February 7, 2019

Steroids—a Dirty Word, Part 4

I received this note recently from the owner of a darling little dog named Milo. You can read our conversation below and you can read more about Milo’s recovery here.

January 29, 2019

Hi Caroline,
Our dog has been on the SARD protocol since August and regained vision in his left eye soon after the treatment started. Within the last week I noticed he now has some vision in his right eye as well! The vet said structurally his eyes still appear normal. I would like to start weaning him off the steroids, but I’m worried about him having a rebound reaction. Do you have any advice for long term therapy maintenance?

This was my reply:

Hi Janet,

I’m happy to hear the good news!

The short answer is that the underlying adrenal condition does not repair itself. The adrenal exhaustion — the low cortisol production — is a lifelong problem that requires lifelong treatment (i.e. low-dose daily cortisol replacement via either low-dose Medrol or low-dose prednisone.)

It is not an anti-inflammatory medication. It is not an anti-inflammatory dose. It is a hormone replacement for a hormone that is no longer being produced.

There is every chance that if you wean off the hormone replacement therapy that your dog will experience a rise in the adrenal sex-hormone steroids (including estrogen) and will experience a resurgence of all his original symptoms including vision loss.

Hormone replacement — low dose prednisone or Medrol— is simply replacing what his body would make if it were healthy. This is why the treatment does not require “weaning off”.

Please, please read the following three articles carefully.

Steroids Part 1

Steroids Part 2

Steroids Part 3

Readers,

Here’s another way to think of this. Perhaps you know someone who is an “insulin diabetic”, a person who takes insulin injections to treat his or her diabetes. Insulin is a hormone that controls blood sugar. That person takes insulin daily because the pancreas no longer makes it. Once the blood sugar is controlled, the insulin is NOT discontinued. Similarly, low-dose cortisol replacement is typically NOT discontinued because it is simply replacing what the body can no longer make.

Another example is thyroid hormone. Perhaps you know someone who takes a small daily dose of thyroid hormone each day. Once the symptoms improve, the hormone is NOT discontinued, it is necessary for life just as cortisol is necessary for life.

Remember, the typical result of discontinuing low-dose cortisol replacement is a rise in sex-hormone STEROIDS.

I wish you all the best,
Caroline