A Conversation with Dr. Z: Understanding Canine Addison's Disease

Dr. Xenia Zawadzkas (Dr. Z) returns as our special guest for an eye-opening episode dedicated to Addison's disease in dogs. In this in-depth conversation, Dr. Z sheds light on the complexities of Addison's disease in dogs. With Dr. Z's expertise, you'll gain a deeper understanding of how Addison's affects your canine companions and why timely intervention is crucial.

Throughout the episode, Dr. Z walks us through the diagnostic process, highlighting the nuances of interpreting baseline cortisol levels and sodium-to-potassium ratios. You'll also discover why the ACTH stimulation test is the gold standard for diagnosing Addison's.

Once diagnosed, Dr. Z shares valuable insights into treatment options, particularly the use of Zycortal injections and prednisone. You'll learn how to tailor the treatment plan to your dog's needs, ensuring they enjoy a high quality of life. Whether your dog is young or elderly, large or small, this episode equips you with the knowledge and confidence to provide them with the best care possible.

What You’ll Learn:

• Recognize the subtle symptoms of Addison's disease in dogs, such as lethargy, vomiting, and diarrhea.

• Understand the prevalence of Addison's disease across countless dog breeds.

• Explore the diagnostic challenges veterinarians face in differentiating Addison's disease from other conditions.

• Discover the gold standard diagnostic test for Addison's disease: the ACTH stimulation test.

• Gain insights into how baseline cortisol levels and sodium-to-potassium ratios play a crucial role in diagnosis.

• Learn about atypical cases of Addison's disease and their potential transition to typical Addison's.

• Explore the treatment options available for dogs diagnosed with Addison's, including Zycortal injections and prednisone.

• Understand the importance of tailoring treatment plans to individual dogs' needs and monitoring their progress.

• Discover why timely intervention and collaboration with veterinarians are key to managing Addison's disease effectively.

• Gain confidence in providing the best care for dogs with Addison's disease, whether they're young, old, large, or small.

Ideas Worth Sharing:

• "It's an excellent prognosis once you get it figured out and keep managing and monitoring; they have a normal lifespan and are like a normal dog again." - Dr. Z

• "It's one of those treatable diseases. The hard part is, keep going with the treatments and it can be a little expensive." - Dr. Z

Watch On YouTube:

Read The Transcript:

Dr. Sugerman: [00:00:00] Hi, and welcome to Vetsplanation. I'm your veterinary host, Dr. Sugerman, and I'm going to teach you about veterinary medicine. In this podcast, we can dive deeper into the understanding of what our pets are going through and break down medical terms into easier to understand chunks of information. Just a quick disclaimer, this podcast is for informational purposes only.

This is not meant to be a diagnosis for your pet. If you have questions about diagnostics or treatment options, please talk to your veterinarian about those things. Remember, we are all practicing veterinary medicine and medicine is not an exact science. Your veterinarian may have different treatment options and different opinions.

The information I provide here is to help pet parents have a better understanding about their pets. If you like our podcast, please consider sharing this podcast with at least one friend or just somebody else who has pets as well. Now, let's jump into this week's episode.

Hi, everybody. Welcome back to the podcast. Welcome back to Vetsplanation. I'm your host, Dr. Sugerman And [00:01:00] again, we're going to have Dr. Z here. You might have remembered her from the diabetes talk. So I really appreciate you coming back on again today.

Dr. Z: My pleasure. Happy to be here again.

Dr. Sugerman: Yeah. So we're going to be talking about Addison's disease today.

So I have talked about it on podcast before, but very much on the emergency side and disease is my go to for all things general practice, so a lot of times I fix them for the immediate portion, I have to send them over to her to do all the other stuff.

Dr. Z: Take it over.

Dr. Sugerman: Yeah, exactly.

Dr. Z: No problem.

Dr. Sugerman: Alright, so she's going to talk to us about Addison's disease today.

Dr. Z: Yeah, Addison's disease, what is it? it's an endocrine disease, which means it's a hormonal disease. there's lots of different hormones in our bodies, and hormones are basically messengers that tell one thing to do another thing.

And usually, there's a gland somewhere that secretes the hormone, and another gland somewhere else that picks it up and then does something with it and secretes another hormone. Yeah. So there's always these, loops of, of talking to each other. So Addison's is, actually [00:02:00] hypoadrenocorticism, hypo meaning too low, and then adrenal referring to the adrenal glands and corticism is the cortex or the outside of the adrenal glands.

Which is where the hormones that we're talking about are being produced. But it's just easier to say Addison's, and then

Dr. Sugerman: it's less of a mouthful.

Dr. Z: Yes. It's like the Okay. Addison's disease. Much easier. I actually was wondering where that name came from, because there's always like some dude or dudette the disease is named after, and I actually found out about Thomas Addison, He was an English, physician for humans, and he lived in the 1800s.

