# Masticatory Muscle Myositis question



## Reese9 (Jan 11, 2012)

Hey everyone! 

I will try to make this as short as possible. About a month ago, Reese (our 4 & a half year old Golden) was outside playing with a stick and came back to me crying. I examined her mouth and didn't find anything. For the next few days she was very sore when opening her mouth too wide. Took her to the vet and they sedated her and checked her mouth and did X-rays with everything returning normal. She was put on meloxicam and the doctor warned me about MMM. She quickly got better and wasn't as sore but I noticed she still wouldn't open her mouth all the way when yawning and seemed to be careful when picking up balls. Another vet said it could be TMJ and to continue the nsaid for another week. Other than not being able to fully yawn, she seemed to be completely fine. Eating fine, no drool, no whining, etc. I talked to the vet and they recommended sending out the 2M antibody test and starting prednisone. I did some of my own research and decided to get a 2nd opinion from the holistic vet first. Only thing is, she was booked out 3 weeks. In the meantime, we were careful with her jaw. No bones or chewing and no ball playing. She didn't get any worse and I once again only noticed her yawn being off. Fast forward, Reese had her initial appointment last week and the doctor there agreed with MMM. Said the muscles around her jaw bone felt almost non-existing. She also commented on how her cheek muscles looked like they were slightly sunken in. We sent out the 2M antibody test but have to wait 7-10 business days for results. Only problem is, if it comes back negative, it could still be positive. So as we await results she put her on supplements and Chinese herbs. We are also doing acupuncture weekly (for now). She said at this point since her only symptom seems to be her yawning and muscle atrophy that we don't need to put her on prednisone, or NSAIDs. If it gets worse, we may have to. I will do anything before turning to the steroids. We are reluctant that we caught it before it progressed but doc says no vaccines or toxins that can trigger a reaction since it's an auto immune disease. We already had been feeding partially raw and Orijen kibble which we will continue to do. Anyone have any recommendations or have been through this? I read it is common in the breed but I had never heard of this disease until now. Any advice is much appreciated from me and my girl. Thanks from the both of us! 

Photo is of Reese getting her acupuncture today.


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## Buddy's mom forever (Jun 23, 2011)

I am sorry for your Reese. I remember this thread and you can also PM inge, don't see her on the forum lately but I know she will be glad to help you. http://www.goldenretrieverforum.com...ing-all-dogs-masticatory-muscle-myositis.html


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## Reese9 (Jan 11, 2012)

Thank you Buddy's mom! I appreciate your direction. We got the 2M Antibody test back and it was a borderline antibody titer and they suggested a muscle biopsy. Vet agrees to wait to do the biopsy as they have to actually go in and take a piece of muscle and it can be painful. Since her symptoms at this time aren't bad we will hold off..


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## Buddy's mom forever (Jun 23, 2011)

I wish I could help more, sending good thoughts and prayers. Any time biopsy is mentioned it sounds painful to me. Please keep updating this thread, I will be praying for your sweet Reese.


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## tikiandme (May 16, 2010)

Reese9 said:


> Thank you Buddy's mom! I appreciate your direction. We got the 2M Antibody test back and it was a borderline antibody titer and they suggested a muscle biopsy. Vet agrees to wait to do the biopsy as they have to actually go in and take a piece of muscle and it can be painful. Since her symptoms at this time aren't bad we will hold off..


