In my last blog, I discussed the subject of stress and whether all stress is a bad thing. I was aided tremendously by Dr. Michael Morales, professor of endocrinology (among other things) at the Jacobs School of Medicine & Biomedical Sciences at the University of Buffalo. This week Mike helps me explain why your dog needs to take all of his medicine, even when he is feeling better. While all meds should be finished, this particular discussion is about steroids, such as prednisone, used to treat inflammation and pain in people and animals.
As Mike explains:
Pain control is tricky in dogs. One reason is that many of the safe and inexpensive medications humans rely on, the non-steroidal anti-inflammatory drugs (NSAIDs), such as acetaminophen, aspirin and ibuprofen are not well tolerated or even dangerous to our canine friends. That means often the best choice to treat inflammatory pain (and other conditions) are with drugs that mimic the action of cortisol, often referred to as corticosteroids. Probably the most commonly prescirbed is Prednisone, which is structurally similar to cortisol, but much more potent.
One of the first things most people notice about steroids is the prescription is almost always a “step-down” dosage. This means that you gradually decrease the dosage over a period of time. For example, you might start with 5 tablets a day for 1 day, then 4 tablets for a day, 3 tablets…etc. Often times we see our animal friends respond quickly to the medication and we may stop giving it to them earlier than prescribe. Since they seem so much better, what’s the point in continuing?
This is a bad idea.
Why, you might ask? Mike goes on:
To understand why, it is necessary to know a little about how dogs (and humans) regulate their production of cortisol. It starts in the brain where stresses are initially sensed. This information is transmitted to a brain region called the hypothalamus where the neurons increase their production of corticotropic releasing hormone (CRH). CRH travels to the pituitary gland at the base of the brain, signaling the pituitary to produce adrenocorticotropic hormone (ACTH). That hormone travels through the blood stream to the adrenal gland which increases its production of cortisol. In addition to its other functions, cortisol signals the hypothalamus and pituitary to reduce the amount of CRH and ACTH, respectively, keeping the production of cortisol at the correct level. The technical term for this is negative feedback, and it is one of the most important ideas in biology. (See Figures 1 and 2).
What does this have to with your dog’s pain pills? Mike elaborates:
When the dog cannot produce sufficient cortisol to control its pain, inflammation, or suffering, your vet may prescribe a corticosteroid such as Prednisone. These powerful drugs do most of what cortisol does, including reducing CRH and ACTH production dramatically. That in turn turns off the production of cortisol almost completely, and the adrenal gland will actually start to atrophy. This is not a big deal, as cortisol synthesis can be restarted, but the problem is that it will take a few days (exactly how long depends on your dog’s age and overall health). Cortisol is necessary for normal health.* Quick withdrawal of corticosteroids can leave your dog without the ability make his own, opening it up to problems that might include fatigue, nausea, vomiting, diarrhea, fever, anxiety and many other issues. Slowly reducing corticosteroid dosage gives the adrenal gland a chance to recover and start producing cortisol normally.
So the bottom line here is: take your medicine, all of it. Your dog will be healthier and happier if you follow your vet’s instructions and give him the medicine he needs to be the best dog ever.
*For more on the importance of cortisol in regulating stress see: Is all stress bad?
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