evolutionkennels
02-27-2012, 08:47 AM
SHOCK THERAPY
"The proper uses of cortico-steroids" is an often-debated subject and many a dogman has his own method of using them. For the purposes of this article we will not go into the use of a cortico-steroid prior to a hunt, to "dry" a dog out, but instead we will focus on the proper use and dosage of these drugs.
First, what is a cortico-steroid or "glucocorticoid"? For our purposes here we will define them as anti-inflammatory and/or anti-shock agents. Although they have many other uses, some of which can be of benefit to the dogman such as treatment for septicemic and bacteremic shock (shock from infections), and intracerebral edema (swelling of the brain) we will stay with the most common usage for now, treatment of shock and swelling due to trauma. The drugs we will discuss will be Dexamethasone (AKA Dex) & Dexamethasone Sodium Phosphate (AKA Azium), Prednisolone Sodium Succinate (AKA Solu-Delta Cortef) and a lesser-known but very good drug Methylprednisolone Sodium Succinate (AKA Solu-Medrol).
Lets discuss two major side effects of all these drugs before going into their uses. The first is, they suppress the immune system. That means they stop or inhibit your dog's ability to fight off infections. Second they are diuretics, which means they draw fluid out of your dog. For these reasons I recommend that ANY time you use any of the above-mentioned drugs you use them concurrently with fluid therapy and antibiotics, both of which are discussed in different chapters. And, if you can get by WITHOUT using cortico-steroids, then DO SO.
Use cortico-steroids only when absolutely necessary!
For convenience, I will use the word "Azuim," though all 4 drugs are interchangeable. Now, when do you use these drugs? I recently attended a hunt that involved two hard-mouthed dogs. The event lasted a total of 35 minutes after which both sides began attending to their dogs after they got the boar. I was surprised when I learned one party involved did not intend to use any Azuim on their dog even though they had some on hand. It seems they were under the impression that because they had given the dog some prior to the hunt that the dog would be fine. WRONG! It does not matter if the dog received a few ccs prior to the hunt. The doses given to dogs prior to a hunt are much too small to have any anti-shock properties of any importance.
Let's bust a couple of myths.
Myth #1: Azium given the day of, or the day prior to, a hunt stays with the dog and stops swelling. WRONG! These are fast-acting drugs and are not meant to have a strong prolonged effect.
Myth #2: Dogs don't need Azuim unless the hunt lasts a long time. WRONG! Dogs can take severe damage in the first ten minutes of a hunt. Especially with some of the hard biting monsters out there today.
Here are some good "Rules" to follow when using Azium:
1. If your dog hunts over an hour, even if you believe he hasn't taken any damage.
2. If your dog has had bleeders hit.
3. If your dog has faced a hard mouthed boar, especially if it gets bitten in the guts.
4. If your dog has run very hot for any period of time.
5. If your dog is in blatant shock, i.e.. glazed far away look in its eyes, cannot stand up, does not respond at all to painful stimulus.
Now for dosages. Most people I've seen do not use proper amounts of these drugs even when they do use them. Perhaps it has to do with the fact that these drugs can be hard to come by so people tend to be frugal with them. I will list as follows the correct dosages for all 3 drugs mentioned above. For those who may not know, for the purposes of administering injectable drugs (ml) and (cc) are considered to be the same. Also all doses are for intravenous use. All these drugs may be given in the muscle or under the skin, but that is not the preferred route of administration - and the doses would be different from what is listed here.
Azuim and Dex: 2.5 mg per pound of body weight. So if you have a 42 LB dog (42 x 2.5 = 105 mg) check the bottle to get the strength of the solution you are using. It may be 2 mg per ml, 3 mg per ml, or 4 mg per ml. If you have the 2 mg strength you would have to inject 52.5 ml to give 105 mg, if you have the 4 mg strength you would only need to inject 26.25 ml to have 105 mg. You see, the strength (%) tells you how many milligrams (mg) of drug you will inject for each milliliter (ml). So if you injected 10 ml of Azuim that was the 2-mg strength, you just injected 20 milligrams of Azuim. I used Azium to explain this but it holds true for all the drugs. Another thing to note is try to use these drugs only ONCE. You "can" go up to every 12 hrs, until stabilized, if you have to, but again they inhibit the immune system so carefully assess each situation to see if the use of Azium is warranted at all. If he needs just one dose after the hunt, then give him that first dose immediately and right with his fluids. If he is really bad off, then give whatever follow-up you deem to be warranted. For follow-up keep in mind it is preferable to give corticosteroids in the morning.