 I'll tell you my experience regarding my dog. One evening he couldn't pick up a toy without crying. Saw the vet the next morning. He suspected MMM, as did I. He took a blood sample for titer testing, and it came back as a positive titer, in the gray zone (can't remember the exact numbers). He sent me home with a large bottle of pred. I gave him one dose of 60mg although the vet told me 80 mg 2xday (the recommended starting dosage for my dogs size). By the next morning, my dog had regained normal usage of his jaws, so I discontinued the pred. I went ahead with the muscle biopsy. The biopsy report stated that no disease was present in the sample, but MMM can have a focal presentation and could be present in a different spot that wasn't included in the biopsy. I wished they would have explained that to me before I put him through the biopsy. On the lab's website it states that there is no such thing as a false positive on the blood test, so why put him through a biopsy that could possibly be inconclusive. It didn't make sense to me. Then ten days after the biopsy he bloated, probably from all of the stress. At any rate, his was a mild case and has not yet returned in 2 years. His beautiful head is shrunken and he has very little jaw muscle, but normal function. I make sure he plays tug of war often to keep the strength in what muscle he has left. I try to keep his stress level low to keep the MMM and his frequently recurring bloat episodes at bay. I hope the MMM doesn't return. If it does I'm not sure he could survive the treatment. I'm sorry you are dealing with this. I hope you get more of a "cut and dried" answer.


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## lhowemt (Jun 28, 2013)

Get him on Pred asap! I have researched mmm, as my youngest pup has some ancestors that produced dogs that got mmm. So I have no experience, but researched it at length before deciding to get her. From what I read, Pred can prevent further damage and if you wait, losses can be irreversible. I understand the desire not to do pred, it is a nasty drug. But for certain conditions it can be miraculous. I am so sorry for you baby.


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## tikiandme (May 16, 2010)

lhowemt said:


> Get him on Pred asap! I have researched mmm, as my youngest pup has some ancestors that produced dogs that got mmm. So I have no experience, but researched it at length before deciding to get her. From what I read, Pred can prevent further damage and if you wait, losses can be irreversible. I understand the desire not to do pred, it is a nasty drug. But for certain conditions it can be miraculous. I am so sorry for you baby.


 I agree with this. Unfortunately pred is the only thing that will stop it. Again, my dog's case was very weird and transient. My vet couldn't really explain it. If you have an active case and there is loss of jaw function, pred is considered the only hope. Hopefully Inge will notice this thread and give you her valuable experience.


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## Reese9 (Jan 11, 2012)

I want to clarify one thing. Reese's symptoms aren't bad enough that both her traditional and holistic vet agree that we can hold off on prednisone. If symptoms worsen, I of course would start the steroids. I am just trying to reach out and find something else that will work before resorting to that.. If the course of action we are taking now doesn't work, I understand that prednisone can be helpful. But how am I supposed to know that what we are currently trying won't help if I immediately started prednisone? We wouldn't, and that's why I am seeking other options since her symptoms are minimal. We have prednisone on hand if that were to change overnight. I have read a lot of people's experience with this disease and many said their dog did worse on prednisone and ended up with liver damage. It's almost a "cure is worse than the disease" and I don't want to give my baby a drug that could cause worse damage that is irreversible. I agree with not submitting a muscle biopsy. Thankfully, my vet did tell me that even if they went in and and got a peice of her muscle that it might not be an affected peice and we would still get negative results with an invasive procedure. On the bright side of things, I feel like Reese is yawning better!! I'm so happy. She has another acupuncture appointment Friday and I'm going to ask the vet if we can start letting her chew on bones and using her muscles again. Attached is a picture of Reese yesterday on a walk with her dad. The other is of her playing in the snow a few weeks ago.


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## tikiandme (May 16, 2010)

I'm glad your girl is improving. I'm not a vet, but just a dog owner with a dog with a slew of problems, three of them being autoimmune thyroiditis, frequently recurring GDV and a bout with MMM. I can't help but think these problems may be inter-related somehow. I would suggest you get a full panel thyroid test done (if you haven't already). I would have blood drawn and sent to the lab at Michigan State. They are the gold standard for thyroid testing. If the results come back low normal, that is too low for a golden and she might need supplementation. Again, this may not have anything to do with the MMM, but it is another autoimmune disease, and, if warranted, supplementation with thyroid hormone might help her immune system. Just a crazy off-the-cuff thought. The testing isn't an invasive procedure and couldn't hurt. The only other thing I can suggest is to try and keep her stress level low (easier said than done). I'm convinced certain stresses cause my dog's MMM to surface. At any rate, good luck with your girl. I hope you have no more problems with your precious girl.