And he liked to do autopsies on dead people, like he would just cut them open and look at things and try to learn about them. And he was very interested in the adrenal glands, and he found that people would, die from the same symptoms. And then they tended to have the same problems with their adrenal glands looking small, whatever.

Yeah. So he figured that out. And he, he did a lot of other work too. [00:03:00] Like he figured out pneumonia, the pathology of pneumonia. Wow. So he's pretty famous. So that's the Addison's, yeah, that's why it's called the Addison's, because he figured it out.

So what's happening with that disease is, the outside of the adrenal glands, which maybe I should talk about, where they are,

Dr. Sugerman: Yeah, where do they, where do they live, yeah.

Dr. Z: They are these little glands that live above our kidneys, or towards our head, cranial as we would say, cranial to the kidneys. if you imagine a little triangle, like a equilateral triangle with even sides and then just smush it a little bit, and round the edges, that's what the adrenal glands look like. And they're normally pretty small. and they have this outer layer and then an inner layer. And the outer layer is where these specific, hormones are made.

So there's actually three of them, and I was actually listening to your previous podcast, and I was reminded about the, the salts.

Dr. Sugerman: Salt, sugar, sex.

Dr. Z: Sugar and sex, yeah. Yeah. So the salt part is what we call the Mineralocorticoids. I have such a hard time saying that.

Dr. Sugerman: [00:04:00] It's another mouthful.

Yeah. I think it's just a lot of mouthfuls on this one. Yes. Yeah.

Dr. Z: But that one I can't get around it. I'm gonna have to say it over and over. . So that one, balances our, our electrolytes. Our salts basically. Helps with many things, which I'll go into in a second. And then the other big hormone there, the sugar one is the glucocorticoids, which is also known as cortisol, or it's just another steroid that, helps do many things, which I'll go into in a sec.

Um, and then the last one is like some androgens, some sex hormones are produced there too, but that's not the only spot obviously, that those are made. We have our ovaries and our testicles where, where the majority of the sex hormones are produced. And that doesn't seem to be as affected in general, probably because it's In other places as well. And we really just don't worry about it in dogs and cats. Because we're mostly neutering them anyway. So really we're just talking about the glucocorticoids and the mineralocorticoids. And when you have Addison's disease, there's a deficiency in those hormones. They're not being [00:05:00] produced anymore.

And so all kinds of problems happen when you don't have them. So let's talk about the glucocorticoids. Yeah. They, basically, in summary, help us deal with everyday stresses. And they do that by telling our liver to produce glucose and, give us energy. so glucose, as I talked about in our diabetes lecture, Is the, the smallest molecule of sugar that's used to make us have energy basically function and all of our cells need it to work. if we don't have those glucocorticoids telling us to make it, then all kinds of bad things happen. glucocorticoids help us move our fats and our protein, to again, produce energy.

They talk to our blood vessels actually, to help us respond to stresses, and they help regulate our body temperature and our blood pressure. And it helps our stomach maintain a mucosal barrier so that we don't get ulcers and digest our own stomach.

Dr. Sugerman: Yeah, I actually didn't know that. So it was very interesting to read about that.

Dr. Z: Yeah, glucocorticoids have a ton of [00:06:00] functions and they're involved in many metabolic functions besides that too. it's a very important hormone that we need every day. the mineralocorticoids, help us, again, regulate our electrolytes. And so the big ones that are working for us to maintain our fluid and our blood volumes are potassium and sodium.

And that, if we don't have the right levels of those, then again, our blood pressures are off, our muscles aren't working, the heart isn't working right. The heart is very responsive to potassium levels. Our gut needs our sodium and potassium to work properly, and then our brain, of course, needs it too. When we have those sodium and potassium levels going out of whack, it's very dangerous and life-threatening. Okay, so I wanted to talk about the normal physiology, of how these hormones are circulating in our body and making all these things happen. It's what I call a negative feedback loop in general. So if you were to think of like your [00:07:00] thermostat in your house, say it's winter time and you have it set to heat the house if it drops below, I don't know, 60. it's made to detect the temperature, right? So that's what it's detecting.

And if the temperature falls below that 60, whatever, then it talks to the furnace and says turn on and start heating the house. And so then the furnace turns on, starts heating the house, and that thermostat is then feeling the temperature go up. And when it hits, 70 or whatever you want it.

It'll say, oop, that's where I want to be, and then it tells the furnace to turn off. And it's like this constant loop talking to itself. It's constantly adjusting and tweaking things to keep things balanced in the temperature where you want. So that's how all of these hormones work. And it's really important that we understand that to figure out what's happening with addison's disease. So in the loop, you've got to start somewhere, so I'll just start in the brain.

