Should pets have extended steroid treatments?
Pet Health Alert: Even with all the colder weather, we are still seeing ticks on pets on an almost daily basis. Ticks are becoming more aggressive and more diseased than ever before. Pet owners and veterinarians must work together to wage war on this growing threat to the health of pets and people. A reliable, veterinary-quality tick control product must be used all year. Please do not skip this month or next. It is just not worth the risk. Also, ask your veterinarian about back-up options like vaccination or routine blood screening for subclinical Lyme infection.
Q: My dog is scratching a lot and losing hair. My old vet used to give him a cortisone shot and the itching went away. Now the veterinarian I see refuses to give the injection and the medication she prescribed doesn’t seem to be helping. Shouldn’t she just use a cortisone shot?
A: The “cortisone shot” you describe is likely to be an extended release glucocorticoid, like methylprednisolone or triamcilalone. These drugs are synthetic steroid hormones that have a very long list of side effects. Unfortunately, they also work very well for many skin ailments, at least for a period of time.
Glucocorticoid medications commonly cause increased thirst, appetite, urination, susceptibility to infection, and sometimes restlessness. Most pet owners are willing to deal with these reasonably minor side effects. However, it is also common for these drugs to lead to life-threatening problems like diabetes, pancreatitis, liver disease, and Cushings syndrome. They can also destabilize patients with underlying heart disease and lead to increased risk of stokes. The risk of serious side effects increases with every subsequent injection.
Generally, these medications should be limited to only severe cases or for short periods of time to allow other treatments to begin working. When prescribing these drugs, it is usually preferable to use oral forms rather than injections. If side effects do occur, oral forms allow for rapid reduction in dose or change in therapy. Once the injection is given, its effects will last for several weeks – for better or worse.
Most skin conditions can be successfully treated with antibiotics, medicated shampoos, fatty acid supplements, antihistamines, and/or allergy serum. Very occasionally, a patient may require long term suppression of the immune system for adequate symptom control. In these patients, modern alternatives to glucocorticoids are available. While they are more expensive, they have significantly lower risk of life-threatening side effects.
For veterinarians, glucocorticoid injections are very tempting. They make us look terrific. Within a day, the pet feels better and the cure lasts for weeks to months. They are inexpensive and pet owners are generally pleased. In contrast, diagnostic testing, medications, shampoos, and supplements that actually address the underlying process are more expensive and time consuming. I admit to giving in to the temptation every now and again.
However, I have personally seen practices that have developed a habit of routinely using these medications. Scratching is quickly eradicated and pet owners are happy. On the other hand, there is a higher than normal amount of diabetes, liver disease, drug-resistant infections, and other diseases. Most pet owners (and sometimes even the veterinarians) never suspect that the “cortisone shot” habit of yesterday had any role in today’s ailment.
A veterinarian’s job is to speak for the best interest of the pet. With skin diseases, pets are best served by a timely, accurate diagnosis and prescription of the most appropriate course of treatment. As a pet owner, you should value such an approach. Stopping the itch quickly and cheaply is nice, but not if your beloved pet dies early or suffers induced illness as a result.