mouth for eating as well.He has been laying on his bed again and actually playing a bit.Also sleeping up on the couch.All this points to him returning to normal.He even had his mouth open a bit while panting.Enough for his tongue to stick out of the front of his mouth.If everything continues on the forward path of getting him off the preds and the new meds working i think we will finally be on the long road to recovery.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> So the word for Monday is good.Oliver is doing good.Not great,But better than before.He is finally starting to put some weight back on.His breathing is a lot closer to normal.He doesn't have any blood in his urine.His muscles in his cheeks and head are starting to loosen up quite a bit.He is also using his tongue a lot more and starting to articulate his mouth for eating as well.He has been laying on his bed again and actually playing a bit.Also sleeping up on the couch.All this points to him returning to normal.He even had his mouth open a bit while panting.Enough for his tongue to stick out of the front of his mouth.If everything continues on the forward path of getting him off the preds and the new meds working i think we will finally be on the long road to recovery.


So pleased and relieved for you and Oliver that he now seems to be going in the right direction, and that the MMM seems to be easing as well as the horrible side effects being under control now. Onwards and upwards!!!


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## Rott lover (Jan 2, 2015)

I had such a good night with Oliver last night i almost cried.When i got home last night he came running out of the bedroom and almost tackled me.He did his sit pretty to greet me and gave me hugs and what i call the nose nudge. That is where he puts his muzzle in the crook of my shoulder and neck and pushes his nose and head against my cheek.Then when i let him outside he went bounding through the deep snow all the way to the back of the yard.This is something he hasn't done in a long time.He seems to be gaining a good amount of weight back.I can barely see his spine and ribs and the gully in his hips are a lot smaller.He seems to be a lot more aware and alert and has tons more energy.When i gave him his pills last night which i put in hot dogs,He actually used his tongue and i didn't even feel his teeth at all.
I am waiting to get his weight back up before i start playing with him too much.After that then i will start playing more and getting him to run and use his muscles to build them back up.He really did not have any fat on him when this all started so all the weight that he lost was mostly muscle mass.One step at a time i guess.They may be baby steps but they are steps and right now any step forward is a huge step in my book.


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## Rott lover (Jan 2, 2015)

I also believe that a lot of the forward progress is due to dropping his pred down to 10 mg twice a day.If memory serves it stays at this for a week then it goes to 10 mg in the am and 5 mg in the pm.Then after a week it is 5 mg am and pm for a week and so on.


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## Sled dog hotel (Aug 11, 2010)

How they act and behaviour often plays a big part when they are ill, sometimes out of character behaviour is the only or main clue that somethings up.

He seems so much happier and want to do so much more as well as the signs you can see, he must be feeling so much better to be acting like he is.
Im so pleased and relieved for you.


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## Rott lover (Jan 2, 2015)

Three steps forward and another set back.I woke up this morning to a small puddle in the kitchen filled with blood.When i let Oliver out he had blood in his urine again.This is just disheartening.I still have to call the vet this morning when they open.He is still on his antibiotic and i am not sure what it is or the mg but i am guessing that he needs a heavier dosage or a stronger antibiotic.He is doing so good finally and now another set back.I was so happy when i went to bed last night because Oliver was so playful yesterday and before i went to bed i even got him to play nip.Although it looked like it hurt some it proves that there is a want and a desire to do it.I gave him a pain med before i went to bed so it wouldn't hurt much.
Huh,I wonder if i caused this with the pain pill.He hadn't had a pain pill since he had blood in his urine last time and we got the antibiotic.shortly after giving him the antibiotic it went away and there was no sign of blood until today.
I guess that might be something to bring up to the vet as well.
I know he was hungry this morning because he was eating his kibble out of his bowl this morning.That is another good sign since he doesn't do that much anymore.Speaking of the food bowl he seems to be happier with the bowl on the floor instead of being off the floor.I think it is because he can get a better angle and it doesn't move around so he gets better leverage.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> Three steps forward and another set back.I woke up this morning to a small puddle in the kitchen filled with blood.When i let Oliver out he had blood in his urine again.This is just disheartening.I still have to call the vet this morning when they open.He is still on his antibiotic and i am not sure what it is or the mg but i am guessing that he needs a heavier dosage or a stronger antibiotic.He is doing so good finally and now another set back.I was so happy when i went to bed last night because Oliver was so playful yesterday and before i went to bed i even got him to play nip.Although it looked like it hurt some it proves that there is a want and a desire to do it.I gave him a pain med before i went to bed so it wouldn't hurt much.
> Huh,I wonder if i caused this with the pain pill.He hadn't had a pain pill since he had blood in his urine last time and we got the antibiotic.shortly after giving him the antibiotic it went away and there was no sign of blood until today.
> I guess that might be something to bring up to the vet as well.
> I know he was hungry this morning because he was eating his kibble out of his bowl this morning.That is another good sign since he doesn't do that much anymore.Speaking of the food bowl he seems to be happier with the bowl on the floor instead of being off the floor.I think it is because he can get a better angle and it doesn't move around so he gets better leverage.


One of mine had a urinary tract infection with cystitis (even when her bladder was empty she still kept squatting obviously feeling she still needed to go)
She has one beginning of Aug and one a couple of weeks ago. The second time I know there wasn't blood as I took a sample, sometimes its there but not visible to the eye. With her something called Nisamox 500mg x twice daily did the job. You may call it something else in the states though it contains Amoxicillin and Clauvulanic acid. Its pretty broad spectrum. Both times she was given 2 weeks worth. With her though in both cases she was back to normal peeing wise in about 36 hours of starting maybe a bit less.

You do sometimes have infections that need to be identified to make sure you have the right antibiotic for the right bacteria. UTIs are common when they are on steroids because the immune system is lowered and that makes them more prone to UTIs and infection in general.

When did the vet last run his bloods? Really when they are on strong medications like steroids, pain killers, etc you should have monitoring blood tests to make sure that organs like kidneys, liver etc etc are coping.

Just had a thought too, What pain killers is her on? Steroids are anti inflammatory anyway, sometimes they give them purely for that reason alone.
You should not, However, mix steroids with non steroidal anti inflammatory pain killers. As well as dog wise, I know because I have to take hydrocortisone for a cortisol deficiency and its a right pain literally because the Pain killers I can take with it, are very very limited.


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## Sled dog hotel (Aug 11, 2010)

Just done some checking on the Azathioprine for you as regards to side effect and use and contra indications. There are a few points that are possibly relevant.

He should be being monitored with blood tests according to this

Side Effects

One of the main issues with azathioprine is a problem with the bone marrow suppression. Cells of the bone marrow are rapidly dividing and thus at risk for suppression from azathioprine. For this reason, at least in early stages of use, complete blood counts (CBC) are monitored frequently (typically every 2 weeks for the first couple of months).

Signs of a bone marrow problem that might be observable at home include abnormal bruising or inappropriate bleeding (bloody nose, bloody stool, blood in urine, excess bleeding from a minor wound etc.) If bone marrow suppression has not occurred in the first couple of months of therapy, it is unlikely that it will occur later on.

Some patients develop a liver toxicity with azathioprine. This should resolve with discontinuation of the medication but it is important to watch for any signs of nausea, diarrhea, or appetite loss. If these occur, especially in the first few weeks of starting azathioprine, discontinue the medication and notify your veterinarian of these effects.

Azathioprine can also promote pancreatitis (pancreatic inflammation). Again, signs of nausea/intestinal upset can result. If this occurs, discontinue azathioprine and notify your veterinarian.

Although we know it can be used alongside steroids before he even went on it 
it seems you can use it with certain types of antibiotics either, don't know what type he is on but:-

Interactions with other Drugs

Because it can take a good month or two before the benefits of azathioprine are seen, it is a good idea to begin azathioprine in conjunction with an aggressive prednisone course. The prednisone will hopefully control the disease rapidly such that by the time the azathioprine has kicked in the prednisone can be tapered to a maintenance level.

Concurrent use of allopurinol can present a problem with azathioprine use. This normally would only come up in the event of a Dalmatian using allopurinol to control uric acid bladder stone issues. If azathioprine is to be used with allopurinol, the dose of azathioprine must be dramatically reduced.

Other medications that could pose problems include enalapril and other ACE inhibitors (used in heart failure or in control of urinary protein loss) and sulfa containing antibiotics (such as sulfadiazine, sulfadimethoxazole, and sulfasalazine. The use of these drugs with azathioprine makes bone marrow problems more likely.

01 Azathioprine (Imuran) - VeterinaryPartner.com - a VIN company!


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## Rott lover (Jan 2, 2015)

I don't remember what antibiotic he is on or the mg of it.I do know it is some kind of amoxicillon as my wife had said.He had a blood work up about 3 weeks ago maybe two weeks ago.That was when we first took him for the breathing issues and weight loss and had to drop the pred dosage.I don't remember what kind of pain med it is either but the vet did prescribe them all.Just aggravated by all this.Things were just starting to go good and now this.


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## Sled dog hotel (Aug 11, 2010)

I know its fraustrating when he seemed to be doing so well, hope when you speak to the vet you can sort it out.


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## Rott lover (Jan 2, 2015)

OK so the real thing i need to watch for is the first part of your post.He hasn't had diarrhea for a while now and he hasn't lost one single bit of his apatite and has had no stomach upset at all


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## Rott lover (Jan 2, 2015)

I talked to the vet and he said there could be a situation with Oliver being over sensitive to the pain pills like he was with the pred. When the wife let him out yesterday afternoon there was only a small drop of blood and by the time i got home there was no blood.Also this morning there was no blood at all.Since that was the only thing i did different in the last couple weeks i think that might be the case.The vet said to not give him any for awhile to make sure it doesn't repeat itself.
Other than that it was a very good night for Oliver. He did very good at eating dinner and hardly pushed the bowl at all.He used his tongue and articulated everything very well.For the first time since before Christmas he played with the laser light for a short while but i didn't do it for long since it seemed he got really tired very quickly.So little by little i will have to get him back into shape and get his muscles back into shape.After that we were watching tv and he got up and went to his room and dug out his bone and brought it out.Also the first since before Christmas.He really didn't do much with it but he pulled it out and nipped at it a bit and then just left it there and went to sleep.It was a very positive moment for us.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> I talked to the vet and he said there could be a situation with Oliver being over sensitive to the pain pills like he was with the pred. When the wife let him out yesterday afternoon there was only a small drop of blood and by the time i got home there was no blood.Also this morning there was no blood at all.Since that was the only thing i did different in the last couple weeks i think that might be the case.The vet said to not give him any for awhile to make sure it doesn't repeat itself.
> Other than that it was a very good night for Oliver. He did very good at eating dinner and hardly pushed the bowl at all.He used his tongue and articulated everything very well.For the first time since before Christmas he played with the laser light for a short while but i didn't do it for long since it seemed he got really tired very quickly.So little by little i will have to get him back into shape and get his muscles back into shape.After that we were watching tv and he got up and went to his room and dug out his bone and brought it out.Also the first since before Christmas.He really didn't do much with it but he pulled it out and nipped at it a bit and then just left it there and went to sleep.It was a very positive moment for us.


Hopefully now you have stopped the pain meds the problem will resolve itself then. It does sound a bit suspect that the antibiotics seemed to do the trick or from what I can remember you have said, and without the pain killers he was fine until he had one again.

Does sound like the Azathioprine is doing the trick with the MMM too, it did say that its used for dogs that don't do well or cant cope on the preds because of side effects, and also for use when the MMM didn't seem to respond to preds or preds alone. So maybe that was the problem and why although the preds alone were doing something it was so slow. The difference in him since the preds were reduced and on the Azathoprine seems to be moving along much quicker.


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## Rott lover (Jan 2, 2015)

Yes it seems that the preds alone were causing way more problems then they were supposed to be fixing.The vet said for 2 weeks to keep in on the 10 mg twice a day then 2 weeks at 10 mg once a day then 2 weeks at 10 mg 1 every other day then done.Every time there is a drop in the dosage he gets much much better


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## Rott lover (Jan 2, 2015)

Just thought i would give an update on Oliver.

So it seems some things are getting better and others are getting worse again.Oliver is gaining weight quite nicely.You cant see and feel his ribs any longer.His waist is starting to fill out very well and his spine is barely visible any more.Oliver is back to sleeping on the couch and greeting us at the door and always excited when we get home from anywhere.His breathing is pretty much normal again as well.Also all the blood has cleared up in hid urine and he is drinking a normal amount of water and urinating a normal amount again as well.

Now on to the bad news.We dropped Oliver down to 10 mg of pred twice a day on Jan 31st.Over the last three days his head has sunken way in again and he is drooling like crazy again.He is having trouble eating again and when ever you pull his lips up his teeth are clenched shut with his tongue sticking out of the sides of his teeth.He also seems to be off balance and very sluggish the last few days.

It would seem to me that maybe we need to get him back up to 20 mg of pred twice a day.He seemed to be in a very good place at that dose.The sweet spot if you will.I still need to get a hold of my vet to see if he wants to pull him off the preds completely and replace them with another anti inflammatory or if he thinks the preds will be the most beneficial for what we are to trying to achieve.Another thought is since the aza and pred are used as immune suppressants is it possible that we need to raise one while lowering the other.He does not appear to be in any pain what so ever so i know it is not pain keeping him from opening his mouth and i have seen him open his mouth several inches but the only time he will do it is while eating dinner.I did an experiment the other day.I fed him his dinner the other day and i noticed that he was opening his mouth at least an inch and a half.Shortly after he ate his dinner i gave him one of his beef and cheese twist treats.He chewed the whole thing down with his nippers until it was all gone.He barely opened his mouth at all.I am not sure what is going on with that.Even when he was doing really good it seemed any thing that he had to do any work with his mouth he would barely open it and chew only with his nippers.If he can swallow it whole then he has no issues opening up wide.I also had my wife feed him the other day while i held my hands on his "hallows" On the top of his head.You can feel those muscles working for sure.I am starting to think some of this is just him being traumatized by this whole thing and just always keeping his jaws clenched shut.

Sorry for such a long post and all the rambling.Just trying to throw everything out there and see if anything makes sense.Right now not a whole lot makes any sense to me.I was really hoping to kick this thing and have my boy on the way to recovery by now or at least chewing properly but it has just been one setback after another.


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## Sled dog hotel (Aug 11, 2010)

It seems that everything on the subject of MMM says that the mainstay treatment is preds, and that once the maximum function has been achieved again then they can be tapered off.


> TREATMENT
> A favorable outcome in masticatory muscle myositis
> necessitates early accurate diagnosis and appropriate
> therapy. Treatment is centered on aggressive immunosuppression,
> ...


Above is talking about Pred theraphy only but on there it seems to talk about decreasing it by 50% (half) each time on a monthly basis. Also over 4/6 months, so its not a quick process getting them reduced going by that.

Going onto Azathioprine theraphy used in conjunction with Preds.


> Azathioprine is another immunosuppressive drug
> that can be considered in addition to traditional
> corticosteroid therapy. Although azathioprine is generally
> not included in the initial therapy for masticatory
> ...


Again as far as I can see even with the addition of the Azathioprine or according to that, that needs also to be continued over several months while the preds are slowly tapered off to a maintenance levels, then you can think about tapering off the Azathioprine too, but even then you have to be careful the patients doesn't relapse.

I would from that think that Oliver has had a relapse possibly due to the meds probably the preds although you will have to speak to your vet, being tapered off too quickly and the dose reduced too quickly in all honesty.

I would think, although you will need to speak to your vet of course, that he needs to go back up again, with the right balancing act, where the side effects of the preds don't cause him problems but the MMM will respond and get better.

There is more on the treatment, above are just excerpts, have a look though the whole thing in context, so save you looking back the links below.

http://vetneuromuscular.ucsd.edu/publications/melmed.pdf


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## Rott lover (Jan 2, 2015)

Thank you sled

You pretty much verified what i was thinking.It is a fine line balancing act between what is effective and the side affects.I am just going to have to let the vet know whats going on.Time wise i was talking about just having some normal mouth movement by now.He has not opened up his mouth more than a couple of inches as of this point in time.He hasn't used his mouth in a normal manor since his x rays and his teeth cleaning.I know that it will be a looooong time if ever that he gets off the pills but the function of his mouth is what concerns me he has shown signs of improvement at times but he has never regained full control of his mouth.Just baby steps at best.I had really hoped i would get enough improvement for him to be able to use his mouth.

I have learned more from you sled than i have from my own vet.I have been telling and teaching him more than anything.It is just so aggravating that it has been over a month and he is right back where he started.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> Thank you sled
> 
> You pretty much verified what i was thinking.It is a fine line balancing act between what is effective and the side affects.I am just going to have to let the vet know whats going on.Time wise i was talking about just having some normal mouth movement by now.He has not opened up his mouth more than a couple of inches as of this point in time*.He hasn't used his mouth in a normal manor since his x rays and his teeth cleaning*.I know that it will be a looooong time if ever that he gets off the pills but the function of his mouth is what concerns me he has shown signs of improvement at times but he has never regained full control of his mouth.Just baby steps at best.I had really hoped i would get enough improvement for him to be able to use his mouth.
> 
> I have learned more from you sled than i have from my own vet.I have been telling and teaching him more than anything.It is just so aggravating that it has been over a month and he is right back where he started.


The comment in bold got my thinking about something I had read and was niggling. Did he have the MMM when he had the x rays and teeth clean? If so 
there was something in the link I remembered too in the treatment part.



> The
> literature has historically recommended forcible opening
> of the jaw while patients are under anesthesia.
> Studies have found significant morbidity, including
> ...


I May be wrong but I would read that as you shouldn't forcibly open the jaws of a dog with MMM as it can cause damage and other problems on top. That being the case Im wondering if that was why it seemed worse after the xrays and dental?


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## Rott lover (Jan 2, 2015)

He did have it at that point.That was the whole reason we took him to this other vet.My vet did not have the proper x ray machine to do dental x rays.He recommended me take Oliver to them to do x rays to make sure nothing was wrong with his teeth which was all i had requested and surprise surprise they did a dental as well.My vet said he had wished they hadn't done that as did we.So what you are thinking is there may be some other damage done by them doing the dental and dental x rays.When he went in to have the x rays done and they put him under the vet knew right away since he had stated that When under anesthesia he could only open his mouth a few inches.He did say that the did not forcibly open his mouth. 

If they did do more damage than good what do i have to do to get this figured out.I cant afford any more x rays.I can hardly keep up with the meds.All of this has pretty much wiped out my bank account.

I can tell you that he could use his mouth ok and do everything normal before he went in to have the x rays done and when we brought him home he couldn't open his mouth at all.


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## Rott lover (Jan 2, 2015)

Sled dog hotel said:


> The comment in bold got my thinking about something I had read and was niggling. Did he have the MMM when he had the x rays and teeth clean? If so
> there was something in the link I remembered too in the treatment part.
> 
> I May be wrong but I would read that as you shouldn't forcibly open the jaws of a dog with MMM as it can cause damage and other problems on top. That being the case Im wondering if that was why it seemed worse after the xrays and dental?


I just looked up mandibular
fractures,temporomandibular joint luxation
i don't think this is the case since he does open and close his mouth properly and when i move his lips around looking at his teeth everything seems to line up just as it always had.he has his mouth closed and in most cased they are clenched.Or closed very tight with force.so with all that said this is what i found.

The animal will present with an inability to close the mouth and, in unilateral cases, with the lower jaw deviated away from the luxated side.
If the luxation is caudoventral, the jaw will be deviated towards the luxated side.
If other fractures or significant head trauma is present, TMJ joint luxation may be more difficult to diagnose, but should be suspected in any head trauma case which is unable to close its mouth.
If bilateral luxation occurs, there will be no deviation of the mandible.

or Fractures of the mandible are very common in the dog and cat.(3) Dislocations are uncommon but may occur by themselves or in combination with fractures of the mandible and maxilla.(8,11) The often dramatic and pathetic appearance of an animal with a severe mandibular fracture on presentation should not prevent a thorough examination of the entire patient. Occasionally giant breed dogs may have unilateral or bilateral radial and ulnar fractures that will need attention. Other fractures or soft tissue trauma may be life-threatening as well. Establishment of a patent airway may be necessary in some dogs following head trauma, even some time after admission, hence close observation of the patient is necessary.

