How to recognize and treat this serious disease
Over the past few decades, I have seen an alarming increase in hormonal conditions in dogs and this also includes adrenal gland problems. This article is for you if your dog's breed is genetically predisposed to this life threatening condition or if you have already received the diagnosis. Please read the whole article before purchasing supplements for Addison's disease.
Superheroes in your dog's body
The adrenal glands are hidden right by the kidneys and they truly are the superheroes of the canine body. They help the body fight the evil forces of stress, viruses and bacteria and ensure the bloodstream electrolytes are in perfect balance. Most people do not realize that without properly functioning adrenals, the heart would stop and no mammals would be able to live.
Who was Dr. Addison?
Adrenal glands suffer from two opposing pathologies, hyper-function (Cushing’s disease) and hypo-function (Addison’s disease). Hypoadrenocorticism was discovered by Dr. Thomas Addison, who was an extremely talented and dedicated physician. Dr. Addison worked in Central London’s Guy’s Hospital. In addition to discovering that hypo-function of adrenal glands can lead to serious and life-threatening disease, he was also the person behind the discovery that vitamin B12 deficiency can lead to pernicious anemia.
However, as often happens, people with extraordinary talents have their shadows. Dr. Thomas Addison suffered from deep depression and eventually committed suicide.
Who is at fault? The general or the soldier?
The adrenal glands can be thought of as the body’s two soldiers who
report to the captain - the pituitary gland in the center of the brain. The pituitary gland can be viewed as the 'hormonal thermostat' that continuously monitors the hormone levels including those of adrenal glands. If the levels are low, the pituitary gland (the thermostat) signals the adrenal gland to produce more adrenal hormones.
However, the hierarchy doesn’t end there. Hypothalamus is the endocrine system’s 'general' that governs the pituitary gland and how much hormone is produced. It is located in the center of the brain.
This means that Addison’s disease can be caused by the dysfunction of either 'the general' (the hypothalamus), 'the captain' (the pituitary gland) or the 'soldier' (the adrenal gland). If any of these elements do not do their job, there will be a lack of adrenal gland hormone.
If you are like most people, reading any medical book makes you feel like you have every disease out there. Because Addison’s is called the “great pretender” it is quite difficult to diagnose and is often missed.
There are two key symptoms that always make me think of Addison’s disease:
- A fluctuating cyclic pattern of diarrhea that often happens after a period of increased stress
- Periods of listlessness and lethargy
Dogs usually do not appear sick and at first the blood chemistry appears to be normal. Later on, you may start seeing potassium and sodium levels creeping away from each other, with potassium too high and sodium in the low to normal level. Diagnostic labs in different countries use different units so it is easier to say that if potassium is high and sodium low or low normal, it is a warning sign.
Adrenal glands regulate electrolyte levels in the bloodstream. Potassium and sodium’s primary role is to regulate hydration and balance between the intracellular and extra-cellular space. The heart and other muscle contractility are dependent on very precise potassium and sodium levels in the bloodstream and the heart can simply stop if Addison’s is severe enough.
Most common causes
My clients often ask why a certain condition happened to their dog and if it could have been prevented. Most people would love to hear a simple explanation for a disease, but most diseases are caused by a multitude of factors. In order to prevent disease, one has to look at as many contributing factors as possible.
Addressing as many as we can will statistically reduce the likelihood of disease. Some people still believe that certain genetic tendencies will express no matter what, but many of these predispositions will never turn into a disease if we address other predisposing factors. Here are some that play a significant role in development of Addison disease:
- Processed food that causes nutritional imbalances, excessive toxin build-up and immune system stimulation such as wheat gluten, starches, preservatives, fungi and molds in food
- Excessive vaccination overwhelms the immune system and causes dysfunction, in which the body starts creating antibodies against its own tissue and glands
- Essential nutrient deficit - minerals, amino acids, omega oils and vitamins
- Injury or congestion of the spinal energy flow, especially in the region of the third lumbar vertebra. This section of the spine supplies energy to the kidneys and adrenal glands
- Excessive stress, physical or emotional trauma such as abandonment or abuse
Poodles, Leonbergers and Nova Scotia duck tolling retrievers are the most predisposed to Addison’s disease. On the other side of the spectrum, American pit bull terriers, American Staffordshire terriers, Chihuahuas, cocker spaniels, golden retrievers, Lhasa Apsos, Schnauzers, and Yorkshire terriers are the least predisposed.
The up and down roller-coaster ride
Addison’s disease is often missed as the cause of lethargy, muscle weakness and exercise intolerance, low appetite and digestive problems.
A dog with adrenal insufficiency (Addison’s) has usually repetitive up and down patterns of being unwell and then doing fine. The symptoms range from mild to very severe. When the adrenal glands lose the ability to produce adrenal hormones completely it is called an Addison’s crisis and is life threatening.
The most significant change in dogs’ adrenal insufficiency is the shift in the levels of potassium and sodium. For easier explanation, it is as if potassium and sodium were two repelling magnets. Their values move apart - sodium low and potassium high. While some other blood chemistry parameters can go up and down by tens or even hundreds of units, potassium and sodium values that shift just by a few tenths of a unit can have serious life-threatening consequences.Their precise concentration is essential to good health and life. That is why early and accurate diagnosis is so important.
