Myasthenia gravis in dogs affects the way nerves send signals to muscles, leading to muscle weakness. Integrative veterinarian Dr. Julie Buzby breaks down the symptoms, causes, diagnosis, treatment, and prognosis for myasthenia gravis in dogs. Then, she shares the story of Brutus, one of her beloved dog patients with myasthenia gravis.
It’s easy for us to take for granted how our muscles work the way they should so we can accomplish everyday tasks like walking, swallowing food, etc. And the same goes for our dogs.
However, some conditions such a myasthenia gravis in dogs can change all that.
What is myasthenia gravis in dogs?
Myasthenia gravis in dogs is a disease that occurs when the nerves can’t send as strong a signal to the skeletal muscles, leading to muscle weakness. There are various forms of myasthenia gravis (MG), which we will discuss soon. But all of them involve something going wrong in the space between nerves and muscles called the neuromuscular junction.
In a healthy dog, nerves send a signal across the neuromuscular junction to the skeletal muscles in order to make the muscles move. To accomplish this, nerve endings send a chemical called acetylcholine (ACh) into the neuromuscular junction. It binds to acetylcholine receptors on the muscle cells, which creates the signal for the muscles to fire. The body then releases an enzyme called acetylcholinesterase to “turn off” the signal. That way the muscles aren’t constantly stimulated to work.
However, in dogs with myasthenia gravis, something goes wrong with the signaling cascade (e.g. there isn’t enough acetylcholine or enough acetylcholine receptors). Therefore, the signal that causes muscles to fire is diminished and the dog experiences muscle weakness.
Two causes of myasthenia gravis in dogs
There are two forms of myasthenia gravis in dogs—inherited and acquired. First, let’s take a look at inherited myasthenia gravis.
Inherited myasthenia gravis in dogs (i.e. congenital)
In the congenital form of myasthenia gravis, a dog is born with abnormal neuromuscular junctions. Clinical signs are therefore obvious at a very young age (typically six to eight weeks old).
Breeds that are more likely to exhibit inherited (i.e. congenital) myasthenia gravis include:
- Jack Russell Terriers
- Springer Spaniels
- Smooth Haired Fox Terriers
- Miniature Dachshunds
- Old Danish Pointers
- Labrador Retrievers
Acquired myasthenia gravis in dogs
On the other hand, adult dogs can develop acquired myasthenia gravis, which is the more common form. It may occur in response to a thymoma (i.e. tumor of the thymus, a gland in the chest) or another type of tumor. Or it may happen spontaneously.
In all of these cases, the immune system makes antibodies that attack the acetylcholine receptors in the neuromuscular junction. Thus, when acetylcholine is released into the gap, fewer receptors are available to participate in relaying the signal.
I like to use a sports analogy to explain acquired (i.e. immune-mediated) myasthenia gravis. Imagine a track race where the relay racer tries to hand off the baton. But the next runner isn’t available to take it. In acquired myasthenia gravis, the signal (acetylcholine) is there but because of the lack of receptors to receive it, it can’t pass its message on to the muscles. This results in decreased muscle strength.
Dogs are typically diagnosed with acquired MG when they are young adults (between the ages of 1 and 4 years) or seniors (between the ages of 9 and 13 years).
Acquired MG disease can occur in any dog breed, but it tends to occur more often in:
- Akitas
- Newfoundlands
- Labrador Retrievers
- Golden Retrievers
- Great Danes
- Chihuhahas
- German Shorthaired Pointers
- Scottish Terriers
- Yorkshire Terriers
Types of acquired myasthenia gravis
Within the category of acquired myasthenia gravis, there are three different forms—generalized, focal, and acute fulminating.
- Generalized acquired myasthenia gravis—This is the most common type. It affects muscles in the whole dog, with particular impact on the muscles of the limbs and esophagus.
- Focal acquired myasthenia gravis—In this condition, symptoms are localized to the muscles of the face and head.
- Acute fulminating myasthenia gravis—This form may be a more severe subset of generalized myasthenia gravis and results in rapidly progressive severe weakness or paralysis of all four limbs.
What are the symptoms of myasthenia gravis in dogs?
As you may have gathered, one of the hallmarks of myasthenia gravis is muscle weakness. Depending on the form and severity of the myasthenia gravis, the poor muscle tone can cause a variety of symptoms.
Difficulty walking and gait changes
Because the skeletal muscles are the ones affected by myasthenia gravis, dogs with congenital or generalized acquired myasthenia gravis may show the following gait and posture-related symptoms:
- The dog’s back legs collapsing or having a stiff or stilted appearance when moving (MG causes more severe symptoms in the back legs than the front legs but can affect all four limbs.)
- Hunched posture after mild activity
- Muscle weakness which worsens with exercise and improves with rest
- Being a lethargic dog (i.e. being unable or unwilling to get up and move around)
One of the key things that stands out about these dogs is that their symptoms tend to progress as they exercise or are active and then go back to baseline after some rest. This doesn’t tend to be the case for most other causes of muscle weakness.
Regurgitation of food
Additionally, dogs with focal or generalized myasthenia gravis may also have poor esophageal function. This is the case because the esophagus is largely comprised of skeletal muscle, which is the type of muscle affected by myasthenia gravis. Since signals are not getting through to the esophagus, it can become dilated and flaccid. The term for this enlarged esophagus is megaesophagus in dogs.
