Prednisolone vs. Medrol

03/24/14 - Today I started Reo on PediaPred (5 mg/5ml) prednisolone sodium phosphate, instead of Medrol.  The reason?  I could only get 4 mg Medrol tablets, and was cutting them into fourths for Reo's daily dose.  When she needs to get a little more (and hopefully in the future, a little less), it is hard to add more or less to her dose by using the tablets.  The liquid gives us more flexibility to titrate her dose down in the future, and increase during times of stress.

Decision for Reo

09/16/12 - Finally, Sean and I have decided how we are going to proceed with Reo.  You may recall that I've been struggling with whether or not to continue to give Reo the retinal protection supplements, as it seems she has very little vision remaining these days.  I have not been sure whether the small amount of remaining vision is worth preserving - she might get around better if she were completely blind.  And, I don't want to continue to give her things that her body doesn't need/can't use.

We have decided not to give most of her supplements any longer.  We will be suspending the following:
- Lutein (her last capsule was given yesterday)
- Phosphatidyl Serine (have about a month left, will suspend when we use the last of it)
- Magnesium Taurate (have about 2 months left, will suspend when we use the last of it)
- Standard Process Adrenal Support (have about 1 week left; just not sure she needs this any more)
- Sardines (these were given as a source of adenosine, which works in conjunction with the Magnesium Taurate)

We will continue to give Reo the Cell Advance 440, Nutramin, and Prozyme, and keep the rest of her diet the same (Welactin, Dasuquin) as we like the benefits of those supplements for older dogs (and Leigh gets these three supplements as well).

I do have a huge amount of guilt for not being more pro-active for Reo surrounding the time of our big move in March of this year.  I really thought that we were "in the clear" since her vision had returned, and I severely underestimated the effects of stress on Reo's vision.  Literally, when we started packing up our house, her vision started to decline.  She then got a toe infection, and allergens in the air were high.  A lot of stress for our little girl (plus lots of stress on the humans, too!), really affected her.  I'm working on letting my guilt go, and taking comfort in the fact that Reo is as healthy as she has been in years.  She is still such a happy dog, and her health truly is the most important part.

We will continue to get blood chemistry and thyroid tests every 6 months, to make sure that we are on the right track with her care.  I envision getting and EI-1 panel from NVDS every year or so, again, to make sure that we are staying on track.  If there are any issues that make me think she may be unbalanced, I may test more frequently - we will just have to play it by ear!

I will likely update this blog less frequently, as I hope (?) Reo will be quite stable.  But, of course I will share any new things that I learn about SARDS, relevant articles, and updates on Reo's condition.  I am also very happy to hear from readers whose dogs have been diagnosed with SARDS, and help in any way that I can.

Sixth EI-1 Panel

07/17/12 - Annnnd we're back!  I'll write a subsequent post about our two-week trip to California after this, but first I wanted to post Reo's most recent blood panels.

	Reference Range	16-Mar-11	30-Apr-11	15-Jun-11	4-Aug-11	4-Jan-12	25-Jun-12
Total Estrogen	30 - 35	35.19	35.15	35.11	35.06	35.04	35.05
Cortisol	1.0 - 2.5	8.43	7.03	0.97	0.82	0.68	1.4
T3	100 - 200	62.7	72.12	87.92	156.94	135.29	169.94
T4	2.0 - 4.5	0.87	1.15	1.6	3.99	3.21	7.17**
IgA	70 - 170	50	53	57	65	67	66
IgG	1,000 - 2,000	722	754	883	946	973	970
IgM	100 - 200	74	76	87	97	97	97

Estrogen is about the same as her last panel in January.  It is possible that this number is Reo's "normal" now, being an older dog.

Cortisol is now within normal limits (I was a little surprised at this!).

T3 is normal, but T4 is quite elevated.  I put two asterisks next to this number, as Reo was on a course of Clavamox (antibiotic) for her uveitis.  Dr. V feels that the T4 is elevated due to this, and so is not concerned, especially as T3 is normal (T3 is the more "active" molecule in the body).  We will retest her thyroid in another 6 months, so we will keep an eye.

