Myasthenia Gravis - a case study

Talisker, known as Tali was a beautiful, red standard Wire Haired Dachshund who would have been nine on the 7^th February 2012. Sadly we lost her on the 18^th November 2011 due to the rare muscle illness Myasthenia Gravis. This is Tali’s story, the last two months of her life. Tali was a real character, very loving, bright, had to be first at everything!, extremely loud (most of the time). She was bossy and stubborn. Tali was also very brave and special to everyone who knew her.

On the 28^thSeptember 2011, I was feeding Tali and our two Italian Spinonis Luna and Paolo. I fed Tali separately in the hallway as she would eat her food and try and eat Paolo’s given half the chance!. So they were separated by a baby gate. This particular teatime as they were all eating I heard this strange scratting noise on the wooden floor in the hallway. When I looked to see what it was, Tali was unable to keep upright on her back legs. They just went from under her, she was trying to get herself upright, but she couldn’t. Then she went off her front legs and she was also arching her back. I knew this wasn’t normal so I 'phoned our vet (who were twenty/thirty minutes away depending on traffic and the time of day). We got an appointment and my son Cameron came with me.

Once at the Vet's, she was examined and at this point she was turning her nose to the side in a very strange involuntary way. She also was doing the strange things with her legs again. Tali also made a strange noise from her throat, it was like she was going to be sick but also sounded like a strange growl. The vet gave her an anti-inflammatory injection and we were told to crate her overnight and take her back first thing in the morning.

Next morning she just wasn’t walking properly. She would walk a few feet and lie down, she’d also do a strange movement like a puppet . Shuffling from side to side, her gait was completely different and she also looked very stiff in her legs. The vet decided to keep her in overnight so she could monitor her.

The following morning we got a call to collect Tali and take her to a specialist referral practice. Tali was seen by a Neurologist who examined her in front of me and my husband and then took her away for about twenty minutes. When the vet came back with Tali she said she thought Tali had all the symptoms of Myasthenia Gravis. For those of you who have never heard of Myasthenia Gravis (I’ll refer to it as MG), it is a rare Neuromuscular disease and there are two forms of it. The first is from birth and a dog or a person (as people can have the illness too) are lacking in the neurotransmitter Acetylcholine. The other is in adults, where there is a destruction by the dog's own immune system to the receptors making it an autoimmune disorder. The dogs have a weak Oesophagus (megaesophagus) which means food is inhaled and not moved into the stomach appropriately. This then can cause the risk of the dog inhaling food causing aspiration pneumonia.

I knew something about MG as, when I was a teenager, I was very ill and was tested for it. The Vet said she would keep Tali in over the weekend and do various tests. We kissed Tali goodbye and thought that at least we would find out the reason for Tali’s awful symptoms.

The referral practice has an excellent reputation, it has some of the best Vets in the country, Europe and beyond. It is a very busy practice and they have very strict rules about 'phoning them. We appreciated their rules, but it soon became apparent that you had to wait for them to 'phone you and on the Saturday we hadn’t heard from anyone by 4.30 p.m. (virtually a full day without any news of Tali) so I decided to 'phone them. I got a very “stroppy” receptionist on the other end of the 'phone and sadly this was the start of a very disastrous experience for us, but mostly for Tali.

I was put through to a Vet who was just someone on call that weekend who was looking after Tali, they told me they didn’t think it was Neurological and they thought it was more Orthopaedic. We couldn’t believe it! We had looked after one of our Bernese Mountain Dogs years before with a Neurological condition and Tali was definitely showing Neurological symptoms.

On the Sunday we were told Tali was put on a drip as they have a lot of Dachshunds that ”become Anorexic“ while they’re in there! I was outraged by this comment and felt very worried that Tali was there. Monday morning Tali had an x-ray on her elbows and we were told she had incongruent elbows, which was “in the breed” but that’s all they came up with. The Vet I spoke to said we could pick her up the following lunchtime (it couldn’t have come soon enough for us to bring Tali home).

The next morning I got a 'phone call from an Orthopaedic Vet saying she wasn’t happy with the way Tali was and she wanted to keep Tali in one more day, take her off all the pain relief they had her on and look at her again! We weren’t happy at all with this, but felt they were the “experts”.

The next day at lunchtime we went to get Tali, when we saw her we were really shocked. Her face was gaunt and looked haunted. She had lost 1.9 kg in five days! She went to the loo in front of us and she had diarrhoea which looked like it had blood in it. I said to the Vet I wasn’t happy and she said it was nerves! I said that we’d nearly lost Tali a few years previously due to her haemorrhaging due to Metacam. They had been giving her Metacam (we didn’t know) and they even were going to send her home with Metacam! We were really not impressed at all, I was so upset. Tali looked so weak and ill. It was heartbreaking to see her.

