Prednisone 101

In episode 68, Dr. Buzby revealed how a lingering health concern led her to seek care from a specialist, who prescribed steroids (prednisone) as a necessary part of her treatment. As an integrative veterinarian, she found this to be a “hard pill to swallow”.

That personal process offered insight into what many pet owners face when their dogs are prescribed prednisone. This episode is all about those concerns, the reasons to be concerned about prednisone and other steroids, as well as the reasons they are still an essential part of every veterinary (and human) pharmacy.

Simply put, steroids are the most powerful class of anti-inflammatory drugs that doctors can prescribe. Dr. Buzby dispels the myths, focuses on the facts, and helps give you a better overview of this commonly used medication.

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Podcast Transcription

Intro: (00:16)
Welcome to the Buzby Dog podcast where our passion and focus is proactive care and longer, healthier, happier lives for our dogs. Here’s your host integrative veterinarian, Dr. Julie Buzby.

Dr. Julie Buzby: (00:33)
Welcome to this week’s episode of the Buzby Dog podcast, where we are picking up where we left off last week. I gave you my personal story of needing to take a drug that I never wanted to take in my whole life. And that’s prednisone. And as an integrative veterinarian, who really focuses on trying to help animals heal as naturally as possible using that innate God-given healing ability that we have. It was a hard pill for me to swallow pun, fully intended to take prednisone. And as I thought about it, I thought about my clients who sort of have this phobia of the medication and rightly so in a sense. I mean, it’s definitely not a drug that I would take lightly. It’s got some really significant side effects, both in the short-term and the long-term, but occasionally it’s necessary and actually life-saving.

Dr. Julie Buzby: (01:26)
I love this quote from Dr. Wendy Brooks, a colleague of mine who said there has never been a class of drug that has more applications and disease treatment than the glucocorticoid class. That’s what prednisone is. This group is rivaled only by antibiotics in the lives saved and frankly that’s the truth. It is a class of drugs, like I said, that I would say the body has to pay a high price to take it, but it has saved countless, countless lives. And I actually wonder if mine is one of them after, like I said, my podcast last week when I was on a downhill spiral with respiratory disease and it really helped me greatly to stop that inflammation. And that’s mainly how the drug is used is as a powerful anti-inflammatory. So I just want to go over several points today on the truth about prednisone.

Dr. Julie Buzby: (02:18)
And it’s not all going to be pretty. I mean, there’s definitely some bad stuff, but I think it’s important to take a balanced approach and to just get the facts. So if your dog is prescribed prednisone, you can have an honest and open discussion with your veterinarian as to why, to make sure that you are in understanding of, like I said, the side effects that you’re going to be experiencing with your dog. I’m sure they would go over them with you as well. But it’s, it’s just good to know. This is a common drug in human and veterinary medicine. So first of all, I think it’s good to point out that your dog is not going to fail a drug test taking prednisone. These are not anabolic steroids like body builders or NFL players illegally take. These are actually catabolic steroids. Instead of building up the body, they actually can be used to break down the body so that tissues can be broken down into individual elements, individual components to be used for energy and in times of stress.

Dr. Julie Buzby: (03:14)
And so this is called the glucocorticoid class of hormones and cortisol. I’m sure you’ve heard. I remember years ago, there were these commercials on the radio about cortisol, and stress cortisol is that natural hormone it’s produced by the adrenal glands. I remember in vet school, I was taught about them as the synonym for the adrenal glands was the super renal G gland “super” meaning above because there are little tiny glands that sit right above the kidney. So you can picture where your kidneys are in your back. Most people understand what kidney pain is and how that affects the back. Well, right in that area, above the kidneys, the adrenal glands are located. And so they’re producing several things, lot of important things to keep us alive. Actually, one of which is cortisol this natural hormone, but scientists can also manufacture this in the lab and give it as a medication.

