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Myasthenia gravis

Species: Dog
Breed: Chocolate Labrador R
Age: 11-15 years

I am grieving the loss of my beloved companion who was euthanized on May 18, 2011. He seemed healthy for his age (10 y/o plus)with the normal signs of aging: retinal atrophy, arthritis in front legs, some muscle wasting in his hind legs, and 6 or 7 non-cancerous fatty tumors. He was taking 1 Dasuquin and (2) 50mg Tramadol per day with excellent results. He had some trouble getting in the car without a boost and hesitated ascending stairs but could still manage with some coaxing. I would like your professional insight as to the manner of his diagnosis and treatment prior this death. Here is a timeline leading up to May 18.
My question is following the timeline.

February 2011: I research canine dental cleaning and schedule two dental exams. Both recommend that scaling is necessary but not imperative. I've brushed his teeth for years. I'm uncertain if I should proceed due to his age and needing anesthesia for the procedure.

April 26: He yelps when eating a small milk bone, and days later when given a piece of pizza crust. He shuns "treats". I examine his gums and teeth. He yelps when I touch his right jaw (no bleeding or visible signs of decay or cracked teeth).

May 1: I take him to vet for a blood panel and dental exam. The blood work is negative for infections, liver enzyme is a bit elevated. He yelps again during the exam but vet can't see any dental abnormalities. His weight is 86lbs.

May 3, 2011: Follow-up, head x-ray and consultation with his regular vet. His vet explains that she cannot find any cracked or abscessed teeth - if anything they look fine. She suspects Myasthenia Gravis and prescribes Prednisone (20mg) for 50 pill duration. She explains that it's an aggressive dosage: 2 pills (twice a day) for 4-5 days then 1.5 pills (twice a day) for 3 days then 1 (twice daily) for 3 days then 1 daily for 7 days then 1 every other day for 7 days. We decided to cancel and reschedule dental cleaning. I left feeling good about his prognosis.

May 7: He is taking Pred and Tramadol as prescribed. It's his 11th Birthday and he is eating like a horse, drinking alot of water and urinating frequently.

May 14: He chokes while eating this morning. We go on a road trip and he seems lethargic. I call to schedule a vet appointment for next morning.

May 15: He looks worse. Vet gives him IV fluid therapy, Cerenia, Pred injection, x-rays of chest. X-ray shows esophagus is enlarged and he has some fluid in his lungs. Vet gives Baytril 136mg (2 per day) That evening he eats and drinks some. He now weighs 75.3 lbs. I'm concerned.

May 16: I resort to feeding him by hand. He has some appetite but regurgitates all food and water. He staggers when walking. I'm conflicted - he is getting worse?

May 17: He won't eat. I take him to vet at 3PM. He receives fluid therapy, Pred injection, an injection for nausea. His vet is surprised by weight loss, and explains that his condition is deteriorating. He has (pneumonia). She explains his prognosis is grim. He refuses to eat at home.

May 18: He will eagerly drink water but will not eat. I even tried a McD's cheeseburger which he never refused. His breathing is labored, heart rate is rapid, coughing water and mucus, and he cannot stand at all. I decide that I can no longer see him suffer and take him to the vet.
At 3PM He passes peacefully.

Dear Doctor, my dog was the smartest most loving pet I've ever owned and my grief is consuming me. It's unbelievable that he would go from a seemingly healthy older dog to death in less than 1 month! I've read about Myasthenia Gravis/Megaesophagus and come to my own conclusions but I need closure so I can move past grief, blame and into acceptance.

Would you would make the same conclusions, decisions and prescribe the same medications (Prednisone 20mg) and (Baytril 136mg) in my dog's case? I have a schedule of date/times/and dosages if needed. Let me know if you need further clarification.

Thank-you for your advice!

Online vet, Dr. Marie

Dr. Marie replied:

I'm so sorry to hear your dog's story. It sounds like he was a wonderful dog.

Myasthenia gravis is not a common problem in dogs. There are two kinds of myasthenia gravis - congenital (meaning the dog was born with it) and acquired. In your dog's case it would be acquired.

We don't know why dogs get acquired myasthenia gravis but it is believed to be an autoimmune condition. What that means is that for some reason the immune system starts to develop antibodies against something called acetylcholine receptors. This causes the body to experience weakness. While the weakness can occur anywhere in the body, the esophagus and throat muscles are often affected the most. As the disease progresses it can affect the rest of the body as well.

This weakness in the esophagus can cause food to not go down to the stomach properly. It will often get regurgitated back up. Sometimes, when a dog regurgitates there is a risk that the food can be aspirated into the lungs. Many dogs with megaesophagus can develop aspiration pneumonia which is really serious. It sounds like this is what happened to your dog. The Baytril was prescribed to treat the pneumonia.

I mentioned that most of the time we don't know what causes myasthenia gravis. Sometimes in older dogs it can be because of a tumor in the thymus (an organ in the chest). Whether it is because of a tumor or because of an autoimmune condition, the treatment we usually use first is prednisone. We would have to use immunosuppressive doses of prednisone which means that a high dose has to be used.

If the disease was autoimmune then the prednisone helps stop the immune system from destroying the acetylcholine receptors. If the disease was because of a tumor it will help with temporarily shrinking the tumor (but will not cure the disease.)

Another medication that can be used for megaesophagus is called pyridostigmine. However, it can often have significant side effects.

It sounds like your vet did everything the same that I would. It really doesn't sound like anything should have been done differently.

I'm so sorry for your loss, but it doesn't sound like there was anything else that could have been done. If you have more questions or things that need clarifying, please let me know.

Dr. Marie.

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Disclaimer: Although Dr. Marie is a qualified veterinarian, the information found on this site is not meant to replace the advice of your own veterinarian. and Dr. Marie do not accept any responsibility for any loss, damage, injury, death, or disease which may arise from reliance on information contained on this site. Do not use information found on this site for diagnosing or treating your pet. Anything you read here is for information only.

Customer reply:

Dear Dr. Marie, Thank you for your quick reply. I feel better knowing that everything was done to extend his quality of life. Now I can close this chapter and grieve properly.

I have two more clarifications:

1. Could he have had MG for months with no outward signs? I only noticed a behavioral change in April when he yelped, was tentative when eating hard treats, and seemed to lose fullness in his temples. I ask this because of the sudden nature of his megaesophagus and there was no other "signs". He was always a good eater - Gotta love Labs!

2. Are my questions and your replies able to be viewed by others? I would prefer that not be the case or could you remove his name if that is the case?

I rescued him but he repaid me a thousand times with love and devotion.
Thanks again.

Online vet, Dr. Marie

Dr. Marie replied:

This is a tough question to answer. Most likely he did not have MG for long from what you have described.

To answer the second part of your question...yes, the questions and my replies are viewable by the public. The reason that I do that is this: I created this website in order to provide good, accurate veterinary information for people who are searching for information online. I can't tell you how many times my clients come to me with inaccurate advice they have received online. The information in this post is very likely to help others.

If it is ok with you, I would love to publish your question but simply change some names. Is this ok? If you would prefer for none of this to be published, I can certainly take it down.

Customer reply:

Absolutely, you may publish my questions and your answers w/o names. I hope this information helps others with a similar situation.

Customer reply:

You may title this article: My lab was diagnosed with Myastenia Gravis and Megaesophagus and died

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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

Is an online vet visit just as good as a trip to your veterinarian? No! But, many times, asking an online veterinarian a question can help save you money. While Dr. Marie can't officially diagnose your pet or prescribe medications, she can often advise you on whether a vet visit is necessary. You can also ask Dr. Marie for a second opinion on your pet's condition.