Dr. Sugerman: Okay. Important part.

Dr. Z: Yes. There's kind of two parts in the [00:08:00] brain that are in this loop. And it starts in the hypothalamus, which is a part of the brain. It secretes, when we don't have enough glucocorticoids and mineralocorticoids, just like the temperature is too low, right?

This is what it detects. Oh, I need more of that. Okay. So it secretes a hormone called the... Corticotropin releasing hormone, so C R H, which we don't really talk about that much because it's like a small signal, but it's important. And that goes to the pituitary gland, which is just a little bit lower in the brain.

And the pituitary gland has many different hormones functioning at it. It's like a hot center for hormones. It has many different functions and talks to many. It's like the, I don't know. What am I trying to say? Like the central Yeah. I feel like it's like Houston talking to the spaceship.

Dr. Sugerman: Exactly. I was thinking also like your Google Nest, it talks like you can tell, have it talk to your lights. You can have it talk to your garage. Yeah. You can talk to all sorts of things.

Dr. Z: Yeah. Yeah. It's the, the main [00:09:00] center. Yeah. so anyway, the pituitary then is like, oh, now the hypothalamus is telling me that we need more glucocorticoids or mineralocorticoids.

So it squirts out ACTH, which is, Adrenocorticotropin hormone, and that's also a mouthful, so we just say ACTH. Yes. That's what it is. And it's coming from the pituitary gland. And that then goes and talks to the adrenal glands, and just the outside part of the adrenal glands.

And it tells them, okay, time to release mineralocorticoids and glucocorticoids, because the boss says we need more.

Dr. Sugerman: Time to turn the heat on, essentially.

Dr. Z: Yes. Let's turn the heat on. It's like the furnace, right? Turn on. the adrenal glands do a little squeeze and those mineralocorticoids and glucocorticoids are released.

Dr. Sugerman: They're released into the bloodstream.

Dr. Z: Into the bloodstream, yep. And then they can start doing all of their lovely functions to deal with stress and keep our lytes where they need to be. And then when there's too much, then it turns back off and just circles around again and again.

[00:10:00] Also, a little fact is the ACTH actually keeps that cortex the right size. So if you don't have ACTH, like there's a lack of it, those adrenal glands will start to shrink. Yeah. And you can actually measure those and figure that out, with an ultrasound.

Dr. Sugerman: I will say they are hard to find.

Dr. Z: Yeah. They're tiny to begin with. And then if they're not working, they're really small. Really tiny. Yeah. Yeah. So yeah, it influences the size of the adrenal glands as well. Yeah. I think that's the whole physiology.

Dr. Sugerman: It's a lot, right? It is. It's complicated. But it's such an important thing that happens inside of our body.

Dr. Z: Yeah, it's, it's unbelievable all the messages that are happening constantly to keep us going. Right. In many different ways with all of our organs and everything. Yeah. It's amazing. I love it.

Dr. Sugerman: Yeah. So now that we've kind of like talked about you know, a little bit about Addison's and adrenal glands and stuff, are there different types of Addison's disease? [00:11:00]

Dr. Z: Yeah, and you talked about them too, there's just the main two that we talk about mostly, but there's actually three types, and I'll go through it. there's the typical Addison's disease, which is the most common, and that's what we normally deal with.

And that's when the entire adrenal cortex is faulty, so both mineralocorticoids and glucocorticoids are not being produced. And, it's, I think it's like an autoimmune cause, like as far as why does this happen, we're not sure. like a lot of these diseases, but it seems to be the body starts to attack its own adrenal glands and then they just stop working.

Yeah. So that's the most common. And then there's atypical, which is where only the very outermost part, I think, is where the glucocorticoids are produced. That's where, just that part is not working. So we don't have glucocorticoids, but we still have mineralocorticoids. So all of those electrolyte disturbances are not happening, but we just don't have the glucocorticoids and can't deal with stress. That's a little bit harder to [00:12:00] diagnose because oftentimes we use those lytes as a big red flag. That's when we're trying to diagnose what's wrong, usually it's oh, those lytes are wrong, must be Addison's. Let's test for that. Yeah. so it's a little trickier when it's just the atypical, but you can still figure it out with, step by step.

Yeah. And then there's what we call secondary Addison's, which is. hard to understand because maybe that's also atypical. Anyway. Secondary is very rare. That's when the pituitary gland isn't working. So that's the gland in your head. Yeah. The brain tumor like has affected the pituitary or somehow, or there can be a weird infection that gets there or something like that.