Diagnosis - step by step
- Blood work consisting of chemistry, complete blood count and thyroid values.
- Urine examination.
- An ultrasound to assess the adrenal gland size can be very helpful. Some practitioners reach immediately for the ACTH stimulation test. I like to do an ultrasound first because dogs with adrenal insufficiency usually have a small adrenal gland. Doing an ultrasound also helps to rule out other potential problems such as tumors, pancreatitis, gall bladder issues or intestinal foreign bodies. I suggest that an ultrasound is done under the guidance of a specialist. Some general practitioners have ultrasound machines, however, it takes time to acquire the proper skills to interpret the findings and mistakes can be easily made.
- The ACTH stimulation test usually confirms the diagnosis of Addison’s disease. It consists of measuring the cortisol levels in two blood samples. One sample is taken before and one after an injection of ACTH (Adreno-Cortico-Trophin-Hormone). ACTH is a pituitary gland hormone that stimulates the adrenal glands to produce cortisol. If the cortisol in the second blood sample is low, it means that the adrenals are insufficient and the patient has Addison’s disease. A single blood cortisol level test without running ACTH test may be helpful, but a stimulation test is usually needed to confirm the diagnosis.
When it comes to treatment of any hormonal condition, a very precise and well-organized approach to treatment and good client-practitioner communication is the key to success. Regular blood test rechecks and fine tuning are usually required.
Treatment of all cases of Addison's disease
- Put your dog on Livton (liver support and cleanse) for the first two months, the rest of the supplements below should be given on ongoing basis:
- GreenMin - mineral, amino acid rich, green superfood
- GutSense - canine-specific probiotics cleanse the intestinal tract and support the immune system.
- SoulFood - a certified organic multivitamin
- Consult with a chiropractor or physiotherapist to improve spinal energy flow especially in the region of the third lumbar vertebra.
- Try to avoid unnecessary stress, drama or over-strenuous exercise. Healthy moderate exercise is good. Ball retrieving, frisbee or agility is not recommended for dogs with Addison’s.
If your dog has marginal adrenal gland function, but is relatively asymptomatic, I suggest using no drugs and Skip STEP B if this is the case. (This situation is relatively rare because Addison’s is usually diagnosed when a dog already has clear symptoms.)
Additional treatment for moderate to advanced cases of Addison’s disease - dogs that are symptomatic
Despite my strong preference for holistic medicine, in the case of moderate to advanced cases of Addison’s, I usually suggest using conventional medication, in addition to the above protocol. In my opinion, dogs with moderate to severe Addison’s disease can rarely restore normal adrenal function. Supplementing adrenal hormones is essential, in addition to the above-mentioned supplements.
To treat Addison’s we need to supplement two groups of hormones: Mineralocorticoids and Glucocorticoids
These are the hormones that regulate electrolyte levels, such as Aldosterone and its precursor Deoxycorticosterone (DOC). These two hormones stimulate the kidneys to let go of potassium. If they are missing, as in the case of Addison’s disease, hyperkalemia (high potassium state) occurs.
Mineralocorticoids can be artificially supplemented in two forms:
• Fludrocortisone acetate (brand name Florinef)
• Desoxycorticosterone pivalate (brand name Percorten-V)
While Florinef is less costly then Percorten-V , I have never seen a dog that did well on this drug. Several patients who came to me for a second opinion did so because they did poorly on Florinef. They recovered and did very well as soon as they were switched to injections of Percorten. Knowing this, I always suggest my clients use Percorten-V and supplement Prednisone in minimal required doses.
The name glucocorticoid is derived from the words (glucose + cortex + steroid) suggesting that these hormones’ function is to regulate glucose, which is true, to a point. However, these hormones have a wide array of effects on every cell in the body and are capable of reducing inflammation, but also heavily suppress immune system function. Supplementing these hormones in Addison’s disease may or may not be necessary and your veterinarian should help you establish the accurate dose.
Most practitioners would use prednisone as the drug of choice in Addison’s disease. Addison’s is, in fact, the only indication where I prescribe steroids in my practice because the body does not produce them on its own.
I have seen that most dog guardians are able to recognize when prednisone is needed. The need is usually higher at times of stress, travel or increased demands on the body in general. I would like to repeat that this is a very rare situation where supplementing steroids is necessary and not contraindicated from the holistic point of view.
The goal of any hormonal therapy should be to use minimal doses of medication and attempt to restore the normal production of the natural hormone. This can only happen in a dog that has a mild form of Addison’s disease or has no signs, but is considered predisposed. As in every other medical condition, the best way is to support the predisposed patient so he or she never reaches the clinical state. I hope this article will help you do exactly that.
If you are aware that your dog’s breed is prone to adrenal disorders, focus on feeding a healthy raw or cooked diet, adopt a minimal or no vaccination protocol and supplement essential supplements such as GreenMin, Soulfood, omega oils and probiotics. I normally do not recommend giving canine adrenal support, unless there a is an obvious weakness of the adrenal glands.
If your dog has already been diagnosed with Addison’s, getting used to the treatment protocol takes some time, but it is worth it. After the initial dose adjustments and repeated testing, the right protocol and dosages are usually established and most dogs do well. Normal levels of potassium and sodium, good energy and overall symptom resolution are good indicators of successful treatment.