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Speaker 3: Here in the good old USFA, I am your host,
Doctor Jeff Over.
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Ask the Vets with Doctor Jeff here on pet Life Radio.
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Speaker 2: Without them, we wouldn't be here to help you. You know,
it's funny I'm giving this away. You know, I have
clients that come in, we'll make the office call, make
an appointment, and we'll talk. And you know, oftentimes, and
this is what you've learning from me here on the show,
is that we don't have to panic. You get a
really thorough history, you do a thorough exam, and oftentimes
is that you don't even have to do a single test.
And I'll talk to a client about some of the possibilities.
Let's try this, and that try this usually means that
we don't have to panic, we don't have to do
anything now.
Speaker 3: And clients actually love it. It's great.
Speaker 2: But here I am giving advice and it's free without
even have to make the office call. And even then,
my clients complain they say, They say, well, you just
talked to me for fifteen twenty minutes and now you're
to charge Well, yeah, because I saved you on hundreds
of dollars, had to go on someplace else.
Speaker 3: So anyway, give us a call here.
Speaker 2: At eight seven seven three eight five eight eight eight
two once again eight seven seven three eight five eight
eight A two. And as I mentioned, I always have
a game plan, my lesson plan for the day if
you will, and if you don't call, I have to
talk to you about something. And we've been doing a
series first of some common ailments that the gamut of
work up of treatment really ranges. And we've talked about vomiting.
I mean they're vomiting cases. I probably most that we
see are not serious at all limping. So we've gone
through all the different things that you might bring your
pet in four and try to help you sift through
the diagnostic procedures that your veterinarian may or may not
want to do based on the history and the physical exam.
Then we moved on to some of our metabolic diseases,
and we had spoken about cushings disease last week, and
just as a refresher Cushing's disease is an over secretion
of either the adrenal gland itself as in Cushing's disease,
or the petuitary gland, which signals the adrenal gland to
fire and release the cortisol hormones. And that is the
case of Cushing's syndrome very common. You know. We used
to think that the Cushing's syndrome, in other words, the
petuitary problem was the more common condition in the small breeds,
and the actual Cushings disease, which is the problem of
the adrenal gland itself, was a problem in the larger breeds.
And we have since learned many believe that you really
can't tell. We've see both of them in both the tests.
Speaker 3: That we do.
Speaker 2: We talked about last week the low dose dex methisone
suppression test will help us often determine which is which
and we have to treat accordingly. We talked about the
different treatments in the case of adrenal disease. Adrenal tumor
surgery is an option. In the case of the pituitary
problem or non surgical disease, there is a medication that
we are sort of been using lately called trilif stain
under the trade name Veteral, that has replaced the might
attain or OPDDD lysodron, which was the drug and still
often is the drug that we often use. But now
I just wanted to switch gears a bit to Addison's disease.
And Addison's disease is a real interesting disease because it's
very difficult, unlike cushings that has.
Speaker 3: I mean such clear clinical signs.
Speaker 2: I mean it's that dog using dogs that are drinking
water like it's going out of style, peeing therefore, like
it's going out of style. Their skin that gets very
thin and greasy, and they kind of get this appearance
of a rounded appearance, which is very similar to dogs
that are getting too much cortisome. And that's exactly what's
going on in the body. The doctor's not giving too
much rtisol as in case what we call iatrogenic cushings.
This is the body giving itself too much cortisol, and
therefore the history of the clinical the signs that we're
going to see are very similar to that of the
dog who's receiving too much cortisome, too much prednisone. So
with Addison's it's the exact opposite, and it's much harder
to diagnose it. Well, that's much harder to diagnose. This
is much harder to tell because the signs are much
more subtle. Maybe and oh one thing about Adison's. These
all of the signs that we're going to discuss are
maybe's like you don't even see it all the time,
and not every dog is going to present the same way.
But some of the things we look at are going
to be vomiting, excessive water drinking. So as we mentioned this,
you're going to stay to yourself, Oh my god. But
we talked about vomiting for all these other conditions. So
that's why it's such a puzzle. This is one that
is sort of a lot of what we call a
dr ain't doing right, just a little bit off. You
can't really pinpoint it. They just don't have the energy
they used to, maybe a less of ability to respond
to trauma, slower healing, episodic shivering and shaking where you
don't notice your dog just going through these fits where
there's like a little muscle weakness and or maybe a
shivering trembling episodes almost looks like maybe the minor little
pettit mal seizures and that's it. I mean, they're very subtle.
