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Author Topic: Help - New diagnosis of Addisons - Update 21/11  (Read 3371 times)

helshaw

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Help - New diagnosis of Addisons - Update 21/11
« on: November 07, 2013, 04:55:59 PM »

I wrote on this website back in February as Buster had been diagnosed with AIHA and was very poorly, we very nearly lost him. He came off all steroids about 6 weeks ago and its been down hill from then. At the vets most of last week but all blood tests were ok, he did need an overnight stay though as he was dehydrated. He has slowly got worse, not eating and drinking again then tues evening he was so lethargic that I thought he must be dehydrated again so rang the vets. Got an appointment that evening, vet checked him over and straight away said she would get him into Cambridge that evening as an emergency. They did more blood tests, xrays and ultrasounds  and have now diagnosed him with Addisons. Waiting for a call tonight to say he can come home tomorrow but know it will be hard work. Just wonder what else the poor dog will have to go through. If they hadn't found anything yesterday we weren't going to put him through anything else but reading about Addisons I know it is treatable. Any advice would be greatly appreciated.
« Last Edit: November 22, 2013, 07:37:13 AM by helshaw »
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patp

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Re: Help - New diagnosis of Addisons
« Reply #1 on: November 07, 2013, 05:27:02 PM »

So sorry to hear that your poor dog has been through all this. You must feel completely shell shocked. My Whippet was diagnosed with Addisons last year and, as you say, it is treatable. In most cases the dog has tablets called Florinef administered twice daily. Firstly the vets will make sure your dog is fully hydrated and then they will want to get the electrolytes in balance. At first the bloods need checking at least weekly and sometimes you are up and down to the vets every other day. Once they find the right level of dosage things settle down and the blood tests thin out to fortnightly then monthly until, hopefully, it is just a couple of times a year.
Those with more technical knowledge than me will probably ask for the results of the blood tests which are shortened to "lytes" from electrolytes. The results that form the lytes are potassium and sodium. Once these two balance each other out you get a dog that looks and feels well. That's my amateur explanation!
Dogs with Addisons do not deal with stress very well. I have found that my, well socialised, Whippet deals with most things but not travelling and staying in strange places. She has taken part in Whippet Racing and Rally Obedience competitions with no noticeable effect on her health. They are all different though. What stresses one dog will not bother another. If we travel we take a low dose Prednisolone with us to give to her if she appears unwell. Willow is still not right for some reason and we go for yet another referral appointment tomorrow to see if her Thyroid is causing her to be unwell.
Hope this helps a little way towards your journey of understanding this disease.
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helshaw

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Re: Help - New diagnosis of Addisons
« Reply #2 on: November 07, 2013, 05:51:38 PM »

Thanks for the info, poor Buster has been going to the vets every 3 weeks since Feb for blood checks for his AIHA so he will be really fed up of going. I do wonder how much he will have to put up with but if that tail keeps wagging I will know he is happy.
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Jo CIMDA

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Re: Help - New diagnosis of Addisons
« Reply #3 on: November 07, 2013, 10:01:25 PM »

Hi

Your vet has done very well to diagnose Addison's disease and the good news is the prognosis is excellent.  It may take a little while for Buster to become stable but the biggest hurdle of getting a diagnosis is over - thank goodness.  It just goes to prove how difficult it can be to pin point these intermittent signs.  Patp has kindly given you some useful information, but I have copied the section about Addison's disease from my seminar notes.  Some of it is no longer relevant as you already have a diagnosis but I thought it might be useful to others to read the difficulties in getting a diagnosis and also to note the life saving support treatment that is sometimes necessary.

I hope you will see a big difference in Buster very soon.

Jo


Primary Addison’s Disease (Hypoadrenocorticism)

The diagnosis of primary Addison’s disease is not complicated but some vets seem to have a reluctance even considering it in their differential diagnoses. It is often misdiagnosed as CRF (chronic renal failure), heart failure, gastrointestinal disease and even autoimmune haemolytic anaemia (AIHA).  Many vets say “It won’t be Addison’s as we never see it”. Unless your vet is looking for Addison’s disease then it will not be diagnosed.  Addison’s disease is known as ‘The Great Pretender’. Many dogs are presented to their vet at least three times in the six months prior to diagnosis, and many are in an Addisonian crisis before it is identified.  Dogs have died waiting for the results of an ACTH test through lack of supportive care; and this is why I have detailed the tell-tale signs and the supportive care procedure.
The biggest hurdle might be to convince your vet that it’s possible that your dog may have Addison’s disease and not to dismiss the notion without serious consideration and carrying out a thorough investigation and possibly an ACTH test. 
However, even if your breed is known to be predisposed to Addison’s disease, it is important not to become too obsessive and suspect that your dog has Addison’s just because of a bout of diarrhoea or an episode of being a little off colour, but it is equally important to be aware of the telltale signs which could aid a diagnosis and maybe save your dog’s life.