Solu-Delta Cortef: 2.5 to 5 mg per pound of body weight. So a 40-lb. dog would get 100 - 200 mg, depending on the severity. Again, try to use this drug only ONCE. You "can" go up to every 12 hrs, until stabilized ... if you have to ... but again cortico-steroids inhibit the immune system, so carefully assess each situation to see if the continued use of this drug is warranted. If he needs just one dose after the hunt, then give him that first dose immediately and right with his fluids. If he is really bad off, then any follow-up is preferably given IN THE MORNING, so any follow-up dosages would be given when you wake up.
Solu-Medrol: 15 mg per pound of body weight. So a 40-lb dog would get 600 mg. Again, try to use this drug only ONCE. You "can" go up to every 12 hrs, until stabilized ... if you have to ... but again cortico-steroids inhibit the immune system, so carefully assess each situation to see if the continued use of this drug is warranted. If he needs just one dose after the hunt, then give him that first dose immediately and right with his fluids. If he is really bad off, then any follow-up is preferably given IN THE MORNING, so any follow-up dosages would be given when you wake up.
Here are a few things you should know when using these drugs. First, inject SLOWLY and if possible place an I.V. catheter in your dog and give with his ringers; it makes it easier to give medication with the fluids, and you won't need to worry about finding a vein multiple times once you have one in place. If you have a catheter in place inject all the solution over about a 10minute time period, 1 ml every minute, down the same line you are running your fluids in. This really distributes the drug well. If you don't have a catheter, it makes IV administration much more difficult, and you may have to stick your dog multiple times to get the entire dose into him (unless you have a very steady hand and your dog is not moving).
Second, don't be fooled if your dog seems to be "Fine" after the injection, that just means it's working! Keep a constant eye on your dog for the next 48 hours. If needed, you can repeat the dose as often as every 12 hours (actually it can be repeated more often than that but if you need it more often than every 8 hours your dog should be at the vet), but in most cases after a hunt, a dog can probably be OK with just one post-hunt dosage. If he's still a little shocky in the morning, give him one more full injection when you wake up, again IF he needs it. Don't be too gung-ho with these drugs. If he's fine and "up," then leave him be and let his immune system work naturaly. If he is bad off, then he needs the full dose again, once every 24 hours, given IN THE MORNING, until better. If he doesn't seem responsive by 48 hours, he needs a vet. After 48 hours, if your dog is eating, drinking, urinating, and is not anemic you then wean him off (again, see below).
Third, if you cannot hit a vein at all, your best bet is using one of the high strength drugs like Solu*delta Cortef. You can give an intra-muscular injection of about 5 mls in each leg and give the remaining dose (if any) under the skin (Sub-Q). This is not practical with Azuim due to the high volume needed for effective doses.
Finally, do not just stop cortico-steroid therapy if your dog has needed it for a long time. If you just give one or two doses, there is no need to wean them off the drug, but there IS a need to wean them off these drugs if you've been using them for awhile. READ THIS:
According to the Merck Veterinary Manual: "On cessation of steroid therapy, the HPA axis recovers slowly over several weeks, and animals are particularly vulnerable to stress if treatment is terminated abruptly. Restoration of the HPA function is best achieved by gradually reducing the dosage while increasing the interval between doses ... The abrupt termination of dosing after a prolonged course of treatment may reveal a life-threatening degree of adrenal insufficiency."
In other words, you can kill your dog if you just stop prolonged cortico-steroid treatment. Therefore, you must wean your dog off of any prolonged such therapy SLOWLY if your dog is severely injured. That is, decrease the dosage by 1/2 of what it was, and double the interval time between doses, over a week or two, and then cease treatment. This will gradually wean your dog off of these system*altering drugs.
Well, that should just about cover it. But here are a couple of last details: (1) use the correct drugs for the correct problems. If your dog is extremely SHOCKY, you will want to use some form of prednisolone, either Solu-Delta or Solu-Medrol. If your dog isn't very shocky, but is extremely SWOLLEN and STIFF, you will want to use some form of dexamethasone, either straight Dex or Azium. The prednisolone group of cortico-steroids have weaker anti-inflammatory properties, but much stronger anti-shock properties, while the dexamethasone group has weaker anti-shock properties, but are about 10x as strong in decreasing inflammation. Solu-Medrol has the greatest degree of both properties. (2) If your dog doesn't need them, don't use them. (3) I know I said we would not go into giving these drugs prior to a hunt, but I have to give my two cents. Although many dogmen do practice this, I only know this, ALL these drugs can effect blood sugar levels, blood pressure levels, and affect the adrenal gland. This can have a profound affect on how your dog feels, not to mention you can dehydrate your dog if you are not careful with your dose and the time you give it. Adversely affecting the way your dog feels before a hunt isn't too bright, and anyone who has ever been dehydrated knows this is not what you want going into a hunt. That's just our opinion.
