06-15-2018, 11:46 AM
Cushing’s and What Your Vet SHOULD Discuss With You PRIOR To Treatment Plans
Hyperadrenocorticism is common canine disorder associated with abnormally high circulating concentrations of glucocorticoids. In spontaneous hyperadrenocorticism, approximately 80 to 85% of cases are due to pituitary dependent hyperadrenocorticism (PDH), with the remainder due to functional adrenocortical tumours (AT). A clinically identical syndrome may also be caused by the iatrogenic administration of corticosteroids. In this case the severity of clinical signs is directly related to the dose and duration of corticosteroid administration. There are many profound metabolic consequences of hyperadrenocorticism that occur due to the effects of excessive circulating corticosteroids on gene transcription in the cell nucleus.
Although many of the neuromuscular sequelae of hyperadrenocorticism resolve with effective treatment of hyperadrenocorticism, in some dogs orthopaedic problems may not improve or may worsen with treatment. Because of the anti-inflammatory effects of glucocorticoids, osteoarthritis, which was not causing clinical signs prior to treatment, may start to become a clinical problem. In many cases a good orthopaedic examination prior to starting treatment will allow high risk dogs to be identified.
Regardless of the cause, it is imperative to: - Perform a thorough orthopaedic and musculoskeletal evaluation of patients prior to initiating treatment for hyperadrenocorticism - Warn owners of the risk of worsening clinical signs associated with osteoarthritis, and that controlling the pain associated with this may be very difficult - Not use NSAIDs to control OA pain until the endogenous production of steroid is under control. Use of NSAIDs increases the risk of gastro-intestinal ulceration. When the hyperadrenocorticism is under control, periodic evaluation of this control is warranted if NSAIDs are used for pain control.
Hyperflexion of joints, and joint laxity is a significant musculoskeletal problem associated with hyperadrenocorticism. Treatment of hyperadrenocorticism rarely improves any joint laxity present. The limitations of medical therapy to improve these manifestations of Cushings need to be explained to the owner prior to stating treatment. The main points to remember about joint laxity are: - Surgical intervention while the dog has high circulating levels of steroid is not advised - Orthotics and braces can be used to help stabilize joints, but may exacerbate the laxity in the absence of therapeutic exercise
Some patients with hyperadrenocorticism present with concurrent orthopedic problems that require surgical intervention (e.g. rupture of the cranial cruciate ligament). In many cases it can be difficult to decide which problem to address first. In dogs with severe manifestations of Cushings, the endocrine disease should be well controlled for 2-3 months prior to considering surgical intervention. Even then, surgical interventions for cranial cruciate ligament disease that do not rely on development of scar tissue (e.g. TPLO, TTA) are preferred. Dogs with severe Cushing’s are poor surgical candidates for multiple reasons. These include predisposition to infection, poor respiratory function, delayed wound healing, cutaneous atrophy (complicates surgical recovery), and predisposition to thromboembolism. Any major surgical procedure should be delayed until good control of the hyperadrenocorticism is accomplished. Good clinical control of hyperadrenocorticism should result in normalization of the complications mentioned above and result in a much better surgical candidate
In dogs with hyperadrenocorticism, where treatment is not, for whatever reason, performed, conservative management of osteoarthritis and other neuromuscular problems is complicated by the risk of using non-steroidal anti-inflammatory drugs in a patient with high circulating glucocorticoid concentrations. Although the risk has not been well defined in the literature, it is there !
As with many things mammal weight (obesity in particular) can exacerbate orthopaedic complaints so the first step in any future treatment plan should be to reduce weight in a Cushing’s dog. Then the use of fatty acid supplements and glucosamine and chondratin should be used as these are excellent cartilage repair systems and anti-inflammatories. The RICE method in human studies can be an effective management procedure for dogs with Cushing’s and those presenting with orthopaedic concerns, strengthen muscles etc to hold bones in place and the body moves easier and more importantly pain free Rest Ice Compress Elevate and use heat then cold alternatively to stretch the muscles then contract them thus strengthening them. Acupuncture although the literature has not yet caught up with what we know scientifically it will and you can see improvement immediately from a clinical observation , if we know it works clinically then we ought to know it is working in a psychological as well as a physiological.
