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November 7, 2018

Steroids, a Dirty Word — Part 2

If you haven’t read Part 1, please click here.

In that article we discussed how the term “steroid” has mistakenly come to mean cortisone and prednisone. We also noted that SARD dogs routinely develop high levels of steroids called sex-hormones. And we corrected some misconceptions about steroids.

Here in Part 2 we’re going to address another misconception.

A Quick History

For decades, prednisone has been typically been prescribed in what’s called an anti-inflammatory or immuno-suppressant dose. These are the large doses that suppress the immune system response.

When a dog develops sudden blindness, it’s been the standard practice to rule out inflammatory activity. Veterinary ophthalmologists prescribe oral prednisone in an anti-inflammatory dose. The dog generally shows no improvement and in fact, may experience MORE hunger, thirst and lethargy than before.

Why? Because not only are these dogs producing high levels of sex-hormone steroids internally, they’ve been prescribed high levels of prednisone, another steroid, on top of that. No wonder these dogs feel worse than when they started!

The Difference is in the Dose

If you’ve read any of my work you know that sex-hormone levels rise when adrenal glands can no longer make sufficient cortisol. And you also know that when these dogs are given (and I cannot emphasize this enough) LOW DOSE, DAILY REPLACEMENT-LEVEL cortisol, it corrects the over-production of those sex-hormones.

A LOW, DAILY REPLACEMENT-LEVEL DOSE of cortisol (prednisone or Medrol) is very different than the large, short-term, anti-inflammatory dose that SARD dogs are typically prescribed at diagnosis. Understanding the difference in these dosages is crucial. An anti-inflammatory dose suppresses the immune system response and may worsen symptoms. A low dose corrects the sex-hormone problem and improves symptoms.

Some Examples

Let’s take the example of a 20-pound dog. Holistic veterinarians would typically give a 20-pound dog about 2mg of prednisone or Medrol as a daily replacement dose. On the other hand, an anti-inflammatory dose can range from 5mg-20mg per day. That’s double, triple, or even 10-fold as much as a daily replacement dose!

Here’s another way to look at it. Do you know someone who takes thyroid hormone? That person takes a tiny dose each day. It’s a lifelong treatment to replace the amount of thyroid hormone a body would normally make. If that person took 10 times what they actually needed, there would be some serious medical consequences.

So, when a SARD-dog owner says to me, “We tried the prednisone treatment and our dog felt even worse,” in all likelihood their dog was given a high, anti-inflammatory dose rather than a LOW, DAILY REPLACEMENT-LEVEL DOSE as described in the SARD protocol.

In Part 3 we will discuss some nuances of low-dose cortisol replacement therapy. I hope this has been helpful. Good luck.

November 7, 2018

Steroids, a Dirty Word — Part 1

We’ve all been taught that the term “steroid” means cortisol and its cousins cortisone, prednisone, methylpred, etc. Medical and veterinary personnel fall into this trap, as well. Doctors say things like, “I’m going to write you a prescription for a steroid.” So, we all tend to equate “steroid” with cortisone and prednisone.

When we discuss SARD dogs it becomes clear just how inaccurate and impractical this description is.

A steroid is a molecule with a particular shape — four rings of carbon atoms. More importantly, it’s a molecule with a mission. A steroid signals cells to do their work. It’s called a signaling molecule. There are hundreds of steroids produced by the body in addition to cortisol and cortisone.

Surely, you’ve heard stories of bodybuilders taking testosterone injections. They do this because testosterone is a steroid that signals muscle development. In fact, all of the sex-hormones are steroids: androgens, progesterones, and estrogens.

We know that when SARD dogs are tested, there is a high incidence of elevated sex-hormone production. These steroids signal many cells in the body. It’s the reason these dogs suffer such a wide variety of problems including hunger, thirst, obesity, lethargy, seizures, liver degeneration, etc.

So, when a SARD-dog owner says, “I would never put my dog on steroids” as though it’s a dirty word — Guess what!? — that dog is already experiencing high levels of steroids circulating through its body.

