MUE or Meningioencephalititis of Unknown Etiology

aka Immune Mediated Meningitis in Dogs

  Phony Diagnosis, Dangerous Treatment!

By Kelly Thompson, DC

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(link to beginning of article) Over the years I have had the privilege and opportunity to work alongside Veterinarians in over 50 clinics and hospitals. In my 35 plus year experience involved in the Veterinary milieu, if someone’s canine companion hurt their back they would take them into their Vet, who would examine, perhaps x-ray, and in most cases not finding anything specific, would release them to their owners with a round of NSAID’s, muscle relaxers, and perhaps a narcotic depending on the severity of the exhibited pain and or incapacity. Sometimes that would be enough with the tincture of time to resolve the episode (at least for the time being as I have found). If not they would be referred to a Specialty Veterinary clinic and find their way eventually to the Veterinary Neurologist. After an MRI, perhaps some blood tests, the owners would be informed that other than a little spondylosis (common arthritis of the spine due to aging), there is nothing to explain their pet’s condition. Subsequently, they might prescribe more powerful narcotics such as a Fentanyl patch or perhaps steroids and be sent on their way. This left concerned and frustrated pet owners with a hefty bill and really no closer to an answer than when they started.

 

That is often when they would find their way to me. I would locate the spinal and connective tissue derangements and in a few visits, “happy days are here again,” one more satisfied customer, and greatly relieved and grateful pet owners. Taking a moment to pat myself on the back, my Yelp reviews are replete with such stories.

 

Now present day, things have taken a dramatic, if tragic turn in my opinion. I guess pet owners weren’t happy spending thousands of dollars at the specialty clinic just to be told that all these expensive tests failed to identify the source of their precious companion’s suffering.  It appears now when the Veterinary Neurologist views the MRI they apparently see some sort of increased signal in certain areas of the spine indicating inflammation.  Having spent years viewing MRI studies I question this finding, especially with the lower powered (Low Tesla) and lower resolution MRI units utilized here in the San Francisco Bay Area.  So the next step becomes a Spinal Tap. CSF Tap results show no signs of infection, now what??!!  What could possibly explain the dog's apparent back pain in the absence of any diagnostic markers in the spine?  I know, I know as I raise my hand to explain what is causing their malady... except I have a no audience and my voice is small relative to the credentialed voices of the Veterinarians proffering this diagnosis that is arrived at without even a shred of clinical evidence.  What is this mystery clinical "Unicorn" you ask?  Enter the newly and creatively discovered, IMMUNE MEDIATED MENINGITIS aka MUE or Meningioencephalitis of Unknown Etiology!  It could also be called Autoimmune Meningitis. These clinicians failing to effectively deal with simple back or neck problems in dogs have with what could be called "creative diagnosis," conjured up a condition where they theorized that a dog's body begins attacking its own spinal cord. Now if this very costly travesty of diagnostic "reductio ad absurdum" weren't bad enough it only gets much worse when they begin to render treatment.  The Hippocratic Oath that doctors have traditionally lived by in their medical practices, affirms, "Primum non Nocere" or "First do no Harm."  Well that one is out the window apparently with immune mediated meningitis as a diagnosis. Would you in your wildest imagination ever think the day would come when a simple back or neck problem causing pain in your dog would be treated with CHEMOTHERAPY agents? In fact the prescription is for 6 months of treatment on Chemo, followed by another 6 months if the first 6 months doesn't resolve the issue. That is exactly what is being perpetrated on our precious animal companions at Specialty Clinics here in the San Francisco Bay Area. One of these Veterinary Neurologists even told a client when asked what percentage of her practice involves this diagnosis and treatment. The answer was 20%! The following cases who were diagnosed with Immune Mediated Meningitis should clearly demonstrate that at least in this case Immune Mediated Meningitis, "the cure is far more dangerous than the disease!"

 

Last year I had the opportunity in as many weeks to be contacted by two Pet Owners stating that their Dogs were apparently suffering from this Immune Mediated Meningitis. They were both on Chemotherapy agents and neither had improved at all since the beginning. I saw them both at different Veterinary Clinics. One was a small Yorkie as I recall and the other a rescued Formosan Mountain dog. The Yorkie had a neck injury that was plain to see on examination. I explained to the relieved pet owners that this patently was not Immune Mediated Meningitis but merely an injury to his neck that was very correctable.  I rendered my first treatment to this very sad and painful Yorkie and scheduled another session for the following week. Later I received a call from the Yorkie's owners saying that they had talked with their Veterinary Neurologist and she had convinced them to stay with her program. I was saddened by this outcome and knew how this would end. After hanging up and collecting my thoughts, I penned an text to them which in essence explained that the Veterinary Neurologist was, "chasing ghosts," and that this would eventually end with them euthanizing their beloved companion. I believe this angered or upset them inasmuch as I never received a return text. Some time later the person who had referred them to me related that they had in fact put their Yorkie to sleep. I was saddened by this completely preventable outcome.

 

The Formosan Mountain dog also came to see me and I diagnosed a simple back problem. I rendered my first treatment and a number of follow-ups. The difference was that these pet owners never told their Veterinary Neurologist that they were bringing their dog to me for treatment.  Within 4 sessions as I recall their companion was out of pain and back to his old self. They had stopped the Chemo of their own accord when we started. Subsequently they brought their companion in for a previously scheduled appointment with their Veterinary Neurologist. The owners related that at the appointment the Vet was quite pleased with the outcome of 5 months worth of Chemo and pronounced that he was basically curred and could discontinue the medication. They never did tell the Vet about my treatment. So happy ending right? Unfortunately no. Some weeks later the owners called me to explain that he was acting weird, bumping into table legs and furniture. I told them to take him back to their Vet and that they would probably need a CT for MRI of his brain to see why he had most likely become blind, based upon their description of his symptoms. This was undertaken and  they reported back that he had been diagnosed with a serious brain infection of a rather large size that was impinging on the optic nerves.  Sadly he died not long after that.  It was abundantly clear that the Chemotherapeutic agent, which is an immuno-suppressive drug ostensibly prescribed to keep the immune system from attacking the spinal cord, had also suppressed the immune system enough to allow for this fatal brain infection.

 

Both cases had sad, unfortunate, and in my opinion completely preventable clinical outcomes. Please don't let any Veterinary Neurologist convince you that your dog suffers from Immune Mediated Meningitis. These clinicians have absolutely nothing to lose with such creative diagnosis and treatment, but you and your companion have  everything to lose!