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## Karen519 (Aug 21, 2006)

*Reese*



Reese9 said:


> Hey everyone!
> 
> I will try to make this as short as possible. About a month ago, Reese (our 4 & a half year old Golden) was outside playing with a stick and came back to me crying. I examined her mouth and didn't find anything. For the next few days she was very sore when opening her mouth too wide. Took her to the vet and they sedated her and checked her mouth and did X-rays with everything returning normal. She was put on meloxicam and the doctor warned me about MMM. She quickly got better and wasn't as sore but I noticed she still wouldn't open her mouth all the way when yawning and seemed to be careful when picking up balls. Another vet said it could be TMJ and to continue the nsaid for another week. Other than not being able to fully yawn, she seemed to be completely fine. Eating fine, no drool, no whining, etc. I talked to the vet and they recommended sending out the 2M antibody test and starting prednisone. I did some of my own research and decided to get a 2nd opinion from the holistic vet first. Only thing is, she was booked out 3 weeks. In the meantime, we were careful with her jaw. No bones or chewing and no ball playing. She didn't get any worse and I once again only noticed her yawn being off. Fast forward, Reese had her initial appointment last week and the doctor there agreed with MMM. Said the muscles around her jaw bone felt almost non-existing. She also commented on how her cheek muscles looked like they were slightly sunken in. We sent out the 2M antibody test but have to wait 7-10 business days for results. Only problem is, if it comes back negative, it could still be positive. So as we await results she put her on supplements and Chinese herbs. We are also doing acupuncture weekly (for now). She said at this point since her only symptom seems to be her yawning and muscle atrophy that we don't need to put her on prednisone, or NSAIDs. If it gets worse, we may have to. I will do anything before turning to the steroids. We are reluctant that we caught it before it progressed but doc says no vaccines or toxins that can trigger a reaction since it's an auto immune disease. We already had been feeding partially raw and Orijen kibble which we will continue to do. Anyone have any recommendations or have been through this? I read it is common in the breed but I had never heard of this disease until now. Any advice is much appreciated from me and my girl. Thanks from the both of us!
> 
> Photo is of Reese getting her acupuncture today.


Praying for you and Reese. I did on search on this forum about MMM and found all of these topics.
Looks like there are two pages:
http://www.goldenretrieverforum.com/search.php?searchid=9833386


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## Reese9 (Jan 11, 2012)

We had a full blood panel run (annual check up, nothing was wrong at the time) at the end of August with thyroid and everything returned normal. Symptoms for mmm didn't start until end of September. Do you think we should test again? Can thyroid results change that quickly?


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## tikiandme (May 16, 2010)

Reese9 said:


> We had a full blood panel run (annual check up, nothing was wrong at the time) at the end of August with thyroid and everything returned normal. Symptoms for mmm didn't start until end of September. Do you think we should test again? Can thyroid results change that quickly?


 I don't know if things could change that quickly. You could discuss the possibility with your vet. I would think his thyroid is fine, again, I'm no vet. It sounds to me like you are doing everything right to take good care of your girl. I just threw that idea out to you just in case, but you are way ahead of me .


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## lhowemt (Jun 28, 2013)

I don't want to cry wolf or encourage you to overact. However I recommend you find a vet who has seen MMM and has treated it personally (not sure if either of your 2 vets have). Call around. Second opi ions are a critical piece if healthcare. The big thing that sticks in my mind from my research, besides the possibility of damage being irreversible, is that if MMM is less successfully treated the first time around, the second is much more difficult to control.

Pred isn't so bad if it is not long term or high dose. I know it is scary what it can do, however for autoimmune diseases (I have one) brief bursts can be miraculous. Truly. It can knock those symptoms back into the hole they came from.

She is beautiful, please keep us posted and beat wishes!