Immunoglobulins are more or less where they have been for the past year, just slightly low.  It's possible that these numbers are also Reo's "normal", as she is an older dog.  I likely won't have these tested again, as she seems to be pretty consistent now, and can probably save a little money by only testing estrogen/cortisol/thyroid.

Overall, I feel just fine about Reo's results.  As she is not symptomatic right now, I am satisfied that she feels good, has normal liver/kidney function, and reasonable hormone levels.  :)

Hyperestrogenism

05/29/12 - All is good on Reo's end, no major changes, except I rotated out her Addiction food and rotated in Stella and Chewy's raw freeze-dried patties (Duck Duck Goose).  She loves the change!

I wanted to share an article from Healthy Pet Network, written by Dr. P, as it might be of interest to anyone following SARDS as it relates to adrenal exhaustion/Plechner's syndrome.

Original Article Here

Hyperestrogenism by Dr. Plechner, DVM

Published May 29, 2012 | By Terry

An article from the University of Tennessee signals that my esteem fellow professionals are finally beginning to understand what this old Vet’s been saying for many years now. They are beginning to realize the dangers of excessive adrenal estrogen. They are close, but alas…no cigar.

It seems they are attempting to reduce the production of adrenal estrogen by using various chemicals to affect it’s source, the adrenal gland. This approach at least shows someone’s been listening to some of what this Animal Doctor’s been saying for quite some time.

However, They still are off track. They keep trying to affect the middle layer of the adrenal cortex but they’re barking up the wrong layer. They need to be studying the inner layer. That’s where the problem lies. Even so, when they finally get there they’re going to find that it’s not going to be affected by their chemical assault.

I can understand their dilemma. The middle layer adrenal production of cortisol hormone appears quite normal in their eyes. The problem is that they need to understand that the cortisol being produced is defective and is not being recognized by the pituitary gland which keeps churning out the ACTH hormone which can cause an increase in the production of estrogen and androgen (which can be converted into estrogen) due to an enzyme in the fatty tissue called aromatase.

Since the elevated estrogen binds (blocks) the receiver sites of thyroid. The bound thyroid reduces the activity of the liver and kidneys which further guarantees less breakdown and elimination  of the estrogen and androgen. This allows the  estrogen and androgen to remain excessive. The patient, unavoidably, is also bound to gain weight, which at the same time produces more aromatase due to the increase of fatty tissue which inadvertently increases the amount of estrogen present…and so, round we go, in a vicious cycle.

It’s just our luck! The corporate medical industry is finally realizing what I’ve been trying to tell them for years. That excess estrogen can cause real problems. Still it seems that they haven’t listened to all of what this old Vet’s been saying (they must’ve dozed off in the middle of the lecture).

The capper is that certain hormones like cortisol can be defective or bound (unable to get to the right receptors) The decreased or defective cortisol and the increased estrogen throws the immune system out of balance.  When the immune system is imbalanced it may fall victim to a number of problems including;  Aids, Multiple Sclerosis, Muscular Dystrophy, coronary occlusion, all types of auto-immunity, and even cancer.

Now, I understand that I am but a healer of ‘animals’. However, I think we can all agree that all the beings on this planet are very similar on the inside. What’s good for the Goose…well, I think you understand. I just hope that those learned professionals at the University of Tennessee can rise above the status quo and maybe listen to alternative sources in their ‘quest for the cures’. They should at least heed Shakespeare…

“There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy.”

Yours in Health,

Dr Al Plechner

Making a decision

05/13/12 - Today, I ordered what could be Reo's final bottles of Magnesium Taurate and Phosphatidyl Serine.  If we don't notice improvement in her vision by the time she finishes these, I believe that it may not be worth the cost to continue giving her these supplements, since her vision is transient/minimal.  Every once in a while, she surprises me with her vision when she navigates new terrain successfully, but she struggles sometimes too.  I believe she struggles more than she has some sight these days.

I recall that it took about 5 months after her first series of injections last year, to see a good improvement in her vision.  She got her injection series in March, and we are only 2 months after those, so it's possible we have a ways to go, which is okay.  I plan to get another EI-1 Panel from NVDS, as well as a CBC in late June/early July (about 6 months since her last), to see how she is doing, but I know from her demeanor that she is healthy and happy.

