First EI-1 panel

03/21/11 - Today, we got Reo's bloodwork back from NVDS:

	Reference Range	16-Mar-11
Total Estrogen	30 - 35	35.19
Cortisol	1.0 - 2.5	8.43
T3	100 - 200	62.7
T4	2.0 - 4.5	0.87
IgA	70 - 170	50
IgG	1,000 - 2,000	722
IgM	100 - 200	74

Remember that this test is highly sensitive, so even minor changes are significant.  She is severely out-of-whack for every analyte measured!  :(  


Like me, you may be surprised at Reo's very high cortisol number.  You may wonder, after all this talk of adrenal exhaustion, how Reo could possibly have high cortisol!  Well, if you read Dr. P's and Caroline's site thoroughly, you may remember that sometimes the adrenal glands, when stressed, make a mistake and instead of "true" cortisol make an isomer of cortisol.  An isomer of cortisol looks nearly identical to "true" cortisol at the molecular level, but the body can't use it.  The laboratory test cannot distinguish between active cortisol the body can use, and the inactive isomers of cortisol.  Dr. P also states that there is absolutely no reason for an animal to have both high estrogen and high cortisol.  If total estrogen is high, it means that cortisol is low, even if it doesn't appear to be.


Dr. P also asserts that if a dog's CBC reveals normal levels of eosinophils and lymphocytes (these are types of white blood cells), then the cortisol is likely inactive cortisol.  If the eosinophils and lymphocytes were present in reduced numbers, then the cortisol is probably active.  Since Reo's CBC revealed normal levels of both white blood cell types, I proceeded under the assumption that Reo's high number was inactive cortisol.  Most other SARDS dogs' EI-1 panel results that I've seen have revealed low cortisol (which you'll see later in Reo).


Another important consideration is that elevated estrogen can mimic all the effects of elevated cortisol.  I think this is very important, because so many SARDs dog owners report Cushing's-like symptoms.  In reality, it is probably elevated estrogen that is causing the symptoms.


You will also notice that T3 and T4 (thyroid hormones) are low.  This is important because thyroid hormones are essential to normal body function, as they regulate metabolism.  Excess estrogen can increase thyroid binding globulin (TBG), which binds thyroid hormone and renders it useless to the body.  In Reo's case, it was very important to supplement thyroid hormone (L-thyroxine, aka levothyroxine, aka Soloxine - they're all the same thing), so Reo's body had enough available to help her body function.


All of the immunoglobulins assayed were quite low.  IgA is important, because it helps the absorption of nutrients and molecules in the gastrointestinal tract.  With Reo's number so low, it means that she probably isn't absorbing nutrients or medication very well.  Because of this, Dr. N agreed to prescribe the Levin-recommended dose of sulfasalazine (commonly used to treat colitis in dogs).


I also want to mention that we got the results back from the ACTH test from the University of Tennessee.  Their T4 test showed Reo as normal, but TSH (Thyroid Stimulating Hormone, which regulates the thyroid gland and tells it what to do) was low.  The test results showed that Reo was above the baseline for Cortisol,  Androstenedione, and Estradiol pre-ACTH stimulation.  After ACTH stimulation, Reo was above baseline for Cortisol, Androstenedione, Estradiol, and both Progesterone and 17-OH Progesterone.  They reported that Reo's results "indicate presence of increased adrenal activity (significant)".  This lead Dr. N to conclude that Reo had Cushing's disease, maybe atypical Cushing's disease.


This image, taken from http://www.petcarebooks.com/pdf/overview_adr_exhaust.pdf, shows how these hormones fit with each other:

Standard tests usually measure only one estrogen compound: estradiol. However,the NVDS test is for total estrogen, which includes ovarian and adrenal estrogen as well as estrogens from environmental and food sources (such as soy - high in phytoestrogens).  Dr. P and Caroline think (and I agree) that this provides a more accurate measurement.  Therefore, we all recommend the use of the NVDS testing facility.


The take-home message from the University of Tennessee was inconclusive, as far as I was concerned.  Dr. N was so confused by this result, and still thought that Reo had Cushing's disease.  I did my best to explain that elevated estrogen is causing all of these issues, but I think Dr. N begins to doubt me...