The weak esophagus cannot efficiently move food down to the stomach. Therefore, the food just stays in the esophagus. Often the dog will regurgitate (or bring up) that food and water that is sitting in the esophagus.
It’s easy to confuse regurgitation with vomiting, so let’s take a look at what both look like. Regurgitation is a passive process and is not accompanied by the retching noise or abdominal contractions associated with vomiting. Plus, the food a dog regurgitates is undigested and does not contain bile (unlike vomitus, which may be yellow from bile and is usually at least partially digested unless the dog just ate).
The reason I outlined the difference between vomiting and regurgitation is that dogs can die for lack of humans differentiating between the two. According to Dr. Linda Shell, a veterinarian who is board certified in veterinary internal medicine and neurology, “The mortality rate in acquired myasthenia gravis approaches approximately 50%, due in large part to misdiagnosis of vomiting instead of regurgitation from esophageal weakness and dilatation.”
Coughing, difficulty breathing, and fever due to aspiration pneumonia
Regurgitation is particularly dangerous because dogs that regurgitate can accidentally inhale their food and water in the process, causing aspiration pneumonia—an infection in the lungs. Just like in humans, pneumonia in dogs makes dogs very sick. Affected dogs may be breathing fast, coughing, lethargic, or feverish.
Weight loss
Additionally, a dog will tend to lose weight very quickly. This happens because he or she cannot get enough food to the stomach for digestion and absorption of nutrients.
Face and neck problems
Since focal myasthenia gravis affects the muscles of the face and head, you may notice the following symptoms in addition to megaesophagus:
- Inability to close eyes (even during sleep) due to weakness of the eyelids
- Difficulty swallowing (i.e. dysphagia)
- Drooling
- Voice change (For another condition that can manifest with this odd symptom, read my article on laryngeal paralysis in dogs.)
How is myasthenia gravis in dogs diagnosed?
If your dog is displaying any of the symptoms we just discussed, you should make an appointment with your veterinarian. During that appointment, the vet will examine your dog, ask you questions about your dog’s history, and then potentially run some diagnostic tests.
A veterinarian might suspect that a dog has myasthenia gravis if the clinical signs and history fit. But to be honest, it’s an “oddball” diagnosis that might not be top of mind. Therefore, your vet may start with some other tests to gather more information before deciding to test your dog for myasthenia gravis.
Blood and urine testing
The vet may run blood tests for dogs to look for electrolyte abnormalities, low blood sugar, hypothyroidism in dogs, or other problems that could cause muscle weakness.
Chest X-ray or ultrasound
Especially if your dog is regurgitating, the vet may want to take a chest X-ray to check for esophageal enlargement (i.e. megaesophagus) and/or signs of aspiration pneumonia.
Additionally, since tumors of the thymus—a gland located in the upper chest—can cause myasthenia gravis, veterinarians will also look for a mass in the region of the thymus on X-rays. Or sometimes they may use an ultrasound to examine the thymus.
Acetylcholine receptor (AChR) antibody test
If your vet suspects myasthenia gravis in your dog, he or she may send out an acetylcholine receptor (AChR) antibody test. This is a highly sensitive blood test that looks for antibodies (one of the immune system’s weapons) against acetylcholine receptors. It is the “gold standard” test for myasthenia gravis in dogs and accurately diagnoses about 98% of dogs with acquired myasthenia gravis. However, it can yield false negatives.
Keep in mind, it can take up to two weeks for the AChR antibody test to come back. So you aren’t going to have answers right away.
Tensilon test
Another test, called the Tensilon test, originally involved giving an intravenous injection of the drug edrophonium chloride (trade name Tensilon). However, since the manufacturer of Tensilon discontinued production, we now use a similar medication called neostigmine.
Both drugs are short-acting enzymes that block acetylcholinesterase (the enzyme that breaks down acetylcholine). This temporarily floods the neuromuscular junction with acetylcholine, which allows for normal conduction of nerve signals to the skeletal muscles.
Dogs with acquired myasthenia gravis can sometimes have a dramatic response, going from severely weak to normal within moments of the intravenous injection. However, sometimes they can have minimal to no response, especially with focal myasthenia gravis.
Video of the Tensilon test for a dog with myasthenia gravis
Thanks to the brilliant team at Southeast Veterinary Neurology, you can watch this video of a Tensilon test for a dog who ended up being diagnosed with myasthenia gravis. Note the dramatic difference in the dog’s gait and stance before and after the vet gave the Tensilon injection.
A tissue sample
Finally, a veterinarian may submit tissue samples for biopsy to look for antibodies near the neuromuscular junction. However, taking a tissue sample from a muscle can be very invasive and painful for a dog. And the test isn’t specific to the MG disease. Therefore, most veterinarians rely on clinical history and the acetylcholine receptor antibody blood test for answers.
Genetic testing
Puppies with congenital myasthenia gravis tend to have negative AChR tests since there isn’t an immune-mediated component. And they often don’t respond to the Tensilon test either, or may actually get weaker. This can make diagnosing MG more challenging.
However, there are genetic tests available for the Labrador Retriever, Jack Russell Terrier, and Old Danish Pointer types of congenital myasthenia gravis.
How is myasthenia gravis treated?
While waiting for the results of the specific myasthenia gravis tests, the veterinarian will start treatment for concurrent issues such as aspiration pneumonia. Pneumonia can be life-threatening, so it is important to address it right away. Depending on the severity of the pneumonia, the dog may need oxygen therapy, fluid therapy, nebulization and coupage treatments (to help break up mucus), and/or broad-spectrum antibiotics.