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## lhowemt (Jun 28, 2013)

Just checking in on Reese, I hope she is doing well.


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## Reese9 (Jan 11, 2012)

lhowemt said:


> Just checking in on Reese, I hope she is doing well.



Ihowemt thanks for checking in on Reese! She's doing fine! Has been on all supplements for 3 and a half weeks. She still isn't painful and I feel like I notice her yawn getting a small amount better week by week. Her last acupuncture session was on December 4th! Doc said she felt like she was gaining more strength in her jaw muscles. We are lengthening the acupuncture out 2 weeks now.. She has her next one in about 5 days. She still isn't painful and I don't notice any muscle atrophy. We did add golden paste (turmeric, black pepper, & olive oil paste) to her diet from a recommendation on a dog forum. The vet agreed it could be helpful. We have been giving her a small Kong filled with canned food to help exercise her jaw. So, we continue with what we are doing and pray we never get a bad flare up!

I tried to add a photo but keep getting an error. Once again, thanks for checking in! I will try to post updates as I can.


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## Karen519 (Aug 21, 2006)

*Reese*

Your girl is just beautiful-I see her picture in your profile!
http://www.goldenretrieverforum.com/members/20782-reese9.html

Glad to hear she is doing better.


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## Reese9 (Jan 11, 2012)

So... Here's a little update on Reese. We are looking for some advice once again. Reese is doing fine as always. She is chewing on marrow bones regularly with no pain or crying. She plays with my friends puppy every day and is able to open her mouth fully with no problem.. No crying. Once again, I still haven't heard her whine since that first day that she was chewing on the stick. The only real symptom I've seen is that she still is reluctant to yawn. We had her teeth cleaned by Animal Dental Care, without anesthesia because her breath has been rancid and getting worse ever since all of this started. The girl who cleaned her teeth has done it a handful of times in the past and always tells me how beautiful all of her teeth are. Well, this time she said on her lower left side she whined while she was cleaning around her gums and it seemed sensitive. The weirdest part is the day she came to me crying after she was chewing on the stick, she was bleeding on that same area a bit around her gum line. The girl that cleaned her teeth said her gums aren't inflamed and everything looked fine and cleaned up nicely. I spoke with all three of the vets at Reese's gp and they all agreed that there is still possibility there is a small fragment (foreign body) stuck in there that won't make its way out by itself. They re-evaluated her X-rays from the end of September and said everything looked fine. Her teeth and roots looked beautiful and hey couldn't notice anything abnormal. Two of them agreed that the next step would be to take X-rays again.. And if we do so she would have to be sedated to get the best pictures. I feel like if this is a small fragment I'd rather just have her sedated once and take her for a ct scan which both of them agreed would be the next step if nothing showed up on X-ray. I know Reese so well and I just feel like something is still stuck in her mouth because her symptoms just don't fully add up with mmm. We live in Northern California and there is one vet who is close to us who has a ct machine but the board certified radiologist is only there once a month and I haven't read the best reviews. I feel like if I want the best service for my girl that UC Davis would be the closest, and best place to take her. I'm just so worried about having to put her under anesthesia. I have never had to leave her for any procedure besides her spay and it kills me.. But I want what is best for my girl. Has anyone ever been through this. Even better yet, has anyone had this done at UC Davis? What's the procedure like? I am going to call on Monday to get more information but thought I'd reach out here for personal advice and information. Thank you all so much for always being so wonderful with Reese and I!