Hyperadrenocorticism is common canine disorder associated with abnormally high circulating concentrations of glucocorticoids. In spontaneous hyperadrenocorticism, approximately 80 to 85% of cases are due to pituitary dependent hyperadrenocorticism (PDH), with the remainder due to functional adrenocortical tumours (AT). A clinically identical syndrome may also be caused by the iatrogenic administration of corticosteroids. In this case the severity of clinical signs is directly related to the dose and duration of corticosteroid administration. There are many profound metabolic consequences of hyperadrenocorticism that occur due to the effects of excessive circulating corticosteroids on gene transcription in the cell nucleus.
Although many of the neuromuscular sequelae of hyperadrenocorticism resolve with effective treatment of hyperadrenocorticism, in some dogs orthopaedic problems may not improve or may worsen with treatment. Because of the anti-inflammatory effects of glucocorticoids, osteoarthritis, which was not causing clinical signs prior to treatment, may start to become a clinical problem. In many cases a good orthopaedic examination prior to starting treatment will allow high risk dogs to be identified.
Regardless of the cause, it is imperative to: - Perform a thorough orthopaedic and musculoskeletal evaluation of patients prior to initiating treatment for hyperadrenocorticism - Warn owners of the risk of worsening clinical signs associated with osteoarthritis, and that controlling the pain associated with this may be very difficult - Not use NSAIDs to control OA pain until the endogenous production of steroid is under control. Use of NSAIDs increases the risk of gastro-intestinal ulceration. When the hyperadrenocorticism is under control, periodic evaluation of this control is warranted if NSAIDs are used for pain control.
Hyperflexion of joints, and joint laxity is a significant musculoskeletal problem associated with hyperadrenocorticism. Treatment of hyperadrenocorticism rarely improves any joint laxity present. The limitations of medical therapy to improve these manifestations of Cushings need to be explained to the owner prior to stating treatment. The main points to remember about joint laxity are: - Surgical intervention while the dog has high circulating levels of steroid is not advised - Orthotics and braces can be used to help stabilize joints, but may exacerbate the laxity in the absence of therapeutic exercise
Some patients with hyperadrenocorticism present with concurrent orthopedic problems that require surgical intervention (e.g. rupture of the cranial cruciate ligament). In many cases it can be difficult to decide which problem to address first. In dogs with severe manifestations of Cushings, the endocrine disease should be well controlled for 2-3 months prior to considering surgical intervention. Even then, surgical interventions for cranial cruciate ligament disease that do not rely on development of scar tissue (e.g. TPLO, TTA) are preferred. Dogs with severe Cushing’s are poor surgical candidates for multiple reasons. These include predisposition to infection, poor respiratory function, delayed wound healing, cutaneous atrophy (complicates surgical recovery), and predisposition to thromboembolism. Any major surgical procedure should be delayed until good control of the hyperadrenocorticism is accomplished. Good clinical control of hyperadrenocorticism should result in normalization of the complications mentioned above and result in a much better surgical candidate
In dogs with hyperadrenocorticism, where treatment is not, for whatever reason, performed, conservative management of osteoarthritis and other neuromuscular problems is complicated by the risk of using non-steroidal anti-inflammatory drugs in a patient with high circulating glucocorticoid concentrations. Although the risk has not been well defined in the literature, it is there !
As with many things mammal weight (obesity in particular) can exacerbate orthopaedic complaints so the first step in any future treatment plan should be to reduce weight in a Cushing’s dog. Then the use of fatty acid supplements and glucosamine and chondratin should be used as these are excellent cartilage repair systems and anti-inflammatories. The RICE method in human studies can be an effective management procedure for dogs with Cushing’s and those presenting with orthopaedic concerns, strengthen muscles etc to hold bones in place and the body moves easier and more importantly pain free Rest Ice Compress Elevate and use heat then cold alternatively to stretch the muscles then contract them thus strengthening them. Acupuncture although the literature has not yet caught up with what we know scientifically it will and you can see improvement immediately from a clinical observation , if we know it works clinically then we ought to know it is working in a psychological as well as a physiological.