Thanks for the replies. It is so nice to have a support community like Cavalier Talk. It certainly eases the pain a bit. Bev – your statements about Riley on prednisone give me so much hope. I really pray that Butters can have a similar successful tolerance. Rod—Thanks for the additional information. I have found those resources to be very useful. Melissa – it warms my heart that you and Mr. Monster enjoy Butters’ stories and photos. It is fun to share his adventures with you
Overall, I feel everything went pretty well today. I am really thankful to have a vet whom listens and values my concerns. Last night, she had contacted some specialist colleagues and dug further into her literature after hours. She came to the same conclusion as I, and also strongly feels that Butters fits the clinical picture of masticatory muscle myositis (to my surprise when I walked into the office, that was the first thing she mentioned before I could bring it up!). Before Butters’ work-up started this morning, she and I had a chance to discuss the literature and some of the revisions in his planned work-up for the day.
Butters received numerous blood tests, including a CK level and the 2M antibody test applicable to MMM, as well as other tests intended to rule-out tick-borne diseases and other medical conditions. He received a chest and head X-ray, both of which the radiologist read as normal including no signs of abscesses, tumors, or tooth/jawbone problems. Butters ended up not receiving an endoscopy (his mouth opened only 1.5 inches under anesthesia, and the vet agreed that forced opening of the jaw would potentially be harmful). However, a thorough mouth exam under sedation was performed instead, and he did not have any foreign bodies or other observable problems. The vet was able to watch him swallow, which also was helpful information to show that those muscle groups were working.
The CK and 2M tests had to be sent out (will take about a week for results), but his blood cells, electrolytes, liver enzymes, and kidneys all looked good on the blood tests. Since there is such a high suspicion at this point for MMM, Butters was started on Prednisone 10mg daily, which will be continued for at least 3-4 weeks. He will then be reevaluated (unless there is a problem before) to see the effectiveness of his treatment, and may be slowly tapered from there.
My husband and I feel very fortunate that we at least had him checked out while he still has some intact jaw function. Based on the progression of Butters’ symptoms, the vet feels that he likely has the chronic form of MMM. Looking back at his photos, I can see some signs of atrophy all the way back to around 7 months old. The vet reinforced that in the chronic form, it can be less responsive to therapy because the muscles can become completely fibrosed (full of scar tissue). However, she is hopeful that his function will improve with therapy. Apparently, there are many dogs that present at a point where they have lost a great deal of weight and have little or no function of their jaws. Some require tube feeding. Their fibrosis is likely more extensive. At this point, Butters can still continue on his present diet, which he is able to tolerate although with some difficulty. He can still drink water on his own, but it takes him a long time and we will keep close eye on him. We will just have to wait and see how he responds…