So they're brought into your veterinarian because of problems that
just you can't really pinpoint, but it's just there.
Speaker 3: We do see this more.
Speaker 2: Frequently in the females than males. It's usually the middle
age female where we see it the most. And the symptoms,
as I said, are very difficult to really to pinpoint exactly.
Speaker 3: And then we get our blood tests back.
Speaker 2: And one value that we clearly see abnormal in most
of these cases. And you know, I've learned over the years,
there's no such thing as the absolutes. It's not all,
it's not none, it's not always, it's not never. But
because that's going to get you to trouble because, as
they always joke, we read the books we went to school.
Apparently your pets have not, so they don't always know
how they are supposed to react to something, how they
are supposed to behave under certain conditions, how are they
supposed to present when they have a certain disease. So
all this data is based on the averages, the norms,
the mosts, but never the allls. So again most of
the cases we have, we look at the sodium potassium
ratio and we see it low. Now there's a low
normal typically of twenty seven, and we will see this low,
sometimes as low as twenty three twenty four. I used
to use twenty four as my quote unquote low, and
now they're even saying twenty five, meaning that if you
have a sodium potassum ratio of twenty five or less
and any semblance of the clinical symptoms of addisons, you
should go ahead and have your dog tested for addisons.
And the test we use for addisons is obviously similar.
It is one of the two tests that are often
used for cushions. Now, if you were twoed in last week,
and of course paying attention with the test that we
used to use a lot and names do for cushings
is called the ACTCH response test, the adrena cordicotropic hormone
response test, where we give the adrenochotropic hormone that's the
hormone that typically comes from the tuitary gland to stimulate
the adrenal glant of fire. And when we give ACTCH
to a dog with cushings, that same amount of stimulus
with cushions stimulates that adrenal way more so, the post
actch cortisol levels are much higher than they would be
if this for a normal dog. What we see with
Addison's disease is a low pre cortisol level, and then
even after we go ahead and stimulate the adrenal to fire,
the post ACTCH value is also low, and often it
doesn't even change at all. I mean sometimes it will
go as low as point one before you stimulate them
with the act hormone value is point one.
Speaker 3: That is classic classic Addison's disease.
Speaker 2: So now also the reason why the amt of potential
symptoms are so different with addisons with the hypo or
low secretion of the adrenal gland, it's because there are
the different zones of the adrenal and when with Addison's disease,
it's not just the zone glamory looso, which actually will
control the secretion of the cortisol, but it also is
a zone that is responsible for the minerali corticoids, thus
your sodin and potassium ratios. So when we have these imbalances,
there is more symptomology that we see in the body
and often, as I mentioned, it's very subtle. So once
Addison's is diagnosed, the treatments vary.
Speaker 3: Again.
Speaker 2: We have the old standard, which if many of you
have had Pat's dogs with Addison's disease years ago, you
probably remember giving a pill every day called fluorine F
and you probably result. We're also giving a little bit
of and I mean a very small amount of daily
prednosome smaller dose by the way then you would use
if you were using it to treat an anti inflammatory condition,
and way smaller than that even if you were using
it to treat an immunosuppressive im mean mediated condition where
you were.
Speaker 3: Using the cortisone.
Speaker 2: As an aminosuppressive agent, because as we know, that dose
is four times the dose of anti inflammatory and with
using it to supplement the very very small amount of
the hormone that we need four cases of addisons, we
just give a I mean it might be for a
fifty pound dog that you might get one milligram. I mean,
it's very small. It's just to give the body that
small amount that it needs to offer to provide the
necessary steroid for the day to day function.
Speaker 3: And the key is a floor n F.
Speaker 2: Now we actually have another medication that has gained a
lot of favor, certainly for the pet parent. It's a
lot easier. And that is an injection. The medication is
called per Corton. It is given well, here's another one.
We used to give it a based on weight, a
weighted dose and given every twenty five days, and then
we've noticed again not every dog is the same. So
we are now finding out that some dogs could use
it every forty or forty one days. And there is
a veterinary internist, university internist, and I forget what school
she's at, but she's been writing a lot of really
really cool papers that almost like a homeopathic type of
medication that you can give a tenth of the dose
of the per courdant and it would actually do the
same job.
Speaker 3: And she is an advocate of using the.
Speaker 2: Smallest amount of per courton that will satisfy the needs
of the patient and giving them as long as it
takes in between, if you can get up to thirty
to thirty five forty days, do it. And that's also
gaining a lot of favor. It's something you need to
talk to your veterinan aaron about, but it is it's
a very very treatable condition.