Additionally, if the dog is having severe difficulty eating or swallowing due to the megaesophagus and/or presumed myasthenia gravis, the vet may also consider inserting a feeding tube to provide nutrition.
Oral medications to treat myasthenia gravis
Once he or she has addressed the secondary conditions like pneumonia, and your dog is officially diagnosed with myasthenia gravis, the veterinarian can work on treating the MG directly.
The mainstay of treatment is an oral medication called pyridostigmine bromide (brand name Mestinon®). This is a longer-acting tablet version of the Tensilon injection. Dogs normally take pyridostigmine two to three times a day. I recommend giving this medication with food to avoid stomach upset and nausea.
Most dogs improve with pyridostigmine alone. Some need to be on this medication for life, but others can be successfully tapered off.
Immunosuppressive drugs to treat myasthenia gravis
In some cases, immunosuppressive drugs are also necessary. Remember, the immune system is the underlying trigger of acquired myasthenia gravis in dogs. So if the dog isn’t responding to pyridostigmine alone, the next step is to add medications to suppress the immune system.
A steroid like prednisone for dogs can be immunosuppressive when given at a high dose. However, if the dog has problems taking prednisone due to its side effects, then your vet may prescribe a different immunosuppressive medication.
Surgery for dogs with myasthenia gravis due to a tumor
If a dog’s myasthenia gravis is due to a thymic tumor, surgical removal of the tumor is the treatment of choice. This kind of procedure is highly invasive because the thymus is located inside the chest cavity.
At-home care for megaesophagus from myasthenia gravis
In addition to daily medications, dogs with megaesophagus from myasthenia gravis require a special feeding routine. Normally, dogs with megaesophagus are prone to regurgitation because the food stays in the esophagus. One way to help your dog is to give him or her elevated food and water dishes to keep the esophagus in a more neutral position while eating and drinking.
But what tends to be even better is a special highchair for dogs called the Bailey chair. You can purchase one or find plans to build one yourself. The dog sits upright in the Bailey chair while eating so that gravity helps the food slide down the esophagus. Then ideally, the dog will remain in a position that elevates the head above the belly for 20-30 minutes after each meal.
Experimenting with the consistency of the food (i.e. altering it to a gruel or making canned food “meatballs”) also may be helpful in minimizing regurgitation.
How will my veterinarian monitor my dog’s progress?
After starting treatment, your veterinarian will want to see your dog for frequent recheck visits. In cases with megaesophagus, your vet may recommend chest X-rays every month or so to make sure that the condition is resolving.
Plus, the vet may use the AChR antibody blood test we discussed earlier to monitor a dog’s response to treatment. Usually he or she will check the acetylcholine receptor antibody levels every two to three months after starting medication. The dog is considered in clinical remission once the dog’s symptoms resolve. And once the AChR antibody test is negative, the dog is in immunological remission.
Once the dog is in clinical remission, the vet will taper the dose of medication to the lowest effective dose. However, the dog will need to remain on the medications until he or she reaches immunological remission (or for life if the ACh antibody titer never becomes negative).
What is the expected outcome for dogs with myasthenia gravis?
The overall outlook for dogs with myasthenia gravis can vary significantly depending on the type and cause of the myasthenia gravis.
Congenital myasthenia gravis
Unfortunately, most cases of congenital myasthenia gravis are fatal by the time the dog is around 9 months old. However, the forms found in Miniature Dachshunds and Jack Russells carry a more favorable prognosis.
Focal or generalized myasthenia gravis
Dogs who have focal or generalized myasthenia gravis that is not associated with a thymoma or other type of cancer and do not suffer severe complications have a good prognosis. With appropriate treatment, the clinical signs of myasthenia gravis can resolve. And dogs usually show improved muscle strength after several months of treatment.
In fact, in a small study of 53 dogs with myasthenia gravis who were treated with acetylcholinesterase medications (e.g. pyridostigmine), 47 of the 53 went into spontaneous remission within an average of 6.4 months.
On the other hand, dogs whose myasthenia gravis is related to a tumor do not have as favorable of a prognosis. Thymomas are invasive or can spread to other locations. And they may return after surgery if the surgeon is not able to fully remove the tumor. In the study mentioned above, the dogs that did not go into remission ended up having cancer of some sort.
Acute fulminating myasthenia gravis
Finally, dogs with acute fulminating myasthenia gravis have the worst prognosis due to the severity of the disease. They are significantly more likely to die in the first year after diagnosis than dogs with the other forms.
Life expectancy and survival rate for dogs with myasthenia gravis
Overall, the two biggest killers of dogs with any of the forms of myasthenia gravis are respiratory failure and aspiration pneumonia. Sadly, because of the potential for complications, the overall one year mortality rate (i.e. death rate) is 40-60% for dogs with myasthenia gravis.
I know that last statistic sounds scary, so I want to leave you with a story of hope. This is the story of Brutus, and how he conquered myasthenia gravis.
Dr. Buzby shares Brutus’ story
I’m not sure if it’s appropriate to confess that vets have favorite patients, but we do. Brutus, a 10-year-old Miniature Pinscher owned by a super conscientious client, was one of my favorites. If you know anything about Miniature Pinschers, you know they are, shall we say, “feisty.” So to see Brutus in my office with dullness in his eyes instead of his usual fire made my heart hurt.