Since we noticed Oliver having problems we were inspecting his mouth continuously to see if we could see anything wrong.So i pretty much know his mouth.All the teeth are lining up very well there are no gaps in anything there shouldn't be.So i really don't think this is the case.

However i know they have to put the spacers in the mouth for doing x rays which would have required opening his mouth maybe further than they should have.Also having his mouth open at its max even under Anastasia for extended periods of time could cause some stretching and could cause some issues as well.Which they did by doing the dental.However as i said when he is eating his dinner he opens his mouth fairly well.I wouldn't say it is great but he does open it a couple of inches.However he will not open it to swallow or eat his treats or drink water or even pant.So many things just don't seem to make sense.Unless he just needs a lot more time to recover the damage done by the x rays and the dental before things get any better or maybe they just traumatized him so badly that he wont let it go and just keeps his teeth clenched all the time now.So many things fit in some areas but not in others and vise versa.Man my head hurts i think i am going to take a break for the day.

By the way sled thank you for all you do.I know you have looked up a lot of info on this for me and read all my ramblings and coached me through this and i would just like to say thank you and you are a very good kind hearted person.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> He did have it at that point.That was the whole reason we took him to this other vet.My vet did not have the proper x ray machine to do dental x rays.He recommended me take Oliver to them to do x rays to make sure nothing was wrong with his teeth which was all i had requested and surprise surprise they did a dental as well.My vet said he had wished they hadn't done that as did we.So what you are thinking is there may be some other damage done by them doing the dental and dental x rays.When he went in to have the x rays done and they put him under the vet knew right away since he had stated that When under anesthesia he could only open his mouth a few inches.He did say that the did not forcibly open his mouth.
> 
> If they did do more damage than good what do i have to do to get this figured out.I cant afford any more x rays.I can hardly keep up with the meds.All of this has pretty much wiped out my bank account.
> 
> I can tell you that he could use his mouth ok and do everything normal before he went in to have the x rays done and when we brought him home he couldn't open his mouth at all.


What I cant figure out is if he went in for what I assume was just x rays why do a dental or even attempt to do one. You couldn't do a full dental surely without opening the mouth, especially the rear teeth, assuming they did the dental in the end or just attempted to do it? Like you said they couldn't open his mouth more then a couple of inches then did they try and fail?
If your vet told them it was MMM or suspected MMM even personally I cant understand why you would even attempt a dental on a dog in that state.

From what I found out MMM has two stages. The first stage is acute which is characterised clinically as jaw pain, trismus which means inability to open the jaws, and swelling. That is then followed by the chronic stage which is marked by muscle atrophy which means loss of the muscle as far as I know. The key factor in treatment seems to be the recognition of the acute stage when there is just the pain and inability to open the jaws and maybe the swelling. The link I gave says that without the early recognition and aggressive treatment myofibre loss and muscle fibrosis may result in irreversible jaw dysfunction and sever muscle atrophy (loss of muscle).

If you then go down to the prognosis section it says.


> PROGNOSIS
> The prognosis is determined by the degree of fibrosis present and the
> clinical response to immunosuppression. Aggressive treatment during the
> acute phase generally results in a good prognosis. Patients may ultimately
> ...


Prognosis seems to be better if they start to treat in that acute phase with the aggressive preds. According to that it seems they can still get muscle atrophy even then but often still get complete or partial remission.

I suppose the questions to ask would be, at what stage was he diagnosed, was the theraphy aggressive enough, and even if it was back then and it was working have the problems been caused by reducing the steroids too early that's caused the remission. Also has those xrays and the dental caused a problem. Bear in mind too that steroids can also cause muscle atrophy.

As far as actual diagnosis goes for MMM it seems that Blood tests should be carried out, it appears that pointers can show up on bloods. It seems though the special confirming blood test for MMM is the 2M Antibody titre test. 
So from that it seems that the examination, blood tests and the specific antibody test should have been able to confirm if it was MMM or not. That's providing they did the antibody test before he started the steroids, as it appears if they have been given them 7/10 days before the test in large doses it can cause false negatives, it appears too you can also get false negatives if its in the end stage of MMM once loss of myofibres and fibrosis have happened.

It does mention radiology


> Because of the numerous causes associated with jaw
> pain and trismus (see box on this page), additional diagnostics
> are warranted before initiating immunosuppressive
> therapy for masticatory muscle myositis. Other procedures
> ...


From that I would think that should there have been any problems with the jaws or fractures othr then MMM causing the symptoms it should have showed up, assuming the x rays were done correctly.
I would have thought though the x rays would have been done before the dental.

Also on there it doesn't seem to mention dental xrays as such more scull radiographs.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> I just looked up mandibular
> fractures,temporomandibular joint luxation
> i don't think this is the case since he does open and close his mouth properly and when i move his lips around looking at his teeth everything seems to line up just as it always had.he has his mouth closed and in most cased they are clenched.Or closed very tight with force.so with all that said this is what i found.
> 
> ...


Looking at things another way and putting all else aside at the moment.

If Oliver was showing progress, all be it slower then you would like, although it seems its no quick fix, as they are talking several months rather then weeks even to get the steroids tapered off, that was a good thing.

Reducing the steroids has or seems to have gotten rid of the nasty symptoms and other problems he was having and he is now brighter and more himself, so as far as that all goes it would seem it was caused by the meds.

All seemed to be going a lot better both the progress with the MMM and his other symptoms, until the vet reduced the steroids, then it seems you have had a relapse as far as the MMM goes. From what it seems of the steroid reduction on that link, even with the addition of the azathioprine it does look possible that it is a relapse caused by the dose being lowered too quickly. From what I understand until then he was doing pretty well.

I would speak to the vet about taking the meds back up. If I got it correctly then there was a point where the MMM seemed to be improving and the effects of the steroids stopped, until you lowered them again and now the MMM symptoms seem to have come back. If Ive understood correct then it may be that he just needs to go back to the previous dose and stay there awhile and then try reducing them again but much slower and in smaller increments.

It could well be purely this, its stated that you can get a relapse if they are taken off the steroids too quick or they are tapered off in too big increments or too soon. Sometimes you can just over think things.


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## Rott lover (Jan 2, 2015)

Sled dog hotel said:


> What I cant figure out is if he went in for what I assume was just x rays why do a dental or even attempt to do one. You couldn't do a full dental surely without opening the mouth, especially the rear teeth, assuming they did the dental in the end or just attempted to do it? Like you said they couldn't open his mouth more then a couple of inches then did they try and fail?
> If your vet told them it was MMM or suspected MMM even personally I cant understand why you would even attempt a dental on a dog in that state.
> 
> That is what we couldn't figure out as well.I was not a happy camper about this.I can only imagine all the undo pain and un needed problems this brought about.
> ...


The x rays were done i would think before the dental as well but nothing was ever said about anything else being suspect or any other issues.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> The x rays were done i would think before the dental as well but nothing was ever said about anything else being suspect or any other issues.


I did post again after that one looking at things from the medication point of view and relapses in case you missed it, it could well be a case of overthinking things, and its purely the withdrawal/reduction of the meds too much too soon.


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## Rott lover (Jan 2, 2015)

Sled dog hotel said:


> Looking at things another way and putting all else aside at the moment.
> 
> If Oliver was showing progress, all be it slower then you would like, although it seems its no quick fix, as they are talking several months rather then weeks even to get the steroids tapered off, that was a good thing.
> 
> ...


I talked to the vet and told him pretty much the same thing i told you.He told me to take his pred back up to 20 mg twice a day.I explained that his symptoms were all back.The vet said that with all the issues Oliver has had with the pred that that is kind of what we were looking for was the max dose we could give him without it affecting him.He explained to me that the comeback from this is one of two ways.The first way is lightning in a bottle and the animal has full functionality of their mouth within a week and if it is not this then there is number two which is where Oliver fits in.It can take up to six months for them to regain full control.

He also agrees that something just doesn't add up with his opening his mouth.I explained all the steps of his mouth opening and then not wanting to open it.He is completely baffled by this.We know the pain is not an influence on this.If it were pain i know i would see some of that at some point.He does not exhibit any signs of pain at any time.We know nothing is broken.I also believe that part of the reason his jaw muscles are always stiff is because he is always clenching his teeth shut.This in itself is a big reason we can not get all the forward progress that we think we should be getting.He can and does articulate his mouth quite well when he wants to.I had a small piece of cheese and cracker and he took it very nice and gentle out of my fingers.But when you look at his mouth or teeth at any point they are clenched shut.

I have to wonder if it is a psychological thing.


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## Rott lover (Jan 2, 2015)

Sled dog hotel said:


> I did post again after that one looking at things from the medication point of view and relapses in case you missed it, it could well be a case of overthinking things, and its purely the withdrawal/reduction of the meds too much too soon.


I am sorry this post did not turn out as i had hoped.I added in all the answers in with your quote and forgot to put them in bold.There is an answer and instance between every paragraph


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> I talked to the vet and told him pretty much the same thing i told you.He told me to take his pred back up to 20 mg twice a day.I explained that his symptoms were all back.The vet said that with all the issues Oliver has had with the pred that that is kind of what we were looking for was the max dose we could give him without it affecting him.He explained to me that the comeback from this is one of two ways.The first way is lightning in a bottle and the animal has full functionality of their mouth within a week and if it is not this then there is number two which is where Oliver fits in.It can take up to six months for them to regain full control.
> 
> He also agrees that something just doesn't add up with his opening his mouth.I explained all the steps of his mouth opening and then not wanting to open it.He is completely baffled by this.We know the pain is not an influence on this.If it were pain i know i would see some of that at some point.He does not exhibit any signs of pain at any time.We know nothing is broken.I also believe that part of the reason his jaw muscles are always stiff is because he is always clenching his teeth shut.This in itself is a big reason we can not get all the forward progress that we think we should be getting.He can and does articulate his mouth quite well when he wants to.I had a small piece of cheese and cracker and he took it very nice and gentle out of my fingers.But when you look at his mouth or teeth at any point they are clenched shut.
> 
> I have to wonder if it is a psychological thing.


I know what you mean it doesn't seem so much a case of cant but wont for some reason sometimes. If there isn't a physical reason then its quite possibly a psychological reason. I think I told you about the dog that wouldn't use the garden because of some pain experienced out there on one occasion for a long time. Dogs learn by association, and it could be that when his greed takes over all else and he is wanting the something special he forgets about the pain.

I know in one if not both of those links on the diagnosis treatment etc, it did suggest encouraging dogs to chew as exercise, wonder if you got him something like a meaty bones to gnaw at or special type safe chew it would help, not only as exercise but to try to get him over the brick wall mentally if that's whats occurring. Obviously speak to the vet but it may be an idea.

Thank you for the really nice comments and the thanks, there is really no need though Im really happy to help, even if its just someone to air your worries with and get it out of your system when you need too.


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## Rott lover (Jan 2, 2015)

I just wanted to give an update and add a couple things that add to the weird factor of all this.
I took Oliver's preds up to 20 mg twice a day starting Monday night.His breathing was fast for the first day but Tuesday night it seemed to come back to close normal.All the drooling has stopped and he seems to be in really good spirits.He was playful and the nub was wagging like crazy and he seemed really happy.

Now for the good.He used his tongue really well while eating and used his mouth very well.I saw his mouth open up really well and i would say it was about an inch and a half or so.Everything was going good.Then i saw something i hadn't seen but once since all this started.He yawned.He happened to be right in front of me when he did it and i saw his mouth open about three to four inches.This was great.It proves to me that he can open it but just wont for what ever reason.

At this point i would have to agree with sled and with my vet that he just doesn't want to use his mouth for what ever reason.As long as he can open it when it is needed.I can work with that in the near future.Right now i just want to get him stabilized and get his muscle built back up and get the weight back on.


I have a strong feeling that with him clenching his mouth closed all the time he is causing a lot of stiffness in his jaw muscles.I checked his mouth again last night before we went to bed and he had his mouth clenched shut again with his tongue stuck through his teeth again.


I have to wonder why his tongue sticks out both sides of his teeth so much.I need to remember to ask the vet this.It was sticking out from between his teeth about a half inch and from the moler to the k9.It was very thick as well.I know he was warm so that is what i thought it was from.I should check that in the morning when i know he has calmed down and is not hot.


So those are the updates so far.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> I just wanted to give an update and add a couple things that add to the weird factor of all this.
> I took Oliver's preds up to 20 mg twice a day starting Monday night.His breathing was fast for the first day but Tuesday night it seemed to come back to close normal.All the drooling has stopped and he seems to be in really good spirits.He was playful and the nub was wagging like crazy and he seemed really happy.
> 
> Now for the good.He used his tongue really well while eating and used his mouth very well.I saw his mouth open up really well and i would say it was about an inch and a half or so.Everything was going good.Then i saw something i hadn't seen but once since all this started.He yawned.He happened to be right in front of me when he did it and i saw his mouth open about three to four inches.This was great.It proves to me that he can open it but just wont for what ever reason.
> ...


Glad that things are progressing again in the right direction. If he is clenching his teeth and jaws a lot it would put pressure on the muscles and jaw itself. You only need to sit there with your teeth and jaws clenched yourself to realise.

The thing with the tounge Ive been trying to work out, but without actually seeing it its hard to visualise even with your explanation.

I even looked up sites on rotweiller dentition to try to figure out what you are saying and what might be happening, but as Im having trouble visualising what your saying, Ive drawn a bit of a blank. The site I found is pretty good at explaining the correct bite which is a scissor bite, and also things like under and over shot jaws etc. There are diagrams too and photographs of the bites together with the incorrect bites and dentition. If you haven't seen it, it may help for you to figure out what might be going on. It starts with Puppy teeth and dentition, and does on to adult teeth and the correct and incorrect.

Rottweiler Teeth and Dentition


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## Rott lover (Jan 2, 2015)

I cant blame you for not being able to visualize what i am describing.The best i can do is describe it with the site you gave me.


If you look at diagram 9 imagine a good quarter inch to half inch of his tongue sticking out along p1 through p3 on each side of his mouth.

As i said he does it at night but i have not checked to see if it is like that in the morning when he is cooled down and relaxed.

His teeth all line up and his jaw does work properly i do believe.Everything seems to line up with all that i have read and looked at.He does not appear to have any alignment problems at all.The whole tongue thing is something i had just noticed a couple of days ago.It seems like maybe he is hot and his tongue is fanned out but doesn't fit in his mouth.I will take a picture of his tongue and teeth tonight and see if i can get a picture posted of it.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> I cant blame you for not being able to visualize what i am describing.The best i can do is describe it with the site you gave me.
> 
> If you look at diagram 9 imagine a good quarter inch to half inch of his tongue sticking out along p1 through p3 on each side of his mouth.
> 
> ...


Right see more what you mean now.

Dogs only way (apologies here if Im stating the obvious and you know already)
of cooling down is through panting, pulling the air over the tongue and mucos membranes in the mouth, and evaporation comes into it too, this then cools the blood nearest the surface, which then circulates the body, not the quickest of processes. They do sweat from the pads too, but as far as I remember it doesn't do a lot.

I never thought more about the tongues role before other then the basics above. So I did some checking and found this.

When a dogs body temperature rises,* the tongue will hang outside of the mouth, in fact a dogs tongue actually increases in size during exercise due to increased blood flow within the tongue. As the tongue gets larger the dog will pant.* These shallow quick breathes cause the dogs wet tongue
to evaporate moisture, thereby cooling the dogs tongue. Since blood flows through the tongue it is cooled off.
Dog Tongue Hanging Out

Its not the most scientific looking site I tend to try and use, but assuming its correct might throw some light on what/why he is doing it.

I then remembered something I had seen and remembered about steroid dosing in dogs that got me wondering.

I then got to thinking more about cortisol and natural cortisol production.
In humans cortisol winds down at night, then in the early hours starts to build up to peak at morning levels and then winds down again gradually throughout the day. Or it should mine doesn't I have to take hydrocortisone as soon as Im up and then other doses that's how I know about it.

Going back to dogs and rechecking prednidale which is prednisolone I found this.


> Dogs should be dosed in the morning and cats should be dosed at night to coincide with the endogenous cortisol peak.


NOAH Compendium of Animal Medicines: Prednidale Tablets - Clinical particulars

From that if I have understood it correctly dogs look seem the same as humans. Cortisol levels go down at night, to almost non existant up to a point and then start to rise again so peak levels are in the morning.

With Olivers condition he has to be dosed 2 x daily morning and night. Which means that naturally when his cortisol levels should be going down, you are giving him his night preds so they are going up or remaining higher then they would naturally. Which if Ive worked it out right, would likely be causing what you see and why you see the symptoms of the panting/mouth thing whatever.

Because if the type of condition I would assume that it is necessary to keep the levels up and suppress the auto antibodies that are attacking his muscles. Im not suggesting you change to once daily or even if its something you can do, but it might be worth speaking to the vet about.

Purely theory of course but might explain it if I have got it right.


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## Rott lover (Jan 2, 2015)

OK you and i are on the same page then.He does most of his panting during the evening.This is when we and he are most active around the house.Plus we have the oven going and cooking and so forth.That is why i wanted to check it first thing in the morning as well.If it is a case of being hot combined with not wanting to open his mouth would make his tongue bigger and since there is not room for his tongue in his mouth it spills over to the out side as it would if he were to be panting so to speak.By checking it in the morning will tell me if this is the case.If his tongue is small and contained then i can write it off as this.If it is just as big after being rested all night and relaxed then it would tell me we have yet another problem to contend with.


Also i now know that his teeth clenching and not opening his mouth is definitely not a physical issue.As i fed him his food last night he opened his mouth about an inch and a half to two inches again.Then when we gave him some left over chicken pattys that were only quartered he opened his mouth about three inches or so to get it in his mouth.A little bit after he was done eating he yawned.Thats only the second time he has yawned since christmas however he got his mouth open about half way in my best guess.So that tells me he can but he just wont.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> OK you and i are on the same page then.He does most of his panting during the evening.This is when we and he are most active around the house.Plus we have the oven going and cooking and so forth.That is why i wanted to check it first thing in the morning as well.If it is a case of being hot combined with not wanting to open his mouth would make his tongue bigger and since there is not room for his tongue in his mouth it spills over to the out side as it would if he were to be panting so to speak.By checking it in the morning will tell me if this is the case.If his tongue is small and contained then i can write it off as this.If it is just as big after being rested all night and relaxed then it would tell me we have yet another problem to contend with.
> 
> Also i now know that his teeth clenching and not opening his mouth is definitely not a physical issue.As i fed him his food last night he opened his mouth about an inch and a half to two inches again.Then when we gave him some left over chicken pattys that were only quartered he opened his mouth about three inches or so to get it in his mouth.A little bit after he was done eating he yawned.Thats only the second time he has yawned since christmas however he got his mouth open about half way in my best guess.So that tells me he can but he just wont.


It seems that way, if it was painful or he couldn't as you say he just wouldn't do it, or going by common sense logical thinking he wouldn't. It seems too when you give him something special, the greed and expectation of the goody, overrides all else. Yawning I suppose is a more involuntary movement too so maybe that's why.

I would have a look at his mouth first thing as you suggest and maybe before you give him his preds. Maybe do the same in the evening, pre and post preds too or it you can.

When I have to go for my best part of the day cortisol tests to check my levels, I don't take my meds, get there early have bloods done, take the med and then they take bloods every so often. So keeping a regular evaluation of what happens and when pre and post meds and how long after may be interesting. There will be a take up time, which will then peak and after it peaks it will start to wane again until the next meds, thats what happens with mine, so I would assume that will happen with him.


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## Rott lover (Jan 2, 2015)

i am going to see if this works.I attached a photo of Olivers mouth.His tongue was like this even this morning before he got up.


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## Rott lover (Jan 2, 2015)

Good it worked.This is what his tongue is doing so you have a better understanding.I think this could be a good reason i always hear that slurping sound when he swallows.This could also be a good reason he is having trouble eating as well.I will be sending the same pic to my vet as well.just what i need is more problems


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## Rott lover (Jan 2, 2015)

I found this link that has some info about MMM and the tongue.Hmm got to wonder if it is all connected after all.

Masticatory muscle myositis - Dog

What concerns me is if his tongue is like this that would explain the way he drinks and eats and lack of chewing.I know i wouldn't chew if my tongue was between my teeth.Since we already know he had and still kind of has cushings as well it is noted in one of the sites that i was reading that the tongue may become atrphyied and swollen with that as well.

Hmmm this is alot to read over and try to comprehend and make sense out of it.


