Split: Split: For Hope and Steve – Page 10

Keymaster

Hope,

The adrenal glands atrophy over time when we administer a high dose of prednisone. This can cause Iatrogenic Cushing’s Disease.

Iatrogenic means “of or relating to illness caused by medical examination or treatment.”

Cushing’s Disease, which is essentially an excess of cortisol in the body, does occur in dogs due to organic disease, such as a tumor growth on the adrenal glands.

But the symptoms for both are pretty much the same, excess cortisol causes multiple unwanted side effects and over time can lead to serious health issues.

Dogs with Iatrogenic Cushing’s have two small atrophied adrenal glands. I can’t say always, but in just about every case I have seen in the past, dogs seem to recover the function of the gland once the prednisone is reduced.

The desired result of decreasing the prednisone is to get it down to a level that matches what the body would produce for itself. Once you reach a certain dosage, (and that varies according to many factors such as weight etc), the prednisone no longer provides the function of immunosuppression. At that point it is merely attempting to replace what the body would need throughout the day to respond to stress. (And remember stress to a dog can mean anything even mildly stimulating.)

At that point there is a challenge to the body during stress that requires cortisol. There are intricate systems in place that provide the feedback that this is needed and a message is sent out to the adrenals to respond. If they are atrophied, they may receive the message but not be able to respond at all or very little. Over time, as you decrease, they will begin to respond better.

So the tricky part is determining what the lowest dose of prednisone is that begins to challenge the adrenals. The accepted practice for most dogs we have seen is to decrease about 25-33% every two or three weeks. When you reach lower doses that are not immunosuppressive, a schedule is started that is kind of like “training wheels” for the glands. Dose every other day for instance.

The goal is to wake the glands up but also make sure that your dog has enough cortisol to properly respond to stress. Most every dog is going to feel fatigued. They may be reluctant to go for a walk. What we worry about is if they cannot respond to excitement well. If they are suddenly on alert and the body cannot get the message out “increase blood flow, get more oxygen to the brain and muscles, slow down digestion” they may jump up in response to their alerted nervous system and then collapse. Have I ever heard of a dog doing this during these reductions? No. Is it possible? Maybe.

How long does this take? Hard to say because each dog is different, just as humans who go through this are different. I have done this decrease. I felt just awful. And I had only been on prednisone for about 3 weeks.

So the best way to approach this is to follow the instructions your vet gives you carefully. I think once we describe this to owners they understand the need to reduce carefully. What would not be good is if an owner decided to go cold turkey and stop it suddenly.

Some dogs also may have other conditions that have been responding to prednisone. Arthritis, colitis etc improve with prednisone. Reducing the med will make these conditions worse again. So not only is your dog feeling weak, they are also feeling more joint pain or having digestive problems again. You may think that your dog is relapsing! It is so hard to tease out all the influences prednisone has on the body.

my best, patrice

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