Brutus’s mom had scheduled a vet appointment because her beloved dog was vomiting and coughing. As I stood at the exam table observing Brutus, it occurred to me that he may not actually be vomiting, but rather regurgitating—an important clue to making a diagnosis.
Turns out, Brutus generally “vomited” soon after eating. And he didn’t retch or have abdominal muscle contraction (like dogs typically do before vomiting). His mom described the food as “splashing out of him.” It was almost as if it took Brutus by surprise.
It sounded to me like he was regurgitating.
Making a diagnosis of myasthenia gravis
During Brutus’s physical exam, his mom mentioned that he’d seemed lethargic, so I recommended we start with blood work and urine testing. These test results were unremarkable. His liver, kidneys, electrolytes, and blood cell counts all looked good.
I also recommended a chest X-ray. The regurgitation clue made me eager to look at his esophagus. And the cough made me want to look at his lungs.
Brutus’s chest X-ray had some interesting findings. One of his lung lobes had a different color (or opacity) compared to the other lung lobes, suggesting pneumonia. This explained his cough.
And then I noticed the telltale sign—severe enlargement of his esophagus.
Because of Brutus’s enlarged esophagus, called megaesophagus, and because of his other clinical signs, I suspected that Brutus had aspiration pneumonia secondary to an underlying diagnosis of myasthenia gravis.
When I sent out the acetylcholine receptor antibody test for Brutus, it did seem to take an eternity to come back. But when it came back positive, I did the dance of joy! We had answers. And we could help him!
Brutus’s return to good health
Thankfully, after treating his aspiration pneumonia, starting him on pyridostigmine, and getting him a Bailey chair for his megaesophagus, Brutus never suffered another bout of aspiration pneumonia.
He regained his full zeal for life and went into remission after about six months of treatment for myasthenia gravis. We then gradually tapered his medication to the lowest effective dose and continued to monitor him at vet visits.
Brutus’s mom made the difficult decision to let him go at the ripe old age of 15, due to causes unrelated to myasthenia gravis.
You have an important part in your dog’s MG story
I hope reading Brutus’ story has encouraged you and given you a bit more hope to hold on to. It can be incredibly difficult to have your dog diagnosed with a condition like myasthenia gravis that has the potential to have serious complications.
While you can’t change the fact that your dog has myasthenia gravis, you can commit to doing what is in your power to care for your dog. Carefully follow your vet’s directions (especially about feeding your dog if he or she has megaesophagus) and administer all medications as directed. Plus, keep a close eye on your dog, and work closely with your vet. Doing these things can help decrease the chances of complications or allow you to catch them early if they do occur.
And don’t forget to keep enjoying the time you have with your dog too. It can be easy to get caught up in caring for your dog and forget to pause for a moment to appreciate the bond you have.
What questions do you have about myasthenia gravis in dogs?
Please comment below.
Thanks so much for your compassion and wonderful information shared..
Our beloved 4YO Mini Aussie started losing her back legs periodically at age 1.5 when she would “herd other dogs at the park”. Within a few seconds she was back at it. Over time she has developed tremors in her back legs, and weakness to her left rear leg. Now, she really can’t walk more than a few feet before tripping. She was also tested for Ataxia and it was negative. We’ve given her prednisone, cortisone, steroids and none of that helped. We’ve give her CBD treats, Hemp Oil and other natural tinctures. No improvement.
We took her to an excellent Neuro-Vet and he suggested M-Gravis was possible.
We ordered a small dosage of Pyridostigmine Bromide (10 MG Oral) thru our regular vet, and we are about to start treatment when it arrives. My vet says we do not need to bring her in, but observe and report. The medication contains Almond Oil for taste?
Appreciate any feedback you can provide as we have tried just about everything imaginable including xray, MRI, myriad of tests for Valley Fever, Lupus etc.. She is still getting around okay, normal bowel movements and no vomiting at all. She’s amazing.
Thanks in advance for your prompt followup.
Hi George,
I am sorry you have been through so much with your young Aussie these past few years. It sounds like you and your vet have done everything possible to try and solve this mystery. I am not sure I have much else to add but think doing a trial of the pyridostigmine bromide sounds like a good next step. Hoping you will see improvement and praying for a favorable outcome. Feel free to leave an update when you have a chance. Best of luck to you and your sweet girl.
My lab just turned 7 in March, 2024. We noticed a very slight change in his stamina. We had his vet do a physical exam, blood, chemistry, addisons, thyroid and blood glucose test. All came back normal. She suggested a AChR antibody test. His level was .90. With his level of .90 shouldn’t he be way more symptomatic? Do triggers make the disease progress? Is is safe if he swims? Would it be advisable to retest? Are there standards for dosing of the medications? Example what is considered a low dose? Do they dose by weight of the dog? Or by the AChR test results?
Hi Krs,
I am sorry you are facing this difficult situation with your Lab. I can understand your concern when left with more questions than answers. While I would love to help offer clarity, I think it would be best if I defer to the specialists in this case. I encourage you to ask your vet about a consultation with an internal medicine specialist. They will be able to give you all the specifics when it comes to testing and treatment. Hoping you can find a way to allow your boy to continue living his best life. Best wishes.