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## Rott lover (Jan 2, 2015)

I also found this as well.I dont understand it but i know it has to do with the tongue and MMM

https://www.jstage.jst.go.jp/article/jvms/71/8/71_8_1063/_pdf


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## Sled dog hotel (Aug 11, 2010)

Polymyosotis is the form that affects many muscles not just the Masticatory muscles as in MMM. it seems that's the first time it was reported in a dog, and I cant find anything else.

Atrophy means, loss of as in muscle wasting. Atypical means what you wouldn't expect so different from the normal or normal pattern.

It mentions a similar case in a human but that seems to be a single incident but it appears that patient too had polymyosotis. The human ones mentions affecting the tongue and causing Macroglossia which as far as I can tell means big tongue.

Doesn't seem to be well known.


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## Rott lover (Jan 2, 2015)

I have that picture sent to the vet and i guess i wait until he calls me to see what he comes up with.


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## Sled dog hotel (Aug 11, 2010)

Hope he can come up with something once he has seen the photos, keep us updated.


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## Rott lover (Jan 2, 2015)

Here it is Monday again.

It is update day lol.


So for the good news.Oliver is up and around and moving again.He is more alert than he has been in a long time.I had him playing a bit both with my hand and with the laser light.He has been eating out of his bowl in the living room that we always leave food in for him(he is normally free fed).

Now for the not good but not bad news.He has gotten soft stool again.I think this one is my fault.We bought a new high protein food and i added to much of it to his bowl.The stink he lets out from gas is enough to peel the paint off the walls as well.Also the vet said to not worry about the tongue.The vet said he has seen many dogs with their tongue like that during their checkup.He asked me to play with it to see if he can pull it all the way in and to check it for bite marks or scarring or any other abnormality.I have seen nothing wrong and he can suck it all the way.


Now for the not so good news.I noticed Oliver's weight has only stabilized now.He is not gaining any weight but he is not losing it either.I also noticed he is starting to knuckle in the rear paws.Not often but when he goes up the stairs and at times walking in the snow.The other new thing that has developed is he has started pushing his face and head in the snow.Not in the fluffy stuff that gives way but the hard stuff.He will push from the side of his nose all the way to his cheek into the snow and start rubbing really hard.Then he takes his paw and rubs from the back of his ear all the way down across his eye to his nose.Not sure what this is about but i think it may tie into the worst news.I have seen no improvement in the last few days with his mouth.I have not heard him chew anything at all just swallowing everything.

I will give it a couple of days and if i still don't see anything improving then we might need to up his new meds.(The aza........)Right now he is on 75 mg once a day.I also think from the knuckling and his big old pot belly that we still may need to get him off the pred and a higher dose of aza or something else with the aza.


That's all the news i have for now.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> Here it is Monday again.
> 
> It is update day lol.
> 
> So for the good news.Oliver is up and around and moving again.He is more alert than he has been in a long time.I had him playing a bit both with my hand and with the laser light.He has been eating out of his bowl in the living room that we always leave food in for him(he is normally free fed).


So gland that he is doing more and seems a lot happier.


> Now for the not good but not bad news.He has gotten soft stool again.I think this one is my fault.We bought a new high protein food and i added to much of it to his bowl.The stink he lets out from gas is enough to peel the paint off the walls as well.Also the vet said to not worry about the tongue.The vet said he has seen many dogs with their tongue like that during their checkup.He asked me to play with it to see if he can pull it all the way in and to check it for bite marks or scarring or any other abnormality.I have seen nothing wrong and he can suck it all the way.


Normally sudden abrupt changes of food and/or especially too much at one time first off will often do it and cause sloopy stools. It sounds like it might be a lot richer too, it should hopefully settle down, the gas too I hope for your sakes Glad the vet doesn't think the tongue is any issue, and your exam of it it seems to be fine.



> Now for the not so good news.I noticed Oliver's weight has only stabilized now.He is not gaining any weight but he is not losing it either.I also noticed he is starting to knuckle in the rear paws.Not often but when he goes up the stairs and at times walking in the snow.The other new thing that has developed is he has started pushing his face and head in the snow.Not in the fluffy stuff that gives way but the hard stuff.He will push from the side of his nose all the way to his cheek into the snow and start rubbing really hard.Then he takes his paw and rubs from the back of his ear all the way down across his eye to his nose.Not sure what this is about but i think it may tie into the worst news.I have seen no improvement in the last few days with his mouth.I have not heard him chew anything at all just swallowing everything.


Im wondering if its the steroids affecting his legs. I did find this.
Changes in protein metabolism: Glucocorticoids will alter the animal's metabolism of protein and can easily lead to muscular weakness or atrophy. With consistent and long-term use, the signs of this can become quite apparent. The abdominal muscles may weaken, causing the animal to have a sagging or pendulous abdomen.* Additional strength can be lost from the legs, causing the animal to have difficulty rising after lying down, climbing steps, or walking long distances.*

Its from a pretty good article on steroids tells you lots of things about what it does.

Glucocorticosteroids (Corticosteroids) in Dogs, Cats and Other Pets

cant immediately come up with any suggestions for the face rubbing.


> I will give it a couple of days and if i still don't see anything improving then we might need to up his new meds.(The aza........)Right now he is on 75 mg once a day.I also think from the knuckling and his big old pot belly that we still may need to get him off the pred and a higher dose of aza or something else with the aza.
> 
> That's all the news i have for now.


have you tried juggling or lowering his meds prior to what might seem to be a hitch on the progression of the MMM again. If so I would be a bit suspect its that maybe and its either a bit of a relapse or its in a static state. Then of course there is the steroid. It a fine balancing act isn't to get it spot on low enough to alleviate any nasty symptoms and unwanted side effects but high enough to sort the MMM out.


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## Pasuded (Feb 13, 2015)

I found a great link:
Masticatory muscle myositis - Wikipedia, the free encyclopedia

Here is another good one:
https://purinaproclub.com/resource-...scle-myositis-is-needed-for-treatment-success

I have never heard of PM in dogs before. I hope your vet can help you. Im glad to hear your pup is doing better.


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## Rott lover (Jan 2, 2015)

Sled dog hotel said:


> So gland that he is doing more and seems a lot happier.
> 
> That makes two of us
> 
> ...


The last time we did this was a few weeks back.We dropped him to 10 mg twice a day and the symptoms of 3m came back.I let the vet know and we discussed what seemed to be the sweet spot for his body which seemed to be 20 mg twice a day.He still gets over worked and panting easily but he doesn't pant while he is sleeping.His breathing is still faster than normal but manageable.He stopped dropping weight like crazy.And he started getting up and moving around instead of just laying in he bedroom at all times not wanting to do anything or being a part of anything.

The real problem is where he is at now body and spirit he is ok.But not much going on with the 3m.It doesnt seem to be worse nor does it seem to be getting better.If we raise the pred we are sending his body and spirit back down the tubes but getting his 3m better.However if doesnt do anything or want to even be active then he is not using his mouth to work out the muscles.If we lower the pred then his 3m comes back and his body and spirit is better than ever.

That is why i am wondering if we can up the aza.Not sure what max dosage is but i remember my vet saying he was hoping to knock out the 3m with just the aza and get him off the pred completely.Not sure what to make of this situation but i know the preds are not doing him any justice.


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## Rott lover (Jan 2, 2015)

i added some stuff in the quote as well


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## Rott lover (Jan 2, 2015)

Thank you pasuded


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> The last time we did this was a few weeks back.We dropped him to 10 mg twice a day and the symptoms of 3m came back.I let the vet know and we discussed what seemed to be the sweet spot for his body which seemed to be 20 mg twice a day.He still gets over worked and panting easily but he doesn't pant while he is sleeping.His breathing is still faster than normal but manageable.He stopped dropping weight like crazy.And he started getting up and moving around instead of just laying in he bedroom at all times not wanting to do anything or being a part of anything.
> 
> The real problem is where he is at now body and spirit he is ok.But not much going on with the 3m.It doesnt seem to be worse nor does it seem to be getting better.If we raise the pred we are sending his body and spirit back down the tubes but getting his 3m better.However if doesnt do anything or want to even be active then he is not using his mouth to work out the muscles.If we lower the pred then his 3m comes back and his body and spirit is better than ever.
> 
> That is why i am wondering if we can up the aza.Not sure what max dosage is but i remember my vet saying he was hoping to knock out the 3m with just the aza and get him off the pred completely.Not sure what to make of this situation but i know the preds are not doing him any justice.


Obviously you must speak to your vet but on those links on one it says
.Immunosuppressive doses of corticosteroids (prednisolone 1 to 2 mg/kg every 12 hours orally)
comprises the cornerstone of treatment of MMM. This dose should be maintained until jaw
function and serum CK level (when initially elevated) have both returned to normal. Dosage of
prednisolone is then slowly decreased over a few months to the lowest every-other day dose that
keeps the clinical signs at bay. Other immuno-suppressive agents such as azathioprine (1 to 2
mg/kg every 24 hours orally) are indicated in dogs that failed to respond to corticosteroids
treatment or that relapse when the dose is tapered
Which is from
http://www.veterinarywebinars.com/assets/NSK_Session2_Notes.pdf

The other one says 
TREATMENT
A favorable outcome in masticatory muscle myositis
necessitates early accurate diagnosis and appropriate
therapy. Treatment is centered on aggressive immunosuppression,
which is generally achieved by corticosteroid
administration. The cornerstone of therapy is
prednisone at 2 mg/kg PO bid during the acute phase.
This dose should be maintained until maximum jaw
function has been regained and CK levels have returned
to normal. At that time, prednisone can be slowly
tapered to the lowest every-other-day dose that abates
clinical signs.14 This process should generally occur
slowly over 4 to 6 months, with no more than a 50%
decrease in the dose every month. After several months
of decreasing the dose of prednisone, the minimal maintenance
dose that abates clinical signs can be established.
Although many patients require this maintenance
dose for a lifetime, others can ultimately
discontinue all therapy. While tapering prednisone, clinicians
are advised to observe patients for relapses in
clinical signs, which may signify a need for increased
immunosuppression. Although low-dose alternate-day
therapy is generally well tolerated, long-term prednisone
may result in iatrogenic hyperadrenocorticism and susceptibility
to infections. Owners should be prepared for
resultant polyuria, polydipsia, and polyphagia associated
with prednisone administration as well as the potential
for steroid-induced gastric ulcers. In addition, corticosteroid
therapy alone can result in masticatory muscle
atrophy. If the side effects of prednisone therapy cannot
be tolerated, alternative immunosuppressive agents may
be used.
Azathioprine is another immunosuppressive drug
that can be considered in addition to traditional
corticosteroid therapy. Although azathioprine is generally
not included in the initial therapy for masticatory
muscle myositis, it can be used in conjunction with
prednisone in patients that are unable to tolerate the
side effects of corticosteroids or are refractory to prednisone
therapy alone. Azathioprine should be dosed at
2 mg/kg PO q2448h and continued over several
months while prednisone is slowly tapered to a maintenance
dose. Thereafter, azathioprine may be slowly
tapered as long as the patient does not experience a
relapse. Side effects associated with azathioprine
include bone marrow suppression and hepatotoxicity.
Therefore, regular evaluations of the complete blood
count and hepatic enzymes are warranted. Cyclosporine
is another immunosuppressive drug that may
be used adjunctively; however, its use requires extensive
therapeutic monitoring. Colchicine has also been proposed
as being potentially useful because of its
reported antifibrotic properties in liver disease. However,
colchicine has never been proven to have antifibrotic
properties in skeletal muscle.9
If untreated or treated inappropriately, the acute phase
will progress to the chronic phase. A common problem
in treating masticatory muscle myositis is using an inadequate
dose of corticosteroids for too short a time. It is
common for masticatory muscle myositis to respond
initially to therapy, but relapses usually occur quickly if
treatment is discontinued prematurely. The chronic
phase is marked by severe muscle atrophy resulting from
gradual replacement of muscle fibers with fibrous tissue.
Corticosteroids may prove helpful in the chronic phase,
although lower doses are recommended.11 The clinical
application of corticosteroids in the chronic phase is
based on the belief that therapy may reduce further
fibrosis.
Patients experiencing significant trismus may require
gruel diets to maintain adequate nutritional intake.
Patients can also be encouraged to chew toys or bones
to promote use of their masticatory muscles. The
literature has historically recommended forcible opening
of the jaw while patients are under anesthesia.
Studies have found significant morbidity, including
temporomandibular joint luxation and mandibular
fractures, associated with this procedure, without documented
improvement in clinical outcome afterward.
Therefore, manual retraction of the jaw is strictly contraindicated.
9

http://vetneuromuscular.ucsd.edu/publications/melmed.pdf


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## Rott lover (Jan 2, 2015)

Thank you sled i will show this to my vet.


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## Rott lover (Jan 2, 2015)

so i had a long heart to heart with my vet.My vet says that we are playing this one by ear because of all the issues we have been going through.

We cant get him to the point of getting his jaw back to normal motion since we cant give him any more than 20 mg of pred twice a day.The aza is as high as he wants to go at this point since the side affects can be lethal in the long run.

Since the drooling and most affects of the MMM are weaning all be it very slow here is what the vet is hoping.

Since Oliver has made small steps in the right direction over time he wants to use the slow and steady approach,As long as things continue to progress he wants to keep everything right where it is.As the vet put it Oliver has taken the normal playbook and thrown it out the window.

The vet is afraid of giving Oliver any more pred since even half dose almost killed him and we haven't even recovered from that.At 20 mg twice a day he is at close to a even keil.He is still getting weak in the hind end and legs but he is not getting any worse nor is he losing weight any more.

When we tried going to 10 mg the symptoms of the MMM came back.So we are in a very fine balancing act and behind from the very start.The vet said as long as there is forward progress we will keep him where he is untill there is no more progress or untill he starts to relapse and we will have to deal with that from there.

On the good side of things.He is not having accidents in the house anymore.He is eating a lot more out of his food bowl in the living room.He is actually playing again and active again(aside from being weak in the back end).I have been playing little by little with the laser light to get him exercising again.I would love to take him for walks but with the extreme cold and my bad knees i cant do that.So the laser light is the next best thing.It was -13 this morning brrrrrrr lol.

So i guess it is going to be a long haul to even get him close to normal again.


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## Rott lover (Jan 2, 2015)

I also have to ask.Do you think there could be any connection between any of this and horrible rancid make me puke breath that has been coming out of him for about the last year.Everyone thought it was his teeth but before all this started he had beautiful teeth but his breath just reeked like garbage cans in the hot summer sun filled with old meat containers from last month.No i am not exaggerating.I can tolerate a lot but he on occasion has almost made me puke.

When they cleaned his teeth(which they weren't supposed to do) They said that should take care of it.Ummmm not so much.Still smells the same.My vet said to let all this other stuff settle first then we can deal with that.What if that is a sign or if whats causing all this in the first place?


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> so i had a long heart to heart with my vet.My vet says that we are playing this one by ear because of all the issues we have been going through.
> 
> We cant get him to the point of getting his jaw back to normal motion since we cant give him any more than 20 mg of pred twice a day.The aza is as high as he wants to go at this point since the side affects can be lethal in the long run.
> 
> ...


As you say you cant push it too high, the MMM may get better quicker but then he is very poorly and its making him ill. It sounds like what your vet says is the only way too go. In your position I would be doing exactly the same.

He seems to be doing a lot more so as well as seeming better and the MMM reasonably under control he must be feeling a much happier boy. Unfortunately dogs don't read textbook and they are far from all textbook classic cases.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> I also have to ask.Do you think there could be any connection between any of this and horrible rancid make me puke breath that has been coming out of him for about the last year.Everyone thought it was his teeth but before all this started he had beautiful teeth but his breath just reeked like garbage cans in the hot summer sun filled with old meat containers from last month.No i am not exaggerating.I can tolerate a lot but he on occasion has almost made me puke.
> 
> When they cleaned his teeth(which they weren't supposed to do) They said that should take care of it.Ummmm not so much.Still smells the same.My vet said to let all this other stuff settle first then we can deal with that.What if that is a sign or if whats causing all this in the first place?


Well the most common cause of bad breath is often teeth/gums and gum disease.

Digestive or gut problems can cause it, as can diabetes but with diabetes its usually described as sweet or a fruity type smell, which doesn't sound like the delightful description that you have given

Liver and kidney problems can cause it too Im sure I have read in the past, which would figure as they remove toxins from the body or its part of their jobs, so if they were not working then you would get toxins build up in the body. I suppose he has had bloods done, Im pretty sure they should be doing them now quite regularly with the steroids and the azathioprine as regards to kidney and liver function.

Might be something in his food, or you can get bad bacteria over growth in the small gut, yeasts too. How is his toileting normally pre drugs?
You can actually get pre and probiotics that are for dogs which help with the good gut bacteria needed for healthy gut and digestion, which also helps crowd out bad bacteria and yeasts.

There is a good arfticle on candida yeasts

http://www.tristateweimrescue.org/storage/Coconut Oil.pdf


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## Rott lover (Jan 2, 2015)

Another Monday and another update.

Oliver has had diarrhea for about two weeks now and nothing seems to stop it.I think it is time for another vet call.I have tried yogurt,Pumpkin,Fasting for 24 hours and bland diet and as a last resort pepto.Nothing has helped.This needs to stop.I am losing my mind.I am really tired of cleaning it up.It is not dark in color it is like a lite tan but when he goes there is a lot of gas with it.I even tried just rice with boiled chicken but there was no change at all.I remember even a few weeks ago when the vet gave some pills he never came back to regular.

Also yesterday we gave him some carrots and he was actually chewing them but then last night i saw blood on his fangs.At least is looked like blood.I will be keeping an eye on this just in case.I was thinking it could have been from the carrots.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> Another Monday and another update.
> 
> Oliver has had diarrhea for about two weeks now and nothing seems to stop it.I think it is time for another vet call.I have tried yogurt,Pumpkin,Fasting for 24 hours and bland diet and as a last resort pepto.Nothing has helped.This needs to stop.I am losing my mind.I am really tired of cleaning it up.It is not dark in color it is like a lite tan but when he goes there is a lot of gas with it.I even tried just rice with boiled chicken but there was no change at all.I remember even a few weeks ago when the vet gave some pills he never came back to regular.
> 
> Also yesterday we gave him some carrots and he was actually chewing them but then last night i saw blood on his fangs.At least is looked like blood.I will be keeping an eye on this just in case.I was thinking it could have been from the carrots.


Azathoprine Im pretty sure I read can cause diarrhoea as a side effect.
As his immune system is being clobbered and suppressed by the preds and the azathioprine, it can make them more prone to picking up bugs and infection so I suppose he could even have a stomach bug he has picked up and its hitting him hard.

Keep a watch for any signs of bleeding, Im pretty sure it also said that it can sometimes cause anemia and bleeding problems. If they are becoming anemic then usually their gums go pale. So that might help as far as that goes keeping a watch on his gums.

I would have a word with the vet about the diarrhoea, just to see if he thinks it may indicate a problem, even if its just a side effect, maybe he can give you something to help firm him up. We have something called protexin prokolin here which is kaolin, pectin and probiotic that often helps together with a light easily digestible resting diet.


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## Rott lover (Jan 2, 2015)

Sled dog hotel said:


> Azathoprine Im pretty sure I read can cause diarrhoea as a side effect.
> As his immune system is being clobbered and suppressed by the preds and the azathioprine, it can make them more prone to picking up bugs and infection so I suppose he could even have a stomach bug he has picked up and its hitting him hard.
> 
> Keep a watch for any signs of bleeding, Im pretty sure it also said that it can sometimes cause anemia and bleeding problems. If they are becoming anemic then usually their gums go pale. So that might help as far as that goes keeping a watch on his gums.
> ...


No blood in the poo at all and it is not like pure water diarrhea.It is hard to describe but it would almost be like a say tomato soup out of a can.I know he has to go in for blood tests in about 2 weeks again unless this raises any red flags to get it done sooner.


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## Rott lover (Jan 2, 2015)

I think that is what the vet gave me last time as well.It firmed it up enough to where he didn't have accidents anymore at least.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> No blood in the poo at all and it is not like pure water diarrhea.It is hard to describe but it would almost be like a say tomato soup out of a can.I know he has to go in for blood tests in about 2 weeks again unless this raises any red flags to get it done sooner.


