this article originally appeared in the february 2003...

”“Learn

about

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of many

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be fata l

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The GreatPretenderthis article originally appeared in the February 2003 issue of the Whole Dog Journal.

IIn June 1999, Booker, our 10-month-old Great Dane collapsed, again. Justfour days previously, he was diag-nosed with kidney disease. Hospi-talization and fluids helped himimmensely after that first collapse. Heeven had started eating again. Whatcould be wrong now?

We took him back to the vet. Thistime, Booker was so weak he could-n’t get up from the waiting room floor.The vet examined him there, but hadno immediate answers. He asked usto leave Booker overnight for moretests and IVs. Reluctantly, we did.

Later that day the vet called withgood news and bad news. The goodnews was that in consultation with spe-cialists, he identified the problem asAddison’s disease, an imminently treat-able condition. And, the bad news?Addison’s disease is a chronic healthproblem that will require a lifetime ofmanagement, including expensivemedication and regular blood tests.

Addison’s disease is the commonname for hypoadrenocorticism, oradrenal insufficiency. The adrenalglands do not produce enough, if any,of a number of hormones, includingaldosterone, which maintains sodiumand potassium levels to regulateblood pressure (among other impor-tant functions), and cortisol, whichhelps the body metabolize glucoseand deal effectively with physical andmental stresses of all kinds. It canoccur with people as well as animals.

The two adrenal glands are locat-ed on top of each kidney, and aresometimes called the suprarenalglands. They are made up of two lay-ers, the outer cortex and the innermedulla. The cortex secretes gluco-corticoids, such as cortisol, and min-eralocorticoids, such as aldosterone.The medulla area of the adrenalgland, part of the sympathetic nerv-ous system, secretes epinephrine andis generally not affected by Addison’s.

There are three types of Addison’s

disease: primary, secondary, andatypical. Primary and atypicalAddison’s are usually the result ofimmune-mediated damage to theglands. Secondary hypoadrenocorti-

cism is failure of the pituitary tostimulate the adrenals with adreno-corticotropic hormone (ACTH). It ismost often a result of long-term corti-costeroid therapy (i.e., prednisone),and also can be caused by tumors,trauma, or pituitary deformities.

Who gets Addison’s?Research shows that some breeds aremore likely to have Addison’s diseasecompared to other breeds. Forinstance, one study shows that WestHighland White Terriers are six timesand Great Danes seven times morelikely to be affected by Addison’scompared to all other breeds.

Another study indicates thatStandard Poodles are nearly ninetimes, Wheaton Terriers nearly seventimes, and Portuguese Water Dogsover 46 times more likely to be affect-ed than other breeds.

The same studies also deter-

mined that Dalmatians, Pit BullTerriers, Golden Retrievers, and ahandful of other breeds are less likelyto develop Addison’s compared to allother breeds.

At the University of California,Davis, Professor Anita Oberbauer,Ph.D., is conducting research todetermine if there is a genetic com-ponent to the disease, as indicated bythe breed statistics. Information isbeing collected for Bearded Collies,Standard Poodles, Leonbergers, andPortuguese Water Dogs. According to

Dr. Oberbauer, “The data we have forthe beardies suggest a polygenicmode of inheritance without a con-firmed major gene present.” The datafor the Standard Poodles also suggesta polygenic mode of inheritance but,“with a single locus/gene of largeeffect.” However, she qualifies that

Booker, the author’s GreatDane, was diagnosed withAddison’s disease when he wasjust 10 months old. Withscrupulous care and a whole,raw food diet, he stays healthyand strong.

“The Great Pretender” | 2 | © Shannon Wilkinson 2003

BY SHANNON WILKINSON

they aren’t aware of definitive breed-ing of affected Poodle to affectedPoodle, as a result there are not yetany data to show that it is indeed asingle gene.

Interestingly, some studies havefound that 70 to 85 percent of dogswith Addison’s disease are female,and that the dogs affected are mostoften between four and seven yearsold. However, Addison’s diseaseshould be suspected any time theclassic symptoms are seen, regardlessof the dog’s age or sex.

SymptomsOne of the difficulties of properlydiagnosing Addison’s disease is thecommon waxing and waning ofsymptoms. Karen Ivin, DVM, saysthat she always considers testing forAddison’s disease with dogs who“have their ups and downs. Whenthey aren’t quite right, but aren’t allthe way sick either.”

