Where is Addison's centered?
Addison's is an imbalance in the adrenal glands; it is an imbalance in hormone levels. Addison's is believed to be primarily genetic with environmental triggers. The adrenal glands are located in front of the canine kidneys and produce hormones. These hormones are important in a body's ability to cope with stress (physical and psycholocigal) plus balance minerals critical to life. Of the two adrenal glands, the Adrenal cortex produces hormones essential to life, including mineralocorticoid, glucocorticoid. Addison's is basically hyposecretion of the hormones or the lack of mineralocorticoids whereas the result is a loss of sodium, and the ability of the body to retain potassium and water. All of the various adrenal produced hormones (there are more than just mineralocorticoid) need to be balanced, the increase in one or decrease in one hormone causes illness. Commercial drugs (corticosteroids or steroids) are available to substitute for the lack of mineralocorticoids produced naturally. However, while low levels of mineralocorticoid causes illness (Addison's), high levels of these steroids (given for other reasons) has a profound effect in the opposite direction and can actually trigger Addison's or bring on an Addison's crisis in dogs that carry the genetics for Addison's. Simply put Addison's is believed to be genetic, even requiring two or more specific genes; however environmental factors are believed to trigger these genes. Without the trigger even those with Addison's genetics may never have or even know they carry Addison's.
When would you see the signs?
Usually after a stressful situation (psychically or psychological) in dogs between the age of 18 months to 7 years of age Addison's symptoms may arrive. The younger age in that range occurs if, for other reasons, steroids have been given to the dog.
The problem with Addison's is that many times it goes undiagnosed until it is too late. What to look for are the commonly reported symptoms, which can vary from dog to dog, and include loss of appetite, weight loss, depression, listlessness, vomiting, diarrhea, hind-end pain, muscle weakness, tremors, shivering, increased thirst, dehydration, excessive urination, a painful or sensitive abdomen, muscle or joint pain, and changes in coat, which may become thicker, thinner, longer, or even curly and about 15 to 20 percent of Addisonian dogs will have dark, tarry stools or blood in their vomit, mental depression, patches of darkened skin, a slow and weak pulse, low body temperature, low blood pressure, and pale mucous membranes. These symptoms usually come in waves; the dog is sick and then seems to get over it for no apparent reason multiple times over a year or longer. Many owners miss these bouts as they can be short in time. This temporary illness is when the adrenal functions are fluctuating but not yet at a critical stage. As the illness progresses a lack mineralocorticoid results in marked changes in blood serum levels (potassium, sodium and chloride). Excess potassium causes a decrease in heart rate leaving the dog predisposed to circulatory collapse and renal failure (acute renal failure is a common misdiagnosis). An adrenal crisis is an acute medical emergency. The dog will need fluids, emergency doses of glucose and perhaps glucocorticoid. This is sometimes given even if the ATCH (Addison's test) is not back yet but blood levels indicate changes in levels of potassium, sodium and chloride (specifically elevated potassium, low sodium, elevated BUN and creatinine, elevated liver enzymes, low glucose, high calcium, low protein (albumin and globulin), anemia, low cholesterol, and metabolic acidosis. A sodium/potassium ratio of less than 27 is strongly indicator of Addison's) indicating Addison's. Once these drugs are given the dog will be over the crisis and seem back to normal. This of course is a preliminary indication that the problem is indeed Addison's. Note, only an ACTH stimulation test can determine positive Addison's. Currently there is NO test to determine if your dog carries the necessary genetics for Addison's. UCDavis is working on this test but it may be years before one is available. Currently, prior to any illness the best you can do is follow the recommendations:
Always keep your dog on high quality foods low in grains (no wheat, corn, and soy); I cannot say this enough; a good food is well worth the price in exchange for long term health. Dogs are carnivores not omnivores, they are not able to digest grains and making a canine body to digest grain causes daily stress on the dogs complete system.
If you are worried, because a dog in your dog's pedigree line has Addison's, you can supplement with licorice root (pill or liquid) daily (consult a holistic vet) to help your dogs body deal with stress. Research has shown that licorice helps prolong the activity of natural (and synthetic) corticosteroids like hydrocortisone.
Digestive enzyme powders (probiotics or good bacteria) are a sensible addition for any dog with digestive problems and can be found at almost all pet stores.
Melatonin (consult a holistic vet) is recommended occasionally (one 3-mg tablet or capsule for a medium-sized dog) 20 to 30 minutes before stressful events such as fireworks, thunder, long distance moves, etc., if a dog has reactions.
Be aware of Addison's symptoms
IF a crisis arrives along checking for other issues (obstructions, etc) request a blood test be preformed to check potassium, sodium and chloride levels. If levels indicate possible Addison's, run a ACTH test (this test is two blood draws one hour apart, after the first an injection is given to stimulate cortisol both blood tests check for cortisol levels) and IF the crisis is a critical situation treat for Addison's with fluids and glucocorticoid. The ACTH test is a blood test and can take up to 24 hours to get the results, the time some dogs do not have.
IF your dog has been diagnosed with Addison's the recommendation is to move to a holistic veterinarians for long term treatment. A dog on long term treatment can lead a normal happy life. Treatments vary depending on a dog's size and the extent of illness plus a negotiated price at your vet for blood work and finding the lowest cost treatments. But in general, long term treatment can be holistic or commercial drugs or usually best a combination of both to reduce dependence on synthetic drugs and lower costs, all and all about $30/month on average. Addison's groups on line can help find the lowest prices for long term treatments. Each dog will vary on what is effective and what is not so obviously that cost varies as well.
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