Its worth speaking to the vet and see what he says, at least if he thinks it may be a concern then he can get checked out sooner if needs be. If he doesn't think its anything to worry about, he might at least be able to give you something to settle it down and firm the stools up.


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## Rott lover (Jan 2, 2015)

Also forgot to mention that the yogurt seems to have helped his breath.Not a lot but it has only been a week.I think i really need to look into those probiotics.My only concern is that giving him probiotics is supposed to strengthen the immune system and that is what we ware trying to kill in this case.


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## Rott lover (Jan 2, 2015)

just thought i would share some good news in light of all the bad news i have been posting.

Last night was a very good night.Oliver was all sorts of playful and full of energy.He ate his marrow bone treats without breaking them up.He took them and chewed them.He ate his dinner with authority and using his mouth the way he should be.He even chewed his hot dog and spit his pill out.Then i went to change his water and noticed his food bowl was empty so i filled that and he ate even more.While he was drinking i watched him and even that was a lot closer to what it should be.He didn't even leak tons of water all over the place.Also his poo is back to normal without the pills i just got from the vet.I guess the yogurt is doing wonders for his system.I also saw that even when he was done with his water it wasn't all full of slime like it usually is.Another very positive thing is that when he swallows he is starting to open his mouth instead of having his mouth completely closed with that weird slurping swallowing sound.

I also noticed that since i have started giving him the yogurt his tongue has been staying more and more in his mouth instead of between his teeth.Any ideas on that?The yogurt has seemed to help alot of things from his breath to his poo and his energy level to his appetite.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> Also forgot to mention that the yogurt seems to have helped his breath.Not a lot but it has only been a week.I think i really need to look into those probiotics.My only concern is that giving him probiotics is supposed to strengthen the immune system and that is what we ware trying to kill in this case.


If its natural live yoghurt you are giving him then really its probably doing the same as giving a pre and pro biotic anyway. The main thing a pre and probiotic does is help with the good gut flora needed for a healthy digestion.

Im wondering if he did have an overgrowth of candida albicans, which is classed as a yeast and a fungus (details on that link I gave of the problems in dogs) Candida albicans is also known as thrush. Its naturally present in the body in us as well as dogs, and can be found in the digestive tract and even the mouth and suffice to say some more err intimate areas. When alls in balance the immune system and a healthy gut good bacteria keeps it all down to levels that don't cause problems. However you can get an overgrowth of it and that's when you get problems. Drugs like antibiotics and steroids can upset the natural balance, so that could be why you have the problem.

So at a guess and just lateral thinking that may well have been your problems as regards his gut and the gas and his smelly breath.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> just thought i would share some good news in light of all the bad news i have been posting.
> 
> Last night was a very good night.Oliver was all sorts of playful and full of energy.He ate his marrow bone treats without breaking them up.He took them and chewed them.He ate his dinner with authority and using his mouth the way he should be.He even chewed his hot dog and spit his pill out.Then i went to change his water and noticed his food bowl was empty so i filled that and he ate even more.While he was drinking i watched him and even that was a lot closer to what it should be.He didn't even leak tons of water all over the place.Also his poo is back to normal without the pills i just got from the vet.I guess the yogurt is doing wonders for his system.I also saw that even when he was done with his water it wasn't all full of slime like it usually is.Another very positive thing is that when he swallows he is starting to open his mouth instead of having his mouth completely closed with that weird slurping swallowing sound.
> 
> I also noticed that since i have started giving him the yogurt his tongue has been staying more and more in his mouth instead of between his teeth.Any ideas on that?The yogurt has seemed to help alot of things from his breath to his poo and his energy level to his appetite.


Well from what you say it looks like the meds are at last are really beginning to make progress with the MMM, and lowering the steroids has gotten rid of the nasty side effects making him feel a lot better too.

When human babies and people get candidia albicans (thrush) overgrowth in the mouth, they normally get whiteish raised lesions, on the tounge, gums, inside the cheeks and roof of the mouth, if they are aggravated with things like brushing they can bleed and it can get very sore and painful. So Im just wondering if that whats happened to oliver, which wouldn't help on top of the MMM and the problems he already has with that. The tonsils can get affected with it too, and the oesophagus making that sore so that swallowing can be painful too sometimes.

So in theory at least it would make sense why it may be helping.

Did you have a read of that link re candida albicans in dogs, if you missed it or didn't, here it is again to save you hunting through the thread.

There is a symptoms check list on there too.

http://www.tristateweimrescue.org/storage/Coconut Oil.pdf

Another thing they suggest to help on the link is coconut oil. Not suggesting you just use it its something you would need to speak to the vet about, but there is another link below on that too written by Dr Jean Dodds DVM.

Dr. Jean Dodds' Pet Health Resource Blog | Coconut Oil: The ?Good? Saturated Fat


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## Rott lover (Jan 2, 2015)

Thank you for that sled.It is funny you mention coconut oil as we have it in the house for our dry hands and for some cooking as well.I know there are a lot of health benefits from coconut oil as well.One of my good friends was having a lot of skin issues with his two dogs and was in and out of the vets office.They were getting really bad dry and flaky spots and itching until they bleed.He spent tons of money on meds and creams and all kinds of stuff.Some one suggested coconut oil in their food.They started with two spoonfuls mixed in and After about a week all the skin issues started to clear up.He now only adds it once a week or so and they have been cleared up for years.


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## Rott lover (Jan 2, 2015)

Also wanted to let me know that Oliver has been eating a ton of food(10 to 15 cups) a day throughout the day.However he is only pooping out about 2 cups a day.He is starting to look a little bit more like normal.


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## Rott lover (Jan 2, 2015)

I have a bit of a strange question for you sled.

I was wondering if the muscles in his head could have started shrinking from lack of use before all this started.If the muscles were already starting to shrink and we kicked in the pred which would have shrunken them even more.

The reason i am asking you this is i have been really paying attention to his mouth and his jaws now that we have everything under control.Honestly his mouth is not any better than it was two weeks after his original diagnosis before new years.

I am going to run a few things past you and be as descriptive as possible.

Some days he opens his mouth just fine others he wont open it at all.This even changes minute to minute.I can give him one piece of hot dog and he wont open his mouth wide enough to even get it past his teeth then the second he takes it the long way and opens wide,then seconds later it is back to not opening for the third.

Another thing that concerns me is he is always slamming the front of his mouth into what ever he is eating off of.Weather it is a plate,his bowl,the floor.Even the carpet.You can hear him hitting the front teeth on what ever he is eating.

Something else that still bothers me greatly is when he get something out of no where he will start chewing but swinging his head while he is chewing.Almost like you would see a horse swing their head while playing.It seems that he is trying to get the food into a certain spot in his mouth to chew it or something.then the next bite he is fine.

He still paws constantly at the back side of his jaw right in front of his ear.He also rubs his head into his pillows as well.There are many things that are just not adding up.

A little story from before Christmas.We were getting ready for bed and we were playing with Oliver with his stuffed animal as we always did.We would wave the toy around and he would grab it and then drop it and start all over.Just out of the blue after doing this maybe 10 or 20 times his head shot up and to the left while he started howling.Even now you can get him to do things and it all changes in an instant.I have been able to throw him a piece of hot dog and he will snatch it out of the air several times and the next he wont even try but a couple of minutes go by and he will do it again.

In all honesty i don't think he is any better than he was 2 weeks after New Years.I have an idea of a possibility but i want to see what you make of this.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> I have a bit of a strange question for you sled.
> 
> I was wondering if the muscles in his head could have started shrinking from lack of use before all this started.If the muscles were already starting to shrink and we kicked in the pred which would have shrunken them even more.


From what Ive read about it, there is two phases too MMM. The Acute stage which is jaw pain, inability to open the jaws, and swelling. Then if I read and understood correctly after this comes the chronic stage which is when you get 
the muscle wasting/loss. It did say that the earlier the conditions diagnosed and the aggressive treatments started with the meds the better, and without early recognition and treatment you can get myofibre loss and muscle fibrosis may result in irreversible jaw dysfunction and muscle wasting.
It did also say that the corticosteroids alone (preds) can cause muscle wasting and that if there is worsening muscle atrophy then it may not be due to the worsening of the MMM but purely due to the preds.
It also did say that treatment failure and relapses are often due too inadequate immunosuppression. (don't forget the problem is caused by the body/ immune system getting confused and making antibodies to its own muscles destroying them in the first place, so you have to suppress the whole immune system to stop it making these bad antibodies).
Or the other cause can be too hasty withdrawal of the steroids. I would assume that would also mean if you bring them down too quickly too.

There was also this too.


> It is essential that patients be treated aggressively because evidence shows that
> patients that relapse are less likely to experience remission in the future.
> Patients treated in the chronic phase of the disease carry a more uncertain
> prognosis but can do well if extensive fibrosis does not result in persistent
> ...


Unfortuanately I cant say what has happened in Olivers case all I can do is dig up the above, which are scenarios of what can happen and may possibly explain whats going on.



> The reason i am asking you this is i have been really paying attention to his mouth and his jaws now that we have everything under control.Honestly his mouth is not any better than it was two weeks after his original diagnosis before new years.
> 
> I am going to run a few things past you and be as descriptive as possible.
> 
> ...


I need to pop off for a bit, but the second part of your post above, I will have a through read through properly and then read all the information I dug up again through in detail and see if I can connect anything relevant that may explain more later when I get back on.


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## Rott lover (Jan 2, 2015)

When you pop on and read through what you quoted in my last post i want you to skip MMM or the diagnosis and see what you come up with.I came up with something and i feel it in my gut that we are missing something.None of this adds up in my mind and nothing seems to fit.Until i ran across another situation.I found out that the original vet never did any other x rays other than the teeth.none of the tests for MMM were done.They did a baseline blood test and when they put him under they opened his mouth and said it stopped half way open.If they said it opened half way when he was put under then why is it he hasn't opened it that far since.Also how far do you need to open the mouth to put a tube in?They had a tube down his throat while he was under we saw the pictures they took.This really got me digging since i have felt things don't add up for a while now.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> I have a bit of a strange question for you sled.
> 
> I was wondering if the muscles in his head could have started shrinking from lack of use before all this started.If the muscles were already starting to shrink and we kicked in the pred which would have shrunken them even more.
> 
> ...


If he can open his mouth wide and if You are saying it looks pretty normal at times or not so far off? Then it sounds like he is capable of it. the literature I dug up did suggest encouraging them to chew on toys or bones so they use the masticatory muscles too. I should imagine its like anything else when somethings not being used or used fully then you will get muscle atrophy from that, I remember when my daughters arm was in plaster and the muscle loss and the difference in the size of her bad arm was astounding in just those 6 weeks in plaster purely through no use. Im just wondering if there is still pain there, maybe not continuous pain, but more like intermittent or stabbing pain, when he perhaps opens that bit too wide. That would maybe explain the times when he is almost normal and opens wide, then he experiences an intermittent or sharp pain so wont open his mouth. 


> Another thing that concerns me is he is always slamming the front of his mouth into what ever he is eating off of.Weather it is a plate,his bowl,the floor.Even the carpet.You can hear him hitting the front teeth on what ever he is eating.


The only thing I can think of is that maybe the coordination of opening his jaws are off and he doesn't sometimes have control or cant coordinate the movement/opening the jaws.


> Something else that still bothers me greatly is when he get something out of no where he will start chewing but swinging his head while he is chewing.Almost like you would see a horse swing their head while playing.It seems that he is trying to get the food into a certain spot in his mouth to chew it or something.then the next bite he is fine.


Im just wondering if the head movement is him trying to keep a hold of, or keep the food in the right place. Trying to think of an example to explain it, may not be the best one, but like when you throw a piece of food to a dog to catch, and they move the head in the direction to grab at it nearly miss cue and then use the movement of the head in conjuction with the jaws too keep a hold of it. If that makes sense, if he hasn't got full range of movement and/or power in the jaws, maybe the head swinging or other movement is to aid the grab/hold/positioning and to stop it slipping away or dropping it.


> He still paws constantly at the back side of his jaw right in front of his ear.He also rubs his head into his pillows as well.There are many things that are just not adding up.


Dogs will often paw at their faces or rub their faces when they have tooth ache or mouth pain so Im wondering if this indicates that he may have some pain there still, maybe as I said before not a continuous pain, but bursts of or sudden sharp intermittent pain.


> A little story from before Christmas.We were getting ready for bed and we were playing with Oliver with his stuffed animal as we always did.We would wave the toy around and he would grab it and then drop it and start all over.Just out of the blue after doing this maybe 10 or 20 times his head shot up and to the left while he started howling.Even now you can get him to do things and it all changes in an instant.I have been able to throw him a piece of hot dog and he will snatch it out of the air several times and the next he wont even try but a couple of minutes go by and he will do it again.


Again makes me wonder if there are bursts of pain or discomfort, or the jaw or muscles seize inbetween, so you get periods of intermittent more free moving, and then it catches or seizes and maybe then pain or discomfort with it.


> In all honesty i don't think he is any better than he was 2 weeks after New Years.I have an idea of a possibility but i want to see what you make of this.


Never having had to personally experience a dog with MMM, I cant draw from anything apart from basic things I already knew and what Ive learned since trying to find out relevant information to help in Olivers case. Above really are just ideas and thoughts thrown in the mix, in case they may have some significance or be a possible explanation or even something to ask the vet about.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> When you pop on and read through what you quoted in my last post i want you to skip MMM or the diagnosis and see what you come up with.I came up with something and i feel it in my gut that we are missing something.None of this adds up in my mind and nothing seems to fit.Until i ran across another situation.I found out that the original vet never did any other x rays other than the teeth.none of the tests for MMM were done.They did a baseline blood test and when they put him under they opened his mouth and said it stopped half way open.If they said it opened half waywhen he was put under then why is it he hasn't opened it that far since.Also how far do you need to open the mouth to put a tube in?They had a tube down his throat while he was under we saw the pictures they took.This really got me digging since i have felt things don't add up for a while now.


There was this comment.
The
literature has historically recommended forcible opening
of the jaw while patients are under anesthesia.
Studies have found significant morbidity, including
temporomandibular joint luxation and mandibular
fractures, associated with this procedure, without documented
improvement in clinical outcome afterward.
Therefore, manual retraction of the jaw is strictly contraindicated.

There was this too.
Complete physical and neurologic examinations are important to confirm
that clinical signs are restricted to the muscles of mastication. Corticosteroid
therapy can result in atrophy of the masticatory muscles; therefore,
this should be considered in the initial evaluation. Patients should also be
closely examined for evidence of trauma that could have resulted in a
mandibular fracture or temporomandibular joint luxation or subluxation.
Thorough oral examinations should be performed but often require heavy
sedation or anesthesia.

Patients presenting in the acute phase demonstrate trismus and swollen,
painful masticatory muscles (Figure 2). Clinical signs are usually bilateral
but may appear to be unilateral in some cases if one side is more severely
affected than the other. Clinical signs can vary in the rate of onset and
severity.

One of the diagnostics mentioned is muscle biopsy, but it makes an interesting point.

. The information gained from a muscle
biopsy must be weighed against the anesthesia risks
associated with masticatory muscle myositis. Trismus
can be severe enough that it prohibits tracheal intubation.
In addition, patients may be at greater risk of aspiration
pneumonia.

Don't know if this is any help?


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## Sled dog hotel (Aug 11, 2010)

This is from a new link on MMM

Dogs with lockjaw present a challenge when endotracheal intubation and general anaesthesia needs to be carried out. Other diseases that cause a limited ability to open the oral cavity should be ruled out before diagnosing MMM.

There are two forms of MMM: acute and chronic. A common clinical feature in both types of MMM is trismus, also called lockjaw, in which dogs have a limited ability to open the mouth due to contraction, pain and mechanical resistance of the muscles concerned with the jaw movements.

This may be interesting too, it concerns a case study of a dog with MMM that had been put under anaesthesia and was intubated.

malnourishment. It is worth underlying that forceful physical attempts to open the jaw in dogs under sedation or general anaesthesia must not be carried out because there is the risk of causing mandibular luxation or fractures.

The inability to fully open the mouth in a dog with MMM presents a challenge when endotracheal intubation needs to be carried out. If endotracheal intubation is not possible, a laryngeal mask airway can be inserted to maintain the patient on inhalational anaesthesia. During the anaesthesia, the patient needs to be carefully monitored because complications may occur. An interesting case report showed that during anaesthesia in a dog with MMM, tongue protrusion occurred. Since there was trismus, it was not possible to reposition the tongue within the oral cavity and this resulted in venous congestion and severe swelling of the tongue. The jaw mobility was not improved even after removal of the rostral digastricus and masseteric muscle attachments from the mandible. Only a mandibular symphysiotomy resolved the tongue swelling.

It looks pretty good alround information wise and worth a read.

Masticatory muscle myositis in dogs - Publications - Vetsonline.com


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## Rott lover (Jan 2, 2015)

the reason i was asking about all this is i found something else that really fits much closer than MMM.If you look at this whole thread and then look at temporomandibular joint disorder.Am i reading too much into this?I am waiting for my vet to call me and find out how much it will be to x ray Olivers jaws just to know for sure.Also as i recall reading having a xray done of the jaws will tell me if his jaws have atrophied at all.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> the reason i was asking about all this is i found something else that really fits much closer than MMM.If you look at this whole thread and then look at temporomandibular joint disorder.Am i reading too much into this?I am waiting for my vet to call me and find out how much it will be to x ray Olivers jaws just to know for sure.Also as i recall reading having a xray done of the jaws will tell me if his jaws have atrophied at all.


There is the differential diagnosis for trismus on that sheet.

Masticatory muscle myositis
 Polymyositis (pain and reluctance to open the jaw, but
not actual trismus)
 Temporomandibular joint luxation, subluxation, or
fusion from chronic joint disease
 Tetanus
 Craniomandibular osteopathy
 Retrobulbar abscess
 Extraocular myositis (referred jaw pain)
 Muscular dystrophy
 Foreign body

. Other procedures
that may aid in diagnosing masticatory muscle
myositis include radiology and advanced imaging, electrodiagnostics,
and histologic evaluation of biopsy specimens.
Skull radiographs or computed tomograms
should be obtained while patients are under general
anesthesia. One classic finding in masticatory muscle
myositis is the inability to open the jaw under anesthesia.
Other abnormalities, such as fusion of the temporomandibular
joints or healed fractures, may result in similar
findings but should be eliminated from the
differential diagnosis by the imaging studies.
complicatio
however it does say that temporal subluxation has happened when dogs with MMM have had their jaws forced under anaesthetic.

. The
literature has historically recommended forcible opening
of the jaw while patients are under anesthesia.
Studies have found significant morbidity, including
temporomandibular joint luxation and mandibular
fractures, associated with this procedure, without documented
improvement in clinical outcome afterward.
Therefore, manual retraction of the jaw is strictly contraindicated.

Did you see the new stuff I found on that mentions complication with intubation too in dogs with MMM, and also the bit about the swollen tounge complication its a couple back if you missed it.

We did talk about the possibility of damage before due to the dental that was carried out. So Im still wondering if it is indeed MMM but with further complications still, but due to something like temporomandular luxation or other complication in that area.


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## Rott lover (Jan 2, 2015)

Only a mandibular symphysiotomy resolved the tongue swelling.


Sorry for my lack of knowledge but what is this?

From that new article it sound like everything i am going through is pretty normal aside from the tongue thing.

I am taking Oliver in for a check up and to have blood work done next week so i will talk to the vet about that as well.

My other idea with the vet is to see if maybe i can start pulling back on his preds again.I read a bunch of articles on the aza and how it works and what it does and found that it can take a month to two months to fully kick in and stop the immune system fully.That would mean that the last time we tried o get him down off of the preds his immune system was still working pretty well.So maybe we can try doing that again.His back legs are getting so bad he is starting to have troubles going potty.

The main reason i want to get him in for a blood check is i had noticed that he had a couple of drops of blood when he would first start to pee and while laying around the house.I went and got a urinary track infection test kit and it was all negative.Also i want to have his mouth looked at since his fangs keep getting what looks like blood residue on them even though i clean them daily and can never find and place that is bleeding.

after finding out that he vet we took him to didn't do and real blood work or x rays of his head i am am feeling like i am at square one after all these months.I feel like i should be doing at least head x rays to see if it could be anything to do with the jaws.This dog used to go through 16 to 20 inch rawhide bones with knots the size of softballs in less than 2 weeks.with the way he chewed through those bones i just think for peace of mind i should have the x rays done to make sure nothing else is wrong.


