Vet Blog
11/14/09
 My 10 month old dog got spayed this past Tuesday. She was fine on wed except for excessive thirst and urination. Thursday she started to pant and shake A LOT! I took her back to her vet who said that during surgery (he didn’t tell me this previously) he had a problem hematoma I think, and he had to give her steroids intravenously to reduce the risk of shock.
He took a full panel of blood work and all shows normal as well as her temp. He believes it is all the steroids working their way out and suggested giving her 1 tsp. of baking soda to 1 qt. of water. I did that. I am taking her out every 10 minutes to pee, she is shaking and panting like crazy and I am really concerned and worried. Any ideas or suggestions?
Amy
I agree that the steroid injection probably caused the symptoms you describe. Steroids are very useful medicines in many situations. In some instances (such as when there is a risk of shock), steroids can be life saving.
However, steroids are very powerful medications. They can cause many side effects. Panting, restlessness, trembling, and increased urination are among the most common.
The side effects should wear off as the medicine clears from your dog’s system. This may take several days.
I think you should talk to your vet more about why the steroid injection was administered. Steroid injections are not routine during spay surgeries. If your dog was at risk of shock, you should try to learn more about why that happened–shock is a very rare (and serious) development during routine surgeries. Was the problem something that might occur again in the future if she is anesthetized? Might there be complications from the problem as your dog matures? For the sake of your dog, you need to know the answers to these questions.
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10/22/09
As I was driving home from work this morning after a night shift I heard a story about the health care debate on the radio news. The topic was one of the most poorly understood concepts in the debate: unnecessary diagnostic testing.
Many people have cited the elimination of unnecessary tests as a way to reduce health care costs. As a medical clinician I would like to know how an unnecessary test is defined.
It is not possible to know whether a diagnostic test is necessary without knowing the results. In other words, it is not possible to know whether a diagnostic test is necessary without running it. Only with hindsight can one determine whether the test was needed.
Consider the following example from veterinary medicine. Imagine your dog has suffered a two day period of lethargy and poor appetite. You authorize your veterinarian to run basic blood tests. The results are normal, but the ratio of blood sodium and potassium levels is on the low end of what is considered normal.
In cases such as this, the overwhelming majority of dogs do not have a serious condition. Transient gastrointestinal upset due to dietary indiscretion is most likely. An adverse reaction to a mild toxin also may be to blame. A self-limiting viral infection or dozens of other mild pathologies could be the cause of the issue. All of these problems generally resolve on their own.
But a much more serious problem can cause the symptoms and initial test results I have described: Addison’s disease. Addison’s disease is much less common than the milder problems I have described above. But if it is not detected and treated it is deadly.
The test for Addison’s disease is specialized and expensive. It is non-invasive and low risk. Without the test, it is not possible to know whether the syndrome is causing the symptoms. The treatment for Addison’s disease can be harmful to dogs who don’t have the syndrome.
Imagine that one out of every thousand dogs with lethargy, poor appetite, and a borderline sodium to potassium ratio has Addison’s disease. If a thousand dogs develop the symptoms I have described (and initial test results are as I have described), 999 of them will get better without treatment. One will die.
Those may sound like good odds. But what if your dog is the one?
If you think a one-in-a-thousand chance isn’t bad, I hope you don’t buy lottery tickets. The odds of hitting the mega jackpot make one-in-a-thousand look almost certain.
When I treat dogs like the imaginary one in this post, I always recommend the test for Addison’s disease. After I get the results, I usually learn that the test was not necessary. But every once in a while the test saves a dog’s life. In those instances the test was very necessary indeed.
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09/04/09
 Four day ago the groomer found a rash on my Shi-poo’s tummy and thought it may be ringworm. We went directly to the vet to see what it could be. He said that it was a summer time rash and gave her a prednisone shot.