Also it can happen when, steroids are taken away too quickly. Say you're giving steroids as a treatment to a patient, and then, instead of tapering it off slowly like you're supposed to, you're giving high doses and then suddenly you just stop it. And what's happened is, like, all those steroids have suppressed the [00:13:00] ACTH normally from happening, and again, that makes our adrenal glands stay the right size, and so when you don't have ACTH, it just shrinks down and atrophies, and so then when you take away the steroids.

It's just, we can't produce our own anymore. it's just, it's been taken away, and then, ugh, we can't make any, and then we start falling into Addison's. So it's rare, because usually, we're pretty good about tapering, I think, steroids? I don't see that that often, and honestly, I don't know if that's something that would be...

Eventually get better. Seems like it probably would.

Dr. Sugerman: I feel like it should eventually, like your heater should kick on, right? .

Dr. Z: Yeah. . If it gets cold enough for long enough, right?

Dr. Sugerman: Exactly. Yeah. I guess it's hard to know. I don't, I haven't really seen any that's been a secondary one. So I don't know for sure.

Dr. Z: Again, it's super rare. Yeah. I just was reading about it that I mention it, but definitely we, we deal with normal, typical Addisons the most. Where we don't have both mineralocorticoid or glucocorticoid.

Dr. Sugerman: And then, now that we've kind of like talked about what, the types of them, are there [00:14:00] differences in what the symptoms of everything are?

Dr. Z: Yeah. So the symptoms of Addison's are very vague, and I think you talked about that too, and it's probably one of the hardest things you deal with in the ER is there's no one symptom that you're like, yes, this is Addison's. It's often called the great pretender because it affects so many systems as we talked about all the different places that these hormones work, so GI is a big one, vomiting and diarrhea, bloody stools....

and as it progresses and turns into the crisis, it gets much more dramatic. Like they'll collapse and their heart will slow down and their blood pressure drops and they're like in shock.

And that's [00:15:00] the Addisonian crisis. When they've not had those hormones for too long and they can die. It's an emergency for sure. That's probably how you've seen them.

Dr. Sugerman: Yes The majority of when I see them is usually in crisis at that point because the interesting thing is also it's you know these very intermittent signs.

It's like they have this vomiting diarrhea and then they get better without really anybody do anything and then they come back again and then

Dr. Z: something like they'll come in and you're like, oh, let's Let's treat for your GI symptoms, let's give you some fluids, and let's give you some anti nausea meds, and here's some diarrhea medicine, and that helps.

And then sometimes maybe you give a steroid for whatever, a shot of dex, oh, maybe this is an allergic reaction, here's some steroids, and that helps them so much because that's what they needed.

Dr. Sugerman: That's what they needed, right? Exactly.

Dr. Z: So yeah, if they have that waxing and waning history, and then, suddenly it just gets super bad one day and then, and then you run the full, full diagnostic blood work and then you can figure, Oh, this actually is Addison's.

Dr. Sugerman: Yeah. Since we're [00:16:00] talking about this now, how do we diagnose it?

Dr. Z: Yeah. blood work, is how you end up, in a nutshell, diagnosing it, but let's go through it. And you did a bit on yours too, I was listening. But, so the CBC is the complete blood cell count. You'll see what's what we call a lack of a stress leukogram.

So these patients are usually stressed out, just coming to the hospital is enough to make a dog or cat, or cats don't get this, but, to make a dog stressed out. So usually we'll see certain levels of white blood cells that indicate stress, like their neutrophils will be up, their lymphocytes will be down, those sort of things.

And you don't see that, so there's normal looking blood cell counts, or maybe those lymphocytes are a little bit up. Which is weird for, a stressed dog. So there's that. And then sometimes that's all you see when it's an atypical Addison's dog. Right? Because they're then on the chemistry panel, you have your electrolytes on there, and I know the typical Addison's dog will have [00:17:00] a very high potassium and kind of a lowish sodium and then the ratio between the two is decreased. So that's what we talk about mainly is the sodium to potassium ratio. Because sometimes you can have a lowish sodium potassium ratio and they're not Addisonian but if the potassium is actually high, like above the normal range, then that's a big red flag. And so then the next test you would run would be called a baseline cortisol test and so that's looking at cortisol levels, right? Those glucocorticoids. And if it's, normal, five or something, then you're like, okay, it's not Addison's.

Because it couldn't be. Like, if they had Addison's, they're not going to have any cortisol. So a baseline cortisol is super helpful to just rule it out. but it doesn't rule it in. Say it's low, then you're like, okay, I think it is Addison's. Everything's adding up. But you have to do one more thing.

You have to do what's called the ACTH stimulation test. To confirm that it's Addison's. And we have fake ACTH, it's called cortrosyn. [00:18:00] That's the hormone that's produced in the pituitary gland. And we can give an injection of it to the dog. and then test their cortisol level after that.

Dr. Sugerman: See how it's responding, see if that furnace is turning on, essentially.