Hi my dog was diagnosed with mg about 4 years ago , however my vet has never suggested blood test to monitor him after being on 60 mg Mestinon half a tablet twice daily. He now has recurring inflamed mouth ,red swollen jowls , painful ,cannot eat and terrible yeast smell. He has been give antibiotics to clear this which it does after 2 weeks but come back when he stops taking them . Getting back to the MG , now I’m wondering if I have destroyed his immune system with the Mestinon which he may not actually no longer need. He has the megaesophgus which is controlled by using the Bailey chair But I’m wondering if there is a link between the acid reflux and his mouth . Any help or information would be greatly appreciated .
Dear Pamela,
I am sorry your boy is experiencing so many issues at once and I understand your concern for his well-being. From what you describe, his case is quite complicated and without playing a personal role in his medical care it is hard to make specific conclusions and recommendations. In these types of situations, I like to defer to the experience of a specialist. I encourage you to ask your vet about a referral to an internal medicine specialist. They will be able to discuss all the testing and treatment options available and help offer guidance as you navigate this unknown path. Hoping for a clear path forward and praying for a positive outcome for your sweet boy.
Good morning Dr. Buzby, I am writing on behalf of my brother. He has a 10 year old scotty (Harley) that was just diagnosed Myasthenia Gravis. Harley was good one day, playing with her ball and all and the next day having problems walking, her bark is very quiet and it used to be loud and acting like she is constatipated. Our vet is making this diagnoses based on an x-ray. We have not done any bloodwork because as much as we love Harley we are also on a budget. Is it normal for this to come on as fast as it did and what should we do? I am writing you because our vet hasnt seen very many of these cases.
Hi Doris,
What a blessing you are to your brother to be searching for ways to help his beloved pup. Yes, the symptoms of this disease can come on very quickly. My best advice is to have your vet reach out to a local internal medicine specialist in your area. They can always refer you for an evaluation, but that will be costly. Most specialists are willing to take calls from local general practice veterinarians and offer guidance on how to treat their own cases. The expert advice may be just what your vet needs to feel more confident in medically managing your brother’s dog. Wishing you all the best and praying for a full recovery for Harley.
Hello!
I enjoyed reading your article because it helped me understand this condition even better! My pet, Roxie, seems to have symptoms that you described from generalized and focal MG. Although, one thing she has not experienced is regurgitation. She has went from 40 pounds to 30 pounds and I am starting to feed her upright and seeing if this will help her gain her weight back. Additionally, all her tests had come back great. However, she has been on pyridostigmine for over a month now and steroids for over a week and she is still unable to walk on her own and is somewhat getting weaker but not to the point where she is unable to walk even with assistance. I was wondering if you had any experiences similar to hers because my veterinarians have led me to believe there’s not much hope.
(Sorry, accidentally replied to another comment)
Hi,
I understand why you are concerned and agree this is quite a puzzling situation. Without examining your dog, myself, it is hard to make specific conclusions or recommendations. Even though Roxie has similar symptoms to Myasthenia Gravis, if her test results were normal, it might be worth investigating some more to make sure nothing else is contributing to her issues. It could be helpful to schedule a consultation with a specialist and your vet can make a referral if needed. I am hopeful you can find the answers you need to give Roxie the best chance at life. Praying for healing and recovery.
About 8 months ago, our 4 year old mini dachshund began to regurgitate frequently and was reluctant to walk far, showing some weakness of his rear legs. He also had voice changes and developed an odd grunt. At first our vet suspected a back problem and he was treated with pain medications. Because of the odd symptoms, tests were done for MG which were positive. About a month ago, right before we were to begin dosing him with Mestinon, the regurgitation stopped and he began to walk normally. He still has the strange grunt and occasionally retches without actually vomiting. Is it possible that he has gone into spontaneous remission? Could the MG have damaged his throat, causing this strange grunt? Are there less serious cases of acquired MG that get better without treatment?
Hi Angela,
It sounds like you have had a wild ride the last few months with your dachshund’s health. Kudos to your vet for pursing a MG diagnosis, and to you for continuing to advocate for your dog through the process. The literature does report that spontaneous remission is possible for some dogs with MG, and based on what you are saying, your pup could potentially be one of the lucky dogs that go into remission! (As an interesting FYI, it is considered clinical remission when the clinical signs are gone, and immune remission when the dog has a negative MG titer plus resolution of clinical signs.) If you want to investigate further, you could talk to your vet about a recheck exam and possibly re-running the MG titer or checking a neck and chest X-ray.
Unfortunately, having not examined your dog and heard the grunt for myself, I can’t say with any degree of confidence if it could have been related to the MG or if it is its own separate problem. Your vet may be able to shed more light on that for you.
I hope that your pup is still doing well and that he really is in remission! Feel free to give us an update on how he is doing now!
Hi Dr. Buzby, . Thank you for this article. I try to keep up on all things MG and ME. Thankfully, my 7 year old potcake Alika has been in remission from Focal MG for over two years. And her megaesophagus resolved around the same time as well. I feel very fortunate. Initially, it was tough to get a firm diagnosis but in the end, an MG titre confirmed it. The only medication she required really (given it was focal) was to treat the esophagitis that was causing her pain, and antibiotics after one bout of pneumonia. . Eight months of upright feedings in her Bailey chair, many canned food meatballs, and unflavoured Knox Blocks (for hydration and to help the meatballs go down easily) did the trick. She now eats from raised bowls but again, her radiographs indicated her megaesophagus resolved. As you’ve indicated above, I err on the side of caution and have had titres done the last two years. So far, she’s held sufficient immunity for everything. I’ll vaccinate taking my veterinarian’s lead but so far so good. She’s a normal, active and happy dog. I’m wondering, however, if there are any data on the possibility of recurrence after remission? I don’t overly concern myself with this possibility but simply wondered what the research indicates about the probability/possibility of a flare?