Dr. Ivin has a small, housecall-oriented holistic practice in Gilbert,

Arizona. Although Addison’s is oftendescribed as “rare,” she is treating sev-eral dogs with Addison’s disease, andhas always had a couple among herclientele at any given time. She thinksthat any vet who doesn’t have at leasta couple of dogs with Addison’s intheir practice just isn’t seeing it.According to the pharmaceutical com-pany Novartis, “a typical practice withtwo veterinarians who each see 1,500dogs per year should expect to diag-nose one case of adrenal insufficiencyeach year on average.”

Symptoms can be subtle and oftenmimic those common to many otherdiseases. Typical symptoms include:depression or lethargy; anorexia;weight loss; vomiting; shaking or trem-bling; weakness; and diarrhea. Oftenthe dog may experience episodes, suchas vomiting or weakness, that resolvewith fluids or perhaps even a dose ofsteroids. Unfortunately, the symptomsusually return.

This was our experience withTyler, our second dog. We adoptedTyler, a Boxer, in June 2001, at eightmonths old. He was extremely thinand had regular bouts of diarrhea.After a stay with caregivers overThanksgiving in 2001, he developedbloody diarrhea. Because of ourexperience with Booker we had Tylertested for Addison’s disease. Goodnews, his results were negative. Threemonths later, though, after Tyler vom-ited four times in two days, we hadhim tested him again. This time, theresults were positive for atypicalAddison’s. Note that neither of ourAddisonian dogs were female orbetween four and seven years old atthe time of the onset of the disease!

Diagnosing Addison’sBoth dogs’ diagnoses of Addison’s dis-ease were confirmed by the onlydefinitive diagnostic tool, the ACTHresponse or stimulation test. In thistest, blood is drawn to determine


Any dog with symptoms of thedisease should be tested.Tyler, the author’s male Boxer,was diagnosed with Addison’swhen he was 14 months old,despite being the “wrong” ageand sex for the disease.

Until recently, some owners of Addisonian dogs bought their medications fromInternet veterinary pharmacies such as MyPetPrescriptions.com, where the med-ications were available (with a prescription from a vet) at a lower cost than someveterinary clinics charge. However, Novartis, maker of the medication Percorten-V,has ceased the sale of its products to online pharmacies.

A Novartis spokesperson released a statement that explained in part, “Novartismaintains a strict policy of selling its products only to licensed veterinarians becausewe believe it is in the best interest of a pet’s health that our medication be dispensedwithin a direct, veterinarian-client relationship.... Novartis products are availablefrom most licensed veterinarians across the country, consistent with Novartis’ long-standing sales policy of selling its products only to licensed veterinarians.

“If any pet owner who has purchased Novartis products through an Internet sitehas questions about this or any other Novartis product and how it can be purchasedin the future, please contact Novartis Customer Relations at (800) 332-2761.

We would add that dog guardians should negotiate with their veterinarians forminimally marked-up prescriptions.

Novartis Ceases Salesto Online Pharmacies

baseline cortisol levels. The animal isinjected with ACTH. After approxi-mately one hour, blood is drawnagain to measure cortisol levels.

A dog with healthy, normal adre-nal glands will have a baseline corti-sol reading of between 1- 4 micro-grams/deciliter. The cortisol levelshould be significantly higher, in therange of 6 - 20 micrograms/deciliter,post-stimulation. If resting cortisol islow and the dog has no or a lowresponse to the stimulation, the diag-nosis is Addison’s disease.

Certain values on blood testresults also may indicate Addison’s asa possibility. This includes elevatedpotassium (hyperkalemia), low sodi-um (hyponatremia), low sodium topotassium ratio (Na/K), anemia,azotemia or uremia (high levels ofnitrogen), eosinophilia (elevation inwhite blood cells called eosinophils),lymphocytosis (elevation in whiteblood cells called lymphocytes), ele-vated liver enzymes (ALT/AST), andurine specific gravity less than 1.030.

Conventional treatmentThe conventional treatment forAddison’s, like hypothyroidism ordiabetes, is to replace the missinghormones. With primary Addison’sdisease, both mineralocorticoidsand glucocort icoids must bereplaced. Atypical and secondaryAddison’s require replacing only theglucocorticoid.

There are two medications avail-able for the replacement of the min-eralocorticoid, aldosterone, and bothof these medications help the bodykeep sodium and potassium at nor-mal levels. The first, fludrocortisoneacetate (brand name Florinef™), isgiven orally on a daily basis. Theother option is desoxycorticosteronepivilate or DOCP (Percorten-V™), aninjectable medication that is usuallygiven every 25 - 28 days.