Dr. Z: Yeah. Yeah. You like my analogy.

Dr. Sugerman: I do like your analogy.

Dr. Z: Yeah. So you have your baseline cortisol's really low, and then you give them some cortrosyn, an hour later you check the cortisol level again with the second blood draw, and then if it's still low, like usually it's like undetectable.

It's 0.2 or less on a Addison dog, and if it's still that same number or you can't detect it after the cortrosyn shot, then they're definitely addisonian. And this is one good thing about this disease is that's how you can diagnose it for sure. It's, it's your, gold standard for diagnosing this disease.

Dr. Sugerman: Yeah. Which is really nice. 'cause we have that in-house. You know, there's so many things that we have that we have send out or we have to just rule things out in order to get to that disease. But this is such a nice one 'cause you can. We have an in-house [00:19:00] test to do that.

Dr. Z: Yep. We have the, the ACTH or the cortrosyn and we can just do those stim tests.

As we'd like. Yeah. And there's other like diagnostics that you can do too that can help us figure out, like their blood pressure will be low and if you do that ultrasound you can see atrophied or very tiny adrenal glands. And then, on the urinalysis, not much there, except maybe it's dilute urine, when the electrolytes are, out of whack, it can actually wash out those kidneys and then they can't concentrate their pee anymore, and that's what makes them thirsty, and so it's a different way of causing that symptom in this disease, but, yeah, that's how you get your increased thirst and increased urination, is because those electrolytes are not normal. But really the kicker is that ACTH stim test and you need blood work to diagnose it.

Dr. Sugerman: And you know. You're talking about like the baseline cortisol, and that's I do think that's also a hard one too 'cause we don't always run that if we're just seeing some of those other [00:20:00] signs just vomiting, diarrhea, but when we start seeing all that blood work. So hard to diagnose those atypical ones, like you said. We don't always run it because we don't always think about this disease.

Dr. Z: And then the cortisol would be normal and you'd be like, meh, it's not Addison's. But it might be.

Dr. Sugerman: It could be. Yes, exactly.

Dr. Z: So I think it takes a little bit of time on those. 'Cause, like they'll come back again and again.

And you're like, oh, maybe this is, and then you can do a stim test and maybe it'll be negative, but maybe it'll be positive and you'll be like, oh, that's what it is.

Dr. Sugerman: And I know there's also a gray zone to this as well, because I've had to test Nora, my great dane for it because she would not eat intermittently and have intermittent vomiting and diarrhea.

And hers was like 2.5. This perfect gray zone. And it was like, it could be, could not be. We just have to retest it later. Sometimes you do have to do that too.

Dr. Z: I think sometimes it's like getting worse over time too. It's like progressing. And I just realized I misspoke. I think [00:21:00] baseline cortisol would be low on the atypical.

Dr. Sugerman: It usually is low on the atypical still.

Dr. Z: Yeah. Yeah. It's the lytes that would be normal. So that's why you're like, I don't think It is but yeah, but then you check your baseline cortisol and it's low and that could trigger you doing the stim test.

But there is a gray zone. Yeah, because usually if it's Addison's it's really low

I was gonna talk about the breeds, but there's so many of them, like it's many of them list just went on and on and on. Honestly, I've seen it in so many, like other breeds that aren't on the list that I just wanna say, many and any breed really.

Dr. Sugerman: I don't think there's any breed that can not get it. So when do we typically, what ages and stuff do we usually diagnose them at?

Dr. Z: Oh, any age. There's the juvenile onset ones, as young as three months even, not two months. And then they can be much older too, like later in life, get it 13 years old, but usually it's in the middle. I'm going to say.

Dr. Sugerman: Yeah. I think that in school, like our testing, I think they said there was two peaks to it, like somewhere around two years old and again, somewhere around ten years old or something like that.[00:22:00] At least that's what they asked us to remember for vet school. But I feel like it could be any time.

Dr. Z: The little bit of reading I was doing was saying the mean is 3 to 4 years, or the median. Typically the young to middle aged. But yeah, really it's kind of across the board.

Dr. Sugerman: Now like I said, so many different types of dogs that get it, right? Do cats get it as well?

Dr. Z: No, it seems like it's a dog only thing, although I'm not sure. Did you look it up?

Dr. Sugerman: I have looked it up before and they have like cases that they think of cats that might have had it before but It's not like a widely known thing that cats usually get.

Dr. Z: I've never seen it.

Honestly, I haven't really looked for it, though.

Dr. Sugerman: Yeah. Neither do I.

Dr. Z: Seems to be not a thing for them.

Dr. Sugerman: Exactly. Yeah. And even then, I don't think you can run, our in house test for it. I think you have to, send something out for them instead, if I remember correctly. I'll have to look that up.

Okay. But I think that's what I remember.