The rash did clear, but then she started having to pee a lot. She sleeps with us, and that night she peed in the bed. She has never done that before (she is 2 1/2 years old). Then she did it again last night. She is having to pee approx. every several hours. I can not let her sleep in the bed any more till this resolves itself, so I slept on the couch with her.
Could the shot have made her have the urination problem, or do you thing there is more that just a rash going on? After all the food and treat scare I am worried that it could be another food comtamination or just disease.
Donna
Hoover, AL
The prednisone injection almost certainly is the cause of your dog’s excessive urination.
The “summer time rash” that your dog developed likely was an allergic reaction to one or more allergens.
Prednisone is simultaneously the best and worst medicine ever invented. Prednisone is a very effective allergy treatment. It also treats a host of autoimmune diseases and skin diseases. But it has many side effects.
The first side effects that animals show after receiving prednisone are increased thirst and urination, panting, and behavior changes (sleeplessness, aggression, or lethargy). After a while, increased appetite may develop. Animals that receive prednisone are prone to infections. Long-term prednisone use may lead to diabetes (cats, dogs), kidney failure, or liver failure.
Your dog’s excessive urination should go away as the drug is eliminated from her system. She is unlikely to suffer any long term consequences from the prednisone injection.
I often tell clients that prednisone is a double-edged sword, and your situation is a perfect example. The medicine cured the skin rash as intended. But the medicine also created a new problem.
Prednisone always should be used with caution.
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07/10/09
 My cat, Beau, goes through times when he seems to eat very little food. I watch for other symptoms,but never see anything else. He gets regular vet care. My response is to go out and buy different food from the pet store but when he starts eating again, he eats the same old thing. He only recently started going out but on a leash or tether as the apt. complex where I live does not allow pets to run loose so I know he is not getting in fights, etc. He is on prednisone for asthma. He gets regular blood tests to monitor his level. What’s a worried Mom to do?
Lelia
Lewiston, Maine
Whenever a client expresses concern about her pet’s appetite, the first thing I do is check the pet’s weight. An individual’s weight is the most certain measure of whether he is eating enough.
It sounds like Beau has been to the vet very regularly. The vet should be weighing your cat every time he comes in. I’d recommend that you call the vet’s office and find out whether his weight has been trending up or down or staying stable.
If your cat is maintaining his weight, then I would be less worried about his bouts of inappetence.
If you are worried nonetheless, or if his weight is trending down, then I’d recommend more diagnostic tests. In addition to the routine blood tests that have been run to monitor for adverse effects from prednisone, consider urine tests, tests for leukemia and feline AIDS, X-rays, and an abdominal ultrasound.
The sort of comprehensive tests I’ve described very likely will show whether anything is wrong. But if your cat’s weight is holding steady, I’ll bet that he’s fine.
Photo: Missy digs in.
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08/16/08
 My nine-year-old Orange Tabby has vomited periodically most
of her life. Within the last few months, her
vomiting has increased to the point that I had to
rush her to vet ER. They hydrated her, ran
blood tests, xrays, etc.
Her vet says she is most
likely allergic to her food, so we switched her to
limited ingredient dry food. To combat her
nausea, her vet put her on ground up Pepcid AC,
which she will only consume in a little of the
water from a can of tuna. I also give her a bit
of Kitty probiotics and brush her twice a day.
Her vomiting is not diminishing in spite of all
the treatments and the vet said exploratory
surgery is all that’s left, which is not what he
recommends nor do I want. I even tried her on
raw cat food, which she tried once and vomited and
now won’t touch. Are there any natural means you
could recommend?
Jill
Portland, Oregon, USA
It sounds like you and your cat are going through quite an ordeal!
Many things can cause cats to vomit. Food intolerance, metabolic disorders (such as liver or kidney disease), foreign objects in the stomach, neurological problems, heartworm disease, intestinal parasites, tumors, problems with the pancreas and exposure to poisons are among the many offenders, and this list is far from complete.
However, in cats that have a long history of vomiting that worsens precipitously I am often suspicious of a syndrome called inflammatory (or infiltrative) bowel disease. The syndrome is also known as IBD.