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## Sled dog hotel (Aug 11, 2010)

With something like this it can get to a point where there are so many thoughts and things going on you can get lost and caught up in them, with disjointed thoughts all over the place that just gets totally confusing.
Sometimes it helps of try to put them in some semblance of order. It might be an idea to do a sort of time line, with the actual medical facts and process of the MMM text book, and fit into that Olivers case and progress to compare.

Going first right back to the beginning and his symptoms, what tests he had or didn't, and compare them to the diagnostics that are available and the normal pattern.

We know that there are two stages acute and chronic, the acute where there is jaw pain, inability to open the jaw which is called trismus, and swelling.
This is followed by the chronic phase which is when you get the muscle atrophy (wasting). We also know that without early recognition of the problem and aggressive treatment starting, you can get myofibre loss and muscle fibrosis that may result in irreversible jaw dysfunction and severe muscle loss.

We also know that The prognosis (outcome) is based on the degree of fibrosis present and also the response to the drugs that suppress the immune system.
Aggressive treatment through the acute phase generally results in a good prognosis, they can still develop muscle wastage but often experience partial to complete remission. We also know that steroids alone can cause muscle loss
and if there is still some progressive loss it may not be due to the MMM getting worse. We also know that treatment failure and relapse often result from inadequate suppression of the immune system and too quick withdrawal of steroids. We also know that the treatment has to be aggressive because patients that relapse during treatment are less likely to get remission in the future. Patients that are treated in the chronic stage, the outcome is more uncertain, but can do well if extensive fibrosis does not result in persistent jaw dysfunction. It did also say that owners should be warned that jaw function may be improved but not normalised and the muscle atrophy may be persistent.

The take home points from above therefore, as far as I can see as far as oliver goes and the questions you would need to ask are. What stage was Oliver in when it was diagnosed and treatment started. Acute or chronic Also when was treatment started and was it aggressive enough, was there or to what degree was there myofibre loss and muscle fibrosis, as we know from the above it can result in irreversible jaw dysfunction and severe muscle loss.
The prognosis is dependent on the degree of fibrosis. Also what was his response to the immnosupression of the drugs. The stage he was at is important as recognition in the acute phase and aggressive treatment then has a good prognosis. There is also the question of because of the side effects and problems he had with the preds, and the change in dosage, is it possible that this may have caused a relapse, which can happen when they are withdrawn and/or reduced too quickly, also dogs who relapse can be less likely to get remission in the future. Could this have happened but also you need to bare in mind that the use of preds alone can cause muscle loss to so if muscle loss continued it could be down to the preds and not the progression of the MMM. At the same time too, treatment depends on the treatment being aggressive enough and also how he responded. Also if he was treated in the chronic stage rather then the acute, bearing in mind that the outcome can be more uncertain anyway, they can still do well provided that there isn't extensive fibrosis that can sometimes result in irreversible jaw dysfunction.

Another possible consideration is the dental they carried out which I believe you said was after he was diagnosed with MMM. We know from the literature,
that in the past forcible opening of the jaws while the patients were under anaesthesia was recommended in the past. In recent times studies have found that significant morbidity including temporomandibular joint luxation and mandibular fractures associated with this has occurred without any clinical improvement after, so they now say that manual retraction of the jaw is strictly contraindicated, ie a strict no no. because it doesn't help and can cause damage.
There was also confirmation of this on the new link I found yesterday, which also mentioned complications caused to the tounge, and did you not say there were problems with Olivers tounge too. to recap from the latest link on the subject.

malnourishment. It is worth underlying that forceful physical attempts to open the jaw in dogs under sedation or general anaesthesia must not be carried out because there is the risk of causing mandibular luxation or fractures.

The inability to fully open the mouth in a dog with MMM presents a challenge when endotracheal intubation needs to be carried out. If endotracheal intubation is not possible, a laryngeal mask airway can be inserted to maintain the patient on inhalational anaesthesia. During the anaesthesia, the patient needs to be carefully monitored because complications may occur. An interesting case report showed that during anaesthesia in a dog with MMM, tongue protrusion occurred. Since there was trismus, it was not possible to reposition the tongue within the oral cavity and this resulted in venous congestion and severe swelling of the tongue. The jaw mobility was not improved even after removal of the rostral digastricus and masseteric muscle attachments from the mandible. Only a mandibular symphysiotomy.

So take home point/questions with the above in mind, could it be possible that the dental, and the intubation have caused further complications in addition to the MMM, it seems documented that it possible, and could this be why he is experiencing problems or further complicatiions.

Lastly you mentioned the actual diagnostic procedure that was used to diagnose Oliver in the first place. We know from the literature there is a wide range of diagnostics used/available in the process. Not only to diagnose the MMM itself but also to ensure that differential diagnosis of other things are also ruled out that could be the problem. You said there seemed to be a lack of these. As a recap of the suggested correct diagnostic procedures.

To save time, I will copy and paste over.

1)
Complete physical and neurologic examinations are important to confirm
that clinical signs are restricted to the muscles of mastication. Corticosteroid
therapy can result in atrophy of the masticatory muscles; therefore,
this should be considered in the initial evaluation. Patients should also be
closely examined for evidence of trauma that could have resulted in a
mandibular fracture or temporomandibular joint luxation or subluxation.
Thorough oral examinations should be performed but often require heavy
sedation or anesthesia. Retrobulbar masses, which may result in trismus,
may cause visible swelling or drainage behind the carnassial teeth. Relatively
rapid atrophy of the masticatory muscles can result from any disease that
affects the trigeminal nerve, especially trigeminal neuritis and peripheral
nerve sheath tumors. However, patients with trigeminal neuritis are generally
nonpainful and demonstrate normal to flaccid jaw tone.
Patients presenting in the acute phase demonstrate trismus and swollen,
painful masticatory muscles (Figure 2). Clinical signs are usually bilateral
but may appear to be unilateral in some cases if one side is more severely
affected than the other. Clinical signs can vary in the rate of onset and
severity. Ocular signs have been noted in 44% of all patients with masticatory
muscle myositis, with exophthalmos noted in the acute phase because
of swelling of the pterygoid muscles behind the eyes.9 If severe enough,
exophthalmos can result in stretching of the optic nerve and subsequent
blindness. Patients presenting with clinical signs of exophthalmos secondary
to masticatory muscle myositis must be differentiated from those with
extraocular myositis (see box on page 591).11 Pyrexia and mandibular and
prescapular lymphadenopathy have also been reported during the initial 1 to
3 weeks of masticatory muscle myositis.12 Recognizing typical clinical signs
of masticatory muscle myositis is essential because treatment is most successful
when initiated in this phase.
Unfortunately, most owners do not recognize a problem until the chronic
phase, which is characterized by marked muscle atrophy with or without
persistent trismus (Figure 3). Enophthalmos may be present in the chronic
phase because of atrophied pterygoid muscles.

It then goes onto Differentials and diagnostic tests, You can read through in detail about them on the link at the bottom, but for quickness Ive just made a listing here.

Initial testing complete blood count and serum chemistry profile Including Creatine Kinase (CK]

It seems the diagnostic test as we discussed before is the specific 2M antibody test. However he couldn't have it now because it says that false negatives can occur once they have been on immunosupressent steroids for 7/10 days prior to testing.

There is also a mention that as there are other causes of trismus (inability to open the jaws) and jaw pain other diagnostics are warranted to rule these out and can aid in the diagnosing of MMM too and are listed as radiology, advanced imaging, electrodiagnostics, and histology evaluation or biopsy specimens.
It seems the biopsy can be important as it can confirm diagnosic confirmation of the disease as well as information of the prognosis especially when muscle atrophy is present and if significant fibrosis is suspected, which if you refer to the above about atrophy and fibrosis you will see why. You can tell with the biopsy the severity of the fibre loss and the degree of the fibrosis if present.
This can help work out the long term prognosis and probable success of the theraphy.

All the diagnostics and reasons for them, are in detail in the link below. As is all the other information.

http://vetneuromuscular.ucsd.edu/publications/melmed.pdf

Hope this may help with a check list, to compare olivers case and your thoughts too that may be able to get your thoughts in some semblance of order, and maybe help you make a list of questions and things that you may need to discuss with your vet including any worries you may have about Olivers progress or treatment so far.


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## Rott lover (Jan 2, 2015)

Sled dog hotel said:


> With something like this it can get to a point where there are so many thoughts and things going on you can get lost and caught up in them, with disjointed thoughts all over the place that just gets totally confusing.
> Sometimes it helps of try to put them in some semblance of order. It might be an idea to do a sort of time line, with the actual medical facts and process of the MMM text book, and fit into that Olivers case and progress to compare.
> 
> Going first right back to the beginning and his symptoms, what tests he had or didn't, and compare them to the diagnostics that are available and the normal pattern.
> ...


In ending i would like to thank you for all this info.It was very helpful.It made me realize a few things.I added some info in the quote above as well.I would also like to add in a couple of things as well.Last night when i got Oliver's food ready for him i put his kibble in the bottom and just dumped his wet in a big clump.When i put it down for him i watched from the start of him going to it.When he first went to grab it he didn't even get to the food.He sopped just short of it.He was trying to open his mouth.He got his mouth open about a quarter of an inch.Then tried again and it went to a half inch then again to one inch.Then it finally opened about half way.I think that from not having any muscle built up and not using it all day that maybe it is just stiff and he needs to work it out first.

I was also doing some investigating into the pred some more and one of the side effects of the pred is a swollen tongue.I really think this tongue hing is hindering things a lot.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> In ending i would like to thank you for all this info.It was very helpful.It made me realize a few things.I added some info in the quote above as well.I would also like to add in a couple of things as well.Last night when i got Oliver's food ready for him i put his kibble in the bottom and just dumped his wet in a big clump.When i put it down for him i watched from the start of him going to it.When he first went to grab it he didn't even get to the food.He sopped just short of it.He was trying to open his mouth.He got his mouth open about a quarter of an inch.Then tried again and it went to a half inch then again to one inch.Then it finally opened about half way.I think that from not having any muscle built up and not using it all day that maybe it is just stiff and he needs to work it out first.
> 
> I was also doing some investigating into the pred some more and one of the side effects of the pred is a swollen tongue.I really think this tongue hing is hindering things a lot.


He does sound whatever the actual reason that he is having intermittent problems doesn't he?

On the subject of the prednisolone Vs Prednisone, as far as I knew it was the same, but just to double check to be sure from this seems it is.

01 Prednisone/Prednisolone - VeterinaryPartner.com - a VIN company!


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## Rott lover (Jan 2, 2015)

I am just going to throw this out there to see what you think of this.Last night when i got home the wife said Oliver had a lot of difficulty with his treats and made a huge mess out of them.I sat down on the floor with him and as soon as he got close to me i could smell that awful stench of his breath.So i got him to lay down in my lap and i grabbed some paper towels and went to cleaning his mouth up.When i raised his lip i saw a whole bunch of brown goo that was like pudding in his mouth.When i wiped out his mouth i smelled what came out and it made me gag.It was that nice descriptive rotting meat in the hot July sun stench.The other thing that concerns me is his fangs are all full of blood.While wiping out his mouth I wiped all the way from the back to the front and made sure i came into contact with every part of the outside of his mouth and in his lips but never came back with any blood.Just that brown gooey ick. not all of it was brown but it all stunk really bad.

Also again last night when i made his food i just blobbed all his wet food in one spot.He took almost the whole thing in one bite.As i sat and watched him eat i realized that the reason he slams the front teeth into the floor is not really a problem with coordination it is because he cant use his tongue properly.Although for the first time since i cant remember he was licking the carpet last night where he made a mess with some food.His drinking sounded a lot better as well.He was still kind of slurping but he didn't have the long pauses either.


Also along with this i have to add that yesterday morning i started him on 10 mg of pred instead of 20 to see if we can start backing him down finally.



This thing with his stinky and nasty slobber along with the blood concerns me but he will be going in early next week for blood tests.i also want to have him test his urine to see if he has an infection or why he still has blood occasionally coming out when he pees and while laying around.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> I am just going to throw this out there to see what you think of this.Last night when i got home the wife said Oliver had a lot of difficulty with his treats and made a huge mess out of them.I sat down on the floor with him and as soon as he got close to me i could smell that awful stench of his breath.So i got him to lay down in my lap and i grabbed some paper towels and went to cleaning his mouth up.When i raised his lip i saw a whole bunch of brown goo that was like pudding in his mouth.When i wiped out his mouth i smelled what came out and it made me gag.It was that nice descriptive rotting meat in the hot July sun stench.The other thing that concerns me is his fangs are all full of blood.While wiping out his mouth I wiped all the way from the back to the front and made sure i came into contact with every part of the outside of his mouth and in his lips but never came back with any blood.Just that brown gooey ick. not all of it was brown but it all stunk really bad.
> 
> Also again last night when i made his food i just blobbed all his wet food in one spot.He took almost the whole thing in one bite.As i sat and watched him eat i realized that the reason he slams the front teeth into the floor is not really a problem with coordination it is because he cant use his tongue properly.Although for the first time since i cant remember he was licking the carpet last night where he made a mess with some food.His drinking sounded a lot better as well.He was still kind of slurping but he didn't have the long pauses either.
> 
> ...


Do you think that the brown gunk and the rotting meat smell could be partially digested food. Maybe even food that has been refluxed back or regurgitated, that would explain the rotting meat or food smell.

Whats his gum colour like, is it a nice healthy pink colour you would expect, not pale or especially whiteish that can mean anemia / low red blood cell count. Is there any yellowing of the gums or his eye rims or whites of the eyes? That can often indicate problems with red blood cells too, as when the blood cells break down they produce something called billurubin, which in high levels can build up in the blood causing jaundice.

The only reason I ask because without double checking and trusting my memory didn't the Azathioprine sometimes can cause problems with the bone marrow and red blood cells?

Ill do some more checking, my brains not functioning fully at the moment, I had some what could be worrying news about a test on my youngest and shes got to have some more tests, so Im a bit all over the place.


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## Sled dog hotel (Aug 11, 2010)

My memory might be working better then I thought it seems I have remembered correctly about Azathioprine.

Side Effects

One of the main issues with azathioprine is a problem with the bone marrow suppression.* Cells of the bone marrow are rapidly dividing and thus at risk for suppression from azathioprine. For this reason, at least in early stages of use, complete blood counts (CBC) are monitored frequently (typically every 2 weeks for the first couple of months).*

Red Blood cells are produced in the Bone marrow.

Signs of a* bone marrow problem that might be observable at home include abnormal bruising or inappropriate bleeding (bloody nose, bloody stool, blood in urine, excess bleeding from a minor wound etc.) If bone marrow suppression has not occurred in the first couple of months of therapy, it is unlikely that it will occur later on.*

The other thing I wasn't sure of but it seems it can is also liver toxicity too

*Some patients develop a liver toxicity with azathioprine.* This should resolve with discontinuation of the medication but it is important to* watch for any signs of nausea, diarrhea, or appetite loss. If these occur, especially in the first few weeks of starting azathioprine,* discontinue the medication and notify your veterinarian of these effects.

Azathioprine can also promote pancreatitis (pancreatic inflammation). Again, signs of nausea/intestinal upset can result. If this occurs, discontinue azathioprine and notify your veterinarian.
01 Azathioprine (Imuran) - VeterinaryPartner.com - a VIN company!

It seems that if they are going to get a problem then its in the earlier stages of use with Azathioprine hence he should be checked with completel Blood counts every two weeks. Has he been checked since being on the Azathioprine and how long has he been on it?

It may not be this, but he has had blood in his urine which is mentioned, and bleeding in his mouth, if he has any of the other signs too I mentioned in the previous post, then I would be more suspect. The Jaundice yellowing can also be caused by liver problems and due to toxins. It would be an idea to check his liver function too anyway.


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## Rott lover (Jan 2, 2015)

Sled dog hotel said:


> Do you think that the brown gunk and the rotting meat smell could be partially digested food. Maybe even food that has been refluxed back or regurgitated, that would explain the rotting meat or food smell.
> 
> Whats his gum colour like, is it a nice healthy pink colour you would expect, not pale or especially whiteish that can mean anemia / low red blood cell count. Is there any yellowing of the gums or his eye rims or whites of the eyes? That can often indicate problems with red blood cells too, as when the blood cells break down they produce something called billurubin, which in high levels can build up in the blood causing jaundice.
> 
> ...


His gums and look very good nice and pink and black.Not faded or pale at all.His eyes are nice and white.You are correct on the aza but he doesn't have any of the symptoms that i can tell but that is also why he is going in for the blood test.

Oh no I am sorry about the bad news i truly hope Things will look up.Take your time and make sure your pup is ok.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> His gums and look very good nice and pink and black.Not faded or pale at all.His eyes are nice and white.You are correct on the aza but he doesn't have any of the symptoms that i can tell but that is also why he is going in for the blood test.
> 
> Oh no I am sorry about the bad news i truly hope Things will look up.Take your time and make sure your pup is ok.


We cross posted, I have posted again with more info above but other signs can be.

Signs of a bone marrow problem that might be observable at home include abnormal bruising or inappropriate bleeding (bloody nose, bloody stool, blood in urine, excess bleeding from a minor wound etc.) If bone marrow suppression has not occurred in the first couple of months of therapy, it is unlikely that it will occur later on.

He has got blood in his urine? and it does say minor wounds, could the blood on his fangs be where he has smashed into the bowl etc when eating and caused trauma and hence the bleeding do you think?


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## Rott lover (Jan 2, 2015)

Sled dog hotel said:


> My memory might be working better then I thought it seems I have remembered correctly about Azathioprine.
> 
> Side Effects
> 
> ...


I see we crossed post again.He has not been checked since being on the aza yet.This will be the first blood test since he has been on it and the vet told me to keep watch on all these same things.He has been on it for a little over a month.The only things that point to issues is he blood in the urine which comes and goes.The blood in the urine is a couple of drops for a day or two and then gone for a few weeks.Then it will come back for a day or two and gone again.His mouth and gums and eyes all look normal.Well his gums on the outside anyways.I cant get him to open his mouth to save my life and i don't want to force it.

Not sure what to make of the brown gunk.What made me clean his mouth in the first place is he was doing the weird swallowing again with the squishy noises and he was doing it constantly.There was food caked in his top teeth from his previous treats but the stench was horrendous.If i recall as well a problem with the liver could cause the goo and bad breath as well.I also think i heard somewhere that high protein can cause this as well.He has always been on high protein foods.Science diet lamb and rice and now also kerrick chicken and sweet potato.I have kept him on high protein to try to help his muscle regrowth which is why we also feed him wet treats such as turkey and chicken medley type wet food.


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## Rott lover (Jan 2, 2015)

Sled dog hotel said:


> We cross posted, I have posted again with more info above but other signs can be.
> 
> Signs of a bone marrow problem that might be observable at home include abnormal bruising or inappropriate bleeding (bloody nose, bloody stool, blood in urine, excess bleeding from a minor wound etc.) If bone marrow suppression has not occurred in the first couple of months of therapy, it is unlikely that it will occur later on.
> 
> He has got blood in his urine? and it does say minor wounds, could the blood on his fangs be where he has smashed into the bowl etc when eating and caused trauma and hence the bleeding do you think?


i was wondering that as well but what i find odd is the blood doesn't stick to anything but his upper fangs.All the other teeth and fangs are clean.No blood in the saliva or on the cheeks.No definitive place the blood is coming from


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> I see we crossed post again.He has not been checked since being on the aza yet.This will be the first blood test since he has been on it and the vet told me to keep watch on all these same things.He has been on it for a little over a month.The only things that point to issues is he blood in the urine which comes and goes.The blood in the urine is a couple of drops for a day or two and then gone for a few weeks.Then it will come back for a day or two and gone again.His mouth and gums and eyes all look normal.Well his gums on the outside anyways.I cant get him to open his mouth to save my life and i don't want to force it.
> 
> *Not sure what to make of the brown gunk.What made me clean his mouth in the first place is he was doing the weird swallowing again with the squishy noises and he was doing it constantly.*There was food caked in his top teeth from his previous treats but the stench was horrendous.If i recall as well a problem with the liver could cause the goo and bad breath as well.I also think i heard somewhere that high protein can cause this as well.He has always been on high protein foods.Science diet lamb and rice and now also kerrick chicken and sweet potato.I have kept him on high protein to try to help his muscle regrowth which is why we also feed him wet treats such as turkey and chicken medley type wet food.