Points to Consider When Identifying Primary Addison’s Disease:

Clinical signs:  Lethargy, depression, nervousness, weight loss, anorexia (no appetite), vomiting, weakness (particularly of the back legs), shaking or muscle tremors, limping, diarrhoea (with or without traces of blood), abdominal pain, dehydration, excessive thirst and urination, weak pulse, slow heart rate and abnormal heart rhythm, anaemia (pale gums) and collapse

Is your dog young / middle aged?

Over a period of time, has your dog experienced several of the typical symptoms and has he/she responded well to fluid therapy?

Has your young to middle aged dog been diagnosed with kidney disease?  Is he/she improving on the special treatment/diet provided by your vet? If the answer is no, then consider Addison’s disease.

Do you have a dog whose breed is known to be genetically predisposed to Addison’s disease?

Do you know of any relatives of your dog who may have been diagnosed with Addison’s disease or kidney failure at a young age, or other autoimmune disease? Speak to your dog’s breeder; they may be able to give you valuable information.

If You Suspect Addison’s Disease

Have a Full Serum Biochemistry panel and a Complete Blood Count test done and ask your vet for a copy of the results for your own records.  Study the results yourself and note any abnormalities. If symptoms persist, have a further blood test done to see if there are any changes, but don’t leave it too long in between (a week or less) as deterioration seems to quicken in the last stages.  Keep all laboratory reports for comparison in the future. Blood testing is never a waste of money (in the long term it can save you money), and it provides a ‘bench mark’ on which to compare further tests.  Addison’s disease is progressive so a blood test is only valid at the time it was taken.  As the disease process progresses the values will change.

The Telltale Signs When Looking at Blood Test Results

Routine Laboratory Abnormalities  -  Haematology & Biochemistry

Sodium/Potassium Ratio

Greater than 90% of Primary Addisonian cases will have low sodium (Na) and high potassium (K) values, with a ratio of less than 27.  (Na:K)
Prior to diagnosis, Addisonian dogs often show a ratio of less than 23. The low ratio alone is very suggestive, but not diagnostic, of Addison’s disease. Individual electrolyte concentrations can be more reliable.

As the disease progresses, the ratio will drop even further and the dog may collapse and become critically ill, especially if stressed or excited.  Stress or excitement, to a dog with reduce adrenal function (even in one who has not exhibited typical, clinical signs of Addison’s disease), can cause the dog to collapse or even die suddenly.

When comparing laboratory results, look for the following as these will indicate Addison’s disease.

INCREASED: 
High Potassium (K)
High Creatinine,
High Urea, (BUN – blood urea nitrogen; or SUN - serum urea nitrogen)
High Urea/creatinine ratio (Azotaemia)
Increased Eosinophils
Increased Lymphocytes
High Bilirubin - in some cases
High Calcium (mild to moderate) – in some cases
ALT- ALP - AST (Mild to moderate increase of liver enzymes) – in some cases

DECREASED:
Low Sodium (Na)
Low Sodium/potassium ratio (K:Na ratio -  less than 27)
Note: Addisonian dogs often have a ratio of <23
Low Chloride (80% of Addisonian dogs will have low chloride values)
Low Glucose – in some patients
Low Albumin (moderate to severe) – in some cases
Total white blood cell count (WBC) – in some cases
Red blood cell count (RBC or HCT)

Another possible difference between kidney disease and Addison’s may be seen in the white blood cells (eg., neutrophils, eosinophils, lymphocytes). When a dog is ill (but does not have Addison’s disease) he becomes stressed and this is often reflected in the white cells.   The neutrophil numbers are expected to be high normal to increased, and the eosinophils and lymphocytes numbers are low normal to decreased. This is called ‘stress leucogram’ and is seen in both chronic and acute renal failure, but not in Addison’s disease.

 A dog with Addison’s disease may show a different white cell reading than would be expected in such an ill dog.  In fact there may even be reverse of what would normally be expected, known as ‘reverse stress leucogram’.

Reverse Stress Leucogram – may be seen in Addisonian dogs

Low normal numbers of neutrophils
Increased numbers lymphocytes and eosinophills

Electrocardiogram
•   Electrocardiogram  (ECG) is a very useful tool to detect various abnormalities of the heart resulting from high potassium levels in the blood.
Another very awkward differential is autoimmune haemolytic anaemia (AIHA).  I have known a few dogs to be diagnosed with AIHA prior to being diagnosed with Addison’s disease. The usual treatment for AIHA had been implemented but the dog’s clinical signs did not improve as expected, and clinical signs of Addison’s disease, remained. 

If this happens you should check for signs of Addison’s on previous blood test results to see if there were any undetected telltale results such as high potassium, low sodium.   These cases are further complicated because of the steroid treatment the dog will now be receiving for AIHA. A diagnostic ACTH test cannot be performed whilst a dog is on prednisolone, as it will interfere with the test results, so the dog’s medication would have to be changed to dexamethasone for at least 2-3 days before an ACTH test is performed.