Dr. Julie Buzby: (04:10)
And prednisone is very commonly prescribed. It’s a very, very common medication. Prednisone is another medication that can be manufactured in the lab. Prednisone is actually converted by the liver of the animal or person into prednisone to be the bioactive form that we can use. And again, these natural hormones are very important, actually critical for life. They play a part in stress responses, the way the body manages inflammation, metabolism and the list goes on. I think an important myth to dispel is that steroids are categorically bad like rabies. I mean, rabies is bad. There’s no silver lining in rabies. Murder. Murder’s bad. There’s no silver lining. That’s not true with steroids. They’re not just categorically bad. And as I said before, as an integrative veterinarian, my official position on steroids, on prednisone is I hate them, but I’ve seen them save lives.

Dr. Julie Buzby: (05:07)
So I was just talking to a colleague a couple weeks ago, and she was telling me about a surgery that she did, where a patient was crashing. This little dog was just there for a routine spay and the dog started to do poorly under anesthesia. And she gave the dog every manner of appropriate treatment, fluid therapy, and all the variety of drugs that we give to help stabilize blood pressure under anesthesia, nothing was working. And as a last ditch effort, she injected and gave the dog intravenous steroids and the dog was fine. The dog lived and turned around immediately and did well. And she suspected actually that the dog may be what we call addisonian, when they don’t have the ability to produce their own stress hormones normally. But whether or not that was the case, the bottom line is the steroids. 1000% saved that dog’s life.

Dr. Julie Buzby: (05:59)
So to reiterate steroids are the most powerful class of anti-inflammatories that doctors can prescribe. And at higher doses, they have an added advantage or disadvantage, depending on what we’re trying to accomplish of being immunosuppressive. So they actually suppress the immune system, which in certain categories of disease is also life-threatening. So let’s be open-minded and informed as we learn about our potential friend, also our potential enemy, Mr. Prednisone. So how do we use this in veterinary medicine and probably human medicine too? As I said, anti-inflammatory effect that’s the biggie. It’s a rescue drug for a dog that’s has severe inflammation, whether that be skin. So sometimes a dog is just on a scale of one to 10, a 10 out of 10 itchy. And we use a short course of steroids just to break that cycle and get them some relief. We use it as an anti-inflammatory in the central nervous system.

Dr. Julie Buzby: (06:57)
So the brain, if they’re, swelling in the spinal cord, for example, with inflammatory disc disease, if the dog has a back problem, sometimes it’s used depending on the course of the disease, if it’s acute, or if it’s chronic, we use it as a cancer drug, believe it or not, it actually has a chemotherapeutic benefit. The prednisone of being anti-inflammatory for a dog that is not going to be doing chemotherapy. We use prednisone sometimes to help them feel better and reduce the significant inflammation around a tumor. We use it for autoimmune diseases. I had mentioned the immunosuppressive benefits. There are diseases where the body’s own immune is attacking itself, obviously not supposed to happen, but there are many, many diseases like this. There are not uncommon in human medicine and in veterinary medicine where the body’s attacking its own red blood cells or attacking its own platelets or attacking its own tissue and manifests in skin disease.

Dr. Julie Buzby: (07:56)
These are very serious diseases and you have to calm down or suppress the immune system and steroids have a powerful effect to do that. And then there’s Addison’s disease, which I mentioned earlier. If the adrenal gland is not healthy enough to produce its own cortisol, to produce its own glucocorticoids, you do not have the ability at all to withstand a stressful response because that’s what normally your body would do is spike this hormone production to get you through a stress response. And so for addisonian dogs, they take a little bit of prednisone every day for the rest of their lives, because it mimics what the body should be doing for itself. But can’t, and so again, life saving there. Now people worry if I prescribe, I prednisone, which again, I rarely do, but in the course of my 20 year career, I have, and people automatically assume, oh, you know, my dog’s behavior’s going to change and he’s going to get weird and it’s going to make him feel weird because that’s what happened when I took it.