This information may make some readers angry. Other readers will ignore it. These are normal methods of coping with grief and loss of control. A few readers will have questions. Please see Part 2. And a very few will “be in a place” where they are ready to address the problem. I truly wish all of you the best.  Click here for Part 2.

November 7, 2018

How Low-Dose Cortisol Corrects SARD Symptoms

After some thought I’ve decided to write this article in plain English for the benefit of the average dog owner. If you wish to see a more thorough explanation or bibliography, click here.


As you may know, cortisol is our natural anti-inflammatory hormone. It plays a role in essentially all body functions and is necessary for the body’s survival.

Cortisol is created when the brain sends out a fancy chemical call adrenocorticotropic hormone (ACTH) into the bloodstream. ACTH stimulates the adrenal gland to convert precursor hormones (building blocks) into cortisol. It’s like an assembly line. One hormone molecule Is converted into another until it’s turned into cortisol.

When the brain senses that sufficient cortisol has been produced, it decreases ACTH production, thereby decreasing adrenal gland activity. This feedback loop is a little like the thermostat in your home. When the house is warm enough, the thermostat turns off the furnace.

Adrenal exhaustion is a condition where the body can NO LONGER CONVERT the precursor hormones into cortisol. This may be due to chronic stress, chemical damage, and/or genetic abnormality. Over the years, the veterinary community has called this condition by various names: hyperestrogenism, atypical Cushing’s disease, and Plechner’s syndrome.

When the glands can no longer convert precursors into cortisol, it creates a break or interruption in the assembly line. The precursor hormones pile up behind that break. With nowhere else to go, they are rerouted down an alternate assembly line to produce hormones called adrenal sex-hormones.

Furthermore, because the glands are no longer producing sufficient cortisol, the brain never receives the message to turn off ACTH production. This causes chronically elevated sex-hormone levels. Since the sex-hormones are steroids, the resulting symptoms look almost exactly like those of cortisol excess (Cushing’s disease). This is why a dog in adrenal exhaustion can mistakenly appear to be suffering from Cushing’s disease.

Low dose cortisol supplementation can reestablish the feedback loop. The brain recognizes the presence of the cortisol replacement and reduces ACTH production. Once the ACTH production is normalized, levels of sex-hormones begin to normalize as well. This is how low-dose cortisol replacement therapy reduces elevated sex hormone levels and the symptoms so common in SARD dogs.

Because low dose cortisol replacement simply replaces what the body would normally make, we do not expect to see the side-effects produced by high, anti-inflammatory doses of prednisone or other glucocorticoids.

On the other hand, if aggressive treatments for Cushing’s disease are implemented — treatments that destroy what little cortisol production exists — there can be life-threatening results. When dealing with a SARD dog, test sex-hormone levels, especially estrogen.

October 28, 2018

“My dog is doing great but…”

Since we’re heading into the autumn SARD season, I thought I’d try again to offer a few words of advice. I know SARD dog owners struggle emotionally with this diagnosis. There are feelings of grief and loss and anger. I know the dogs struggle, too.  For over a decade I’ve received emails or read posts that start like this.

“My dog is doing great but…”

• She was just diagnosed with an enlarged liver
• She is ravenous
• He is drinking a lot of water and has accidents in the house
• The snoring keeps me awake at night
• She’s put on a lot of weight and has trouble getting around
• He is acting kind of confused
• She is panting hard
• He’s so lethargic, he’s just a bump on a log
• She wet her bed during the night
• Her belly is so bloated
• She recently had a seizure and was taken to the emergency room
• She wakes up every 2-3 hours wanting to eat or go out
• Her liver values are high
• She constantly licks between her toes
• She’s lost her sense of smell
• She has stomach issues and diarrhea
• She’s just been diagnosed with kidney failure
• He has awful skin sores
• She gets chronic bladder infections

The list goes on and on.  Year after year after year.  These same dog owners also write:

• A few tests have ruled out Cushings
• Cushings blood work is completely normal
• ACTH and LDDS tests and are negative for Cushing’s
• They are still trying to find Cushings. She has a biopsy and an ultrasound scheduled
• We had our girl tested for Cushings. It came back negative

If you are “in a place” where you can accept that there is an underlying problem and that the problem is not Cushing’s disease [1,2], then simply ask your vet to run an adrenal estrogen level. That’s all. You don’t have to believe in my work. Just run an adrenal estrogen level and see what it says. NVDS is the more affordable option and requires only a single blood draw. UTCVM recommends an ACTH component. This can be more expensive and invasive but your general practice vet might prefer it.