Fludrocortisone acetate or Florinef

is the mineralocorticoid of choice forpeople with Addison’s disease. Mostpeople take one-half to two 0.1 mgtablets per day. However dogs don’tmetabolize the medication as effi-ciently and must start with doses of0.05 - 0.1 mg of fludrocortisone perten pounds of body weight. Somedogs require higher doses to regulatetheir electrolyte levels.

Florinef purchased from conven-tional pharmacies ranges in pricefrom about 50 cents per 0.1 mg tablet

to close to a dollar per tablet. A 50-pound dog would require approxi-mately five of the 0.1 mg tablets at acost of $75 to $150 per month.However, there are lower-cost alter-natives for fludrocortisone.

PetPharm, an Internet veterinarypharmacy based in Ontario, chargesabout $35 Canadian for 100 tablets ofFlorinef. At the recent exchange rate,the cost in US dollars is less than $23per 100 tablets. At this price, medica-tion for a 50-pound dog would costabout $35 per month. While thismakes Florinef much more affordable,if you have a large dog, you still con-tend with dosing multiple smalltablets daily. (For more informationabout reducing the price of long-termmedications, see “The Price ofPrescriptions,” WDJ September 2002.)

An alternative to purchasing thename brand tablets is to have the pre-scription customized into capsules,liquids, or flavored chews by a com-pounding pharmacist. Besides con-venience, compounded medicationcan be significantly less expensivethan its brand name equivalent. Onecompounding pharmacy, TiffanyNatural Pharmacy in Westfield, NewJersey, charges about $45 for 100 0.5mg capsules. That equates to just$13.50 a month to treat a 50-pounddog with just one capsule per day.

There are fewer purchasingoptions for Percorten-V, the injectablemedication used only for animalswith Addison’s. Many guardians taketheir dog in for his or her monthlyPercorten injection, allowing the vetto test the dog’s electrolytes if neces-sary, check for any weight changes,and monitor the dog’s overall healthand demeanor.

After time, though, the guardianmay want to give the injection athome. This not only might save someexpense, but may also decreasestress. Novartis, the maker ofPercorten, recommends intramuscular


� Suspect Addison’s disease,particularly if you feel yourdog just isn’t right, but vet(s)haven’t come to any firmdiagnosis.

� Shop around for less expen-sive medications. The initialfinancial burden can be over-whelming, but with sometime and effort, lower costmedications may be available.

� Work with your vet. It’simportant to discuss anychanges to medications, sup-plements and/or diet withyour vet. If your vet isn’t will-ing to listen, find one who will.

� Join an online support group.Talking to other animalguardians with Addisoniandogs can be invaluable.

Whatyou can do…

injections because that was themethod used during the FDA approvalprocess. However, a subsequent studypublished in the Journal of AmericanAnimal Hospital Association foundthat easier to give subcutaneous injec-tions are just as effective.

Like Florinef, the dosage ofPercorten is weight-dependent. Thestandard dose is 1 mg per pound ofbody weight. The medication comesin 4 ml bottles and there are 25 mg ofthe medication in each ml. Therefore,a 50-pound dog would require 50 mgor 2 ml of Percorten.

Percorten is available only fromveterinarians and veterinary pharma-cies. Prices vary widely, dependingon the clinic or pharmacy markup.When Booker was originally diag-nosed, we were charged $60 for thefirst ml and $40 for each ml there-after. That would make the monthlyinjection for the 50-pound dog costabout $100. However, I soon learnedthat the price included a greater than100 percent markup.

We negotiated the price with ourvet by pointing out that a dog withAddison’s requires regular bloodworkand office visits in addition to themedication. (Dog owners may beunable to purchase Percorten fromInternet pharmacies, even with theirveterinarian’s prescription, as theycan with many other long-term med-ications. See sidebar, lower left.)

Amy Rogers’ Rottweiler, Venus,was diagnosed with Addison’s recently.Initially, her vet started Venus onPercorten injections and didn’t evendiscuss the option of oral medication.However, Amy has recently switchedVenus, under the watchful eye of hervet, from the injections to compound-ed fludrocortisone. This change willsave Rogers about $80 per month.

In addition to replacing the min-eralocorticoids, dogs with Addison’sdisease need the glucocorticoid, cor-tisol, replaced as well. About 50 per-

cent of dogs require daily glucocorti-coid supplementation, while all dogswith Addison’s require glucocorticoidsupplementation in times of stress.

