IMT, Part 2: Dealing With the Side Effects of Corticosteroids

After beginning the steroid treatment, my dog Coco started exhibiting some serious side effects.

Caption here. This is Coco againxxxxxxxx. Photos by: Debora Lichtenberg, VMD/Petful
Steroids turn Coco into a dog who just won’t quit tearing up the house. Photos by: Debora Lichtenberg, VMD/Petful

Editor’s Note: This is the second part of a 2-part series on immune-mediated thrombocytopenia. You can read Part 1 here.

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As I mentioned last week, the immediate lifesaving treatment for immune-mediated thrombocytopenia (IMT) and other immune-mediated disorders is immunosuppressive doses of steroids.

As of now, my Coco’s platelet count remains in the lower normal range. This is good news.

But she is showing some problematic side effects from the steroids, and this is what I want to share with you in case your pet is prescribed steroids for a serious problem.

What Is a Steroid?

A sidebar here about the terms “steroid” and “corticosteroid”: Many clients hear the word “steroid” and are confused. They might be thinking about anabolic steroids, not corticosteroids.

Anabolic steroids are those testosterone-like drugs that are misused by athletes and body builders. When your veterinarian talks about using a “steroid,” she is almost always talking about a corticosteroid.

Corticosteroids are used to control many diseases, ranging from allergies to immune-mediated diseases to certain cancers. Cortisol helps control many metabolic and physiologic processes, including stress response, inflammation, immune response, protein metabolism and electrolyte levels, to name a few.

The most common side effects of corticosteroids are increased thirst and appetite. The no-brainer follows — more urination. The medical shorthand we use for this syndrome is PU/PD/PP (polyuria/polydipsia/polyphagia) (increased urination/increased thirst/increased appetite).

There is also a kind of steroid crazy where the dog is just nuts! Eating, drinking, urinating and running around like a maniac.

Coco’s brush with death was a good reminder that dogs need to be protected from themselves when taking corticosteroids.

Coco Attempts Suicide on Steroids

Already crazy and still struggling with potty training, Coco on steroids is faster than a speeding bullet. Able to leap tall cabinets in a single bound. More powerful than any locomotive. Super-steroid dog Coco has tried to eat anything not nailed down — and has found many things we thought were nailed down.

Ancient Chinese takeout condiments. Human gummy vitamins. Newly purchased coffee. I wait in line at the fabulous Porto Rico Coffee in NYC and cherish my purchase. But Coco, on steroids, broke into my organic Sumatra. The coffee is now embedded into a carpet that will never recuperate because she chose to bury it indoors, not eat it.

I was finishing up Saturday morning appointments and left Coco at the house for the last 30 minutes. I arrived home to find she had scaled a counter and put herself into a toxicosis state by eating an ancient bag of semi-sweet chocolate chips in a high, closed cabinet.

At times like this, I wish I had a nanny-cam. How the (bleep) did she get into that cabinet?

Saving My Own Dog

My dog had ingested a lethal dose of chocolate. She was shaking, had tremors and was on her way to a seizure. Time to go into ICU mode with my own dog.

Classic treatment for chocolate toxicosis is immediate emesis (making the dog vomit). Success! The vomit included the pound of semi-sweet chocolate chips and an undigested fortune cookie with the wrapper. Yay!

I gave her activated charcoal to absorb more toxin and monitored her 24/7 until she was out of danger. Soon enough, she was doing just fine. But what is the lesson learned?

If Your Dog Must Take Steroids

Keep an open conversation going on with your vet. Your dog may exhibit many side effects. It is impossible to predict how she’ll be affected.

The dosage and the type of steroid is always negotiable. If the side effects are severe, your vet may try to change the dosage, the particular drug or change drugs completely.

This Vet Always Learns From Her Own Pets

Coco is exhibiting intense steroid-induced hunger. House-training, which was going well, is a bigger challenge right now. These are big reminders for me to be even more sympathetic to others experiencing these problems when their pet is on lifesaving steroids.

Vets must listen. A client might say something like, “Poco’s driving me crazy with her appetite on prednisone.” Or, “She’s peeing so much I can’t take it.” A vet might say, “Yes, it’s a common problem.” But what we need to say is, “How bad is it? What’s going on? Give me specifics.”

Coco could have died if I had not come right home after work. The house is pretty pet-proof, but not if she’s on a steroid hunger mission.

Keep that open dialogue with your vet and remember this: No question or concern is dumb or stupid. It’s what we are here for. And you might just save your pet’s life.

Dr. Debora Lichtenberg, VMD

View posts by Dr. Debora Lichtenberg, VMD
Dr. Debora Lichtenberg, VMD, is a small animal and exotics veterinarian who has split her time between a veterinary practice in Pelham, Massachusetts, and her studio in New York City. Dr. Lichtenberg is a graduate of the University of Pennsylvania School of Veterinary Medicine with 30 years of experience. Her special interests are soft tissue surgery and oncology.

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