Good luck.


[1] Van der Woerdt A, Nasisse MP, Davidson MG. Sudden Acquired Retinal Degeneration in the dog: clinical findings in 36 cases. Progress in Comparative Ophthalmology 1991; 1: 11-18.

[2] Gilmour MA, Cardenas MR, Blaik MA, Bahr RJ, McGinnis JF. Evaluation of a comparative pathogenesis between cancer-associated retinopathy in humans and sudden acquired retinal degeneration syndrome in dogs via diagnostic imaging and western blot analysis  American Journal of Veterinary Research 2006; 67, 5; 877-881

October 15, 2018

Disinformation

 

A woman recently shared the following with me.  She said that when her dog was diagnosed with SARD her veterinary ophthalmologist insisted there was no known cause or cure and also issued a warning. “If you find anything on the internet to the contrary it’s a scam. Someone is just trying to make money off you.”

I’m not sure if the ophthalmologist’s statements would be classified as slander or defamation, but I do know this.  As a general rule, the ophthalmic veterinary community is withholding information from you. And after hearing the comments above, it’s time to address this.

Here are the facts.

In 2003 a research paper was presented at the annual meeting of the American College of Veterinary Ophthalmologists. This study was conducted in part by the prestigious Department of Endocrinology at the University of Tennessee’s College of Veterinary Medicine.  The paper demonstrated that 9 out of 10  SARD dogs had elevated levels of adrenal sex hormones.[1]

In 2007 these findings were substantiated when the American College of Veterinary Ophthalmologists (ACVO) published two additional papers describing elevated levels of adrenal sex hormones in SARD dogs.[2][3] These papers were written and presented at the ACVO meeting by me, Caroline Levin.

In 2008 the laboratory findings of 54 SARD dogs were made public. This paper demonstrated that 53 of 54 SARD dogs had elevated adrenal sex-hormone levels. Results were compiled from four laboratories: the University of Tennessee, Cornell University, Antech Diagnostics and National Veterinary Diagnostic Services.[4]

In 2009 the findings from the endocrinology services at the University of Tennessee’s College of Veterinary Medicine were updated and published in the Journal of the American Animal Hospital Association. They demonstrated that 11 of 13 SARD dogs had elevated adrenal sex-hormone levels.[5]

So, for 15 years the ophthalmic veterinary community has been aware — via data published in their own academic journal and elsewhere — that an adrenal sex-hormone problem exists in virtually all SARD dogs.

Did the veterinary ophthalmologist mentioned above provide such information to the dog owner? No. Not only was the client denied this information, she was warned not to investigate further.  It reminds me of the line from Shakespeare, “The lady doth protest too much, methinks.”

How about you? Did your veterinary ophthalmologist tell you there is a high incidence of elevated sex-hormones in these dogs?  Did he/she suggest that you investigate this issue with your general practice veterinarian?  Did he/she suggest a simple blood test to check your dog for elevated adrenal sex-hormones?

Shall I take a guess that the answer is “No?”

So, there you have it.  On one hand we have peer-reviewed, replicated findings, published over many years documenting an underlying adrenal problem in these dogs.  On the other hand, it is the standard practice of the ophthalmic veterinary community to withhold this information from you.

Now tell me again, who is perpetrating a scam?


[1]Carter RT, Bentley E, Oliver JW, Miller PE, Herring IP. Elevations in Adrenal Sex Hormones in Canine Sudden Acquired Retinal Degeneration Syndrome (SARDS). Proceedings of the 34th Annual Meeting of the American College of Veterinary Ophthalmologists 2003;34: 40.   (Scroll down to abstract #51 if you use the link.)