"The proper uses of cortico-steroids" is an often-debated subject and many a dogman has his own method of using them. For the purposes of this article we will not go into the use of a cortico-steroid prior to a hunt, to "dry" a dog out, but instead we will focus on the proper use and dosage of these drugs.
First, what is a cortico-steroid or "glucocorticoid"? For our purposes here we will define them as anti-inflammatory and/or anti-shock agents. Although they have many other uses, some of which can be of benefit to the dogman such as treatment for septicemic and bacteremic shock (shock from infections), and intracerebral edema (swelling of the brain) we will stay with the most common usage for now, treatment of shock and swelling due to trauma. The drugs we will discuss will be Dexamethasone (AKA Dex) & Dexamethasone Sodium Phosphate (AKA Azium), Prednisolone Sodium Succinate (AKA Solu-Delta Cortef) and a lesser-known but very good drug Methylprednisolone Sodium Succinate (AKA Solu-Medrol).
Lets discuss two major side effects of all these drugs before going into their uses. The first is, they suppress the immune system. That means they stop or inhibit your dog's ability to fight off infections. Second they are diuretics, which means they draw fluid out of your dog. For these reasons I recommend that ANY time you use any of the above-mentioned drugs you use them concurrently with fluid therapy and antibiotics, both of which are discussed in different chapters. And, if you can get by WITHOUT using cortico-steroids, then DO SO.
Use cortico-steroids only when absolutely necessary!
For convenience, I will use the word "Azuim," though all 4 drugs are interchangeable. Now, when do you use these drugs? I recently attended a hunt that involved two hard-mouthed dogs. The event lasted a total of 35 minutes after which both sides began attending to their dogs after they got the boar. I was surprised when I learned one party involved did not intend to use any Azuim on their dog even though they had some on hand. It seems they were under the impression that because they had given the dog some prior to the hunt that the dog would be fine. WRONG! It does not matter if the dog received a few ccs prior to the hunt. The doses given to dogs prior to a hunt are much too small to have any anti-shock properties of any importance.
Let's bust a couple of myths.
Myth #1: Azium given the day of, or the day prior to, a hunt stays with the dog and stops swelling. WRONG! These are fast-acting drugs and are not meant to have a strong prolonged effect.
Myth #2: Dogs don't need Azuim unless the hunt lasts a long time. WRONG! Dogs can take severe damage in the first ten minutes of a hunt. Especially with some of the hard biting monsters out there today.
Here are some good "Rules" to follow when using Azium:
1. If your dog hunts over an hour, even if you believe he hasn't taken any damage.
2. If your dog has had bleeders hit.
3. If your dog has faced a hard mouthed boar, especially if it gets bitten in the guts.
4. If your dog has run very hot for any period of time.
5. If your dog is in blatant shock, i.e.. glazed far away look in its eyes, cannot stand up, does not respond at all to painful stimulus.
Now for dosages. Most people I've seen do not use proper amounts of these drugs even when they do use them. Perhaps it has to do with the fact that these drugs can be hard to come by so people tend to be frugal with them. I will list as follows the correct dosages for all 3 drugs mentioned above. For those who may not know, for the purposes of administering injectable drugs (ml) and (cc) are considered to be the same. Also all doses are for intravenous use. All these drugs may be given in the muscle or under the skin, but that is not the preferred route of administration - and the doses would be different from what is listed here.
Azuim and Dex: 2.5 mg per pound of body weight. So if you have a 42 LB dog (42 x 2.5 = 105 mg) check the bottle to get the strength of the solution you are using. It may be 2 mg per ml, 3 mg per ml, or 4 mg per ml. If you have the 2 mg strength you would have to inject 52.5 ml to give 105 mg, if you have the 4 mg strength you would only need to inject 26.25 ml to have 105 mg. You see, the strength (%) tells you how many milligrams (mg) of drug you will inject for each milliliter (ml). So if you injected 10 ml of Azuim that was the 2-mg strength, you just injected 20 milligrams of Azuim. I used Azium to explain this but it holds true for all the drugs. Another thing to note is try to use these drugs only ONCE. You "can" go up to every 12 hrs, until stabilized, if you have to, but again they inhibit the immune system so carefully assess each situation to see if the use of Azium is warranted at all. If he needs just one dose after the hunt, then give him that first dose immediately and right with his fluids. If he is really bad off, then give whatever follow-up you deem to be warranted. For follow-up keep in mind it is preferable to give corticosteroids in the morning.
