January 20, 2019

Steroids—a Dirty Word, Part 3

In this article I’d like to discuss some finer points of adrenal activity. If you haven’t read Part 1 and Part 2 of this series, please do.

Also, please remember I am not dispensing veterinary advice. I am sharing my observations with you. And I’m sharing information that my holistic veterinarian once shared with me. If you find this information to be complex and counterintuitive, you’d be right. I’ll try to explain it all in plain English and I’ve made some graphs to help, as well.

The Graphs

The center portion of each graph represents normal hormone activity. The top third represents abnormally high activity. The bottom third represents low activity. Sex-hormone activity is represented via estrogen.

Please note that “activity” does not necessarily equate with blood test results, especially in terms of cortisol. Lab tests often lump precursor hormones into the “cortisol” reading, pushing it into the normal range or even above normal when in fact, true cortisol production (activity) is low. For further reading, click here and scroll to page 8.

In addition, most cortisol readings do not identify prescription cortisol replacements. Consequently, even with therapy it’s common for cortisol readings to remain low for the duration of the dog’s life despite obvious clinical improvement. This is why it is more important to evaluate adrenal estrogen levels rather than cortisol levels.

 

Patterns of Adrenal Activity

Concept 1

Insufficient cortisol production increases adrenal sex-hormone production. For further reading, click here and scroll to page 6.

Concept 2

When these dogs are provided low-dose daily cortisol replacement, sex-hormone levels and clinical symptoms begin to normalize. For further reading, click here, here, here, and here.

Concept 3

The adrenal glands periodically experience spikes in activity. If an adrenal gland can no longer produce cortisol, it produces a surge of sex-hormone steroids at such times.

Concept 4

Even dogs receiving appropriate hormone replacement therapy may show an increase in steroid signs/symptoms during these spikes.

Concept 5

Some dog owners and practitioners assume that the increase in steroid signs/symptoms is a result of the daily low-dose cortisol replacement when in fact, it is a spike in sex-hormone steroids that’s to blame.

Discussion

Twice a year there can be noteworthy spikes in adrenal activity. Not all dogs experience these spikes but many do. Those that do may experience varying degrees of severity.

The first spike occurs in autumn when the adrenal glands prepare an animal for winter—colder temperatures, fewer calories, hibernation, etc. The body does this by increasing cortisol production. Individuals that cannot produce sufficient cortisol however, experience a spike in sex-hormone levels instead. In the northern hemisphere this spike often occurs around late November and then subsides.

A secondary, smaller spike in adrenal activity occurs in early spring when the adrenal gland increases sex-hormone production. This is meant to help an animal shed its winter coat and enter breeding season. In the northern hemisphere this often occurs around mid-February and then subsides.

Perhaps you’ve recognized seasonal problems in your own dog. Problems such as seasonal skin and eye allergies, seasonal ear or bladder infections, seasonal hair loss on the flanks. Perhaps your dog was diagnosed with SARD during one or the other of these spikes.

In addition to seasonal cycles, activities of daily life may also cause smaller spikes in adrenal sex-hormones. Stressors such as home remodeling or adding a new family member may increase stress and sex-hormone steroids. Such events are not the cause of SARD, but these events may be more apparent in dogs already suffering adrenal exhaustion.

Estrogen is a catabolic steroid that breaks down organs such as the liver, kidneys, and cardiac muscle. It damages ligaments and tendons. It raises blood glucose levels initiating the equivalent of gestational diabetes. It raises cholesterol and triglyceride levels. It increases mast cell activity, histamine levels, and allergies. It suppresses immunoglobulin levels and the immune system. It is an excitotoxin that causes seizures, tremors, and head tics.

During such a spike, dog owners may report that the treatment doesn’t seem to be working as well as it did initially. Or, they may assume that the therapy is the cause of the problems. If it is wrongly assumed that the steroid signs are from the low-dose cortisol replacement, a practitioner may discontinue therapy. In that case, one of two things may happen:

  • the dog may deteriorate rapidly. Cortisol is, after all, necessary for life and its absence is akin to an Addisonian crash.
  • more often, the dog will ride out the seasonal spike of sex-hormones and the natural decline that follows the spike. Steroid signs/symptoms will dissipate. This may lead the practitioner and owner to believe that terminating the low-dose cortisol replacement was the correct course of action. The long-term outcome, however, is a different story. Untreated adrenal exhaustion (elevated sex-hormone production) contributes to long-term physical deterioration.

Please sit with that last point for a moment: By discontinuing low-dose daily cortisol replacement during an estrogen spike, the typical outcome is a gradual deterioration caused by elevated sex-hormone steroids.

Rather than discontinue therapy during an estrogen spike, holistic veterinarians will initiate a slightly more aggressive approach during these times. (That’s the counterintuitive part.) Holistic veterinarians accomplish this in one of two ways. They will either:

  • repeat the initial SARD protocol injections at 70% of the original dosing. This statement applies to this protocol, no others.
  • or instruct the client to pulse the oral cortisol replacement at a slightly higher dose for 1-2 weeks. No longer.

The chart above depicts only one spike, but such spikes may reoccur year after year. SARD-dog owners are encouraged to mark their calendars and plan ahead.

NOTE: On rare occasions, a dog’s adrenal glands may heal and cortisol replacement is no longer necessary. However, this is very uncommon and it generally occurs only after many years of hormone replacement.

Let’s Review

Starting on the left side of the chart we see insufficient cortisol production resulting in rising sex-hormone levels (A). Once low-dose cortisol replacement therapy is initiated, sex-hormone levels begin to normalize (B).

As the seasons change, however, the dog may experience a seasonal spike in adrenal activity and a rise in sex-hormone levels (C). This translates to increased drinking, urination, appetite, liver enzymes, cholesterol levels, pancreatitis, blood glucose, seizures, lethargy, etc.

Concerned that it is the low-dose cortisol replacement therapy causing these signs/symptoms, the practitioner discontinues therapy. The seasonal estrogen spike naturally dissipates (D), and so do steroid signs. This may lead the owner and practitioner to believe that discontinuing the low-dose cortisol replacement therapy was the correct course of action.

Without therapy, however, sex-hormone steroids may:

  • remain just slightly elevated
  • climb gradually (E)
  • or they may exhibit repeated spikes over time (F)

Rather than discontinue therapy, holistic veterinarians will provide slightly more aggressive therapy during an estrogen spike and then continue baseline therapy thereafter (G).

Closing Thoughts

Is is possible that sex-hormone levels return to normal without intervention? Anything’s possible but observation would suggest otherwise.  SARD-dog owners generally report ongoing health concerns with their dogs…not every one, but many do. Year after year, email after email, owners from every corner of the world describe their dogs’ health problems.

Some dogs appear to tolerate the mildly elevated estrogen. Their owners report that they “have no symptoms” other than the vision loss. But if a dog has SARD it’s almost guaranteed that he/she also has some degree of elevated sex-hormone steroids.  It can be difficult to accept these connections. However, these connections still exist.

I present this information not to upset you, but rather in the hopes that every owner is made aware of their options and that every SARD dog can experience optimum health. I really do wish you and your dogs all the best.

For Part 4 click here.