JFK, Bin Laden and Duke, Continued…

So I wrote this at my mom’s house in Houston this weekend, using MS word, and cut/pasted it onto this page and it’s totally screwing up the fonts and I have no idea how to fix it, so I apologize in advance for anybody who is farsighted (as it seems to be printing it teeny tiny).  I deleted the post and am trying to re-cut/paste, and we’ll see how it goes…maybe it will heal itself …


So Duke got sick again.  He was acting just like he did back in August, when this all started, refusing to eat and drink, very nauseous, painful in his abdomen.  He didn’t look good.   


We had been lowering his Prednisone dosage in an effort to wean him off and just control his IBD with diet.  So my first thought was to bump up his Pred again.  However, I decided I’d better recheck his blood work, to see if anything had changed with his inner workings. 


Duke’s blood work came back very abnormal.  His potassium level was dangerously high, his sodium was very low, and his kidney values were up a little.  Sodium and potassium are electrolytes contained within the cells to control little functions like muscle contraction.  Potassium, in particular has a pretty narrow safety margin as far as blood levels go.  Elevated potassium levels can wreak havoc with muscles, and most importantly the heart muscle…(it can slow down the contractions to the point of cardiac arrest).  


Thankfully, Duke’s heart rate was normal, but we had to get him in and drop those levels fast.  I called Duke’s poor mom and told her to bring him in immediately, probably scaring her half to death, but I didn’t want to lose him now, after all the work we’d done.  Plus, it sure was looking like we’d finally gotten our diagnosis. 


Remember, we’re in zebra land here.  But, of the zebras, the most likely one to cause the changes in sodium/potassium, and the non-specific GI signs, and affect  (usually middle aged but sometimes…) younger dogs, is Addison’s disease.  When I was in veterinary school, they told me I would diagnose this maybe once in my career.  So far I’ve diagnosed it somewhere around 3 times in 10 years and it’s unbelievably challenging every time.   


Oh, and back to the original title of this post:  JFK, and Osama Bin Laden had Addison’s disease.   


The actual name for Addison’s disease is Hypoadrenalcorticism,  (my spell checker just underlined this, guess MS word isn’t up to date on it’s medical terminology) Anyhow, basically, it’s an under active adrenal gland.  These little fellas  (adrenal glands) are little lima bean shaped glands that sit just adjacent to the kidneys.  They produce steroid hormones like:  corticosteroids which control how we deal with stress, and mineralcorticoids that control stuff like whether or not we drink water and our electrolyte balances.  They do other stuff, but I’m super simplifying things because these little nondescript glands are unbelievably complicated, and I’m not an endocrinologist. 


So in Dukes case, his Addison’s came on fairly slowly.  First he developed a deficiency in corticosteroids, which contributed to his sickness back in August (given his super low blood protein levels, I think he may have had a little IBD too along with it).  That deficiency was treated with the Prednisone (a corticosteroid) and he got better, at first. Then the adrenal glands atrophied some more, and he developed the mineralcorticoid deficiency, which made him sick in October, and FINALLY caused him to have the “classical” Addison’s sign of weakness, screwed up Sodium/Potassium levels, etc.


The “good” thing about Addison’s is that once you diagnose it, the treatment is really straight forward, and the dogs do really well.  You supplement the missing hormones (either by injection, or pills).  Personally I like the shots best because you don’t have to tweak the dose and they stay more consistently healthy.   The bad thing is that the shots have to be given every 25 days, and in a dog Duke’s size run around $140 per injection.  Over time the pills don’t save you much because they end up needing to come in for blood work more often because they don’t seem to do as well. 


All in all, this saga ended up costing Duke’s owners a large pile of money (or next years trip to Mexico… as his mom mentioned).  This is where people throw their hands up and proclaim that they would never dream of spending that on their dog (although I’ve seen plenty of people spending over $2500 just BUYING those trendy English Bulldogs. I’m not even going to get into that…).    An old vet once told me that I should ask clients if they want “THIS” dog or “A” dog.  I’ve never had the nerve to actually ask that, but it’s on my mind A LOT.  I understand that vet bills have the ability to skyrocket, and as my dad likes to point out (jokingly) that “ a bullet costs pennies”; or my husband mentions “how much is a new dog, like $100?”  Those viewpoints are totally fine (to a degree), there are plenty of good dogs out there that need homes, but I am trained to help both kinds of clients as best I can.  My job is to give you the treatment/diagnostic options, and your job is to take all that info and figure out what you want to do.  Duke could have been put down months ago (and that is ok, for whom need to make that decision, either way he wouldn’t be suffering anymore), but his owners wanted THIS dog, so I treated him to the best of my ability, and he should live happily ever after.  


His owner came by the other day and said he’s “a new dog”, running and playing, doing things they forgot he used to do.  That, my friends, is one super wonderful vet moment.  The absolute victories seem to be few and far between, too often complicated cases end in sadness…I will relish this one.  

Buenas Noches! 


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