Solu-Delta Cortef: 2.5 to 5 mg per pound of body weight. So a 40-lb. dog would get 100 - 200 mg, depending on the severity. Again, try to use this drug only ONCE. You "can" go up to every 12 hrs, until stabilized ... if you have to ... but again cortico-steroids inhibit the immune system, so carefully assess each situation to see if the continued use of this drug is warranted. If he needs just one dose after the hunt, then give him that first dose immediately and right with his fluids. If he is really bad off, then any follow-up is preferably given IN THE MORNING, so any follow-up dosages would be given when you wake up.
Solu-Medrol: 15 mg per pound of body weight. So a 40-lb dog would get 600 mg. Again, try to use this drug only ONCE. You "can" go up to every 12 hrs, until stabilized ... if you have to ... but again cortico-steroids inhibit the immune system, so carefully assess each situation to see if the continued use of this drug is warranted. If he needs just one dose after the hunt, then give him that first dose immediately and right with his fluids. If he is really bad off, then any follow-up is preferably given IN THE MORNING, so any follow-up dosages would be given when you wake up.
Here are a few things you should know when using these drugs. First, inject SLOWLY and if possible place an I.V. catheter in your dog and give with his ringers; it makes it easier to give medication with the fluids, and you won't need to worry about finding a vein multiple times once you have one in place. If you have a catheter in place inject all the solution over about a 10minute time period, 1 ml every minute, down the same line you are running your fluids in. This really distributes the drug well. If you don't have a catheter, it makes IV administration much more difficult, and you may have to stick your dog multiple times to get the entire dose into him (unless you have a very steady hand and your dog is not moving).
Second, don't be fooled if your dog seems to be "Fine" after the injection, that just means it's working! Keep a constant eye on your dog for the next 48 hours. If needed, you can repeat the dose as often as every 12 hours (actually it can be repeated more often than that but if you need it more often than every 8 hours your dog should be at the vet), but in most cases after a hunt, a dog can probably be OK with just one post-hunt dosage. If he's still a little shocky in the morning, give him one more full injection when you wake up, again IF he needs it. Don't be too gung-ho with these drugs. If he's fine and "up," then leave him be and let his immune system work naturaly. If he is bad off, then he needs the full dose again, once every 24 hours, given IN THE MORNING, until better. If he doesn't seem responsive by 48 hours, he needs a vet. After 48 hours, if your dog is eating, drinking, urinating, and is not anemic you then wean him off (again, see below).
Third, if you cannot hit a vein at all, your best bet is using one of the high strength drugs like Solu*delta Cortef. You can give an intra-muscular injection of about 5 mls in each leg and give the remaining dose (if any) under the skin (Sub-Q). This is not practical with Azuim due to the high volume needed for effective doses.
Finally, do not just stop cortico-steroid therapy if your dog has needed it for a long time. If you just give one or two doses, there is no need to wean them off the drug, but there IS a need to wean them off these drugs if you've been using them for awhile. READ THIS:
According to the Merck Veterinary Manual: "On cessation of steroid therapy, the HPA axis recovers slowly over several weeks, and animals are particularly vulnerable to stress if treatment is terminated abruptly. Restoration of the HPA function is best achieved by gradually reducing the dosage while increasing the interval between doses ... The abrupt termination of dosing after a prolonged course of treatment may reveal a life-threatening degree of adrenal insufficiency."
In other words, you can kill your dog if you just stop prolonged cortico-steroid treatment. Therefore, you must wean your dog off of any prolonged such therapy SLOWLY if your dog is severely injured. That is, decrease the dosage by 1/2 of what it was, and double the interval time between doses, over a week or two, and then cease treatment. This will gradually wean your dog off of these system*altering drugs.
Well, that should just about cover it. But here are a couple of last details: (1) use the correct drugs for the correct problems. If your dog is extremely SHOCKY, you will want to use some form of prednisolone, either Solu-Delta or Solu-Medrol. If your dog isn't very shocky, but is extremely SWOLLEN and STIFF, you will want to use some form of dexamethasone, either straight Dex or Azium. The prednisolone group of cortico-steroids have weaker anti-inflammatory properties, but much stronger anti-shock properties, while the dexamethasone group has weaker anti-shock properties, but are about 10x as strong in decreasing inflammation. Solu-Medrol has the greatest degree of both properties. (2) If your dog doesn't need them, don't use them. (3) I know I said we would not go into giving these drugs prior to a hunt, but I have to give my two cents. Although many dogmen do practice this, I only know this, ALL these drugs can effect blood sugar levels, blood pressure levels, and affect the adrenal gland. This can have a profound affect on how your dog feels, not to mention you can dehydrate your dog if you are not careful with your dose and the time you give it. Adversely affecting the way your dog feels before a hunt isn't too bright, and anyone who has ever been dehydrated knows this is not what you want going into a hunt. That's just our opinion.