Speaker 3: It's not for break.
Speaker 2: When we come back, we're going to talk about some
of the other reasons that dogs can get madisons, and
we're also going to talk about a pretty funky treatment
for Cushing's disease to actually turn them into an addisonian, which,
as I mentioned.
Speaker 3: Is a lot easier to treat.
Speaker 2: So when we come back, don't go away. Stay tuned
here at pet Life Radios ascivest with doctor Jeff.
Speaker 3: We'll be back with you in just a minute.
Speaker 1: We'll be right back right after these messages. Stay tuned.
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Speaker 1: On demand only on petlife Radio dot Com. Let's Talk Past,
Let's Talk Pet, Talk About Life Radio HETLFE Radio.
Speaker 6: Pet life Radio dot com.
Speaker 2: And welcome back, And if you're joining me just now
here on pet Life Radio, I'm your host, doctor Jeff Warber.
That's the best with doctor Jeff Orer, I am here
for you to answer your questions, discuss doggingcat issues, just
kind of help make that bond even better, right, you know,
obviously it's the best thing in the world. I'm having
thirteen pets at home. I can only tell you that
it is the best thing in the world. I wish
they made a bed bigger than a California king. I
think I can get more dogs that way, because right
now it's pricky full. And before the break, we were
talking about continuing with our endocrine related conditions. We were
talking about Addison's disease, having spoken about Cushing's disease last week,
and now we're onto Addison's disease. And we were by
the way, they join in the conversation box here and
my computer is blank, as is our email to doctor
Jeff at Petlife Radio dot com. That's not good. You know, guys,
I'm getting a complex here. I want somebody. You don't
have to ask me a question, you just have to
log on and in those one of those boxes, just
say hey, doctor Jeff, then I'll at least know you're
alive and somewhat paying attention.
Speaker 3: Maybe then if you do that, you'll.
Speaker 2: Have the courage to actually ask me a question about
your pets. You know, if I'm using my small microcosm
of my own clients as any indication, I know that
you guys are loaded with questions because I get them
all the time, and I just have a smallimal practice.
So I can only imagine multiplying the numbers of people
here on pet Life Radio with the number of dogs
and cats out there that are listening to us. Then
I know you have more questions than that, So give
us a call. So back to Addison's disease. So, one
of the other conditions that we see with addisons, and
one of the other causes of addisons, is that when
we have animals that are being given pregnisone cortisomes inappropriately,
and by that I mean they're either giving too high
a dose for too long a period or for too
frequently administered. In other words, one of the important things
about using corticosteroids is that we know this adrenal gland
is on board and what does this adrenal gland do.
One of its jobs is to secrete cortisol. Well, what
happens is if we are giving and as I mentioned,
when it comes to testing, it's all about the feedback mechanism,
Meaning when the body senses that there's enough cortisol on board,
it kicks back and says, hey, I don't got to
work because there's plenty there. So this poor adrenal gland
is functioning based on feedback mechanisms from the body. So
the pituitary is not going to fire if it really
senses through the feedback enough steroid on board, nor will
the adrenal gland.
Speaker 3: Ah. So what happens in.
Speaker 2: Cases where cortisone is given inappropriately, where the drug itself
is not being respected if you will that we can
create an addisonian. So first we have a what we
call iatrogenic cushings. We are creating cushings because we're giving
too much steroid to our pets or your veterinarian or
somebody's not paying attention. And then the poor adrenal gland
who's sitting back and how hasn't had to function in
weeks and weeks and weeks from months and months, and
in a sense it atrophies. In a sense when you
need it to turn back on, it's not working anymore.
We've actually blown out the adrenal gland and so we
now have created an addisonian because of our use of cortosome.
One of the things I say about prednisone, it is
one of the most used drugs in veterinary medicine, but
it's also one of the most abused drugs in veterinary medicine.
It is being used, as I said, it's not being respected.
It is a fantastic medication, and anyone of the clients
come into oh no, no, we can't use thee We heard
so many horror stories. No it's not the drug itself.
The drug itself has amazing implications. We could use it
all the time. The applications are just are endless. But
we have to be careful how we use it. We
have to make sure that we are not using it daily.
We have to make sure we are not going to
suppress the adrenal gland too much. And we have to
you know, if we realize that we have to use
the longer drum, we need to may need to bring
in some other medications for example, as immunosuppressive agents. If
you have a dog with immune mediated hemolytic anemia, it
needs to be on steroids. We're limited as to how
much cortisome we want to use, so we may bring
in azothiopren and amorant. We may bring in CycL fossil vide,
which is site toxin. We may bring in another drug
to using conjunction with to suppress that immune systems so
the body doesn't continue to attack its own red blood cells.
