Canine Addison’s disease is referred to as the great pretender for a reason. The signs and symptoms are ambiguous and can be interpreted in many different ways.
Sadly, many dogs don’t get their diagnosis until they collapse. Thank you, Deanna Lee, for sharing Valentino’s story to help raise awareness for this disease.
Valentino’s story
Valentino came into my life in Feb 2007. He became my foster after a close call at a high kill shelter.
Valentino was half an hour from euthanasia.
He was an emaciated stray, missing most of the hair on his sides (his skin was bright shiny pink!) and a strip of blond hair like a mohawk down his back. He weighed barely 30lb—he is now a healthy 55lb. It took three months to restore him to health and put some weight on him.
By that time, I had become a foster failure, and Valentino was all mine!
He slept most of those first three months between meals and going potty before he seemed to have recovered.
We started going to a dog park regularly, and he loved chasing after tennis balls. For a couple of months, he seemed like the ever-ready bunny—never wanted to stop playing.
The first symptoms
On a few occasions, he would chase the ball 5-6 times and then lie down next to me. He was done playing.
When we got home, he would lie in the car and refuse to get out. That’s what I thought at the time, not realizing he had no more stamina or energy left …
These are the symptoms Valentino had:
- lethargy
- lack of energy
- inability to get in/out of the car
This went on for a couple of months. While Valentino never lost his appetite completely, he started picking at his food, trying to eat.
I knew something was wrong. However, each time I reported his odd behavior to our vet, she dismissed his behavior as “acting out.” She never suggested any testing.
The collapse
Ten months after being rescued, Valentino collapsed completely. It took me several hours before I could get him out of the car after going to the dog park.
Our journey with Addison’s disease began.
Valentino’s vet couldn’t “fit” us in for another week, so we went to a friend’s vet. This new vet, whom we had never seen before, even carried Valentino from my car to the office and back to the car to go to the specialty hospital for the ACTH.
This vet acknowledged that she had never been diagnosed with AD before and was unfamiliar with its treatment. She deferred to the IM specialist.
He referred us to for treatment, yet he suspected Addison’s immediately after his initial exam.
Our research
While I was at the specialty vet clinic, a friend researched canine Addison’s disease online. She found the Addison’s Dog support group at yahoo groups, and it was a welcome lifeline!
It was confusing for the first year. I was reading things in the group that was different from what the IM specialist was telling me.
I later realized that people in the online community were much more knowledgeable about canine Addison’s than even many IM specialists and vets in general. This is because they live with their Addisonian dogs 24/7 and see subtle changes in their sense of well-being and the effects of too much or too little medication.
It’s hard to know if Valentino was already suffering from AD when he first became my foster. When I first got him, e was very ill and emaciated.
The treatment
After his collapse, he spent two days at the specialty hospital. A few days later, he felt well enough to try to abscond with the Christmas duck. Luckily he was nabbed en flagrante as he was heading out the doggie door. The duck survived to be served for Christmas dinner as intended! And yes, he did get some of the duck for his Christmas dinner as well.
Valentino was started on Florinef/compounded fludrocortisone at .4mg (lower than recommended for his weight) and 2.5mg pred in 12/07. He stayed at that dose for a year as his electrolytes were perfect.
After a year, his electrolytes went out of control. He had weekly increases in his Florinef within the next six months until he arrived at 2mg. However, his electrolytes were still not under control.
(He may have initially only needed .4mg. This is because his adrenal glands were still normal size via ultrasound and may have still had some function left that first year.)
Our treatment experience
One of the patterns I’ve noticed over the years, though, is that many dogs started on a lower dose of Florinef/fludrocortisone than the recommended .1mg/10lb, and on a higher dose of pred is that they end up playing catch-up later. As a result, it seems more challenging to get their electrolytes under control. This also ended up being our experience.
I should also note that Florinef/fludrocortisone is a human medication. Some dogs are not able to metabolize it efficiently and need increasingly higher doses or need to use the monthly injectable med – Percorten-V.
We found a vet 1.5 hrs away who was willing to work with us and start Valentino’s Percorten-V dose at 1.8ml. This was considered the “low dose” in 2009 (0.75mg/lb vs. 1mg/lb standard dose). The standard dose was 2.2ml (I remember thinking I wouldn’t even get two doses out of each vial at a monthly cost of about $100 just for the Percorten!) Over the years, we slowly reduced by 10-20% at a time. We started at 1.8ml in 7/09 and did not even get to 1ml til 9/10, .75ml in 6/11, .5ml in 10/13, current .4ml in 9/14.
We were a lot more conservative back then, and we did not have enough info on going to lower doses, except through the experiences of other group members.
It was all new territory!
If Dr. Julia Bates’ low dose study had been available in 2009, we could have started at .95ml and gotten to Valentino’s lowest effective dose that much sooner. Not only would Valentino have felt better all month long between shots, but we would have saved thousands of dollars on both Percorten and monthly lytes testing as a bonus over the years.
I can’t say enough about the difference being on lower doses has made in how Valentino feels throughout the month, with his electrolytes staying pretty close to the mid-range between doses.
Treatment side effects
Valentino spent years doing “ok”— mopey, lethargic for two weeks after each shot. Then, he’d feel a little perkier about a week before his next shot was due. And then he became lethargic again when he got another shot. So now he’s doing “great” all month long on a much lower dose of percorten!
Along with the most recent Percorten reduction, I’ve also been able to reduce his pred to .5mg – he’d been hovering between .75mg in the winter to 1.25mg in the summer for years. We switched to liquid prednisolone as his liver enzymes became slightly elevated, and he had started to shed a lot more.
PS – Valentino’s plight as a sick, unwanted stray was the inspiration for my deep commitment and involvement in animal welfare issues in San Antonio! How many dogs just like Valentino have died because there was no one to step up for them before the mandatory 72 hr stray hold period expired?
Do you have a dog diagnosed with Addison’s? Is your dog unwell, and nobody can figure out why?
Written by Deanna Lee
Addison Dog’s Facebook support group comprises individuals worldwide who are striving toward healthy, active lives for their canine friend(s) with Addison’s disease. They seek to improve wellness for the whole dog—including body, mind, and spirit.
Addison Dogs also works to educate and support the companion animal community about Addison’s disease in dogs. The goal is to foster open communication about the variety of options available to the caregiver of a dog with Addison’s disease.