Stress is individual. It can comein many forms – physical or emotion-al, good or bad. For instance, somedogs may require extra glucocorti-coids for a visit to the vet, while otherdogs may need them because of anextra long play session. While it isimportant to observe all dogs withAddison’s closely, knowing each indi-vidual dog’s stressors is crucial.

There are a number of glucocorti-coids available to replace the cortisolthat the adrenals are no longer pro-ducing. Most vets recommend using

prednisone, while most people withAddison’s take hydrocortisone. Theother glucocorticoids used includeprednisolone, methylprednisolone,and dexamethasone. These all tend tobe inexpensive medications.

You many recognize prednisoneas the steroid frequently prescribed

for allergic reactions, skin problems,or autoimmune conditions. However,its use with the Addisonian patient isat far smaller physiological doses,rather than the therapeutic dosesoften used for anti-inflammatory andother situations. The typical recom-mended dosage of prednisone is 0.1 -0.2 mg per pound per day. That is 5 -10 mg per day for a 50-pound dog.

However, many people find thaton these doses their dog withAddison’s shows undesirable symp-toms such as excessive drinking andurination, increased appetite, infec-tions, even behavioral changes.Because these dogs will be on med-ications for the rest of their lives, it isimportant to fine-tune the dosages tomaximize benefits, while minimizingunwanted side effects.

If a dog suffers from side effects ofprednisone, it might be worth tryinghydrocortisone instead. That’s what Ifound with Booker. He was on 15 mgof prednisone every other day. Yet hewas unable to go more than fourhours without urinating, was havingrecurring skin infections, and wasbalding on his face, chest, legs, andabdomen. After switching to hydro-cortisone under the care of our vet,his dose was reduced significantlyand these problems went away.

Of course, any of these medica-tions require a prescription from yourprimary veterinarian. It is important,particularly with Addison’s disease,that your dog is monitored closelythrough observation and blood tests.Always work with your vet whenexploring changes in medications.

Complementary TherapiesAccording to most experts, there is noreplacement for the conventionalmedications required to treatAddison’s disease. However manybelieve that the quality of life can beimproved and medications evenreduced by using various supple-


When Amy Rogers’ RottweilerVenus was initially diagnosed, Amywas not given information onalternative medicines or therapies.With a little research, she learnedshe could save about $80 permonth on Venus’ medications.

ments, improving the dog’s diet, andincorporating complementary modali-ties such as acupuncture and TTouch.

Booker is a perfect example ofhow complementary therapies canenhance conventional treatment.Months after diagnosis, Booker wasclinically stable with excellent bloodtest results, but he was still experienc-ing a number of problems, such asdigestion issues, skin problems, andlow energy levels.

After incorporating a variety ofcomplementary therapies includingWestern and Chinese herbs, TTouch,acupuncture, supplements, and araw, whole food diet, his digestion isgreatly improved and his energy levelis higher than as a puppy. In addition,his medications have been reducedsignificantly. At the time of switchinghim to hydrocortisone, he was taking30 mg per day. He now takes 7.5 mgper day. He also was receiving 6.4 ml

of Percorten-V every four weeks. Thishas been reduced over 65 percent to3.2 ml every six weeks.

Many vets agree that diet is thekey to a foundation of health for anydog. Before focusing his efforts ondiet, Ian Billinghurst, BVSc, studiedacupuncture and met with herbalistsand homeopaths trying to determinewhat has the greatest impact on thehealth of our dogs. He learned thatwithout a good diet, therapies such asacupuncture and homeopathy won’twork properly.

Gloria Dodd, DVM, agrees. Shebelieves that diet accounts for 70 per-cent of the treatment for an ill dogand this is the first change sheencourages clients to make. BothBillinghurst and Dodd are proponentsof a raw, fresh, whole foods dietdesigned for carnivores.

While Dr. Ivin recognizes theimportance of diet in the overall health

and treatment of an animal, she does-n’t believe it has to be raw, or evenhome-cooked. However, the commer-cial food must be of top quality.

One of the most frequently rec-ommended complementary treat-ments for Addison’s is also one of itsoriginal treatments: glandular supple-mentation. Before the discovery ofcortisol, and later its syntheticanalogs cortisone and prednisone,patients with Addison’s disease weregiven ground-up or extract of adrenalgland. Now the process has evolvedand a number of companies, such asStandard Process and Nutriwest,manufacture glandular products intablet or capsule form.