But we have to be careful with using cortisols. Sometimes
cortizomes as our only medication. So that brings me then
to another treatment of cushings. As we mentioned last week,
in certain countries, the whole method of treating the cushings
dog is completely different. The old drug we used to
use was called OPDDD or lysogren or mightatain different names
for the same medication, and it would actually destroy the
various zones as needed, especially the zone secreting the cortisol,
but it also would have effect on some of the
other zones, and the goal was to titrate this medication
so it would just give enough zonar destruction to normalize
the pet okay, and we would monitor this via the
actch response test. Well, it is very difficult to do.
Every dog is different and to just get it just
right and to have to do the actate response frequently.
So what would have hap and is there would be frustration.
And again this is before the tryal this stand came out,
which is a bit of a different drug. So what
was done in some places in some countries, it is
so difficult to treat these cushions dogs. Let's use this drug,
the OPDDD, and to heck with it, let's just zone out,
blow out that adrenal gland because we know that it's
much easier to treat addisons. And they would literally just
use it to high dose destroy the adrenal gland altogether
and then go ahead. And now you've created through your
treatment of cushions, you've created an addisonian a condition that
is a low or non secretion of the adrenal gland,
the exact opposite of cushings. And you treat that accordingly.
You treat it with your either your fluorine f or
or per cordon. You treat it with your very very
small amount of cortisoon on an everyday basis, you don't
have to worry anymore about the ruining the adrenal event.
It's already shot and it's an easier way according to
many to treat these dogs. You know, it just shows
you that throughout the world there are many, many ways,
different ways to treat these cases. But I think some
of the take home lessons are starting to recognize your
dog's norm And we talk about it all the time.
Speaker 3: Back when I started the show, we.
Speaker 2: Had a whole day on just unreally understanding your dog
or cat's normal behavior, normal activity, normal appetite, just everything
about them, because sometimes the changes that we see are
so subtle that if you really don't have a handle
of grass on what their normal is, you may not
recognize their abnormal. So therefore it's very important to do that.
And then what will happen is once you do, you'll
start noticing some of these subtle changes, as I said,
especially with Addison's disease, where unlike cushings, where you know
they're going to present typically with that pupd excessive peeing,
excessive water drinking, you'll notice it. You're going to notice
their their appetite change, You're going to notice their skin
you're going to notice their roly poly round appearance, that
redistribution of fat. I mean, there are so many things
that you'll pick up on a dog with cushings, but
you don't see the same with Addisons. And sometimes it's
just gonna be that shivering, shaking, of those episodic weakness.
You're gonna notice, maybe some vomiting. You're gonna notice, maybe
some excessive water drinking. But again, some of these symptoms.
Speaker 3: Are so similar to many other diseases.
Speaker 2: It's not going to really just point to Addison's disease.
But again, having that female, young to middle aged, you know,
you have a four to three year old dog, five
year old dog, You don't think many things can happen Addison's.
Addison's gonna happen. So next week what we're gonna do
is we're gonna continue our endocrine series. We're going to
talk about hypo and hyper thyroidism. I don't know if
I can get him all into one day. The hypo
thyroid is that which we're gonna see in dogs, and
the hyper thyroid is what we're going to see in cats.
As a matter of fact, my own cat just finished
his treatment. My almost seventeen year old Magnificent Oreo. He's
obviously a black and white. He's like a main coon
Norwegian forest cat crossed. He is huge, a cat that
I'll tell you a story about next week how we
got him. But he dropped almost eight pounds. I mean
that's a lot of weight for a big guy like that.
And anyway, he's getting back to normal. He did amazingly well,
so we'll talk about that. Also, once again want to
thank our sponsors pro Sens pet products, which are over
the counterproducts available to you and basically better rank quality.
And of course Calm now giving you the hint next week.
Hype pots, irodism mostly in dogs, hyper and cat. If
you have any questions about cushings or Addison's I want
to hear from you. You can send me an email
to DRGF at Petliferadio dot com, or just be prepared
to log in next week and join us here at
pet Life Radio eight seven seven three eight five eight
eight eight two. I want you to have a wonderful
week and we'll see you here next Sunday.
Speaker 3: Thanks for joining me.
Speaker 1: Let's talk Pets every week on demand only on Petlife
Radio dot com. It doesn't any