Dr. Julie Buzby: (08:52)
Well, of course we can’t do a survey of our dogs and really get into their heads and find out how it makes them feel. But we don’t believe that’s the case for most dogs. It can happen that it causes behavioral changes, but I think it’s pretty rare. Dogs actually tolerate the drug pretty well. But what we do see for sure is increased drinking, increased thirst. That’s the biggie. And this is actually because prednisone causes the body, the kidneys, to conserve salt. My own dog — my first dog out of veterinary school, little Jacko bean — the only time he ever had an accident in the house was when he was on prednisone. He had a very painful condition called dead tail, which we have featured in a separate podcast. And I gave him a short, like three-day course of prednisone because I needed a very powerful anti-inflammatory at that time.

Dr. Julie Buzby: (09:44)
And he urinated in the house and he looked mortified. He was horrified. But my point is it causes increased drinking and increased thirst, and dogs will have accidents potentially during this time they have to get them out more frequently. It also increases appetite. It can cause panting. It can cause energy changes. They’re just not as active as usual. And it can cause GI issues as a certainly a negative side effect and even more likely to do so. If combined with other medications, a big, huge red flag, prednisone cannot be given with non-steroidal anti-inflammatory drugs. Those would be like Reil or Dax or any of these drugs that your vet may have your senior dog on for arthritis, drugs that are again in the category of non-steroidal anti-inflammatory drugs. I would include for the purposes of this talk of side effects. I would include aspirin in there as well.

Dr. Julie Buzby: (10:38)
Although I don’t recommend giving dogs aspirin. So the concern is together, high likelihood of GI ulceration, which can cause a GI bleed. You can see that in the dog vomiting, you can see blood in vomit. You can see that in stool. And typically in stool, there’s not fresh red blood because of the length of the intestinal tract and digestion taking place. Instead, we see what we call melena, it’s digested blood. And so it looks black and tarry and sticky. And this is, this is digested blood because there’s been a bleed in the GI tract, but you’re not seeing it. Like I said, as that red frank fresh blood instead it is this dark black tarry coating on the stool or component to the stool. Now, the other thing about prednisone that you probably know is we don’t just stop cold turkey. If we’re going to come off the drug we taper.

Dr. Julie Buzby: (11:31)
And for my own course, last week, when I was talking about my own medication, my doctor gave me a nine day course. So I took three days of a higher dose and then three days of a middle dose and three days of a lower dose. Sometimes we do a very short course in veterinary medicine, maybe just three to five days, in which case, typically a taper is not needed. The reason we taper is because of the bio feedback loop. So what does that mean? Essentially, that means if you’re giving outside sources of cortisol to the body in the form of a medication like prednisone, the adrenal gland reads that and says, oh, you know, there’s plenty of this hormone in the bloodstream. So I don’t need to be making any, and I’m going to shut down. And actually over time, the adrenal gland, for months and months and months, the adrenal gland, was seeing cortisol in the bloodstream from an exogenous source, meaning taken as a medication, it can actually atrophy.

Dr. Julie Buzby: (12:25)
It can actually shrink. And so it’s very important that we do not cause any harm to the adrenal gland. We want that to continue to produce the hormones that it needs to. And that’s why we try to do a very short course, or we do a tapering course to kind of wake it back up. But if it had been sleeping a little bit, if you will, from, from seeing this feedback in the bloodstream from medication. So by tapering the prednisone, it gives the body, the adrenal gland the time it needs to recognize the dropping levels gradually in the bloodstream, and then come back online to produce its own, to supply the body with what it needs. So that’s really critical. Let’s talk about long-term side effects. I think I’ve tried to make clear that prednisone has a place in veterinary medicine.

Dr. Julie Buzby: (13:15)
We certainly use it. It is a life threat, and a life-saving drug, however, where I think we run into trouble and it’s not just me. I think the veterinary community would agree that long-term steroid use is what we really try to avoid. Sometimes it’s unavoidable and it’s literally just saving the dog’s life. And it’s either long-term prednisone or lack of life. I mean, it’s that critical. But for the most part, there are other drugs, other protocols, other things that we can add on to lower the dose of prednisone, if needed. We always want to get to that lowest dose that maintains the lowest dose of prednisone that’s working. And so let’s talk about long-term side effects. Essentially by giving a dog prednisone long term, we’re going to make them cushionoid, it’s called iatrogenic Cushing syndrome. We’ve created it ourselves.