Now that we've diagnosed this, so how do we manage them?

Dr. Z: Good, managing is where I come in after you've saved them, and then I [00:23:00] see them usually like a month later, and there's two treatments that we start and need to continue for the rest of the dog's life. The first one is replacing the mineralocorticoids, and that's an injection. It's called Zycortal or DOCP, which stands for desoxycorticosterone.

Dr. Sugerman: I'm impressed you could say that. I couldn't say that.

Dr. Z: I practiced. But yeah, we just say DOCP, and there's this off brand now called Zycortal that's a little bit cheaper, so we usually just call them Zycortal injections, and it lasts for about a month, and...

We usually have to start at a higher dose when they're first diagnosed, and then we can slowly taper it down to about 50 percent of that starting dose. it usually takes four to six months to get there. I taper it about 25 percent each month, if their lytes continue to look good. So at first I check their lytes.

If the sodium to potassium ratio is... It's above 25. 25 is bad. In the [00:24:00] 30s is better. But, I want him to be, like, in the 30s and not at 25 or near that. Then I think it's working well, and we can decrease it by about 25 percent, and it depends on the dog's weight, too, which can fluctuate.

So I'm always like calculating it. And then we check again in another month, check the lytes. If we're still doing okay, keep going down. So usually about four months down the road, we can get down to the final dose. And then we also have to replace those glucocorticoids. So the easiest way to do that is just give a steroid. Prednisone is the one that we typically use for dogs. And we have to be careful with that because if you give too much then you can get bad side effects, like just taking steroids can be problematic. The biggest thing is it can cause increased thirst and urination.

Dr. Sugerman: Still stuck with that. Yeah.

Dr. Z: And for different reasons though, but they're peeing a lot and owners are complaining that they're having accidents in the house and they're super thirsty. It makes them hungry. So they're stealing the [00:25:00] trash and they're gaining weight. And then if you keep it up, they start to lose muscle. Usually on their head they'll get pred head.

Dr. Sugerman: Pred head.

Dr. Z: You just see the bones stick out on their head and it's sad. And you can avoid all that if you are very conservative with that dose of prednisone. They hardly need any, like the natural body produces just a tiny bit. And so honestly, I just use the dog's clinical signs to tell me what the dose will finally be, and we talk about it at every visit when we're tapering that Zycortal dose. I'm like, okay, how's his thirst? How's his urination? Is he eating a lot still? A lot of them are like, he's just panting all the time.

That's another thing is panting, panting and panting. And, and that usually all gets better as we get down to that final dose. And I've found that you guys actually send 'em home a little too high of a dose most of the time. I know you're being cautious. Because they were dying.

Dr. Sugerman: Because they were dying.

Right, exactly. So we do a little bit of a higher dose.

Dr. Z: Yeah, but I'm always like, oh look at this pred head, we need to give less.

Dr. Sugerman: They do like get that in just even a [00:26:00] month?

Dr. Z: It seems like it. The last one I saw was. He was a pointer. He was an old pointer though, so I think he was,

Dr. Sugerman: Maybe it's just a mixture of things

Dr. Z: Losing muscle anyway, but.

Yeah, he definitely had too much and so I'm always cutting way back on that. And then if it's a small dog, we usually end up, it's hard to cut those pills, especially the oblong prednisolones.

Dr. Sugerman: Yeah, it's real weird.

Dr. Z: Quarters, even hard. So I usually switch them to the liquid. There's a one they make for kids.

It's a 3 mgs per ml suspension. It's really cheap and easy to get at any pharmacy. So I just write them a script for that and tell them how many mls, 0.5 mls or whatever to give every day.

So yeah, but I put a lot of the smaller dogs on that because you can really get down to a nice accurate low dose.

And then that's it really is just keeping them on those two medications. The Zycortal I will say, sometimes their lytes aren't good when I do the recheck and so you can do two things. You can give the Zycortal shot more frequently, like instead of 28 days, give it every 25 days. But that's [00:27:00] hard for the owner to count and, make that appointment.

So I usually try to just keep it up once a month and just go back up with the dose. That's the other thing you can do is just give a little bit bigger injection. And so we're careful with that in the beginning and checking those lytes and then we, I can help them with that plan.

And I look at those numbers, but pretty much all of them seem to be just fine with a smaller dose like I don't think I've ever... There was one but that dog had gained weight I think so they needed a little bit more. So I went back up but that was like years later that's why we have to keep checking. So that's the other thing once we get to the final dose then it's every six months I like to do a full checkup exam, check their weight, talk about everything. And once a year I like to run full blood work, chemistries and senior panel stuff. And then every six months, alternating just plain electrolytes, if they're otherwise doing okay. Lytes every six months. Full blood work once a year.

