maintenance dose for cat with atypical Addison's disease

[Jonas0]

I have a 3.5 year old atypical Addisonian male cat currently weighing about 4.3 kg. He's on a daily dose of 4.8 mg Prednisolone, and two 0.1 mg Florinef pills a day. Although he did well in the initial period of the current dosing protocol, he's not been top notch of late (growing weaker, developing bald patches, lethargic, etc). I suspect he's developed iatrogenic cushing's in the interim period, something his vet has not ruled out. Nonetheless, the vet is of the opinion that the current dosing protocol should be more or less maintained, but with a slight downward adjustment on the Pred if necessary. I'm curious if there are any members with Addisonian cats and what they think of the current dose my cat is on. Within the past few days I've come to learn that dogs that typically weigh multiple times my cat's weight are on a fraction of the Pred dose he currently receives (usually 0.5 or 1 mg a day max), in addition to the Percorten or Zycortal injection they receive every 4 weeks or so for their electrolytes. Grateful for any feedback/guidance. Thank you!

 

[fionasmom]

Search Results for Query: addison's disease

These threads contain TCS information from members about this condition and might be helpful. I don't have anything of help to add from the previous posts, but do agree with your concern that your cat seems to be moving into Cushings. Lethargy and hair loss or change can be two symptoms. Are you noticing appetite or thirst increasing? The delicate balance between Addisons and Cushings is that the cat or dog can easily swing back to the opposite condition. Do you have any options for consulting with a specialist in this area or even another vet for a second opinion. In the case of these adrenal condition, it is not an insult to your existing vet as they can be so difficult to pinpoint.

The feline facets of Cushing's disease
This article explains about testing cats; there are some differences from testing a dog for Cushings. In the case of my dog, we did very regular ACTH stim tests which is what, I believe, kept the dosing on track. It was absolutely the testing which controlled and determined the dosage of the medication (not the same as is used for cats).

 

[Jonas0]

Search Results for Query: addison's disease

These threads contain TCS information from members about this condition and might be helpful. I don't have anything of help to add from the previous posts, but do agree with your concern that your cat seems to be moving into Cushings. Lethargy and hair loss or change can be two symptoms. Are you noticing appetite or thirst increasing? The delicate balance between Addisons and Cushings is that the cat or dog can easily swing back to the opposite condition. Do you have any options for consulting with a specialist in this area or even another vet for a second opinion. In the case of these adrenal condition, it is not an insult to your existing vet as they can be so difficult to pinpoint.

The feline facets of Cushing's disease
This article explains about testing cats; there are some differences from testing a dog for Cushings. In the case of my dog, we did very regular ACTH stim tests which is what, I believe, kept the dosing on track. It was absolutely the testing which controlled and determined the dosage of the medication (not the same as is used for cats).

Thank you very much for your response and the article which I've found very helpful. I will discuss with our vet when she's due to see my cat again next week. We've already been to several other veterinary practices but none of their vets have had any experience with Addison's. I appreciate how our current vet has been handling the case, but she's only handled one other Addison's case, that of a dog. And I believe she tends to err on the side of administering the highest doses possible, which from my readings and online research appears to go against current practice which is to go with the bare minimum maintenance dose (at least for dogs).
To answer your question about appetite and thirst, I noticed increased thirst over a 10-day period or so. His food and liquid intake appears to be finally stabilising over the past 48 hours.
I wonder if there are any options for consulting a specialist online, and if so, if there's anyone who can be recommended.

 

[fionasmom]

These endocrine conditions are not that common, especially in cats, and are often not treated by many vets who see them as a "write off" diagnosis, especially if the animal is older..which your cat is not. It is very logical that your current vet, through no fault of her own, has only handled one case of Addisons. Many vets go with the higher dose. In the case of my dog and Cushings, I eventually found a vet who understood the condition and his medication was cut back to a very low dose from what the original vet had been doing. What you found from your reading is very true for dogs, at least.

It is good that your cat is stabilizing with the appetite and thirst. If an animal swings into Cushings, the signs can be pretty clear...huge thirst, huge appetite, so watch that.

I would try to see if there is any consultation that your vet could do with any major teaching hospital like UC Davis, Colorado State, Cornell, Florida State. Cushings and Addison's are all a matter of numbers for the most part and the numbers controls the dosing. I don't see why this could not be done without you having to travel.

U. S. Veterinary Schools | American Association of Feline Practitioners

Veterinary Diagnostic Investigation and Consultation| Our Team| CA
This site lists Dr. Bruyette as in Los Angeles, if their information is correct.

 

[Jonas0]

Thank you ever so much for the links -- super helpful! So too your suggestion for our vet to perhaps consider a consultation with one of the teaching schools. I will definitely discuss with her at our next appointment. Part of the difficulty we have been facing (in addition to having to treat Addison's disease) is that my cat has had ringworm for almost two years now. We almost lost him when a previous vet had him on a daily dose of 10mg Prednisolone for about a month. My cat's body crumpled like a piece of old paper by the fourth week and the ringworm was out of control. Now that I am better read on the subject, I realise what a terrible mistake it was to up his Prednisolone dose as a means of controlling ringworm. Even though it's been halved since we moved vets, I still feek that the relatively high dosage (currently 4.8mg Pred daily) is not helping in our fight against the ringworm, despite the dozen or so full itranconazole cycles we've been through. I have another cat at home that's been tested at various intervals for ringworm and her wood's lamp and culture tests have always been negative, which reassures me that at least at home we've done everything possible to keep the ringworm in check.
I agree with you the key is probably in "the numbers". It should not be an impossible task.

 

[fionasmom]

My dog's vet actually flew to a conference about Cushing's when he was her patient. I would really push the idea of consulting a specialist in this field. The vets I have worked with have never balked at doing this, or at giving me a referral to a specialist (if it were within driving distance). When my dog had his leg amputated (melanoma), I stated outright that I was not comfortable with his truly excellent vet doing the surgery just because they were not set up with round the clock nursing, ventilators, code blue procedures,etc and she gladly gave me the referral.

You have your hands full; your cats are very lucky to have you caring for them. Please let us know what happens.