Dr. Julie Buzby: (14:08)
Cushing’s disease is where the body is producing extra high levels of cortisol from the adrenal gland. And you’re going to see the same symptoms, whether the dog has naturally occurring Cushings disease, or whether it’s because the dog is getting too much oral prednisone. These symptoms include a change in skin. The skin tends to become very thin. The hair also tends to become very thin and wispy there’s a potential for decrease wound healing because we talked about how prednisone decreases the immune system. And along with that, these dogs can have chronic urinary tract infections. And this really worries me acute, meaning undetected below, below the radar. So I’ve read stats that up to 30% of dogs who are on long term prednisone, have these acute urinary tract infections. And you might say, well, how is that even possible? Because if I had a UTI, I would know it, there’s this lots of symptoms from frequent urination to this burning sensation.

Dr. Julie Buzby: (15:11)
And I would notice that in my dog, well, keep in mind that the prednisone is also a powerful anti-inflammatory and those symptoms come from inflammation. So the symptoms don’t typically appear there. These dogs are just going through life with a chronic urinary tract infection. So it’s a pretty serious thing. Also thyroid function. We know that from long term use of steroids, thyroid, function’s going to be thrown off for a while. Thyroid values won’t be right. And liver enzymes certainly are going to be elevated even from a very short course of steroids. What if I would do blood work on that dog? I’m going to see those liver values likely elevated as a result more seriously, the prednisone can be the straw that breaks the camel’s back for a dog who’s prediabetic whose body is set up and prone to develop diabetes mellitus. It can just push them right over the edge into diabetes.

Dr. Julie Buzby: (16:03)
And then because it impacts the immune system and suppresses immunity to some degree, dogs can have conditions that we don’t expect adult dogs to have like, demodectic nange. This is something that we see in puppies with immature immune systems. Sometimes while we can get adult onset, demodectic mange with dogs who are on chronic prednisone. Fungal diseases is another one that we see more commonly with dogs who are on prednisone or again, dogs who have Cushing syndrome, because essentially it’s the same physiology for the body. Whether it’s being taken orally from a laboratory or the body’s making it itself, still this high level of circulating glucocorticoid this high level of circulating cortisol in the body is going to cause potentially put us at high risk, put us on alert for several problems, long-term. So the goal is short-term use, always trying to use the lowest effective dose.

Dr. Julie Buzby: (16:59)
If I have a dog who’s on any medication steroids being one, but any medication for any length of time, I’m monitoring blood work, I’m tracking the liver, kidneys, blood sugar. I’m tracking how everything is functioning and trying to taper as quickly as possible again, to that lowest possible dose to keep the adrenal gland functional, active, and happy. So my goal in doing this podcast today, like I said, I know my people, my people would rather jump off a second story building than administer prednisone to their dog and I get it. And I understand why, but I wanted to just say that sometimes it’s necessary. It is a valuable drug when used appropriately. And of course you have that trusting relationship with your vet, that if they say this is the drug we need to use, you’re going to say I hate it, but I believe you. And how soon can we get off of it? So again, keep those communication lines open with your veterinarian. If you have questions, discuss them. As veterinarians, we love helping our patients and we love helping our clients understand why we’re doing what we’re doing and how they can best help their pets as well. That’s what we do. That’s what we that’s actually what we live for in our profession. I think prednisone when used very judiciously can actually be a part of our mission of helping dogs live happier, healthier lives.

Outro: (18:18)
And now a message from Dr. Buzby’s mailbag. I have seen the transformation. has dysplasia and arthritis and has been in pain and inactive for a long time until yesterday. When I put his toegrips on was so frisky and active. I haven’t seen him that full of life in so long, and I was actually hoping that he wasn’t going to overdo it, but he was fine this morning. Thanks to all involved with Dr. Buzby’s toegrips. For more info or to help your dog get a grip, go to toegrips.com.

Outro: (18:53)
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