I really love my sweet dog. It was difficult when we first got the diagnosis but I could never have expected the gift of bonding even more with her when she was sick. And seeing her so well now gives me a lot of joy.
Thank you!
Simone
Hi Simone,
I am so glad to hear your pup has achieved remission from MG and ME! I was not aware of what the statistics showed for recurrence rates for this disease. After some research, I only came across one article that mentioned relapse of myasthenia gravis after remission. It quoted a 33% relapse rate, but that was specific to this study that looked at dogs treated with Azathioprine as a sole therapy. Here is a link to the abstract in case you want to take a look: https://pubmed.ncbi.nlm.nih.gov/26802912/
I really appreciate you sharing Alika’s story with us. I am certain this will be a ray of hope to others in a similar situation. Praying your sweet girl continues to thrive and has many happy years ahead. Best wishes and bless you both! ♥
Hi Dr. Buzby
First off, thank you for responding to my query above, over a year ago. I didn’t realize you had done so and only saw it now when I returned to review this MG/ME post. I really appreciate the response.
To recap, my 8 year old potcake dog was diagnosed with acquired Focal MG with secondary ME almost 4 years ago. She went into full remission after 8 months and has remained so all this time. Incredibly, the ME also resolved entirely. Ours is a fortunate case. Treatment primarily addressed esophagitis. My understanding is that because of the focal nature of the MG she was never on pyridostigmine. Once the pain and inflammation of the esophagitis was gone, she was a much happier dog. Upright feeding stopped regurgitation entirely. Her life is currently very normal. Her recent physical showed she was healthy on every level. Again, very fortunate.
The reason I’m writing today is after getting her annual titre results back, her immunity for leptospirosis is now insufficient. Up until now, she’s held sufficient immunity for everything. While I live in an urban area and primarily do leash walks with her, always bringing my own water, lepto is still a concern for me. There are so many dogs around and a lot of wildlife (raccoons, foxes, coyotes, rats etc). So I’m working closely with my vet and considering giving her the lepto vaccine. My vet is great and I know that a vaccination could launch a flare but also, it might not. My vet is doing a little more research to determine any nuance as to what the protocol here might be all things considered. I suppose I’m wondering if you have access to any peer reviewed papers on MG and vaccinating post-remission? I will ultimately take my vet’s advice but want to have as much information as possible to make the best informed decision. To my knowledge, if we moved ahead with a lepto vaccine, it would be a normal dose. And then we’d wait.
Thank you in advance!
So very helpful.
Simone
Hi Simone,
It’s good to hear from you again! I am so glad your girl is still in remission and feeling great. I have been researching these last couple days to see if I could find any information about MG and vaccinating during remission, but so far have not been able to come up with anything significant. I wish I could offer guidance and be of more help, but I know you will do everything in your power to ensure your girl remains happy and healthy. She is very lucky to have you advocating for her and searching for answers. Hoping the vaccination will go smoothly and your pup’s immune system can remain stable. Wishing you all the best and keep up the good work!
I have a 4 m/o mini dachshund puppy who chokes when drinking water (not food), has an absent menace response and a present palpebral response (possibly fatigable). She has had normal x-rays, and blood work is pending. Vet suspects cricopharyngeal achalasia. Recommendation is for endoscopy (and possibly fluoroscopy at UCD or MU). What test is recommended for congenital MG, as I know the antibody test is only for acquired? Do some case cases of congenital MG remit on their own? I read case reports of affected litters remitting at 6 months of age. I suspect congenital MG more than cricopharyngeal based on some subtle signs of generalized delay. Thank you for your response.
Hi Sandra,
I did some research to find the most up to date information on congenital MG. It seems as though the gold standard for making a diagnosis of congenital MG is genetic testing. They are also now calling it “Congenital Myasthenic Syndromes”. Here is an excerpt from the article I was reading in the Journal of Veterinary Internal Medicine:
“With the recent identification of the genetic mutations responsible for some CMSs in dogs and cats, it is now clear that the causative gene plays a pivotal role as to which symptomatic treatment benefits a given CMS.8-11, 13, 71 Efforts must therefore be made to obtain a genetic diagnosis, permitting institution of appropriate symptomatic treatment because inappropriate symptomatic treatment can result in exacerbation of clinical signs.8, 10, 13”
They also mentioned a litter of dachshund puppies that had a spontaneous resolution of MG, but it was just the singular case report. Here is that excerpt:
“Most reported CMSs in dogs and cats have an unfavorable outcome and are fatal.8-13 However certain Jack Russell terriers and Devon Rexes respectively affected by CHRNE- and COLQ-associated CMS can survive for years, and a suspected CMS reported in Smooth Haired Miniature Dachshunds appears to resolve spontaneously.9, 14, 15”
I will attach a link to the article in case you would like to read through it yourself. I am sorry I can’t be of more help. I am praying your little pup doesn’t have this terrible disease and your veterinary team can find a treatment to restore her quality of life. Feel free to leave an update if you have a chance. Wishing you the best.
https://onlinelibrary.wiley.com/doi/full/10.1111/jvim.15855
Hello my name is Dan and my boy, Zeus, was diagnosed with MG and ME (Secondary) he’s been doing well and showing signs of improvement with mestinon alone. We are now coming down on the meds as he keeps showing signs of overdose. He’s been showing signs of spontaneous improvement with walking distance and strength in general both feeding and toilet actions.