Next day Tali was so unwell we took her back to our vet's and got a referral to a specialist Vet's practice called North West Surgeons. They have various Vets who specialised in certain fields. We had taken Tali to see a wonderful Orthopaedic surgeon Mr Eandil Maddock eighteen months previously and he had done a Cruciate operation on Tali and the care she had received had been excellent. We saw Eandil again and as soon as he saw Tali he said she was showing all the signs of MG! We told him that the previous Neurological Vet had thought she had MG but never tested her for it!. Eandil said that he would do the blood test for it and the Tensilon test (chemical test) and would also do various other tests. The only place in the world where a test for MG is done is in America, it usually takes two weeks to do.

On the 11^th October Tali had various blood tests done, one of them was for MG. On the 13^th, Tali was taken in for the day under general anaesthetic and had fluid taken from her joints and she also had muscle conducting tests. On the 18^th Tali was deteriorating and we took her to see Eandil and he kept her for a few days. Also on this day I received an email from Ian Seath (Sunsong) and he had got an email from the Wire Haired Club as I’d sent them an email asking if they’d ever heard of a Dachshund having Tali’s symptoms. Ian sent me a very nice email saying to 'phone him and his wife Sue as they had an article about a Dachshund that sadly seemed to have the symptoms of MG but definitely had the Megaesophagus. On the 20^th Tali was due to have an MRI scan in the afternoon, however at lunchtime we got a 'phone call from Eandil to say the MG test had come back and it was positive! In one way I was so relieved, we knew at last what was causing Tali’s horrific and cruel symptoms. In another way we were furious, angry and in disbelief that the original specialist vet had thought Tali had MG but decided not to test her. We just couldn’t believe it. Eandil said the MRI wasn’t necessary and he would start treatment the next day. We picked Tali up on the 24^thand although she was still weak she was much perkier in herself and was so happy to see us and we her. Tali would now be looked after by Lauren Lacorcia a Vet in Internal Medicines. Lauren had seen a few cases of MG so she knew exactly how to look after Tali and administer the drugs.

Initially when we brought Tali home she was just the same in herself, she would walk a few paces become very tired easily and we’d pick her up if she was in the garden and couldn’t get back. Around the home she found she could walk so far then we’d pick her up and put her on the sofa or whatever. Paolo (our boy Spinoni couldn’t understand at first why Tali could no longer play with him....but one day she did manage a bit of a play for a few minutes and it was really a wonderful moment). The dosage of drugs had to upped every few days and this would upset her stomach and cause diarrhoea for a day or two. It was lucky I don’t work and could care for her and she did need a lot of TLC and also that she was a small dog that could be easily picked up.

On the 13^th November Tali was making the awful sound with her throat in the early hours, and coughing up white phlegm. We got her to the Vet's and it was just so sad to watch her cough up this stuff so many times and be so exhausted. The Vet kept her in and later in the morning she had her Oesophagus x-rayed and we were told the awful news that Tali had now developed the megaesophagus. It was the most awful thing to be told as things were now looking very bleak. We brought her home on the Wednesday but she was back in on the Thursday with a urine infection.

The next morning Tali looked different in her face, she was very heavy eyed. I 'phoned Rebecca (the Vet) and we had a long chat about letting Tali go.....I was crying on the 'phone about her but knew in my heart it wouldn’t be long. We all sat with Tali on the sofa for a few hours but then she had a drink of water and couldn’t keep that down so we 'phoned Rebecca again and she said it was time to let her go......it was heartbreaking for us, but very quick and peaceful for Tali.

The loss of Tali has been immense, we miss her so much and the house is a much quieter place without her. I did write a letter to the Royal College of Veterinary Surgeons and complained about the original referral Vet. We were, and still are, appalled by the whole situation. As you might expect we didn’t get a satisfactory response from the RCVS.

We are still coming to terms with Tali’s loss, but we have to be grateful for our vets, and especially Eandil Maddock and all the vets who looked after Tali at North West Surgeons. They are all dedicated and care so much.....not just for the pets but the owners too.....it is a very special place. Also,the support and kindness from Ian (Seath) and his wife Sue.

We have many wonderful memories of Tali, various holidays in Scotland, Wales and Cornwall. Tali just mooching in the garden looking for frogs and mice!. Tali was very special and she will always be with us.....

More information on Myasthenia Gravis, UC Davis and Megaesophagus.