Craniomandibular osteopathy CMO

My 5 month old lab puppy was just given a suspected diagnosis of CMO earlier this week. I rushed him to the emergency vet on Sunday for sudden lethargy/bony lump under his chin. He spent 2 nights in the icu. He presented with a high fever and high white blood count at the vet. His fever came down by Sunday evening with antibiotics and iv fluids. On Monday they xrayed his skull and the radiologist suspects CMO but the results are not “classic” because it’s not presenting bilaterally. Monday evening they did a chest X-ray and found he has pneumonia. They sent out his bloodwork to a specialist and found no overt signs of cancer. I brought my puppy home on Tuesday. He is on medications for the pneumonia and is doing well with recovery. He will have another chest X-ray next Friday to check his progress.
My bigger issue is the CMO. My puppy can’t undergo further testing (CT scan/biopsy) at this point due to the pneumonia. He can’t be sedated for the tests until his lungs are clear.

My regular vet has not heard of CMO but he has been researching as have I. (The emergency vet has seen very very few cases and they were very doom and gloom.) We’ve both read the bony growth can continue to grow until the puppy stops growing but then there can be regression. I found an old post on a retriever forum from 2008 where the dog had a good outcome with CMO. This is such a rare disease that I can’t find much information on it.

Has anyone had this diagnosis? How did you manage it? I need hope!

 

So update on my precious puppy…good news-he had follow up chest x-rays and the pneumonia is gone from his lungs! We are getting back to our normal routine of walks etc.
As for the lump on his jawbone…my husband and I think it may have shrunk a little. My regular vet was able to see and measure the lump last week. The vet wants to take a “watch and wait” approach for now. In case the antibiotics are having an effect, we are going to continue them for 2 more weeks and re evaluate. If the lump starts growing, my vet will help me get a second opinion at Ohio State University or Metropolitan Hospital in Akron. (I live in Ohio). My puppy is otherwise doing really well. No pain at the lump, eats and plays normally. You’d never know it’s there-it’s not visible under his chin.
Thanks for reading!! Again if anyone has experience with CMO, please reach out to me. My puppy could use all the good thoughts and prayers that this resolves itself. He is so so sweet-we love him so much and will do whatever’s necessary to help him.

 

That's wonderful news, I'm so pleased to read it!

Once you've recovered from the shock of diagnosis, do let your puppy's breeder know about this, if you haven't already. CMO is a recessive inherited condition, meaning both his parents must have carried the faulty gene which causes it. It's likely that some of his siblings are now carriers as well. If any of them are going to be used for further breeding, it's important that their owner is aware of their genetic status, and pairs them with a sire/dam who doesn't carry the faulty gene, to protect future puppies and their human parents from going through what you've just been through.

I hope your puppy continues to recover and heal

Sarah

 

I’ve been in close contact with the breeder. Both parents were clear for CMO according to genetic testing. Could the parents be carriers even if they were clear on the testing?

 

Another update on my puppy: we went back to the emergency vet today for X-rays of his jawbone lump (initially suspicious for CMO) and a checkup. My regular vet wanted my puppy seen by an internal medicine specialist at the emergency vet. We got wonderful news today!! The lump is shrinking. It has decreased by 1 cm in both length and width! The internal medicine vet didn’t even think he needed X-rays today as things are moving in a positive direction. Puppy will continue on antibiotics for another 4 weeks so total of 8 weeks on antibiotics in case this could be a bone infection and go back in 4 weeks for another checkup/bloodwork. I just wanted to share our great news! A Christmas miracle for my sweet boy!

 

That's wonderful news! Thank you for keeping us updated

 

Yes they could be if the breeder was not completely honest. Have they shown you the test results or just told you they were clear?

In any case, I am glad to hear the puppy is doing better.

 

Update on my sweet puppy…
The suspected CMO diagnosis turned into a suspected bone infection. But there was more health issues to come. At the beginning of January, my puppy was diagnosed with Masticatory Muscle Myositis (MMM). I noticed one day he could barely open his mouth-this came out of nowhere. I took him to see his Internal Medicine Vet, she suspected MMM, took blood samples and sent them off to University of California San Diego. The only lab in the US that tests for this. The results were positive.
He started prednisone which gave dramatic improvement almost immediately. Then he started on mycophenolate-another immunosuppressant. Right now 2-1/2 months later, we’re almost done tapering the prednisone. He’ll be finished with it by mid-April. He’ll be on mycophenolate longer 6-12 months total. He’s doing wonderfully well thank goodness!
Back to the jaw lump…vet suspected bone infection because the lump stopped shrinking. She started him on Clindamycin at beginning of January for 6 months but the lump has not shrunk any further. I did not want a bone biopsy done because the risk was a jaw fracture and I felt that my puppy was going through enough at this point without adding more medical issues. At his check up in February the vet said the longer he goes with no change to the lump the less they are going to worry about it. It’s not shrinking but it’s also not growing either.
Puppy is doing great! You’d never know he has any health issues. He continues to be the sweetest boy and my husband and I love and spoil him daily! He’s the joy of our lives! My hope is he goes on to live a long life and we have no more health challenges!

 

You have had such a tough time, haven't you! Thank you so much for sharing the update, I'm so glad to hear that things are mostly looking more positive for your wonderful boy!