Cats with IBD suffer chronic irritation of the intestines. This leads to vomiting, diarrhea, or both.
Diagnosing IBD can be difficult. A biopsy of the intestines (by means of surgery or endoscopy) is the most definitive method, but it is very invasive and I rarely recommend it.
However, you do not mention that your cat has had an ultrasound of her abdomen. Ultrasound is a powerful, non-invasive and painless diagnostic technique. Skilled ultrasonographers can sometimes diagnose IBD. And they almost always offer insight into the cause of chronic vomiting. I would recommend abdominal ultrasound as the next step for your cat.
If your cat is diagnosed with IBD, several treatment options exist. Dietary modification is the mainstay of treatment, but it sounds like you may have exhausted this possibility. Probiotics help many cats; yours, unfortunately, seems refractory to this treatment.
I have seen many cats with chronic vomiting respond favorably to treatment with medicines that modulate the immune system. Prednisone is most commonly used. As I have mentioned before on this blog, prednisone is a double-edged sword. However, you may want to discuss a trial of the medicine with your veterinarian. It may help solve the problem.
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03/18/08
My Lhasa Apsos have allergies and have been tested.
I tried Atopica with no luck and it was expensive.
My vet said that giving my dogs predisone every
other day would not hurt them. Your thoughts
please.
Janeen
Mililani, HI
Allergies are frustrating, to be sure. Just ask anyone who suffers from hay fever. Allergies can make you miserable, and, for now, they cannot be cured. People actually move across the country to try to escape from their allergies. That is part of the reason why Arizona’s population has grown so rapidly in recent decades.
In pets, allergies usually cause skin problems such as hair loss, red skin, and itching. Ear infections also are common.
As I have mentioned, at the current time there is no cure for allergies. But there are several treatments. Some, such as flea control, soothing baths, omega-3 supplements, and hypoallergenic diets are simple and safe, and should be considered in every pet with allergies.
Others treatments, such as antihistamines, are generally safe, but not always effective. They are appropriate for some, but not all, allergy sufferers.
And then there are the bigger guns: allergy testing, followed by allergy shots, may help some pets. You mentioned that you have gone down this road without success. Genesis is a topical spray that significantly helps some pets. Atopica is another potent allergy treatment. It is expensive and generally effective, but it does not work in every pet.
Finally, there is the biggest gun of them all: prednisone. Prednisone is an anti-inflammatory steroid that is related to cortisone. It is simultaneously the best and the worst drug ever invented. No drug is more effective at treating allergies in pets. But prednisone also can cause a large number of side effects.
Pets who take prednisone long-term may suffer increased thirst, increased urination, weight gain, and personality changes. They may develop bladder or sinus infections. They are at risk of liver damage and diabetes.
However, not every pet who takes long-term prednisone suffers from these issues. Some pets can take prednisone for years without developing any problems. Others cannot tolerate the medicine for even a week.
So, to answer your question (finally): it may be safe for your dogs to take prednisone every other day. Or it may not. It depends on your dogs.
Here is what I recommend you do. First, exhaust all of the other treatment options that I have mentioned above, and make sure that none of them works.
If it turns out that only prednisone can make your dogs comfortable, then use it. But use the minimum effective dose. Monitor for the side effects that I mentioned above. And, very importantly, run comprehensive blood and urine tests every three to six months to ensure that the medicine is not having adverse internal effects in your dogs.
Finally, remember that some pets outgrow allergies over time. It may be worth your while to experiment (under the supervision of your veterinarian) with reducing or eliminating their prednisone doses periodically.
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My 10 month old dog got spayed this past Tuesday. She was fine on wed except for excessive thirst and urination. Thursday she started to pant and shake A LOT! I took her back to her vet who said that during surgery (he didn’t tell me this previously) he had a problem hematoma I think, and he had to give her steroids intravenously to reduce the risk of shock.
You have questions. 