“The addition of glandulars maysometimes help reduce the medica-tion levels of my patients,” says Dr.Ivin, “but they nearly always improvehow the dog feels on a day-to-daybasis.” She says they help reduce


Adrenocorticotropic Hormone or ACTH — Hor-mone secreted by the pituitary that stimulates the adrenalglands to produce cortisol. Used to test adrenal functionand diagnose Addison’s disease.

Aldosterone —This adrenal hormone, a mineralcorti-coid, is crucial to virtually every cell as it balances the elec-trolytes sodium and potassium.

Cortisol — This adrenal hormone, a glucocorticoid, isoften referred to as the stress hormone. In addition totimes of stress, the body normally secretes a regularamount every day. It impacts the body in a multitude ofways, including controlling fat, protein and carbohydratemetabolism and the inflammation response.

Desoxycorticosterone Pivilate — The active ingredi-ent in Percorten-V.

Electrolytes — Mineral salts or chemical substances thatconduct electrical current across and between cells. They

include sodium and potassium and are necessary for basicbody functions.

Florinef TM — Oral medication used to replace the min-eralocorticoid, aldosterone.

Fludrocortisone Acetate — The active ingredient inFlorinef. It is available through compounding pharmacies.

Glucocorticoid — Hormones secreted by the adrenalgland, such as cortisol, which metabolize glucose and helpthe body deal stress.

Mineralocorticoid — Hormone secreted by the adre-nal gland, such as aldosterone, which maintains sodiumand potassium levels to regulate blood pressure and otherfunctions.

PercortenTM — Injectable medication used to replacethe mineralocorticoid, aldosterone.

Glossary of Terms

fluctuations in the disease process,help keep the dogs stable, anddecrease deterioration as they age.

Various herbs may be beneficial,including nutritive herbs that supplyvitamins and minerals necessary foradrenal functions, such as dried net-tle, dandelion, parsley, and spirulina;those that support adrenal function,like licorice and borage; those thathelp the liver, like milk thistle; andthose that reduce the impact of stress,such as astragulus and ginseng.

The herb licorice has been report-ed to have a positive effect withAddison’s disease. Research has shownthat licorice helps prolong the activityof natural and synthetic corticosteroidslike hydrocortisone, which mayenhance the activity of medications oreven allow dosage reductions.

Dr. Ivin uses Chinese herbal formu-las with great success. Because, as withhomeopathy, Chinese herbal remediesare prescribed on an individual basis,she may use a variety of formulasdepending on the particular symptomsof her patient. Most of the formulas thatshe chooses contain the key ingredient,ginseng. Ginseng is an adaptogenicherb that helps the body adapt to envi-ronmental and emotional stressors andsupports all the major systems of thebody rather than having strong affinitiesfor any one system or organ.

Since Addison’s disease inhibitsthe body’s ability to effectively dealwith stress, reducing stress and keep-ing your dog’s life stable is important.“Maintaining a low-stress, stable envi-ronment for your dog helps limit thenecessary changes in medication,”says Dr. Ivins. She has found thatflower essences are helpful in reduc-ing stress and limiting the need forextra glucocorticoids.

Acupuncture and chiropracticcare may also be beneficial. Dr. Doddbelieves strongly that in addition tomedications, supplements, and diet, itis necessary to treat the imbalances in


Noel is an eleven and a half year old Great Dane with Addison’s disease. LoryJenkins and her husband adopted her on Christmas Eve, 1991. She was malnour-ished, underweight, timid and very skittish in certain circumstances.

Noel flourished under Jenkins’ care – she gained weight and confidence overtime. In 1997 though, her energy level diminished, as did her appetite. Initial bloodtests indicated early renal failure. She continued to lose weight, became morelethargic and finally quit drinking water.

Jenkins became desperate and started calling all the vets she could find. Ahomeopathic vet strongly suggested having Noel tested for Addison’s disease. TheACTH Stimulation test was done – Noel had a very clear-cut case of Addison’s.

She was started on Percorten-V and prednisone immediately and seemed tofeel better the next day. These medications were continued over the next fiveyears. In general, her health was good – her appetite was normal and her energylevel was stable.

Over time though, Noel became incontinent and was placed on PPA (phenyl-propanalamine). She also began having recurring bladder infections and was givennumerous courses of antibiotics. The infections started reoccurring more quicklyafter finishing each course of antibiotics. Jenkins was concerned that one day Noelwould develop an infection that couldn’t be helped by antibiotics.

