Hi,
I was called to evaluate a 3-month-old lab mix puppy that was recently adopted from a shelter. The owner is pretty dog savvy, and I’ve done rehab work before for her with a former dog. She noticed pretty quickly that this pup was “off”.
She went to see a neurologist who diagnosed Congenital Myasthenia Gravis. No testing was performed. They started him on Pyridostigmine and that made a pretty big difference. He has bouts of energy and strength followed by periods of little activity.
Cranial nerves intact. Ambulatory over short distances with choppy thoracic gait and stilted pelvic gait, fatigues quickly with exercise and progresses to recumbency. Medial deviation of thoracic limbs distal to elbow with internal rotation of the carpi. Proprioception normal. Spinal reflexes intact. Adequate anal/tail tone. Non-painful on spinal palpation. Comfortable on cervical palpation and manipulation. Localization: neuromuscular
I know the overall prognosis for congenital MG is fairly poor for longevity (or so I’ve read). This owner still wanted to try what we could. So, we performed some acupuncture, and I gave her some things to do mostly based on the guidelines for the 5 periods of puppyhood. The puppy is named Turtle (cute!)
Does anyone have any advice on managing this form of the disease?
Congenital Myasthenia Gravis
Re: Congenital Myasthenia Gravis
Hi Laura,
Apologies for not getting to this sooner! May and June seem to be crazier than I anticipated!
Okay... so I had to do a little digging myself on Mayasthenia Gravis and what physical therapy treatments / suggestions are usually made. I've only seen 2 cases in my career... and I really was just a consultant in both incidences.
I found the following links to be very helpful.
https://www.physio-pedia.com/Myasthenia ... Case_Study
https://myasthenia.org/
https://www.ninds.nih.gov/Disorders/Pat ... Fact-Sheet
So, 1) fabulous that the medication is helping.
2) Physical Therapy / Rehab:
Here, we need to look at our GOALS:
- Build muscle
- Prevent fatigue
- Manage fatigue
- Address pain as a result of poor movement strategies and/or muscle weakness
Key Components to address:
- SHORT bouts of exercise (i.e. 5, 10, 15 minute walks... rests as needed and/or bring a wagon)
- Targeted Exercise needs more rest periods (i.e. if doing sit to stands, do 1 or 2, with an exaggerated rest between another set of 1 or 2)
- Proximal muscle strengthening (i.e. shoulder and hip muscles to help with functional activities)... so balancing, sit to stands, and some hill or stair work.) I'd keep tasks as functional as possible.
- Endurance work - i.e. walks should be fine... just remember the rest periods and not to push it. Owners should be encouraged to get a wagon! However... protect the dog from 'over play' with other dogs where fatigue could set in rapidly.
- Lots of breaks.
- Look for ways to minimize unnecessary energy expenditure (i.e. lying down to eat)
- Evaluate for and treat any soft tissue restrictions and/or pain. Massage or stretching might be good to incorporate into therapy or home management.
All in all, it seems that the majority of work to be done is education on exercise & management plus or minus treatment of symptomatic musculoskeletal conditions.
I hope this helps a bit! It's not so much that we can 'improve' things a lot... but sometimes the education piece is actually worth it's weight in gold in regards to helping a patient (or in this case an owners) to manage the condition.
Best of luck!
Cheers,
Laurie
Apologies for not getting to this sooner! May and June seem to be crazier than I anticipated!
Okay... so I had to do a little digging myself on Mayasthenia Gravis and what physical therapy treatments / suggestions are usually made. I've only seen 2 cases in my career... and I really was just a consultant in both incidences.
I found the following links to be very helpful.
https://www.physio-pedia.com/Myasthenia ... Case_Study
https://myasthenia.org/
https://www.ninds.nih.gov/Disorders/Pat ... Fact-Sheet
So, 1) fabulous that the medication is helping.
2) Physical Therapy / Rehab:
Here, we need to look at our GOALS:
- Build muscle
- Prevent fatigue
- Manage fatigue
- Address pain as a result of poor movement strategies and/or muscle weakness
Key Components to address:
- SHORT bouts of exercise (i.e. 5, 10, 15 minute walks... rests as needed and/or bring a wagon)
- Targeted Exercise needs more rest periods (i.e. if doing sit to stands, do 1 or 2, with an exaggerated rest between another set of 1 or 2)
- Proximal muscle strengthening (i.e. shoulder and hip muscles to help with functional activities)... so balancing, sit to stands, and some hill or stair work.) I'd keep tasks as functional as possible.
- Endurance work - i.e. walks should be fine... just remember the rest periods and not to push it. Owners should be encouraged to get a wagon! However... protect the dog from 'over play' with other dogs where fatigue could set in rapidly.
- Lots of breaks.
- Look for ways to minimize unnecessary energy expenditure (i.e. lying down to eat)
- Evaluate for and treat any soft tissue restrictions and/or pain. Massage or stretching might be good to incorporate into therapy or home management.
All in all, it seems that the majority of work to be done is education on exercise & management plus or minus treatment of symptomatic musculoskeletal conditions.
I hope this helps a bit! It's not so much that we can 'improve' things a lot... but sometimes the education piece is actually worth it's weight in gold in regards to helping a patient (or in this case an owners) to manage the condition.
Best of luck!
Cheers,
Laurie
LAURIE EDGE-HUGHES