My question is as he returns to a stronger form of himself will the oesophagus get stronger?
Recently he’s been showing signs of weakness on higher doses and regurgitating more often, I think he’s had a few smaller aspirations which have been treated with antibiotics and he returns to normal within a day of fighting a fever and difficulty breathing.
Other things I’ve found myself trying with him in the past week were mushrooms extracts such as, reishi, turkey tail, and lions mane. I think these have helped with suppressing the autoimmune disease, act as anti inflammatory and also helped with paralysis which is has in one side of his face. This is all subjective and there’s no real way of knowing if these things have truly helped in as I’m just a pet owner treating my own dog. I was at a loss with everything costing so much and putting any more meds with side effects into his body. If anyone else has tried these methods I’d love to hear about how your experiences were!
Hi Dan,
I understand your concern for Zeus and these chronic issues due to MG. I am glad you are seeing some periodic improvement in his strength. The megaesophagus may improve during the periods of time the disease is more controlled and suppressed, but not all dog’s see improvement in this area. Your use of mushroom extracts is intriguing! If you are seeing a benefit from them and your vet thinks they will not interfere with your dog’s current medications, I would continue to use them. You may have already learned a great deal about megaesophagus, but just in case, here is a link to another article with more information: Megaesophagus in Dogs: Causes, Symptoms, Treatment
I am hopeful another reader may have some great advice they are willing to share. Zeus is lucky to have you advocating for his health and well-being. Keep up the good work!
Ive got a Wire Fox Terrier with focal myasthenia gravis (diagnosed with this). He has pyridostigmine bromide mediation but he still regurgitates when out for a walk or run. He will stop, regurgitate then carry on then regurgitate again and etc. Its ONLY happens when he goes for walks or runs because round the house and in the garden he can be running like a madman, playing around, digging etc but never starts regurgitating. Very frustrating because he does eat normally and keeps his food down but its only when he goes for a walk on the lead or is let loose on a walking outing. Conclusion: Buy another house with 2 acre of land so he can just go out, be free and not vomit when on a formal outing.
If you have any ideas let me know. Stuart from UK.
Hi Stuart,
I am sorry your Terrier is living with the symptoms of myasthenia gravis. It is quite puzzling that the regurgitation issues only occur when out for walks. I am honestly not sure why this would be the case and without examining your dog myself, I can’t offer specific recommendations. I am suspicious that maybe his food is collecting in a large pocket in his esophagus? Sometimes dogs with megaesophagus can end up with a food impaction in the esophagus that still allows some food to squeeze by into the stomach. But the food that is trapped can occasionally come back up during a regurgitation episode. I think it would be good to discuss this issue with your vet. They may want to take some x-rays just to evaluate the upper GI area. I am glad your pup is playing and feeling well otherwise. Hoping you can find some answers and wishing you both the best for a happy future.
My chiweenie was diagnosed with megaesophagus a month ago. Took 2 weeks for the blood work to confirm Myasthenia Gravis. We never got to start the Mestinon. She got aspiration pneumonia for a second time, and passed away yesterday. Her blood sugar was really low and we believe she had a seizure.
Her life was saved a month ago, and because of that, we got another month with her. I would’ve loved for a different outcome. However, I’m really glad I know about this condition now and I’m so thankful for the doctors who tried to save her life.
Dear Autumn,
I am sorry for your recent loss of your little pup. I can only imagine what a blessing it was to have gained an extra month with her. Thank you for sharing your story with us. May the memories of the good days bring a smile to your face and comfort to your heart.
I have an Anatolian shepherd who is older and has all classic symptoms of mega esophagus or sphincter function issue and has responded well to treatment for ME including the sildenafil, but she is negative for myesthenia gravis. Her standard blood chemistry looks fine and you could not see any esophageal dilation in an X-ray. Could her test result be a false negative and should we treat her for MG anyway or is there another potential reason for her sphincter to be not functioning properly? My vet is suggesting expensive exploratory surgery. Last bit of info is that before treatment an abdomen ultrasound showed a pretty thickened stomach wall. But she’d been regurging on and off for almost a year prior and lately had lost so much weight and regurged several times a day that I brought her to another vet for a second opinion and he did the blood work and ultrasound. Ideas and thoughts would be appreciated. Thank you
Hi Deanne,
I am sorry you are facing such a difficult situation with your Anatolian Shepherd. Without examining her myself, it is hard to make specific recommendations and help guide the treatment process. I am not sure treatment should be pursued without a definitive diagnosis as there could be another issue contributing to your dog’s symptoms that could be negatively impacted by the medications commonly used for MG. Maybe it is time to schedule a consult with a specialist? I always like to defer to the experts when dealing with complicated cases like your girl seems to be. I hope you can find the answers you need to make the best decision for you and your girl. Wishing you both the best and feel free to leave an update as things progress.