[2]Levin C. Sudden Acquired Retinal Degeneration, Associated Pattern of Adrenal Activity, and Hormone Replacement in Three Dogs – a Retrospective Study. Proceedings of the 38th Annual Meeting of the American College of Veterinary Ophthalmologists 2007; 38: 32.  (Scroll down to abstract #28 if you use the link.)  Full text available here.

[3]Levin C. Sudden Acquired Retinal Degeneration, Associated Pattern of Adrenal Activity, and Hormone Replacement in a Brittany Spaniel – Case Report. Proceedings of the 38th Annual Meeting of the American College of Veterinary Ophthalmologists 2007; 38: 33. (Scroll down to abstract #29 if you use the link.)  Full text available here.

[4]Levin C. Adrenal Exhaustion and Immunoglobulin Suppression: Common Findings in 54 Dogs with Sudden Acquired Retinal Degeneration (SARD). Copyright © 2008 Lantern Publications.

[5]Carter RT, Oliver JW, Stepien RL, Bentley E. Elevations in Sex Hormones in Canine Sudden Acquired Retinal Degeneration Syndrome (SARDS). Journal of the American Animal Hospital Association 2009; 45: 207-214.

 

 

May 13, 2017

How can we prevent SARD?

Great question. I believe this must be addressed by dog owners and their local, home town veterinarians. Why your local vet? Because, to date, veterinary ophthalmologists maintain that they do not  know the cause of SARD. Consequently, they have not identified any preventative measures.

Part 1: If you’ve been reading these pages, you are familiar with the unmistakable relationship between adrenal exhaustion (i.e.. elevated estrogen) and the onset of sudden blindness.  98% of SARD dogs tested demonstrate elevated estrogen. If the adrenal exhaustion could be promptly identified and treated, it might preempt the damage to the retina.

So, perhaps the most effective mode of prevention would be to educate general practice veterinarians and this might have to come from you, the dog owner. General practice vets should be educated:

  • to recognize the signs of adrenal exhaustion and the breeds (Dachshunds, small terriers) most at risk
  • how to test for adrenal exhaustion
  • and how to treat it

Many dog owners make an appointment with their general practice veterinarian prior to the onset of blindness. The owners bring in the dog with signs of increased hunger and thirst, perhaps accidents in the house, and/or any of the other common signs such as, lethargy, depression, aggression, pacing, panting, etc.  The general practice veterinarian may run a blood test to rule out Cushing’s disease (i.e.. a tumor growing on one of the glands that produces excess cortisol).

It seems logical to run a Cushing’s test, since the symptoms mentioned above can be signs of a tumor/excess cortisol. However, these are also signs of adrenal exhaustion (excess estrogen).  How can this be? How can both excess estrogen and excess cortisol produce the same symptoms?

Both estrogen and cortisol are steroid hormones. And as two molecules go, they are very, very similar, so they both have similar effects on the body. They both cause: drinking, peeing, hunger, depression, infections, etc. So, if the Cushing’s test is negative, the veterinarian, should suspect adrenal exhaustion.  And really, to prevent vision loss, the veterinarian should test for adrenal exhaustion along with, or instead of, Cushings, so that no time is wasted.

If the testing can be done and the treatment initiated immediately, how many dogs might retain their vision? How many dog owners could be spared their grief and pain!

Part 2:  For your part, consider raising any future dogs in a more old-fashioned way… treating the dog as we did decades ago, before SARD first made it’s appearance. SARD was only first diagnosed in the late 1970’s-early 1980’s. Rather than type out this information a second time, I am giving you a link to another website of mine.  Here, you will find information about homemade meals, why to minimize chemical exposures, and some thoughts about vaccines. We also have a DVD that covers these topics:

April 16, 2017

SARD Seasons

There are two times each year when I see an uptick in the occurrence of SARD. The first is in the fall. Around Thanksgiving. The second is in the spring. Around Valentines day.  During these times, the adrenal gland typically experiences an increase in activity. Why?

