Saturday, September 22, 2012

Watch Out for Canine Addison's Disease

Dr. Peterson's expertise in veterinary endocrinology was tapped by Dog Fancy Magazine to provide professional insight into the diagnosis and treatment of Addison's disease.

This article was a part of the monthly "Watch Out For" feature which gives an overview of common diseases and medical conditions, with Dr. Peterson's Addison's disease article appearing in the October issue.


Brookie S said...

Hi Dr. Peterson--
I posted a year ago. George is my 3-yr-old Saint Bernard with Typical Addison's. He weighs 142 lbs. He takes 2 mg of Prednisone daily in the AM, and currently gets 1 ml of Percorten every 28 days (on average). I have a spreadsheet of his blood work summary since his September 2013 diagnosis, that I am unable to attach, but I can send it to you if you would like to see it.

--George had waxing and waning symptoms of vomiting, diarrhea, very itchy skin, elevated BUN and Creatinine, prior to diagnosis
--he was NOT diagnosed in crisis (K has never been above 5.5 (3.8-5.7), he was given the ACTH stim test after an ultrasound showed small adrenals
--started low-dose Percorten at diagnosis (2.6 ml) and has reduced steadily ever since to 1 ml
--very sensitive to Prednisone (more than 2 mg causes excessive hair loss), sleeps hard through morning, slow on AM walk as compared to very peppy on PM walk
--very sensitive to a lower K (has lethargy, hanging head, swollen neck glands, for about 1 week to 1.5 weeks after shot)
--kidney values, Na, and CL become askew about one week before shot is due (becomes lethargic and stops drinking as much water, which doesn't help Percorten to work)
--K doesn't elevate as much as Na falls
--just did his aldosterone test, 0 pre, 0 post
--he has seen a specialist at Penn and has no known concurrent endocrine issues or kidney disease

George feels very well about 1.5 or 2 weeks in the mid-cycle, of his Percorten. The goal is to have him feel that well all month, every month.

1) Should we start focusing primarily on his declining Na INSTEAD of waiting for his K to rise (we wait for his K to reach 4.7-4.9 before giving his shot so his K doesn't go super low afterward since he is so sensitive to a lower K)?
How do we do that properly? Should we continue reducing but give his shot SOONER to avoid what lower Na does to his behavior, hydration status and lab values?

I'm concerned that letting his electrolytes/kidney values get slightly out of whack every month, be unnecessarily hard on his kidneys. I would like him to feel balanced throughout the month like other well-managed Addison dogs.

2) Could the Percorten not be working its best on George? Could he be allergic or have tubule issues?

3) Would taking a salt supplement like some human Addison patients do daily or every few days, help or hurt (we already give him lightly salted broth several times a day with meals)?

4) While he has improved tremendously, he has started getting ear infections and severe itching above his tail again (is it possible that Percorten dose has gone too low and isn't managing the disease as well? Or is it just summer allergies/FAD? He does not have fleas on him. No dietary changes, eats grain free)

Thank you for your time and thoughts. We appreciate it!


Dr. Mark E. Peterson said...

I'd start salting by salting the food - that can't hurt but in some dogs results in an increase in thirst.

You may want to split the Percorten dose and give every 14 days instead of every 28 days.

The itching isn't related to the Addison's or the drugs he is getting.