Prompt diagnosis and treatment, or supportive treatment, is crucial to the outcome of an Addisonian crisis and must be treated as a true emergency if the dog is to survive.

Life Saving Support
From BSAVA Manual of Small Animal Endocrinology, Chapter 19 – Endocrine Emergencies

“Whenever a diagnosis of Addisonian crisis is likely, treatment should be initiated without delay.” 
“A tentative diagnosis of acute adrenocortical insufficiency can be made on the basis of the history and results of physical examination.”
“Since death from acute adrenocortical insufficiency is usually attributed to vascular collapse and shock, rapid correction of hypovolaemia is the first priority in treating this condition.”
1.   Restoring blood volume and
2.   Correcting imbalance of sodium and potassium levels and
3.   Treatment of life threatening cardiac arrhythmias
Within 1-2 hours, a saline only intravenous drip can restore correct hydration status, increase sodium levels and lower potassium levels which may be causing hyperkalaemic myocardial toxicity. In addition, other protocols may be used if myocardial toxicity is life threatening.
4.   Correct glucocorticoid deficiency *

*Dexamethasone is usually given as this has little or no effect on the measurement of endogenous cortisol concentrations and therefore does not interfere with the ACTH test.

Once diagnosis is achieved, the prognosis for an Addisonian dog is excellent. The dog should feel much better in a few days but it may take up to 6-8 weeks for the clinical signs and blood results to return to normal. Once stabilised the dogs will be maintained on Florinef (a mineralocorticoid with some glucocorticoid) only needing low replacement dose of prednisolone at times of stress (the ‘supply and demand’ facility for the fight/flight’ response is no longer available to Addisonian dogs).  It might be prudent for the owner to anticipate stress such as a brewing thunderstorm and give a low, one off dose of prednisolone.  Life-long, daily hormone replacement therapy is essential. The oldest dog with Addison’s that I have known was over 16 years old when she died, so getting that diagnosis is worth fighting for.
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helshaw

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Re: Help - New diagnosis of Addisons
« Reply #4 on: November 08, 2013, 07:41:24 PM »

Thanks for the information. We picked Buster up this evening from Cambridge & they have said his potassium & sodium levels are already stable so thats good. Its like having a different dog home from when we took him Tuesday. As soon as he came in the house he was barking & we've not heard that sound for a couple of weeks, it was music to my ears. Bit worried about whats to come but we will deal with  whatever like we did back in February. Thank you for the support.
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patp

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Re: Help - New diagnosis of Addisons
« Reply #5 on: November 09, 2013, 04:05:29 PM »

Glad to hear that Buster is feeling so much better!

One thing I wish I had done was keep a diary of symptoms. The vet always asks "how long has this been going on?" or "When did this start?" and I always struggle to remember and then feel awful!
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helshaw

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Re: Help - New diagnosis of Addisons
« Reply #6 on: November 09, 2013, 07:37:00 PM »

Patp, your'e not on your own there so don't feel bad. You just seem to start noticing little changes but sometimes we just put them down to feeling under the weather. When Buster was poorly back in February it seemed to happen all in the space of a day as he was sick then later that night I noticed his gums were really pale so I rang the emergency vet and it was down hill from there. In hindsight there must have been things going on before that but I didn't notice so I feel really guilty. This time I had been backwards & forwards to the vets & he had loads of blood tests, then he was admitted because he was dehydrated then he picked up a bit until he was finally dehydrated again & was admitted to Cambridge. He has had a really good day today but I'm really not sure about exercising him, thought a walk round the block will do tomorrow just to see how he is. Let me know how Willow gets on, they are such a worry but we love them to bits.
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Penel CIMDA moderator

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Re: Help - New diagnosis of Addisons
« Reply #7 on: November 09, 2013, 10:05:32 PM »

Take it really really easy with the exercise - a little wander up the road will do - just for a wee etc then home again.
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helshaw

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Re: Help - New diagnosis of Addisons - Update 21/11
« Reply #8 on: November 22, 2013, 07:41:04 AM »

Buster has had his first check up after being diagnosed with Addisons and his bloods were normal so really pleased. He hasnt put on any weight that he had lost but as she said its only been a couple of weeks. Lets hope it continues.
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Jo CIMDA

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Re: Help - New diagnosis of Addisons - Update 21/11
« Reply #9 on: November 22, 2013, 11:17:04 AM »

Buster has had his first check up after being diagnosed with Addisons and his bloods were normal so really pleased. He hasnt put on any weight that he had lost but as she said its only been a couple of weeks. Lets hope it continues.

That is fantastic news and things are really looking up for Buster. 

Great!!!

Jo
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patp

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Re: Help - New diagnosis of Addisons - Update 21/11
« Reply #10 on: November 25, 2013, 06:38:08 AM »

So pleased for you and Buster! ;D
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