This week’s blog was written by our wonderful Senior Internal Medicine Nurse, Laura!
3-year-old Pug, Pudding, initially came to The Ralph towards the end of last year.
He had been suffering from episodes of vomiting and diarrhoea, lethargy and reduced appetite for around a month. He improved a little with supportive medications, but this improvement was not sustained.
Blood tests performed at Pudding’s primary care vet showed an increase in his kidney values. This is a measure of the waste products creatinine and urea in the blood. These waste products should be flushed out of the body in the urine, so high kidney values indicate that the kidneys may not be functioning properly.
Tests also showed some changes to Pudding’s electrolyte (salt) levels, so he was referred to our Emergency + Critical Care Service for further investigations.
When Pudding arrived at The Ralph, he was lethargic and severely dehydrated with bradycardia (a slow heart rate) and weak pulses. Blood tests showed a dangerous elevation in his potassium level and a reduction in his sodium level. He was treated with high rates of fluid therapy (a drip) to correct his dehydration and supportive medications to manage his vomiting and diarrhoea.
Our clinical team suspected Pudding had Addison’s disease (hypoadrenocorticism). This is a disorder affecting the adrenal glands. These two small glands (which sit next to the kidneys) play several important roles in the body. The outer layers of the adrenal glands (the cortex) secrete steroid hormones, while the middle of the adrenal glands (the medulla) make our “fight or flight” hormones like adrenaline.
Addison’s disease is seen when the body’s immune system destroys the outer layers of the adrenal glands, affecting their ability to create steroid hormones. Two hormones are affected – cortisol and aldosterone. When the body can’t produce enough cortisol, we see signs such as vomiting, diarrhoea, lethargy and a loss of appetite. These signs can be gradual in onset and hard to diagnose initially.
As the disease progresses, the body also stops being able to produce enough aldosterone. Aldosterone is an important hormone in regulating the balance of electrolytes (salts) in the body – particularly sodium and potassium. When the body can’t create enough aldosterone, potassium levels become very high, and sodium levels become very low. This is a medical emergency (as high potassium levels can have dangerous effects on the heart) and is known as an Addisonian crisis.
Addison’s disease is a lifelong condition. Dogs with Addison’s disease require two medications – a steroid tablet given every day, and an injection which is given once every 4 weeks. In addition, because dogs with Addison’s disease are less able to cope with stress or general illness, they have to be closely monitored, both in the hospital and at home.
Pudding had presented to us in an Addisonian crisis. We performed a specialised blood test called an ACTH stimulation test to diagnose his disease – this involves taking a blood sample, then administering a drug that stimulates his adrenal glands, then repeating the blood test an hour later. Unfortunately, Pudding’s results confirmed our suspicions, and he was diagnosed with Addison’s disease.
After his diagnosis, Pudding began treatment with a steroid injection and steroid infusion (drip) to replace the hormones his body could no longer make. He remained hospitalised in our Dog Intensive Care Unit (ICU) for 3 days, to continue his fluid therapy, steroid injections and close monitoring of his heart. He was discharged back to his family on Christmas Day.
Pudding came back for a follow up with our Internal Medicine team in the New Year to discuss long-term management of his Addison’s disease. He looked like a different dog! He was already much happier, more alert and active, eating more normally and much more like his old self. We performed some blood tests to make sure his medication doses were appropriate, and to provide support and guidance to his family as they adjusted to life with Pudding’s new condition.
In the early stages of treatment, regular visits and blood tests were required to make sure the doses of Pudding’s medications were appropriate, and to administer his 4-weekly steroid injections. At each visit, Pudding looked happier and happier.
Throughout his treatment Pudding has been an absolute star. He has done so well that at his most recent visit, Laura, our Senior Medicine Nurse, taught Pudding’s family how to administer his steroid injections themselves at home:
Pudding now only needs to have his blood tests performed 2-3 times each year, and will be able to live a perfectly normal and happy life.