My 4 year old “coconut retriever” (a rescue from St Maarten) was diagnosed this summer with MG (primary) and ME (secondary). She was hit by a car a year ago this November and lost one of her front legs. She was so lethargic and would cry a lot at night, i thought she was having nerve pain or was just really depressed. She started to recover and i thought we were on our way back but then the regurgitation started. A very similar story as above with an almost 2 week stint in two different hospitals before she was formally diagnosed with MG. She has better days now than before but seems to be regressing a little lately. I was wondering, since this is a neurological disease, if her accident could have caused or factored into her acquisition. Also if nerves are involved would it be possible for acupuncture to help her with her discomfort and nausea? Has anyone had any success with alternative treatments for MG like acupuncture?
Hi Ashley,
I love that you call your girl a “coconut retriever”! I don’t see people use that term often but am familiar with it from several colleagues that went to veterinary school in St. Kitts. I am sorry your pup has been diagnosed with this tough disease process. I wouldn’t think there would be a link between the car accident and the onset of MG. Yes to acupuncture! That is a great idea and might be very helpful to control your dog’s symptoms. If you decide to proceed with alternative treatments like acupuncture, please leave an update and let me know what you think. I love hearing firsthand experience so I can pass it along to other readers in a similar situation. Wishing you the best of luck!
Our lovely black labrador Boo (6yr old bitch) has been diagnosed with MG just before Christmas. The illness started with no warning normal one day and the next completely unable to use her back legs.
At the start of her treatment she responded really well and was able to walk/run and enjoy herself.
In the last 2 weeks she has started to really struggle can barely walk more than 10 metres without having to sit down and has started collapsing after she has had a poo.
She saw the vet again 2 days ago and now is on a higher dose of Mestinon 90mg three times a day along with a course of Dermipred 10mg for 7 days.
When she gets stressed or excited her back legs are all over the place like she is tap dancing and it is very distressing for her and us.
Reading your article was very helpful. I am trying to hang on to any positives in the hope that she might get better.
Hi Louise,
I am sorry your girl is having so much trouble since her MG diagnosis. It sounds like your vet is staying on top of things and you have a good partnership. Don’t forget you can always request a consult with a veterinary neurologist to be extra thorough. I pray Boo can recover and have her quality of life restored. Hold on to hope and know you are doing everything you can. If you have time, keep us updated on her progress.
Hi,
My dog is in remission just got titer test back. Could you tell me how to wean off mestion! He’s a Chiweenie. He’s only on 1ml a day. Thank you ❤️
Hi Sandra,
I am glad to hear your little guy is in remission. I am sure that is a relief and a blessing to your heart! Since I have not personally examined your pup, I am not able to guide you on medication changes. Your current vet or the one that originally prescribed the medication would need to give you guidance on how to wean off this medicine to make sure and avoid possible complications. Best wishes and good luck for the future!
We have an almost 13 yo golden retriever. (Next month). Skipper occasionally regurgitates his food, and is sometimes reticent to eat. (Maybe because of this). His bowls are elevated slighted, but not too much due to the proclivity of bloat in goldens. More recently he has began “twitching” as if involuntary muscle contractions. Although he loves his walks, sometimes he can only go a short way before he stops, and we turn around and go home.
After reading your article on MG, I am going to make a Vet appointment and take this information. He also has lots of lumps and bumps that have always been diagnosed as just fatty tumors, but now I’m wondering if he has an internal one that might be affecting his esophagus. Anyway, thanks for the information, and I will be heading to the vet as soon as they can get us in to see how we can help our sweet best friend who has brought so much joy into our lives,❤️
,
Hi Lisa,
I am glad you found the article to be helpful. It does sound like Skipper may have something neurological going on and a vet visit is due. I hope you find the answers you are looking for and are able to help Skipper maintain his quality of life. Keep us updated!
My dog has recently been diagnosed w MG, and I’m feeling overwhelmed. We are an active family who likes to travel, especially visiting kids in college. How do we do that now… can you leave a dog w myasthenia gravis- either to a boarder or in her crate for even just hours?
Dawn,
A MG diagnosis can definitely be overwhelming, and I am sorry to hear that you are facing this with your dog. Since there are a variety of forms of MG that carry a different prognosis and I don’t know what form your dog has or how well she is responding to treatment, I unfortunately can’t answer those questions for you. I would recommend talking to your veterinarian about if medical boarding at a veterinary clinic, in-home pet sitting, or a different option would be the best plan for your sweet pup. Hopefully talking to them can give you some peace of mind and help you find a solution that allows you to still travel and visit your college kids while also ensuring she is safe. ❤
We have two Daschund brothers-George and Barney, and one of them-George, has MG since he was two years old- they are now 9.
We don’t travel extensively but we do travel by car and by plane yearly and the dogs come with us. George does not show signs of muscle weakness on regular basis-97% of the time he is fine, but he has days where just jumping the 4″ threshold of the patio door is impossible for him. When we notice that, we keep his exercise levels to a minimum and we shield him from anything that can make him bark to reduce his stress levels.
Sadly, we know it isn’t going to get better for him but we try to make sure he understands that we are taking good care of him- and he knows it. We don’t use a Bailey chair, we feed George by having him sit on us and we spoon feed him his food. That quality time with him seems to have made him forget he his sick.
This situation is going to demand more of your attention and your time. In our case we believe that over the 7 years period, George lived as long- and has a life every dog with a good home gets, because he knew that he could count on us.
When we found out about his predicament we were devastated, but George cured us of our anxieties…
Don’t give up.
Thank you for sharing these beautiful words of encouragement and your sweet George’s story. He is a lucky pup to be loved by you! ❤