Do you think this might be regurgitation of the food and/or a combination of trying to get food down?

What should happen with food and water is that the food should go down the oesophagus which should expand an contract to push the food down. It literally should be instant and go from mouth to stomach. The oesophagus is basically a muscular tube anyway. If it doesn't work properly then food can get caught in the oesophagus instead of going down into the stomach, and it then gets regurgitated. It can happen almost immediately in which case it looks like well food still, but it can happen a long time after too.

Regurgitation is different to vomiting where they heave up from the stomach so you see more body movements. With regurgitation there is none of that and the dog can seem quite relaxed. Pure suggestion of course, but would that explain the head swinging thing too maybe. Im not sure if the MMM can affect the oesophagus too, so far Ive not come across anything that says it does though. He did have the tube though. 
Are you still having probs with weight aswell Im pretty sure it can cause that too loss I mean or trouble keeping weight on.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> i was wondering that as well but what i find odd is the blood doesn't stick to anything but his upper fangs.All the other teeth and fangs are clean.No blood in the saliva or on the cheeks.No definitive place the blood is coming from


Well his deffinately due bloods anyway that should be done to make sure there are no effects of the azathioprine and probably the high steroid doses his had too come to that. So CBC and checking his liver readings will tell if there is anything going on, on that score, so maybe the sooner the better.
So as regards to affects on his bone marrow, and liver that will answer that one, and check other general health too.


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## Rott lover (Jan 2, 2015)

Sled dog hotel said:


> Do you think this might be regurgitation of the food and/or a combination of trying to get food down?
> 
> What should happen with food and water is that the food should go down the oesophagus which should expand an contract to push the food down. It literally should be instant and go from mouth to stomach. The oesophagus is basically a muscular tube anyway. If it doesn't work properly then food can get caught in the oesophagus instead of going down into the stomach, and it then gets regurgitated. It can happen almost immediately in which case it looks like well food still, but it can happen a long time after too.
> 
> ...


 It could be something along those lines but i don't see any affects to those.
The bad breath is not something new to this.He has had this for a year or more actually.The swinging head i believe is his way of trying to get things where he wants them in his mouth.I really think that a big part of the problems that are remaining are cause by something else.His tongue is a big part of that something but i just haven't put all the pieces together yet.I truly believe i am fighting two separate problems here.He has been putting on tons of weight since we started giving him yogurt.Once we got rid of the poops he started eating and pooping normal almost over night.

A good tip on the breath.When i took Oliver in to the vet to have the x rays done when the vet walked in the room he made a comment about the stench and that he thought he had to have a bad tooth or teeth just by the smell.We were only in the room for about 10 minutes at that point.Thats how bad it was.


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## Sled dog hotel (Aug 11, 2010)

Ive just looked up oesophageal disorders and it can range from Oesophagitis
which is inflammatory or infectious and will cause regurgitation to other things
but it will cause different things depending on the oesophageal actual problem things like regurgitation of undigested food, painful or inappropriate eating or swallowing, they might be reluctant to eat, eat slowly,
drop food while eating, gag retch or regurgitate after, this is called Dysphagia.
something called ptyalism is mentioned as a symptom too which is excessive drooling or saliva production. The other thing is Halitosis aka bad breath.

So it would explain the things you have said about oliver?


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## Rott lover (Jan 2, 2015)

Sled dog hotel said:


> Ive just looked up oesophageal disorders and it can range from Oesophagitis
> which is inflammatory or infectious and will cause regurgitation to other things
> but it will cause different things depending on the oesophageal actual problem things like regurgitation of undigested food, painful or inappropriate eating or swallowing, they might be reluctant to eat, eat slowly,
> drop food while eating, gag retch or regurgitate after, this is called Dysphagia.
> ...


BINGO WOOOOOOOOO HOOOOOOOO......Oh wait damn another problem.......This explains so many different things.He used to wretch quite often.Not quite a puke but not quite a cough. He would spit out anything from foam to like stomach acid.yellowy mucus looking nasty.He would vomit on average of every couple of weeks.Is there something i can give him?The yogurt seems to help most of the time to keep the stench at bay.he hasn't wretched or choked but once i think since Christmas and that was just a couple of weeks ago.It scared the wife half to death.She thought he was going to choke to death since he wouldn't open his mouth.

OK to the last thing now do you think any of these pills could cause an enlarged tongue that he is on?That is the last piece of the puzzle i have not quite figured out.I know you sent me the link to the enlaged tongue but since i dropped him to 10 mg of pred he seems to be doing better and i know that that side effect is listed.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> BINGO WOOOOOOOOO HOOOOOOOO......Oh wait damn another problem.......This explains so many different things.He used to wretch quite often.Not quite a puke but not quite a cough. He would spit out anything from foam to like stomach acid.yellowy mucus looking nasty.He would vomit on average of every couple of weeks.Is there something i can give him?The yogurt seems to help most of the time to keep the stench at bay.he hasn't wretched or choked but once i think since Christmas and that was just a couple of weeks ago.It scared the wife half to death.She thought he was going to choke to death since he wouldn't open his mouth.
> 
> OK to the last thing now do you think any of these pills could cause an enlarged tongue that he is on?That is the last piece of the puzzle i have not quite figured out.I know you sent me the link to the enlaged tongue but since i dropped him to 10 mg of pred he seems to be doing better and i know that that side effect is listed.


As well as the link I gave you about the dog who had MMM, and was tubed during anaesthetic and that caused complications as regards to tounge swelling, I know there was another one too about exercise/ panting and cooling and the tonge swelling. I would have to look back, this thread is getting so long it needs indexing. If his not panting so much then maybe that's why. The preds do make them pant.

You can get acid reflux too btw, where acid comes up in the throat which isn't protected like the stomach is from digestive enzymes and stomach acid, so that can cause drooling, nausea, vomiting etc. If too bad and left it can also cause ulceration of the throat. One of mine got gastric reflux under anaesthesia once, and I had to give him two types of doggie gaviscon like stuff for a week or so to make sure there wasn't any oesophageal damage or ulceration.
Usually if its yellow stuff then its bile.

Do you give his meds with food? steroids can ulcerate the stomach Im supposed to take mine with food, and if I don't sometimes because I always forget my second one of the day, I get terrible acid reflux that burns my throat and makes me cough and feel sick, If ive been a bit piggy too its actually made me vomit.

Another thing that just occurred to me too is pancreatitis, which is inflammation of the pancreas, you can get acute and chronic versions. mild and severe. I thought steroids can be a cause, according to this I found not so much apparently although it says they can cause increases in lipase on blood tests, but guess what Azathioprine can cause it according to this.

Use of certain drugs can predispose to pancreatitis (sulfa containing antibiotics such as trimethoprim sulfa, chemotherapy agents such as azathioprine or L-asparaginase, and the anti-seizure medication potassium bromide). Exposure to organophosphate insecticides has also been implicated as a cause of pancreatitis. Exposure to steroid hormones have traditionally been thought to be involved as a potential cause of pancreatitis but this appears not to be true, though steroids are able to cause an increase in lipase blood tests.

SIGNS OF PANCREATITIS

The classical signs in the dog are appetite loss, vomiting, diarrhea, painful abdomen, and fever.

Its not the best link on the subject by any means the aboves from though.

Canine Pancreatitis


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## Rott lover (Jan 2, 2015)

Sled dog hotel said:


> As well as the link I gave you about the dog who had MMM, and was tubed during anaesthetic and that caused complications as regards to tounge swelling, I know there was another one too about exercise/ panting and cooling and the tonge swelling. I would have to look back, this thread is getting so long it needs indexing. If his not panting so much then maybe that's why. The preds do make them pant.
> 
> You can get acid reflux too btw, where acid comes up in the throat which isn't protected like the stomach is from digestive enzymes and stomach acid, so that can cause drooling, nausea, vomiting etc. If too bad and left it can also cause ulceration of the throat. One of mine got gastric reflux under anaesthesia once, and I had to give him two types of doggie gaviscon like stuff for a week or so to make sure there wasn't any oesophageal damage or ulceration.
> Usually if its yellow stuff then its bile.
> ...


I know it is not any form of pancreatitis.I have had a dog that had this and it was a chronic condition.I have ruled this out.He hasn't really been panting much the last few days so i don't think it is from being that warm either.I think it is either a separate issue as in the case you posted or caused by the meds or maybe the acid.That would make more sense.

Yes he gets fed dinner at around 6:30 and gets his pred at 7:00 and then his aza at 8:30.


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## Rott lover (Jan 2, 2015)

oh and i forgot he gets his yogurt at dinner as well


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## Sled dog hotel (Aug 11, 2010)

Just dug this up, it seems that what you describe with Olivers problems could be Dysphagia, its a collective term which means difficulty swallowing.

My line of though was going along the lines of Oesophageal problems causing the regurgitation which indeed it does come with those conditions. Guess what it also comes with other conditions too, and MMM is one of them.

Again not the most scientific/veterinary of websites, but it puts it in nice easy to understand laymans terms.

Dysphagia in Dogs


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## Rott lover (Jan 2, 2015)

Sled dog hotel said:


> Just dug this up, it seems that what you describe with Olivers problems could be Dysphagia, its a collective term which means difficulty swallowing.
> 
> My line of though was going along the lines of Oesophageal problems causing the regurgitation which indeed it does come with those conditions. Guess what it also comes with other conditions too, and MMM is one of them.
> 
> ...


everything fits except he doesn't seem to have any problems in swallowing. that's the only thing that still baffles me.he has no lack of appetite and no problems shoveling food down his throat.He has or has had all the other symptoms however.I am definitely sending this to the vet for viewing.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> everything fits except he doesn't seem to have any problems in swallowing. that's the only thing that still baffles me.he has no lack of appetite and no problems shoveling food down his throat.He has or has had all the other symptoms however.I am definitely sending this to the vet for viewing.


Often when you get a list of symptoms, it means that they can variable, ie they may only have a few. So although the food may appear to go down at least most of the time OK, it could be intermittent, and there still could be regurgitation and other sporadic problems.

The symptoms come with a variety of conditions as the link confirms. I was originally thinking along the lines of a problem with the oesophagus like I said which there can be several conditions. It seems though it can come with loads of different conditions including MMM. So in some respects more a secondary thing to another condition. The question is if it is this and the number of things he has on the list if not all, looks like it could be possible, then the question is, is it being caused solely by the MMM, or is there something else going on in addition to cause it.

If he is on the preds too, don't forget even reduced, they do stimulate the appetite anyway as a side effect so he is going to be hungry or hungrier anyway.

He deffinately needs his blood tests too, which look like should have been done way before now, just to check the preds and especially azathioprine isn't messing with his body systems and causing any problems or symptoms as well
that can be contributing to the issues.

Problem at the moment, is there are things that could explain all his problems, but we cant be sure exactly what they are. Is it just MMM, is some of it side effects, is there something else going on medical wise, or if it is all taking longer then it should, is it because, the theraphy wasn't aggressive enough at first, has he had any relapses that have delayed progress, or has the meds been reduced too soon which is why there may have been a relapse, or not so
quick at dealing with it as it should have been. There is still the question of the dental/intubation under anaesthetic too, we know that forcing the jaw under anaesthesia and intubation in dogs with MMM can cause problems. Not saying it did but in light of what we have found out could it be a possibility.
If he were mine I would be wanting some answers now because I know I would becoming very fraustrated with it all never mind the worry and having to sit there and watch him, Im guessing this is whats drving you insane too.

As far as I can see, the test for diagnosis is the antibody test which he didn't have as far as I remember, and it seems the other one which is also not only a confirmation too the muscle biopsies, also tell what the likely prognosis is. It did say a lot depends on the level or fibrosis present as to the eventual outcome and recovery too and from memory the muscle biopsy can tell things like the amount of fibrosis present.


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## Rott lover (Jan 2, 2015)

Sled dog hotel said:


> Often when you get a list of symptoms, it means that they can variable, ie they may only have a few. So although the food may appear to go down at least most of the time OK, it could be intermittent, and there still could be regurgitation and other sporadic problems.
> 
> The symptoms come with a variety of conditions as the link confirms. I was originally thinking along the lines of a problem with the oesophagus like I said which there can be several conditions. It seems though it can come with loads of different conditions including MMM. So in some respects more a secondary thing to another condition. The question is if it is this and the number of things he has on the list if not all, looks like it could be possible, then the question is, is it being caused solely by the MMM, or is there something else going on in addition to cause it.
> 
> ...


Yes the bloods are waaay over due.He was not a team player when it came to treatment.He was on heavy preds for about 2 weeks and we had to drop him because his system was not tolerating them.He was then put on the aza and the preds were drastically dropped to save him.When we first dropped the preds he went from 50 to 25 mg for a week and the to 20 for a week and then 15 and then 10 in one week spans.When he hit 10 his drooling came back and he was having trouble again so we bumped him back to 20.He has been on 20 mg for about a month now.we just dropped him back to 10 again at the beginning of the week now that the aza has taken a good hold on his system.He seems much better.More playful and the drooling has even become less then where he was.The drool has also thinned out quite a bit.More like normal runny drool when he is begging instead of thick and gooey.

Yes i am very frustrated as to the progress but everything it seems we try to do Oliver has to go and mess it up by rejecting our reality and injecting his own.As the vet said,"Oliver took the normal playbook and threw it out the window".I have him going in for a battery of tests this coming week so i will let you know what the vet thinks.


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## Rott lover (Jan 2, 2015)

I just got done sending the vet a 4 page email explaining everything from past to present about the conditions he had been exhibiting and the link you sent me along with a whole bunch of other things.I know it seemed very long but i didn't want to leave anything out because the smallest detail could be the golden key to unlocking this whole thing.So maybe between that and the bloods and whatever other test he needs to do maybe we can finally nip this thing and get it resolved.


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## Sled dog hotel (Aug 11, 2010)

The more information you can give probably the better, last thing you want is to leave out something that may be crucial. Hope you get some feedback from the vet, and also that his blood tests will be OK too.


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## Rott lover (Jan 2, 2015)

Thank you for the info and i will bring any news as soon as i have it.


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## Rott lover (Jan 2, 2015)

Just thought i would shoot you some news from my vet.He said he wants to put Oliver under and look everything over for himself and get the x rays of his jaws as well.After sending him that long e mail with all the info you sent me as well as what i have told him he agrees something else is going on with the MMM. Another tid bit of info is i bought Oliver some large breed kibble food.When i gave it to him with his dinner he was chewing a lot of it.That combined with the other day when i tried to open his mouth just a little and i could not do it no matter how hard i tried.I used my index finger on the lower fang and thumb on the upper fang on both sides and no matter how hard i pushed i could not get his teeth to budge.That along with chewing the large kibble tells me that there is plenty of strength there.I will keep you posted and let you know what happens with all this.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> Just thought i would shoot you some news from my vet.He said he wants to put Oliver under and look everything over for himself and get the x rays of his jaws as well.After sending him that long e mail with all the info you sent me as well as what i have told him he agrees something else is going on with the MMM. Another tid bit of info is i bought Oliver some large breed kibble food.When i gave it to him with his dinner he was chewing a lot of it.That combined with the other day when i tried to open his mouth just a little and i could not do it no matter how hard i tried.I used my index finger on the lower fang and thumb on the upper fang on both sides and no matter how hard i pushed i could not get his teeth to budge.That along with chewing the large kibble tells me that there is plenty of strength there.I will keep you posted and let you know what happens with all this.


Really hope you can get to the bottom of this and find out whats exactly going on. Its been a good while now and you need some answers, for your own sanity probably without anything else.

I hate it when you know somethings wrong and you don't know what it might be. Im trying to work out at the moment how I feel about Nans scan Thursday
half of you wants the results and to know whats what, the other half thinks whats it going to be and where from here. I suppose your feeling similar.


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## Rott lover (Jan 2, 2015)

Sled dog hotel said:


> Really hope you can get to the bottom of this and find out whats exactly going on. Its been a good while now and you need some answers, for your own sanity probably without anything else.
> 
> I hate it when you know somethings wrong and you don't know what it might be. Im trying to work out at the moment how I feel about Nans scan Thursday
> half of you wants the results and to know whats what, the other half thinks whats it going to be and where from here. I suppose your feeling similar.


very very much so.I am so annoyed and angry at the first vet.knowing beyond the shadow of a doubt that there is something more to this.Seeing all the signs that he is not any better and maybe worse that before we took him in after Christmas.Knowing that IF he has what they claim he does then there is something more to this.I am wanting to know so i can make him better.I just feel so helpless and defeated.I feel so horrible for him.He went through all this with the weight loss and all the other issues and with the rear leg muscle loss he can hardly walk anymore.It may have all been for nothing.This is just so hard on him and the wife and i.


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## Rott lover (Jan 2, 2015)

I just came up with something else that has been sort of weird.When Oliver goes out and sniffs around or if he catches a scent in the house his nose starts running like crazy.I am talking it will drip every few seconds.i Don't know if this is something or not but i mentioned it to the vet as well.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> very very much so.I am so annoyed and angry at the first vet.knowing beyond the shadow of a doubt that there is something more to this.Seeing all the signs that he is not any better and maybe worse that before we took him in after Christmas.Knowing that IF he has what they claim he does then there is something more to this.I am wanting to know so i can make him better.I just feel so helpless and defeated.I feel so horrible for him.He went through all this with the weight loss and all the other issues and with the rear leg muscle loss he can hardly walk anymore.It may have all been for nothing.This is just so hard on him and the wife and i.





Rott lover said:


> I just came up with something else that has been sort of weird.When Oliver goes out and sniffs around or if he catches a scent in the house his nose starts running like crazy.I am talking it will drip every few seconds.i Don't know if this is something or not but i mentioned it to the vet as well.


Hopefully they will have some answesr soon, and once you know he can then get all the treatment he needs.

I still wonder why they didn't do more tests at the beginning, I can only assume that based on the clinical signs more then anything they were convinced it was the only problem. Its true from what I can remember the legs can be due to muscle atrophy because of the steroids, it did say that they alone in high doses for long enough can cause it. There was though the more generalised myositis polymyosotis. If I remember rightly when I dug out that large case study on loads of dogs, didn't we question then if it could be the poly form? If memory serves correct didn't some of the dogs have both?


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## Sled dog hotel (Aug 11, 2010)

Ive just dug this out its a client on line information sheet, on a website for a veterinary specialists I have used in the past. Obviously not for MMM, I used the neurology and orthopaedic departments. There is though something that could be interesting.

An animal with a generalised myositis (polymyositis) has a stiff 'stilted' gait, muscle pain, weakness and cannot exercise normally. In the early stages of disease generalised muscle swelling occurs and later the muscles are wasted. Other signs associated with polymyositis include regurgitation of food and water, difficulty swallowing and sometimes breathing problems. Some breeds of dog (Rough coated collies, Shetland sheepdogs, Australian cattle dogs) have a condition called dermatomyositis in which skin lesions develop associated with muscle atrophy, pain or abnormal gait.

On the How will I know if my pet has Myosotis.

On there too, it mentions muscle biopsy as the test, and in the case of MMM
they specific antibody blood test, neither of which he had? It would be too late
for the antibody test now according to the previous information we found I believe because Im sure it said that even after a week or two on the preds anf immunosuppression it will through off the tests.

How will my vet know my pet has myositis?
Myositis can be confirmed by taking a sample of muscle tissue for examination. This will show the inflammatory cells within the muscle. Masticatory muscle myositis can be diagnosed by a simple blood test which measures the level of antibody directed against the masticatory muscle (2M antibody titre test). Other tests may be necessary to eliminate a potential infectious (blood test) or to rule out the presence of a cancer in the body (chest and abdominal X-rays and ultrasound).

It seems too that there are other causes of Myosotis, in the case of MMM as far as I can gather it is the immune system getting confused and producing antibodies against its on masticatory muscles which causes the problem but other myositis can be due to infectious reasons, viral or parasite. I don't know for sure as I haven't checked, but I would assume if the reason was something like viral then the last thing you would want is immune suppression.