Dr. Sugerman: So just to clarify, so they're still coming in each month to get their DOCP [00:28:00] injections? Or Zycortal injections? It's just now we have a dose that we know that they're going to get.

Dr. Z: Yeah, so once that plan is established, yeah, then it can be technician appointments for those Zycortal shots. If they have concerns, they can schedule an exam again, but usually it's just a quick poke. And then also on that last visit, if the owner is comfortable and interested, I can show them how to give the Zycortal shots and we can sell them the whole vial and they can just start doing their shots at home.

They don't have to even bring the dog in. But every six months. Yeah, so you can. Some people are comfortable, some are not, and some are happy to bring the dog in once a month. So yeah, whatever they want to do. That's fine.

Dr. Sugerman: And that's for typical Addisons. So for atypical Addisons, we're not doing the injections, correct?

Dr. Z: So it was interesting because there was one that was recently diagnosed that I took over and they had given DOCP even though it was atypical. And so I just went with that and kept giving it. And that's because, actually, a lot of these atypical ones will eventually [00:29:00] become typical. I think, I forget, there was a study, not all of them, some will stay atypical forever, but it seemed like there was a significant portion of dogs...

I don't know if it's from the DOCP or

Dr. Sugerman: it was just normal? Yeah.

Dr. Z: Because it was normal anyway.

Dr. Sugerman: But if it was, like let's say if it was the DOCP obviously it doesn't have any harmful effects then.

Dr. Z: Nope. It's just like doing nothing then if, if they already have it. Yeah. You can't overdose with that medication.

Dr. Sugerman: Nice. When they are just on pred though, do you still have them come back for rechecks?

Dr. Z: That's a good question. I don't think I've ever had, there's so few and far between, honestly, I haven't managed a lot of atypical ones. I guess I would be less, [00:30:00] I would be worried about them turning into typical, and I would say at least every six months.

Dr. Sugerman: Yeah. I think also you were mentioning before about coming in after a month, after we've diagnosed them usually at the ER, you're having them come in in a month. I think that's actually still important for them to do, even if they're atypical, because at least then you can adjust the pred dose to lower than we, than we sent them home with.

Dr. Z: Yeah. So probably the initial one month checkup, even for an atypical is needed, and then you can go from there. Yeah.

Dr. Sugerman: I think you kind of touched on this too. So how do we know that the medication is working?

Dr. Z: Yeah, basically all those symptoms go away. So they're not vomiting and having diarrhea anymore. Their lytes are normal on the rechecks. And they're just like a normal dog again.

Dr. Sugerman: Nice. Which is what we love. And then, is there anything that the pet's parents should do, like, when they are in times of high stress? Because then we need more glucose during times of high stress.

Dr. Z: Yes. Yeah. And you talked about that, too. You said you give a double dose the day before, the day of the stress, and [00:31:00] then the day after.

Honestly, I think they only need it the day of. But it's, there's no right or wrong with it. I don't think they're going to go into crisis that quickly again, and again, I just see so much overdoing with the prednisone that I'm always like, no, just give it double dose on the stressful day.

That's all it needs.

Dr. Sugerman: Okay. Yeah. I think we're just like, so overly cautious. We don't want to come back in crisis. So

Dr. Z: yeah, I try to just make it easy for the owner too, because they might forget, Oh no, I messed up. And it's no, it's okay. Just give another dose, extra dose. So double dose either can be give double that once a day, like instead of half a tab you give a full tab.

That day. Or you can give a half tab in the morning and a half tab at night. It doesn't really matter. As long as you give it double.

Dr. Sugerman: Nice. Perfect. And then, does this diagnosis like, really decrease the pet's lifespan at all?

Dr. Z: No. It's an excellent prognosis once you get it figured out and keep managing and monitoring, they have a normal lifespan and are like a normal dog again.

[00:32:00] So it's it's an excellent prognosis.

Dr. Sugerman: Yeah. I do love this disease because like I said, it's, sometimes we have this great easy way to be able to diagnose them and then it's not like we're going to cut their lifespan.

Dr. Z: No, not at all. Thank goodness. It's one of those treatable diseases. The hard part is, keep going with the treatments and it can be a little expensive. I actually looked it up on our computer, trying to figure out how much does it cost, for a hundred pound dog. The Zycortal is the expensive part. Prednisone's dirt cheap. Yeah, that's no problem. But the Zycortal injections are expensive. It's priced by volume of the injections. That's another reason why we taper it because it gets cheaper as you give less of it so if you have a big dog, though Like I had a Great Dane Addisonian dog that and his shots was like, 200 bucks every month because it just weighs so much but usually the first shot for a hundred pound dog is going to be around 300 bucks. And then hopefully we can taper it down to about 165 ish long term And then, for comparison, a 10 pound [00:33:00] dog, like a little terrier or something, it's about 60 bucks initially, and then hopefully we can taper it down to about 40 bucks once a month.