In the autumn the adrenal gland helps the body prepare for the stress of the coming winter. It helps the animal grow a winter coat, deal with the cold weather and fewer calories, go into hibernation.  In the spring, the adrenal gland is involved with the new seasonal changes: coming out of hibernation, preparing for breeding.

When an adrenal gland can no longer produce cortisol, it produces adrenal sex-hormones (most notably, estrogen) instead. So in the fall and in the spring, when the adrenal gland is being stimulated by the brain, it produces a spike in estrogen levels.

As you may know from my writings, my thesis is that elevated estrogen triggers a seizure in the retinas. During that time the retina cannot communicate with the brain. Since the brain is where visual images really occur, the dog loses vision suddenly.

 

 

February 12, 2017

What causes Sudden Acquired Retinal Degeneration (SARD)?

Here, in a nutshell is my thesis as to the cause of SARD. You can read the details, below.

  • These dogs develop elevated estrogen levels
  • That estrogen permits excessive levels of calcium to enter the retinal cells
  • This calcium causes a seizure (vision loss)
  • and ultimately retinal cell death

Now for further details, I’m including an excerpt from one of my papers. For those of you who want to check my references, click the link. For those of you who don’t like reading medical jargon, there is a plain English translation down below.

Retinal activity during adrenal exhaustion

Dogs affected with SARD routinely present with signs suggestive of hypercortisolism (1,2,3,4,5) but only a minority are diagnosed with Cushing’s disease. (2,6) Early on, researchers speculated that this hypercortisolism was the physiological response to some unidentified stress. (5) SARD- affected dogs also demonstrate elevated levels of adrenal sex hormones (androstenedione, estradiol, progesterones, and testosterone) within the first year of blindness. (7,8) One explanation for this pattern of events is Selye’s model of stress adaptation, which describes the progression from adrenal gland hyperactivity to adrenal gland exhaustion (cortisol insufficiency and excessive estrogen production).

(snip)

 

Apoptosis is a common final pathway in multiple retinal disorders including SARD. (33) It is also prevalent in other systems such as the central nervous system and immune system. Apoptosis is modulated in these systems is by steroid hormones such as cortisol and sex hormones. (34,35)

Retinal photoreceptor cell membranes contain gated ion channels, which control the influx of calcium ions (Ca++) into these cells. In photoreceptor outer segments, Ca++ controls light adaptation. In photoreceptor inner segments, Ca++ regulates cell metabolism, glutamate release, gene expression, and cell death. (36)

In pathological conditions of steroid hormone excess, Ca++ influx increases. Elevations in intracellular calcium, along with pro-oxidants, neurotoxins, and ishchemia damage the cell mitochondria. Caspases and other apoptosis-inducing factors are then released, degrading cellular components. (37) In SARD cases, retinal abnormalities typically do not develop until weeks or months after SARD onset, indicating that apoptosis is not immediate. (2,3)

 

And here’s the translation in plain English

There are little doors into each retinal cell. These doors are called calcium channels. Normally, the doors open up for a split second, a small amount of calcium enters the cell, and the door closes. That small amount of calcium creates an electrical signal to the brain that we know as vision.

When estrogen levels are high, as they are in SARD dogs, the calcium channels remain open longer and much more calcium enters the cells. This excessive calcium causes an extensive electrical signal to move through the retina, throwing it into a seizure. This is when communication to the brain is interrupted and vision is suddenly lost. The retinal cells are not dead at that point. They are simply unable to communicate with the brain. Over time, the overabundance of calcium damages the mitochondria, the little organs inside the cell. Once the mitochondria are damaged a self-destruct message called apoptosis is initiated, and the retinal cells are finally destroyed.

 

My thesis is actually supported by much research published by the veterinary ophthalmology community, as you can see by the other works I reference. It’s likely, however, that your veterinary ophthalmologist did not inform you about my work. That will be a topic for another blog post.

I have followed hundreds of SARD cases in the past 15 years. There is a clear correlation between the incidence of SARD and elevated levels of adrenal estrogen. The estrogen levels can be brought down to normal levels with hormone replacement therapy. This offers the best chance for a comfortable life. You and your dog should not have to suffer.