What causes myositis?
The inflammation in the muscle can be due to: 
Response of the body to an infectious agent (parasite or virus) within the muscle (infectious myositis) 
Abnormal immune reaction of the body directed against the muscle (immune-mediated myositis). In masticatory myositis the body produces antibodies that target parts of muscle that are only found in the masticatory muscles. No-one knows why the immune system suddenly becomes 'over-excited' and attacks the muscles in this way in some animals. 
Myositis may also be associated with cancer. Inflammation may develop first and turn into cancer with time (pre-cancerous change), or cancer -elsewhere in the body may trigger an immune reaction to the muscle (paracancerous effect).

I will link you to the whole thing as there is more information.
All theoretical thoughts of course though and just weighing up the various possible scenarios.

Myositis


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## Sled dog hotel (Aug 11, 2010)

I have just dug out that "Canine Inflammatory myopathies Review of 200 Cases" which was done from diagnostic Muscle biopsies. If you haven't already don't know if it might be worth sending to your vet?

http://vetneuro.com/portals/124/forms/evans myopthies.pdf

There is also this I have found, "Whats New in Inflammatory myopathies and Muscular Dystrophies"
It discusses MMM and also the Polymyosotis. A couple of things on there seem to stand out and may provoke a question.

Masticatory muscle myositisMasticatory muscle
myositis (MMM) is a focal, immune-mediated inflammatory
myopathy* that affects only the muscles of mastication
(temporalis, masseter, medial and lateral pterygoid,
and rostral portions of the digastricus muscles) and
spares the extraocular, esophageal, and limb muscles.
In the acute phase of the disease, there is swelling of
the masticatory muscles with restricted jaw movement
(trismus). A clinical characteristic of this phase of MMM
is the inability to open the jaw, even under general
anesthesia. In the chronic phase, there is progressive
atrophy of the masticatory muscle group, and trismus
may or may not occur.* Variable degrees of cellular infiltration
are present in the acute phase but fibrosis is not
usually observed. In the chronic phase, myofiber loss
and fibrosis may be extensive.

If Ive understood correctly it doesn't effect the Oesophageal and Limb Muscles
Only really the muscles used for chewing.

If you then look at the interpretation of Polymyosotis

Neuromuscular Laboratory at the University of
California, San Diego in 2006, 58 (11%) were confirmed
with polymyositis based on clinical signs, histopathological
changes in multiple muscles, and the absence of a
known infectious cause. In humans, symptoms may
evolve over weeks to months, and may be difficult to
recognize, so if the same is true for dogs, the actual
incidence may be higher than suspected.* In dogs with
PM, common clinical signs include generalized weakness,
a stiff-stilted gait, generalized and progressive
muscle atrophy including the muscles of mastication,
and esophageal (regurgitation from megaesophagus)
and pharyngeal (dysphagia) weakness. Similar to
humans, clinical signs in dogs may mimic other neuromuscular
disorders such as autoimmune myasthenia
gravis. Results of acetylcholine receptor antibody testing
and the examination of muscle biopsies usually
resolve this diagnostic dilemma.*

So again if Ive understood correctly PM not only affects the Muscles of Mastication as in MMM it also affects other muscles, causing weakness and stiff gait. It also causes oesophageal problems causing the regurgitation we discussed previously and pharyngeal problems ie Dysphagia which is deffination and symptoms as we discussed before and seemed to fit olivers symptoms and behaviour.

The new link the above comes from is here, you really need to read the whole thing.

http://www.ivis.org/proceedings/acvp/2008/shelton.pdf?LA=1

So the question I guess, is could this be it? He didn't have the 
antibody test for MMM, or the muscle Biopsies which from all sources we have found seem to say that these are "The tests"
Or could it just be MMM that's not been treated correctly, and/or the effects of the preds and azathioprine.

Unfortunately I cant tell you, only the vet and probably more testing can.


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## Rott lover (Jan 2, 2015)

Wow,You my friend are a wealth of knowledge.Thank you for all of this info and i am sending all of it to the vet.


I had to take Oliver up to 20 mg on his preds again.He was having a lot of problems the last couple of days eating again.This really confused myself and the vet.He has been on the aza for almost two months now.We should easily be able to bring his preds down to a nominal amount by now and it just is not happening.The other thing that we discussed was the fact that we always used to do what we call squishy cheeks.We used to,and still do,scrunch up his cheeks and play with them all the way up to behind the ears.We never felt any of these muscles getting hard or stiff or swollen for that matter.

The vet is still doing a lot of research as well.I guess we will see what we all come up with.


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## Rott lover (Jan 2, 2015)

By the way i forgot to ask how your pup is doing.


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## Sled dog hotel (Aug 11, 2010)

If the vets doing research too and he hasn't seen the 200 case study or the new link I found then, worth perhaps sending it.

My One goes in for her scan tomorrow, so at the moment am no further forward, guess will find out more then. Thanks for asking.


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## Rott lover (Jan 2, 2015)

I hope for the best for you'r baby.May my best wishes help and see things through.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> I hope for the best for you'r baby.May my best wishes help and see things through.


Thank you, she had had 3 urinary tract infections over the last 5/6 months never had problems before, so this time the urine was sent to the lab and there is struvite crystals in the urine. So the scan is to check for stones and any other irregularities.

The reason Im so worried is that she was as RSPCA pup from a litter born in there, and I hear from a third party how the others are doing. Her and two of the brothers out the four all have auto immune hypo thyroid, out of those two brothers, one had congenital liver shunt, and they also both had stones too.
The thing that's worrying me is that one of these two, died last year at just turned 5 years old, and they found on ultra sound that he had tiny kidneys, 
probably likely to renal dysplasia which is another congenital condition where the kidneys remain immature. So with the history that's why Im so anxious.


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## Rott lover (Jan 2, 2015)

Well i hope for the best and may luck be on you'r side


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## Rott lover (Jan 2, 2015)

Went to the vet last night.Now i get to wait for the results.He is doing a full blood panel to see what comes out of it.We did get Olivers mouth open a little bit much to his objections.The vet said everything looks good in his mouth.What i thought was blood on his fangs is actually tarter build up.The vet got to smell that sewage that Oliver calls breath.He couldn't believe how horrible it was.Oliver shoved his nose right up in his face.Then when he left and came back he said the same thing as the other vet.He said that if he didn't know any better that Oliver had a mouthful of bad teeth.The whole room smelled horrid.The vet is going to look into several possibilities on the breath.Including the info you had sent me.

Unfortunately he said we may be looking at worst case and his muscles may have actually atrophied already.He doesn't know how else to explain what is going on.He said that even though he can at times open his mouth very well doesn't mean that they have not atrophied to some extent.

At this point i am just so sad.I don't know what to do.He said all we can do is wait for the bloods to come back and see where his medication is at and what we can do from there.I am just heart broken.

He felt around on the jaws and did a bunch of pushing and prodding and such on the jaw bone and socket and said that it seems to be fine.He said if we want to do the x rays we can but for the detail we would need he would have to send me to another vet.We will see what happens when i get my returns back.

So how are things with your pup?Did things go well ?


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> Went to the vet last night.Now i get to wait for the results.He is doing a full blood panel to see what comes out of it.We did get Olivers mouth open a little bit much to his objections.The vet said everything looks good in his mouth.What i thought was blood on his fangs is actually tarter build up.The vet got to smell that sewage that Oliver calls breath.He couldn't believe how horrible it was.Oliver shoved his nose right up in his face.Then when he left and came back he said the same thing as the other vet.He said that if he didn't know any better that Oliver had a mouthful of bad teeth.The whole room smelled horrid.The vet is going to look into several possibilities on the breath.Including the info you had sent me.
> 
> Unfortunately he said we may be looking at worst case and his muscles may have actually atrophied already.He doesn't know how else to explain what is going on.He said that even though he can at times open his mouth very well doesn't mean that they have not atrophied to some extent.
> 
> ...


Sorry to hear that at the moment you are no further forward, Hoping that the blood test results may tell you more.

Unfortunately I haven't got my results, vets rang with them while I was out and I was in an area with no mobile phone signal at the time. He then wasn't on again until Monday, so am going to have to wait until then, so none the wiser. I guess now we are both laying the waiting game.


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## Rott lover (Jan 2, 2015)

well i got Olivers blood results late Friday.Every thing was on the money.The vet cant figure out what the heck is going on.He is going to refer me to a specialist.He has nothing more to offer me and has also stated that there has to be more to all this.He is recommending skull x rays to see the jaws and also see if the muscles have atrophied.He said if the muscles have atrophied it will show up on the x rays.He doesn't think they are since he can still use his mouth.I also noticed that when Oliver goes after his soft food he opens up about 2 maybe 3 inches for the first couple of bites then he goes back to opening it only a quarter inch or so.I also noticed he will open wider with soft stuff like a hot dog but he will bite apart his marrow bone with his front teeth.The reason he whips his head around while he is eating is to get the food back to the front of his mouth.It is weird that he would chew with his front teeth but not his rear teeth.I have been feeding him bigger kibble as well to try to keep his mouth working.If the vet has no idea about what is going on then i have pretty much lost all hope.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> well i got Olivers blood results late Friday.Every thing was on the money.The vet cant figure out what the heck is going on.He is going to refer me to a specialist.He has nothing more to offer me and has also stated that there has to be more to all this.He is recommending skull x rays to see the jaws and also see if the muscles have atrophied.He said if the muscles have atrophied it will show up on the x rays.He doesn't think they are since he can still use his mouth.I also noticed that when Oliver goes after his soft food he opens up about 2 maybe 3 inches for the first couple of bites then he goes back to opening it only a quarter inch or so.I also noticed he will open wider with soft stuff like a hot dog but he will bite apart his marrow bone with his front teeth.The reason he whips his head around while he is eating is to get the food back to the front of his mouth.It is weird that he would chew with his front teeth but not his rear teeth.I have been feeding him bigger kibble as well to try to keep his mouth working.If the vet has no idea about what is going on then i have pretty much lost all hope.


As far as Im aware each type of teeth have different jobs. The little ones at the front tend to be used for nibbling at things and scraping, you often see them use these when they do what I call nit themselves when they have an itch. The fangs the canines, are usually used to get a hold of something and rip. Next comes the premolars which they tend to use for the chewing, I notice with mine they will grab with the front teeth say a chew or bone when you give it, but they they seem to chew with the premolars further back, and more to the side if that makes sense. Then you have the really heavy duty crushing/grinding ones the molars at the back. So really as far as the chewing and grinding up goes its usually the premolars and molars.

Going by that, I would assume that the softer the food the more the teeth towards the front would be used, the bigger and harder the food he should be using the premolars that are further back and the Molars to chew and grind it.
The fact that he isn't something really isn't right. In all honesty I would go straight for the specialist and let him decide whats needed diagnostic wise to find out what the hell is going on. Better that then what could be wasted money having the head and jaws xrayed then only to find out the specialist needs to do other diagnostics because they may not be that much help. If the specialist says yes it will tell us whats going on then fine. I take it your footing the complete bill yourself, I know that you will do anything to find out whats going on, but at the same time you need to know that the diagnostics are worth doing and will likely give you the answers.

Its obvious that your vets stumped, and from all we have found out, a) there could have been a lot more tests done at the start for a cast iron diagnosis that it was solely due to MMM which is an auto immune cause because the confused immune system makes antibodies to the Masticatory muscles only.
There is also the muscle biopsies that can also confirm too what type but from what I can remember also tells you things like the fibrosis involved if any and what the likely overall prognosis is.

There is also the fact that his having rear leg problems/weakness and it seems as MMM only attacks the masticatory muscles is it another form of myositis which will attack other muscles as well as the Masticatory muscles too.
Lastly there is still the fact that he was anaestitised and intubated for the dental, again we know that intubation and forcing the jaws of an MMM dog can cause problems with the jaw and further damage. There is even the question, of was the theraphy aggressive enough when it was started and/or because of the side effects and it was decreased and changed, could that be the reason why it hasn't worked as well as it should have done even if it was purely just MMM in the first place.

It seems that there are plenty of questions/scenarios that could perhaps explain whats happened/happening but a severe lack of answers. If he were mine I wouldn't let the GP vet do anything else and I would be going straight for the specialist who would likely have a better idea what diagnostics may be required and worth doing to find the answers you need for Oliver and probably your own sanity.


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## Rott lover (Jan 2, 2015)

Sled dog hotel said:


> As far as Im aware each type of teeth have different jobs. The little ones at the front tend to be used for nibbling at things and scraping, you often see them use these when they do what I call nit themselves when they have an itch. The fangs the canines, are usually used to get a hold of something and rip. Next comes the premolars which they tend to use for the chewing, I notice with mine they will grab with the front teeth say a chew or bone when you give it, but they they seem to chew with the premolars further back, and more to the side if that makes sense. Then you have the really heavy duty crushing/grinding ones the molars at the back. So really as far as the chewing and grinding up goes its usually the premolars and molars.
> 
> Going by that, I would assume that the softer the food the more the teeth towards the front would be used, the bigger and harder the food he should be using the premolars that are further back and the Molars to chew and grind it.
> The fact that he isn't something really isn't right. In all honesty I would go straight for the specialist and let him decide whats needed diagnostic wise to find out what the hell is going on. Better that then what could be wasted money having the head and jaws xrayed then only to find out the specialist needs to do other diagnostics because they may not be that much help. If the specialist says yes it will tell us whats going on then fine. I take it your footing the complete bill yourself, I know that you will do anything to find out whats going on, but at the same time you need to know that the diagnostics are worth doing and will likely give you the answers.
> ...


When he used to chew his rawhide bones that is where he used to always chew them.Always on one side and always way in the back.That all makes sense.Same with his marrow bones.Used to chew them in the back.However,he still chews quite often but he will only chew with his nippers.

The rear leg issues and weakness i have back under control.This is being caused by the pred and lack of exercise.That and the pooping problems and weight loss in general.I wont say they are back to normal but they are coming back.

Thank you for being my hope.Also for the idea of just telling the specialist what is going on and seeing what they can figure out.

Other than that all that you said is so true.

One other question for you and i don't know for sure that anyone except the specialist will have an answer to to this.....Since Oliver has serious issues with pred(which we all know lol).Since the aza is meant as a immune system killer and if Oliver is taking that for that reason shouldn't we be able to pull him off of the pred. The pred is meant to be an anti inflammatory and an immune system killer.So logic would say that if we are using the aza to kill his immune system then the only thing the pred is doing is acting as an anti inflammatory. By.By that logic we could put him on many other cheaper and less harsh things for the anti inflammatory properties.This would be great considering he has a mild case of cushings still even at 20 mg twice a day.I also have to wonder if some of this is affecting his mouth in the wrong ways depending on how badly and in what ways this is affecting him.

Even with him not being able to open his mouth very far.Even at a half an inch he should be able to at least lick his nose properly but he cant.


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## Rott lover (Jan 2, 2015)

Also forgot to ask.Did you get your test results back?


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> When he used to chew his rawhide bones that is where he used to always chew them.Always on one side and always way in the back.That all makes sense.Same with his marrow bones.Used to chew them in the back.However,he still chews quite often but he will only chew with his nippers.
> 
> The rear leg issues and weakness i have back under control.This is being caused by the pred and lack of exercise.That and the pooping problems and weight loss in general.I wont say they are back to normal but they are coming back.
> 
> ...


If it is Just Masticatory muscle myositis, then the problem is caused by the immune system going overboard and producing antibodies against its on self in this case the masticatory muscles. The only treatment is therefore to suppress the immune system to stop it making the antibodies that it is doing in confusion.

The cornerstone treatment is Steroids (preds) as well as being an anti inflammatory steroids are an immune suppressant and are therefore used in auto immune and immune mediated conditions. Azathioprine is also an immune suppressant. It did say in that literature dogs that are having severe side effects to the steroids (preds) can be given Azathioprine and the steroids then can be reduced and I believe from memory stopped altogether, but on this I would have to double check. So in the case of MMM you don't use the steroids for its anti inflammatory properties but for the immune suppressant properties.

The literature did say that the use of the steroids (preds) can cause muscle atrophy too as a side effect.

I really do think that the specialist is your best bet now, I wouldn't be spending any more time with the vets at this stage and go straight to referral and take it from there.


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## Rott lover (Jan 2, 2015)

Thank you for that sled.I will be contacting the specialist soon.I hope your pup is doing good.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> Thank you for that sled.I will be contacting the specialist soon.I hope your pup is doing good.


Thanks for asking, the ultra sound came back OK but has she has struvite crystals so suggested she goes on the prescription diet, its vile and disgusting, and Nan thinks so too, and she wont eat it. If she doesn't eat she then gets acid/bile and makes herself sick. Just doing some research to see if there is a more natural way of doing it.


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## Rott lover (Jan 2, 2015)

Well at least you have answers.That is more than i can say at the moment.I am glad she will be ok.Hopefully you find a way for her to get the food.I always look at the food Oliver eats and wonder how he can enjoy it.Most of that soft food just looks and smells disgusting.


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## Rott lover (Jan 2, 2015)

This week has been testing week all the way around.I dropped Oliver's pred back to 10 mg twice a day.According to what my vet and the specialist had told me for as long as Oliver has been on the aza and the pred he should not have any muscle pain going on and should be able to eat and open his mouth fine.However he doesn't. So when i got home last night i gave Oliver a pain pill and left him alone for a half hour.Then i got his dinner together.Surprise surprise.Before i even got his dinner done he yawned.His mouth opened almost half way.He ate his dinner in record time.He was using his tongue to scoop the food up.When he was done i watched him clean his lips and nose and he even cleaned the inside of his lips.Then he went to his water bowl and even that was closer to normal than i had seen in a loooong time.Almost all the slobber was gone for the majority of the night.My daughter came by last night as well and he actually barked.This was the first time i have heard him bark since Christmas.

All in all it was a very good night.I also noticed that usually when Oliver is done eating he is panting like crazy.Last night he wasn't panting at all.That tells me either he has to work way too hard at eating or it really hurts to eat.Oh and he was also somewhat chewing.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> This week has been testing week all the way around.I dropped Oliver's pred back to 10 mg twice a day.According to what my vet and the specialist had told me for as long as Oliver has been on the aza and the pred he should not have any muscle pain going on and should be able to eat and open his mouth fine.However he doesn't. So when i got home last night i gave Oliver a pain pill and left him alone for a half hour.Then i got his dinner together.Surprise surprise.Before i even got his dinner done he yawned.His mouth opened almost half way.He ate his dinner in record time.He was using his tongue to scoop the food up.When he was done i watched him clean his lips and nose and he even cleaned the inside of his lips.Then he went to his water bowl and even that was closer to normal than i had seen in a loooong time.Almost all the slobber was gone for the majority of the night.My daughter came by last night as well and he actually barked.This was the first time i have heard him bark since Christmas.
> 
> All in all it was a very good night.I also noticed that usually when Oliver is done eating he is panting like crazy.Last night he wasn't panting at all.That tells me either he has to work way too hard at eating or it really hurts to eat.Oh and he was also somewhat chewing.


Sounds like real progress at last, long may it continue, really hoping he has turned the corner now at long last.


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## Rott lover (Jan 2, 2015)

I just got off the phone with the specialist and explained everything to her.She told me this could be a jaw problem.She said that they could have just automatically assumed it was MMM from the mouth stopping at a certain point and the muscle loss.It could very well be that from chewing on bones as much and as long as he has his jaw cartilage could be worn out on the one side.If it is worn out or there are problems in the jaw itself it could be causing the lock up in his jaws also.I have an appointment set up and after the initial visit we will see what we need to do from there.She said not to do anything with his meds for now but agrees 100% that the pain pill should not help that much at this stage if it really was MMM.Maybe we can finally start getting to the bottom of this.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> I just got off the phone with the specialist and explained everything to her.She told me this could be a jaw problem.She said that they could have just automatically assumed it was MMM from the mouth stopping at a certain point and the muscle loss.It could very well be that from chewing on bones as much and as long as he has his jaw cartilage could be worn out on the one side.If it is worn out or there are problems in the jaw itself it could be causing the lock up in his jaws also.I have an appointment set up and after the initial visit we will see what we need to do from there.She said not to do anything with his meds for now but agrees 100% that the pain pill should not help that much at this stage if it really was MMM.Maybe we can finally start getting to the bottom of this.