So smaller dogs, it's a lot cheaper. And then you have every six months you got your exams, which, 100 bucks now for an exam. And then the blood work, a couple hundred bucks for full lab work, and then lytes are what? 80 bucks.

Dr. Sugerman: So they're like 80 bucks? Yeah. Something like that. Yeah.

Dr. Z: So it adds up, but at least that's only every six months. It's really just the monthly Zycortal, that's the biggest expense. And I think mostly for the bigger dogs. We already talked about symptoms coming back. Actually, it can be, again, vague. Because you weren't sure what the symptoms were to begin with. But it's possible for an Addisonian dog that's well regulated to eat some bad turkey. And have, GI side effects from something else, not his Addison. I think the important thing is, if you, especially if you go to a different vet, that's cause your regular vet isn't open or whatever. Tell 'em that your dog is Addisonian. And tell [00:34:00] them when they had their last DOCP shot. So that they're aware of that problem and can rule out that recurring or, or not being well regulated.

Dr. Sugerman: Yeah. I do appreciate it when people tell us that. Like when they come into the ER. 'cause that's a really, you know,

Was there anything you wanted to add to this?

Dr. Z: No, I don't think so. Just that it's, I think it's one of the better diseases out there. Like hypothyroidism. I like that one too, because you can totally fix it.

Dr. Sugerman: Great, you're going to talk about that on another podcast.

Because not, again, not mine.

Dr. Z: Okay, yeah, yeah. You never know, but.

Dr. Sugerman: I never have that.

Dr. Z: Emergency hypothyroid.

Dr. Sugerman: Exactly. So you know, so last time I had asked you about like your favorite animals, so this time I'm going to ask you why did you decide to become a veterinarian?

Dr. Z: I think I'm lucky in that I'm one of those people, like ever since I was little, that's what I wanted to do. I can, The first thing I remember, having kittens at [00:35:00] home is I want to be with them! I want to take care of these forever! That's what I want to do. It was either that or, an astronaut. I really think outer space is amazing. Blows my mind. But I get seasick really easy.

Dr. Sugerman: Oh, that might be a problem.

Dr. Z: So I'm like, nope. Okay, it's a vet. I'll be a vet.

Dr. Sugerman: So you don't go on many boats, I'm assuming.

Dr. Z: No, it's hard. I like want to, but it sucks being, being seasick.

Dr. Sugerman: Yep, yep, exactly. You can't really enjoy things. So did you go to school like directly like directly to become a veterinarian

Dr. Z: I went to New Mexico State, and I was, it's a big Ag school, so they had a lot of fun classes on, there was a horse class.

I thought I wanted to be a horse vet, actually. Yeah. until I went to vet school.

Dr. Sugerman: Yeah. And then you're like, no, no. Not for me.

Dr. Z: Never mind. Yeah. Dog and cats are better. But, yeah, so there was a lot of animals there, and I, I started out with, animal science as my major and then I, it got a little too "farm-y" there's a lot of like cowboys and stuff there and it was [00:36:00] just a little bit, I don't like country music, you know, like.

Dr. Sugerman: Same here. I understand. Yes.

Dr. Z: That's just a thing. I dunno. And so then I switched to biology and, um, majored in that.... so they had this program with Washington State, so we would go up to Washington State for a year and a half we were there doing small animal stuff and then we would go back to Oregon State.

So there's a lot of moving. Yeah. Kinda sucked, But yeah, I actually have a diploma from both schools, kinda cool, yeah. But I applied for both schools because I would rather have just gone to Washington State because they have a four year program there. Yeah. Right. But they declined me, so I'm actually, I'm a beave at heart, man.

Anyway.

Dr. Sugerman: Cool, thank you, Dr. Z. Again, I super appreciate it and I know we're going to be talking about I think Cushing's disease next time that you're going [00:37:00] to be on.

Dr. Z: Okay, yes. I'm sorry I didn't get it together today.

Dr. Sugerman: No, no. This is already going to be a long enough episode, and Cushing's disease is just a whole other...

Dr. Z: Another topic, yeah. Less of an emergency, but there's some good stuff to talk about.

Dr. Sugerman: Yes, which is definitely why I want you to talk about it. Okay.

Dr. Z: Thank you so much again.

Dr. Sugerman: Thank you.

Thank you guys for listening this week. If you have any questions, comments, suggestions, or you just want to say hi, you can email me at Suggs, S U G G S @ VetsplanationPodcast.com or visit the website at VetsplanationPodcast.com or find us on Facebook, Instagram, or TikTok at Vetsplanation. Thank you all for listening and I'll see you back here next week.