Dr. Danny W. Scott, a professor of veterinary dermatology, writes "glucocorticoids (corticosteroids) are decidedly the most used and abused medicaments in veterinary medicine." He is correct. Part of the reason is that corticosteroids are used to treat so many conditions-quite well I might add! Nonetheless, they are a very feared drug by the general public. Read on and relax a bit ¼ knowledge is good. Corticosteroids (or glucocorticoids, or steroids) are hormones naturally secreted by the adrenal glands. They have strong anti-inflammatory and immunosuppressive properties. They are not the same "steroids" taken by bodybuilders; those are anabolic steroids, which are derivatives of sex hormones (e.g., testosterone). In 1949, scientists figured out how to make hydrocortisone, and modern medicine hasn't been the same since. I think we call it a paradigm shift. However, after years of use we discovered that there were adverse effects. After reading this paragraph you'll understand why they were hailed as miracle drugs. Here's a partial list of their indications: inflammatory diseases, inflammatory bowel disease, asthma, chronic bronchitis, hepatitis, colitis, enteritis, gingivitis, stomatitis, encephalitis, allergy, flea allergy, contact dermatitis, hot spots, itching, seborrhea, food hypersensitivities, immune mediated diseases, systemic lupus, pemphigus, arthritis, hypercalcemia, cancer, intervertebral disc disease, spinal cord trauma, nephritis, shock, trauma, and cerebral edema. Are you impressed yet? Veterinarians use cortisone mostly for skin-related diseases, especially those veterinarians who practice in subtropical climates like South Florida. Between 50 percent and 75 percent of the cases presented to a veterinarian here are skin cases (it's not hard to choose lectures when attending continuing ed classes!). Steroids are a very effective part of managing skin cases, but remember they are just that-only a part. Often times they are the only effective means of controlling a condition (i.e., hot spots or pyotraumatic dermatitis) and can be used properly and judiciously. Other times, for example inhalant allergies, we use cortisone (1) as infrequently as possible, (2) at the lowest possible doses, (3) on an every-other-day dosage where possible, and (4) in conjunction with other allergy remedies (e.g., shampoos and rinses, antihistamines, essential fatty acids, etc.). We then try to taper a patient with allergies completely off the drug. Sometimes we're successful; sometimes we're not. Corticosteroids do, however, have side effects. Most relate to alterations of the HPA axis (hypothalamus, pituitary, adrenal). In simpler terms, if you supply the body with cortisone through injection, oral, topical, ophthalmic, or otic preparations, a signal is sent to the adrenal glands to stop making cortisone. The problem is that other areas of the adrenal gland respond as well and the glands can shrink or atrophy. You need your adrenal glands for other metabolic functions, like electrolyte and mineral balance to name a few. Besides problems with the HPA axis, corticosteroids can cause sodium and water retention, increased thirst and urination, a liver disease called steroid hepatopathy, insulin resistance, and stomach ulcers. That is just a partial list! Not all cortisones are created equal either! Some are much stronger than others, some last longer than others, and some suppress the HPA axis more than others. It is key for your veterinarian to know the difference between the forms and when they are indicated. The same cortisone used to treat skin disease (prednisone) is not the same one used in spinal cord trauma (methylpred succinate) or in feline gingivitis (methylpred acetate). The severity and type of condition being treated also dictate which type of cortisone is used and for how long. For short-term therapy as indicated in emergencies (e.g., shock, trauma), we use long-acting and strong preparations because a single dose is usually all that is needed. Chronic conditions requiring continued therapy (e.g., immune mediated disease, cancer, certain skin conditions) are best treated with relatively short-acting drugs, like prednisone. The doses are then tapered to the least amount of drug needed to control the disease given only every second or third day (called alternate day therapy). In this type of regimen, side effects are minimized and alterations to the HPA axis are also lessened. When treating a chronic condition your pet may initially respond and then, for no good reason, stop (steroid tachyphylaxis); if steroids are indicated, your veterinarian should try a different one. Often we can return to the original steroid at a later date; no one knows why with any certainty. Remember, all cortisones are not created equal. Another formulation of cortisone called repository glucocorticoids (methylpred acetate and traimcinalone acetonide) is often used in veterinary medicine. They are usually used for short-term, intensive therapy for inflammatory and skin conditions. They are intermediate in strength, but are released over a period of weeks. They have great advantages for the veterinarian and client who have difficulty medicating the animals. The disadvantage is you can't get rid of them if there are side effects. Fortunately they are tolerated very well, and many authors report no problems using them two to three times a year if needed for dogs. Cats can receive them safely two weeks apart until the condition responds and then every eight weeks if needed. The glucocorticoids are a wonderful class of drugs to have available. We would be hard-pressed to treat pets without them. We need to respect corticosteroids, both for their ability to cure and their potential for harmful side effects. We need to understand their indications and communicate to our clients our goals and objectives of treatment. Medicine is always risk versus benefit. There are many benefits to using corticosteroids. -Dr. Stephen M. Sheldon, D.V.M. practices at and owns Hammocks Veterinary Hospital in Miami, Florida. A University of Florida graduate, he is President of the South Florida Veterinary Medical Association, and a member of the Veterinary Cancer Society. He can be reached at (305) 388-0880. Visit his website at http://www.hammocksvet.com/.

Top of Page

		Table of Contents  Our Latest Issue   Advertise   Chatroom  Comics   Contact   Departments   Discussion  Guestbook   Issues   Pet Links Katsation.com & PuppyStation.com Select Main   OR  Home About Advertising Comics Contact Departments Discussion Editors Guestbook Issues Related Sites Pet Links Directory Select Department Departments 20/20 Facts Ask Dr. Jane Ask A Trainer Bird Stop Book Reviews Breeds Cat's Meow Celebrities' Classifieds Dog Time Editorials Exotics Features Fishy Grooming Harry's Kitchen Holistic Care The Spotlight Kids & Pets Open Wide Pet Post Pets In Court Pet Travel While Away Wild Thing  OR Select Issue  Issues Main Covers 1995 Covers 1996 Covers 1997 September 1997 November 1997 Covers 1998 February 1998 April 1998 June 1998 August 1998 October 1998 Covers 1999 January 1999 March 1999 May 1999 July 1999 September 1999 November 1999 Covers 2000 January 2000 March 2000 May 2000 July 2000 September 2000 November 2000 Covers 2001 February 2001 April 2001 July 2001 September 2001 Covers 2002 March 2002 June 2002 November 2002* Covers 2003
	Have the Tyme? Suggest This Page to a Friend! Your Name and E-Mail: Your Friends E-Mail:		Search The Pet Tribune On-Line ! More Search Options !