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Masticatory Myositis

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Hi Steve,
I have a 4 hear old,Golden Retriever patient. Kyra is a rescue dog. The owner adopted her in April of this year. She had been diagnosed with Masticatory Myositis and was on Prednisone and Azothioprine. Despite this, she was not able to open her mouth more than an inch or so. At this time she was seen by another Holistic Vet. She was very week – having trouble going up stairs or playing for more than a few minutes. She was PU/PD with a ravenous appetite. There was no hair growth where she had been shaved for her spay several months previously. She was dx as Blood Deficient with Liver Qi stagnation. She was put on Shou Wu and Shu Gan and acupuncture was done for her MM.

I saw Kyra about a month after this. Overall she was much stronger and was opening her mouth a bit better. Her temporal muscles were quite atrophied. Since being on the herbs she had developed greasy, dandruff all over and was quite itchy. She had some bouts of large bowel diarrhea. I thought the Blood tonifying herbs might have been too much as she looked very Damp to me. I switched her to Dang Gui Shao Yao San and Si Miao San. Over the next few months did very well. Her energy and strength returned. Her skin cleared up beautifully and she regained her temporal musculature.

I didn't see her again until September. She was having trouble opening her mouth again. Her energy and appetite were still very good. Her tongue looked pale and her pulse was deep and deficient and she was loosing temporal muscles again. I put her back on Dang Gui Shao Yao San and started weekly acupuncture. She continues to be bright and happy. There is no indication of pain when she tries to open her mouth. She has regained most of her temporal muscles but at each visit the distance that she can open her mouth has decreased. Yesterday she could only open about 1/8th of an inch to inhale a treat. She can't chew and just swallows. Her tongue (what I could see of it) is pinker. Her pulse is stronger – maybe a bit wiry. She was active at GB 34 and needling it improved her pulse. I'm worried that her masticatory muscles are becoming fibrotic.

I'm not sure where to go with a herbal formula. I was thinking of Xiao Chai Hu Tang. Does this makes sense or any other suggestions?

Thanks so much
Marilyn

by naturevet

October 23, 2009

Hi Marilyn,

Interesting case. I must say, I think you've handled it very well, and made the same calls I would have.

Regarding the current situation, where she has increased muscle mass, but reduced range of motion of the jaw, it makes me think she might have jaw muscle spasms. So a non-dempening antispasmodic might be helpful. One option to help might be Valerian root (a western herb), although I've never used it for this particular problem. I have seen MM present as spasm, however. I've used Bu Gan Tang in the past for these cases where spasm is present, but from the past history, I would guess this would be way too Dampening.

Moving on from spasm for a moment, the activity at GB 34 does make sense. Janice Crook in Vancouver had a case where she used Qing Ying Tang to completely reverse a dog's MM. In my experience, dogs that benefit from QYT will often have active GB points. Essentially, the GB belongs to the Shao Yang layer, the layer associated with deeply penetrated pathgoens. From a 4 layer perspective (Wei, Qi, Ying, Xue) I believe the Shao Yang corresponds with the deeper of these four layers, namely Ying and Xue (Ying and Blood). So a formula that clears the Ying and Xue layer of pathogens also clears the Shao Yang layer. Since we've seen cases of MM improve with QYT, it indicates it might be best understood as a Shao Yang pathogen. Hence the active GB 34.

If you're still with me, then, my best advice might be to try QYT, which at least dries Damp even if it does not drain it. You could add Mu Gua for an antispasmodic effect, or use some other herb in addition, like Gingko or Valerian.

Hopefully that pans out for you. I'd love to hear how things turn out.

Steve

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