Jaw problems certainly could cause it. Don't want to bang on about my ailments, but Ive always had a jaw one side that has clicked and grinded a bit here and there for ages. One day the damn think locked completely suddenly out the blue it felt like it had unhinged. somehow I managed to get it freed again. It did it a few times, pretty frightening and it damn well hurts at the time. It then stopped again and went back to the occasional grinding again and clicking.
When I went for my next check, I told the dentist, who showed me what to go or get someone else to do if it really stuck anytime. He just said that mine might be due to a period of stress and teeth grinding (which I do) and its then settled down again. So based on experience then it would make sense.

You can get it through just wear and tear just like any other joint. It was something we did speculate about too if you remember as a possible additional thing when it all seemed to get a lot worse after MMM was diagnosed and he had the dental if there could have been damaged caused then.

There was too all those other differential diagnosis for jaw trismus as its called which means inability to open the mouth and jaw pain.

I do hope your getting to the bottom of it now and you can get him completely sorted.


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## Rott lover (Jan 2, 2015)

all that info you sent me on the trismus is what got me thinking about all this.That is why i decided to do the pain killer test.If everyone says there shouldn't be pain anymore and i have just proven there is then we know that there is something else very wrong.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> all that info you sent me on the trismus is what got me thinking about all this.That is why i decided to do the pain killer test.If everyone says there shouldn't be pain anymore and i have just proven there is then we know that there is something else very wrong.


Well no one else knows their dog better then its owner that's for sure, and I always say always trust your gut instincts. You may end up spending money here and there to be told he/shes fine but Ive found most of the time anyway, your gut instincts are more often then not correct.

Im like a dog with a bone anyway, I cant leave it alone, until Im satisfied alls right with the world, or the dogs as they case may be
Somethings wrong with this lot then my world just aint right until its fixed or Ive had a damn good go trying.


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## Rott lover (Jan 2, 2015)

Sled dog hotel said:


> Well no one else knows their dog better then its owner that's for sure, and I always say always trust your gut instincts. You may end up spending money here and there to be told he/shes fine but Ive found most of the time anyway, your gut instincts are more often then not correct.
> 
> Im like a dog with a bone anyway, I cant leave it alone, until Im satisfied alls right with the world, or the dogs as they case may be
> Somethings wrong with this lot then my world just aint right until its fixed or Ive had a damn good go trying.


You are just like myself.If i know something is not right i will not stop until it is fixed and all is right with the babys in my life.All he info you have given me has givin me the ammo and armed me very well going to the vet.If it wasnt for the info you have given me Oliver may not be here today.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> You are just like myself.If i know something is not right i will not stop until it is fixed and all is right with the babys in my life.All he info you have given me has givin me the ammo and armed me very well going to the vet.If it wasnt for the info you have given me Oliver may not be here today.


Your welcome anytime you know that. I know exactly what its like, been there done that, read the book and got the t-shirt as they say.


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## Rott lover (Jan 2, 2015)

got a bit of an update from over the weekend.I really think we are onto something with the jaw thing.Since i noticed that giving Oliver a pain pill helped a lot when the wife got home so i could give him dinner on time.He was eating a lot better and he wasn't panting after dinner.This went on for a couple of days last week.Oliver seemed to be doing much better all the way around.He was more lively and playful and had that "spunk" back.

With all that being said,He was able to have these 2 to 3 times a day and 1 to 2 pills,or as needed.So over the weekend I gave him 1 pill 3 times a day.Talk about Different.He was playing and nipping and yawning again.He was even chewing on his food.

Now that i got the good stuff all out,When he would yawn as we all know it is a reflex.There is no helping what happens when the yawn comes on.When he would yawn the mouth would start to open and then it would hit about the same spot and the wincing pain would hit.Hit head would go up and off to the right side along with a bit of a whine.It would be about the same spot every time.I have seen hiss mouth open wider before without the pain and i have also seen the pain hit with less opening.This tells me,At least this is how i see it,That this is NOT a Muscle problem.If it were a muscle problem it would not hit pain like that at all different ranges.However if as i suspect something is wrong in the jaw(weather it be out of place,Bad cartilage,bone spur) that would most definitely cause every issue i have seen over the weekend.From the not being able to chew quite right to the pain at different ranges of the mouth.It would also explain the tongue since having the jaw wedged open just a bit might be the spot that he doesn't have any pain. 

Sorry for the long post but i wanted to get it all out.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> got a bit of an update from over the weekend.I really think we are onto something with the jaw thing.Since i noticed that giving Oliver a pain pill helped a lot when the wife got home so i could give him dinner on time.He was eating a lot better and he wasn't panting after dinner.This went on for a couple of days last week.Oliver seemed to be doing much better all the way around.He was more lively and playful and had that "spunk" back.
> 
> With all that being said,He was able to have these 2 to 3 times a day and 1 to 2 pills,or as needed.So over the weekend I gave him 1 pill 3 times a day.Talk about Different.He was playing and nipping and yawning again.He was even chewing on his food.
> 
> ...


When my jaw locked up for a period of time it was nearly always when I yawned so that would probably make sense. So it does sound possible that it momentary locks probably causing pain and not only that if it was like mine was it can be pretty scary. Then perhaps like I did he either manages to get it back in place or unlocked hence the movements you described or it pops back in itself maybe. I know the specialist said she suspects a jaw problem of some sort, did she say anything about investigating it to find out for sure?


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## Rott lover (Jan 2, 2015)

Sled dog hotel said:


> When my jaw locked up for a period of time it was nearly always when I yawned so that would probably make sense. So it does sound possible that it momentary locks probably causing pain and not only that if it was like mine was it can be pretty scary. Then perhaps like I did he either manages to get it back in place or unlocked hence the movements you described or it pops back in itself maybe. I know the specialist said she suspects a jaw problem of some sort, did she say anything about investigating it to find out for sure?


I will be taking him in 2 weeks when i get paid to do my initial visit.They are going to do a general once over and meet with Oliver and i.After that we have to set up the x rays and we will have to see what we have from there.


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## Sled dog hotel (Aug 11, 2010)

Rott lover said:


> I will be taking him in 2 weeks when i get paid to do my initial visit.They are going to do a general once over and meet with Oliver and i.After that we have to set up the x rays and we will have to see what we have from there.


Well with a fresh set of eyes on the problem and being as its a specialist, and more diagnostics, lets hope you finally get to the bottom of the problem and get it sorted once and for all.


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## Rott lover (Jan 2, 2015)

This will be my final post on this thread.I thank everyone for their efforts.Sadly Oliver passed in his sleep on march 28th - 29th during the night.Now he is at least at peace and no longer has to fight.To say i am devastated is an understatement.


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## Sled dog hotel (Aug 11, 2010)

For Oliver, 

So sorry that you lost your Brave fight big Lad. Im sure though that you left knowing how much you were truly loved and how well you will be remembered.
May your spirit run forever free in sunshine.

When the body that lived at your single will, 
With its whimper of welcome, is stilled (how still!), 
When the spirit that answered your every mood 
Is gone - wherever it goes - for good, 
You will discover how much you care, 
And will give your heart to a dog to tear! 

From the power of the Dog, Rudyard Kipling.

So very sorry for your loss.


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## Rott lover (Jan 2, 2015)

It has been a couple days now and i can talk a little about this.I want to let anyone and everyone know that if you think there is still a problem and your gut tells you something is not right then fallow your gut.I knew something else was wrong with Oliver and i did not act quickly enough.The vets all failed me and because they failed me i failed my promise to Oliver.I failed to keep the promise to make it all better.

I cant say for sure what happened in the end.What i think happened was that Oliver had some kind of infection in his jaw.All the medications Oliver was on were Immunol suppression drugs and i think the infection took over.What ever the case This was not MMM.

My only solice is that my Oliver didn't seem to be in any pain and he died very peacefully in his sleep.

This is the first dog that passed away this way for me.My whole life I was the one that had to make the call to pts.There is preparation,There is time to say good bye.You know what is to come and what is expected.There was nothing in this case.I didn't get to say goodbye or even say i am sorry.This weighs very heavy on me.

I am happy that the vets office took care of Oliver and myself and my wife with extreme dignity.Making sure everything was just right.I am having him cremated and he will go on my hutch right next to Boz.

In closing please please please please fallow your gut if you think something is not right.

May Olivers plight live on and help anyone who needs it.


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## Rott lover (Jan 2, 2015)

A sight to see

Oliver running through the sunshine free as the wind
his feet moving and ears flopping along with his lips
wagging his nubby and all pretty in anticipation
waiting for his collar anticipating his next trip
Always the character ready to please
doing what he can to make us laugh 
even acting like a clown for the whole world to see
He is my little man which is a lot more than a phrase
He was my companion,my buddy,my friend,my confidont
He would make me laugh with his crazy ways
I loved to tickle him and make him squirm
He would roll around like a little wiggle worm
We could rub his butt and make him dance 
he would be happy and after would prance
Now he is at peace With his angel wings
ranning and playing and doing all his wishful things.
He knows how much we loved him
Of this I am sure
Now he can run full speed again
Running through the sunshine free as the wind
I am sure that is a sight to see


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## Rott lover (Jan 2, 2015)

A Heart Dog


Some one used this term not too long ago and it got me thinking.What is a heart dog?Well here is my idea of what a heart dog is



Is a heart dog a dog that you give your whole heart to
Is a heart dog a dog that gives his whole heart to you
Could it be just a love for a dog
I think it is a love that is true
It is a dog that saves you
It is a dog you save 
It is a dog that makes you happy when you are blue
It is funny that all through his life 
none of this you realize
You get into a routine just like a wife
When the day arrives when your dog is gone
You realize how much you had
These are the days you have to be strong
People say pawprints on the heart they leave
I could say that for some
even though we all grieve
You never know if it is a heart dog
Untill they are not with us anymore
you feel like your walking in fog
then you realize your heart is gone
There can be no pawprints 
not even the imprints
you just lost your heart dog


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## Rott lover (Jan 2, 2015)

how could it be my little man is gone
so much we shared this is just wrong
his pain is now all gone riddled with guilt I am now
how can I move past this someone please tell me how
I never got to say good bye 
I would have liked to at least try
he passed in his sleep I hope with no pain
laid out in his normal spot this is such a drag
I cant eat I cant sleep my mind is filled too deep
My house I just cant stand
There feels no warmth and love it used to be grand
Every where I look and touch
reminds me of my little scruff
he is now at peace and I left with a broken heart
It is better me than him he just has a head start
I know this wound will heal
This is another big ordeal
The scar will always remain
I will always feel the pain
my heart is now not whole
it is going to take time to regrow
is that possible could it be 
I guess I will wait and see


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## Rott lover (Jan 2, 2015)

there are a few things that i would like to add to this.when Oliver was about 3 years old he developed a hatred for linoleum or any slick surface.I could never figure out why.Also at about 4 or 5 he would hit his teeth on the plates he would eat off of.

When he was a puppy he would slide all over the linoleum and it never fazed him.I realize now that a long time ago he would kind of skid out going through the kitchen.Kind of like running across ice.As the time progressed he would wait for me to open the door and dart through to get to the carpet in the hall.someone brought up that this sounded like a nervous system and/or depth perception problem.Also when eating off of a plate his teeth would hit the bottom of the plate as he was trying to eat.We simply thought it he was just trying to get everything off the plate.At the end he was hitting his teeth pretty hard onto anything he ate off of.All little problems and signs that should have been seen as something but were not.


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## Rio's Mum (May 7, 2015)

Rott lover said:


> Yesterday i reached over to pet him and as soon as my hand touched him he fliched and cowered away from me.That is not how my baby reacted to me before this.What is even more frustrating is it seems his mouth is much worse since we took him in.


Hi there, I'm brand new to this site but have just had a possible diagnosis of MMM in my 1yr old puppy and that is how she was with me, when I went to stroke her, she just cowered away - I thought I had done something wrong - never thought she could have such a freakish disease and now she is on her second day in the vets and I've just spent the last 36 hours crying and trying to research as much as I want. I do hope that you are now further down the line and your rotti is making great progress. If you want to swap e-mail addresses, and we can try and help each other - my baby isn't a year old yet - birthday on Sunday.... My puppy wasn't drooling but the only way I could get water into her was by holding an ice cube and her sucking on that...on steroid injections and on a saline and anti biotic drip at the vets as we speak and I'm worried silly.


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## Rio's Mum (May 7, 2015)

Rott lover said:


> how could it be my little man is gone
> so much we shared this is just wrong
> his pain is now all gone riddled with guilt I am now
> how can I move past this someone please tell me how
> ...


I am so so sorry for your loss and please ignore my reply to one of your previous posts, had I scrolled down, I would have realised your pain - sincere sympathies at such a difficult time. Even though I don't know you, my thoughts are with you.


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## Rott lover (Jan 2, 2015)

Rio's Mum said:


> I am so so sorry for your loss and please ignore my reply to one of your previous posts, had I scrolled down, I would have realised your pain - sincere sympathies at such a difficult time. Even though I don't know you, my thoughts are with you.


Thank you very much and all is forgivin


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## Rott lover (Jan 2, 2015)

Rio's Mum said:


> Hi there, I'm brand new to this site but have just had a possible diagnosis of MMM in my 1yr old puppy and that is how she was with me, when I went to stroke her, she just cowered away - I thought I had done something wrong - never thought she could have such a freakish disease and now she is on her second day in the vets and I've just spent the last 36 hours crying and trying to research as much as I want. I do hope that you are now further down the line and your rotti is making great progress. If you want to swap e-mail addresses, and we can try and help each other - my baby isn't a year old yet - birthday on Sunday.... My puppy wasn't drooling but the only way I could get water into her was by holding an ice cube and her sucking on that...on steroid injections and on a saline and anti biotic drip at the vets as we speak and I'm worried silly.


If it is truly MMM there will be a dramatic difference with in a short period of time.If she cowered away from you when you went to stroke her head that would be a good indicator.The first stage in MMM is that the muscles all get inflamed and very sore to the touch.How far along in the disease is she?Is there muscle loss in the jaw muscles.If she is on a drip i am guessing she is well into the second stage where she cant open her mouth to drink.I am here to help or try to if i can.Olivers case is a whole different world and not to be expected at all.That is why i requested this thread to become a sticky.It has so much information in it about no only MMM but many other things as well.Please keep me posted.


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## Rott lover (Jan 2, 2015)

I found some new info as well with some of the things that had happened to Oliver.I found out that the thing with his tongue was definitely not right.I have been told that is was probably the sign of some sort of infection which just hearing that has confirmed my suspicions.


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## Rott lover (Jan 2, 2015)

also from some of the descriptions i have sent out to several other vets in our area it would seem that if there was MMM it was not all there was.Most think it was a jaw issue either with the alignment or something being out of place.


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## waltergibbs (May 19, 2015)

You definitely want to stay constant with taking the steroids. I have not had the same experience you have had, but steroids can sometimes take a while to "soak in" if you will pardon the expression. The further out the affected area is on the body, the longer it may take to get the amount necessary to fill in there. I am concerned that it takes so long in your case and would definitely call your vet. It can also depend on where and how it is administered (injected vs oral, muscle vs fat) and I have seen a "spurt day" where they fill great the first day and then back to bad for a couple before it settles in better. Best of luck and hope things improve.


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## Rott lover (Jan 2, 2015)

waltergibbs said:


> You definitely want to stay constant with taking the steroids. I have not had the same experience you have had, but steroids can sometimes take a while to "soak in" if you will pardon the expression. The further out the affected area is on the body, the longer it may take to get the amount necessary to fill in there. I am concerned that it takes so long in your case and would definitely call your vet. It can also depend on where and how it is administered (injected vs oral, muscle vs fat) and I have seen a "spurt day" where they fill great the first day and then back to bad for a couple before it settles in better. Best of luck and hope things improve.


There is no need to call the vet any longer.My luck ran out long ago and there was no improvement


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## waltergibbs (May 19, 2015)

So sorry, I should have skipped to the end of the thread apparently. Hope you find a way to carry on. Again sorry about the mixup.


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## Rott lover (Jan 2, 2015)

waltergibbs said:


> So sorry, I should have skipped to the end of the thread apparently. Hope you find a way to carry on. Again sorry about the mixup.


It is ok.I keep the post alive since there are many other people out there it can help.


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## Natalie Strudwick (May 21, 2015)

You can ask the free online vet care . They will give you a better understanding on this concern. I hope this helps!


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## Rott lover (Jan 2, 2015)

Natalie Strudwick said:


> You can ask the free online vet care . They will give you a better understanding on this concern. I hope this helps!


Thank you for your concern but i no longer need to have this looked into anymore.


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## Rott lover (Jan 2, 2015)

I got a call from a friend of mine with some curious news over the weekend.He told me that someone he knows had a lab that seemed to go through all the same things that Oliver went through and they had every test in the book done.They found out that the lab had a brain tumor that was affecting all the same things that Oliver had.It was an interesting conversation to add to all the things that my vet had told me also.


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## Rott lover (Jan 2, 2015)

all this time and there are still good and bad days hard to believe it has been over a year already.


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## Rio's Mum (May 7, 2015)

They take your hearts Rottlover, try to take comfort from all the amazing times you had together and know that you did your very very best for Oliver. I'm sure he's smiling down on you and thanking you for all the wonderful times you gave him.

A friend of mine lost her Golden Retriever a while back, she is broken in bits but rather than getting another dog, she has enrolled with a site called BorrowmyDoggy - not sure if you have that, but she takes an owners dog for walks when she can, sits for them, when she can, its not a financial arrangement, more be friending and caring for someone else's dog to suit both the owner and the carers needs - seems to be working really well.

Here if ever you need me, I couldn't have got through what I've been through without you and would love to some way try to help ease your pain xx


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## Rott lover (Jan 2, 2015)

Rio's Mum said:


> They take your hearts Rottlover, try to take comfort from all the amazing times you had together and know that you did your very very best for Oliver. I'm sure he's smiling down on you and thanking you for all the wonderful times you gave him.
> 
> A friend of mine lost her Golden Retriever a while back, she is broken in bits but rather than getting another dog, she has enrolled with a site called BorrowmyDoggy - not sure if you have that, but she takes an owners dog for walks when she can, sits for them, when she can, its not a financial arrangement, more be friending and caring for someone else's dog to suit both the owner and the carers needs - seems to be working really well.
> 
> Here if ever you need me, I couldn't have got through what I've been through without you and would love to some way try to help ease your pain xx


Thank you very much Rio's Mum.I appreciate the offer.I do have a friend that i had rehomed a Mastiff to and I can go by any time i need a dog fix.We will be buying a house very soon I hope and then we will be getting another Rott.

How is Rio by the way.Has Rio stayed in remission.How have things been.I hope a full recovery was made.


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## Rio's Mum (May 7, 2015)

We went to the Vets yesterday and she told us to enjoy Rio, she was discharged with a clean bill of health!! I've just been sitting with her telling her how much she means to us. The other day I was walking a friends dog and throwing tennis balls to both the dogs, Rio did an about turn and ran into a metal gate post - knocked herself out for ages - think she had concussion. Easter Monday and an emergency call out after 7 hours of being "zonked" - got to the vets, having lifted a big heavy dog and what does she do? Bounce up to the vet - this is a dog who hadn't moved all day and needed lifting into the car.....£100 later but she did go with a bang, so maybe just slept it off. As far as her MMM is concerned, I'm always vigilent but she really seems in great condition.

Good luck with the new house and hope to see photos of a little Rott very soon xx


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## Rott lover (Jan 2, 2015)

I am so glad things have gone well for you and am also very happy that we have been of help to you.


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## rottiepointerhouse (Feb 9, 2014)

melissa prama said:


> my dear just take it easy ok i know it hurts but he will be alright





melissa prama said:


> and please do not carry out any change in the what the vet said you should do and if its get worse then please take the dog back to the vet ok for proper check again.


Please don't quote from a thread without reading it properly as @Rott lover sadly lost Oliver some months ago so your advice is rather late and upsetting for him.


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## Rott lover (Jan 2, 2015)

rottiepointerhouse said:


> Please don't quote from a thread without reading it properly as @Rott lover sadly lost Oliver some months ago so your advice is rather late and upsetting for him.


Thank you RPH.I still have my good days where nothing bothers me and then i have my bad where the slightest thing sets me off.What i hate is i dont know how i am going to react.Sometimes it is with extreme anger and others extreme sadness.I guess i am a mixed nut bag.Maybe i do need mental help lol.


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## Rott lover (Jan 2, 2015)

wow I cant believe this was so long ago. He is still my angel and I think about him all the time but at least I am not a mental case anymore. I was just so glad that this thread helped so many people since then.


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