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## Songbird (Jul 8, 2014)

*mmm*

Hi,
I too have a golden with mmm. She was diagnosed at 1 year. Same thing, couldn't open mouth, cried etc. I had her take an M2 test - San diego and the numbers were off the charts. 4000 - plus a dentist also put her under anesthesia and could not open her mouth. short term - immediately put her on prednisone, tapered off as quickly as I could (within the recommended limits by supplementing with chinese herbs (another doctor - homeopathy to get rid of any vaccine buildup) acupuncture and chiro. I will not lie, the pred did a number on her muscle mass and she was miserable, however, within 8 months her body came back. My chiropracter also told me her jaw was out of alignment.
I switched from raw food to cooking for her, adding probiotics, oils, having acupuncture every month for maintenance so that her immune system stays in check. I still see a bit of sunken in cheekbones, but she is happy and stressless.
I know dogs do have relapses which is why I always do a metabolic panel to compare yearly to make adjustments to her supplements. She has 3 doctors and they all think she is doing great. But with mmm you just never know if it's going to make it's ugly return.

My advice, keep her immune system balanced, avoid any shots or chemicals that are not necessary - be careful with rabbis vaccines - get her tested and see what her levels are, She may still have enough. Some dogs get relapses after they get a rabbis booster. By chance, has your dog had any shots lately?

I believe dogs with mmm have a very sensitive system both physically and emotionally. I too am checking the thyroid connection. 
I also stopped giving my dog bones because the dentist said her back teeth were already shot at 1 from all the bones she was chewing. 

Your doggie is beautiful as is my Brandi - I hope this info gives you some insight as to how I help my girl manage this disease. Every day I have her is a blessing!! and she is happy too!


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## Karen519 (Aug 21, 2006)

*Reese*



Reese9 said:


> So... Here's a little update on Reese. We are looking for some advice once again. Reese is doing fine as always. She is chewing on marrow bones regularly with no pain or crying. She plays with my friends puppy every day and is able to open her mouth fully with no problem.. No crying. Once again, I still haven't heard her whine since that first day that she was chewing on the stick. The only real symptom I've seen is that she still is reluctant to yawn. We had her teeth cleaned by Animal Dental Care, without anesthesia because her breath has been rancid and getting worse ever since all of this started. The girl who cleaned her teeth has done it a handful of times in the past and always tells me how beautiful all of her teeth are. Well, this time she said on her lower left side she whined while she was cleaning around her gums and it seemed sensitive. The weirdest part is the day she came to me crying after she was chewing on the stick, she was bleeding on that same area a bit around her gum line. The girl that cleaned her teeth said her gums aren't inflamed and everything looked fine and cleaned up nicely. I spoke with all three of the vets at Reese's gp and they all agreed that there is still possibility there is a small fragment (foreign body) stuck in there that won't make its way out by itself. They re-evaluated her X-rays from the end of September and said everything looked fine. Her teeth and roots looked beautiful and hey couldn't notice anything abnormal. Two of them agreed that the next step would be to take X-rays again.. And if we do so she would have to be sedated to get the best pictures. I feel like if this is a small fragment I'd rather just have her sedated once and take her for a ct scan which both of them agreed would be the next step if nothing showed up on X-ray. I know Reese so well and I just feel like something is still stuck in her mouth because her symptoms just don't fully add up with mmm. We live in Northern California and there is one vet who is close to us who has a ct machine but the board certified radiologist is only there once a month and I haven't read the best reviews. I feel like if I want the best service for my girl that UC Davis would be the closest, and best place to take her. I'm just so worried about having to put her under anesthesia. I have never had to leave her for any procedure besides her spay and it kills me.. But I want what is best for my girl. Has anyone ever been through this. Even better yet, has anyone had this done at UC Davis? What's the procedure like? I am going to call on Monday to get more information but thought I'd reach out here for personal advice and information. Thank you all so much for always being so wonderful with Reese and I!


I think your gut is telling you to follow through with the CT scan. Something is causing her breath to be rancid. I would call on Monday and ask them all of the questions you need to. If it were my dog, I wouldn't want to rule out every scenario.


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## lhowemt (Jun 28, 2013)

I am glad Reese is doing better but that is a bummer about something still in there? Personally, I'd be rushing off to UC Davis if I were you. With her medical condition, especially it being somewhat uncommon, I would opt for specialists. Good luck and keep us posted!


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