Jenkins was referred to homeopathic vet, Larry Bruk in early 2002. Bruk, a clas-sically trained homeopath, doesn’t treat a disease per se, but rather treats a patientbased on the individual and the symptoms they are manifesting. Bruk’s initial consul-tation with Noel and Jenkins took approximately two hours. He wanted details abouteverything from symptoms to preferences for hot or cold to changes during the day.

Based on this information Bruk selected a homeopathic remedy that fit Noel.Jenkins prepared the remedy and gave Noel one dose. Then the waiting andwatching began. She reported her observations to Bruk. Bruk might wait longer,repeat the dose or select a different remedy based on the situation.

At the same time, Noel’s dose of prednisone was transitioned to natural hydro-cortisone from Pet Health Pharmacy. After time this was switched to adrenal glan-dular supplementation. Her dose of Percorten also was reduced.

At the end of several months, Noel’s bladder infections had not recurred. Shewas taken off PPA and showed no incontinence. Plus, her Percorten dose had beenreduced by more than half as she went from a 4.8 ml injection every 25 days to a 2.8ml injection every 32 days. And, according to Bruk there is room for even moreimprovement.

At her last injection, Noel, under close watch and with several blood tests, went53 days in between injections of Percorten. When she was given her last dose at thebeginning of December, it was reduced again to 2.6 mls. Bruk believes that with timeshe may be able to go without conventional meds altogether because the homeo-pathic remedies are helping balance her energetic state so that she can heal herself.

Noel, A Study in Alternative Therapy

the acupuncture energy flow meridi-ans of the endocrine glands, digestiveorgans, immune system, and kidneys.

Post diagnosis follow-upImmediately after diagnosis, andwhenever any changes are made tomedications or supplements, it isimportant to perform blood tests toensure the dog is stabilized. The elec-trolyte levels offer the most specificinformation, particularly about theefficacy of the mineralocorticoids.However, thorough blood workincluding a full chemistry panel,complete blood count, and thyroidpanel are helpful in determining theoverall health of an animal.

Thorough management of anAddison’s patient, and fine-tuning hismedications and treatments to maxi-mum effect can be difficult, especial-ly with so many variables. Dr. Ivinencourages owners to work closely

with their veterinarians to understandthe disease as much as possible.“There is no such thing as a dumbquestion,” she says. Dr. Ivin also rec-ommends keeping track of every-thing, including the dog’s activitylevel. Without a written record, it isdifficult to know the impact ofchanges made in medications, sup-plements, diet, or other therapies.

While managing Addison’s dis-ease can be daunting, it is not impos-sible. The greatest motive for workingat it is the day-to-day health andlongevity of your dog. Researchshows that when properly stabilized,Addison’s disease does not seem toimpact the longevity of a dog.

Dr. Ivin recently lost a caninepatient with Addison’s this summer.The Australian shepard was diag-nosed at about eight years old anddied at 16. Now that is worth workingtoward.


Contacts and Sources:Canine Genetic Analysis Project –Addison’s DiseaseFor more information and to requesta kit, go to: http://cgap.ucdavis.edu

Larry Bruk, DVMMill Valley, California, 415-381-0723 [email protected].

Gloria Dodd, DVMGualala, CA, 707-785-9171 www.holisticvetpetcare.com

Karen Ivin, DVMDesert Mobile Veterinary ServicesGilbert, Arizona, 480-497-6362.

International Academy ofCompounding Pharmacists800-927-4227, fax 281-495-0602www.iacprx.org.

MyPetPrescriptions.com c/o Medicine Man PharmacyLiberty Lake, Washington, 877-666-2501, fax 509-755-3337www.mypetprescriptions.com.

Pet Health PharmacyYoungtown, Arizona 800-742-0516, fax 866-373-0030www.careforpets.com

PetPharm, a division ofBroadview PharmacyToronto, Canada 888-423-9444, fax 888-423-7860www.petpharm.org

Tiffany Natural PharmacyWestfield, New Jersey 908-233-2200, fax 908-233-3975

AddisonDogs.coma non-profit organization thatprovides information and support topeople caring for dogs with Addison’sdisease

Acupuncture is a effective complement to conventional veterinary treatment.Practitioners frequently find that they can reduce the medication a dogreceives if he also receives acupuncture treatments.

this article originally appeared in the february 2003...

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