I am still optimistic, but I am also trying to be realistic.  I wanted to write this on my blog to make it more "real" for me, that it is possible that Reo's vision may not recover from all of the emotional and environmental stresses from earlier this year.

I feel pretty guilty that I wasn't more pro-active, and didn't think about how all of the changes we were making could affect her.  But, ultimately, we wanted to/had to move, as it was the right decision for our family - and how could we have predicted that allergens would have been especially brutal this spring?  My regret is that I didn't give her a "booster"injection of DepoMedrol as soon as I began to notice a regression.  Of course, hindsight is always 20/20 and I can't go back now.

When I took that last obstacle course of Reo recently, I went back and watched her previous videos, and it's clear that she is not doing as well as before.  It crushes my heart, because I feel as though I've let her down in some way, or failed her by not paying closer attention, or realizing what was happening as her vision was regressing.  Yes, the most important thing is that she is healthy and happy - and we are blessed that she is both!  But, a part of me is really sad that her vision has regressed, and I am hopeful that she will get back to "normal"for her, like she was the second half of 2011.  Fingers crossed!

More DepoMedrol

04/09/12 - Hope everyone had a nice weekend!

Reo is doing well lately!  She had a DepoMedrol injection on March 24, and did not display any PD/PU/PP (increased thirst/urination/hunger) afterwards.  This caused me, along with my vet, to conclude that Reo "needed" the injection, and did not have an excess of cortisol (which would cause those symptoms).  This proved to us that as a result of all of the stress (emotional and environmental) over the past couple of months, Reo's estrogen had likely spiked.

Therefore, we agreed to give Reo another injection at the same dosage, which she had on Thursday the 5th.  It's been 4 days, and no symptoms, which has surprised me a little bit - I was expecting to see them with this injection.  Even though there have been no excess cortisol symptoms, I'm not sure if we will have an additional injection after this one, but I need to speak with Dr. Plechner and see what he would suggest in this case.

Otherwise, no changes, really.  Her mood is fantastic, she looks wonderful, and still some light/dark perception.  There have been a few moments where I was sure she was sighted again, only to have her bump something shortly thereafter.  I have to remind myself that this was how it started last year - little glimpses here and there of vision returning.  I remain optimistic.  :)

**Edit** spoke to Dr. Plechner and he suggested that we go back to oral Medrol and not do another injection, so this is what we'll plan on!

Costs of Reo's treatment

04/02/12 - I've been asked a few times about the costs of treatment for adrenal exhaustion/Plechner's syndrome, so I went about the exercise of filling out a table for Reo.  It's worthy of note that I've added a couple of things to Reo's diet that aren't specified by either Caroline Levin or Dr. Plechner (Standard Process Adrenal Support, Lutein, Prozyme, Welactin, Dasuquin).  I consider these to be at my discretion as a dog owner, and contribute to Reo's overall health as a geriatric dog.

I buy Reo's supplements from Amazon.com, as I find the costs reasonable, and the shopping experience easy.

Reo's treatment as below costs $2.35 per day, or about $70 per month (assuming a 30 day month).

Of course, the costs will vary with the size of the dog, and which supplements are used (or not used).  Hopefully, this helps my readers understand some of the breakdowns of costs, and that it is reasonable, as compared to other treatment options available.

(Please note that the table below does not represent any veterinary costs, such as exams, blood tests or panels, diagnoses, ultrasounds, hormone injections, etc.  This is only meant to outline the approximate costs of oral treatment.)

	Cost	Cost Per Day	Cost Per Month	Cost Per Year
Medrol (20, 2 mg tablets)	$27.00	$0.68	$20.25	$243.00
L-Thyroxine (120 0.1 mg tablets)	$18.00	$0.30	$9.00	$108.00
Phosphatidyl Serine (120 caps)	$33.00	$0.28	$8.25	$99.00
Magnesium Taurate (180 caps)	$25.49	$0.14	$4.20	$50.40
Cell Advance (60 caps)	$13.97	$0.23	$6.99	$83.88
Standard Process Adrenal Support (100 g)	$54.00	$0.28	$8.40	$100.80
Lutein (180, 6 mg caps)	$21.94	$0.12	$3.66	$43.92
Prozyme (454 g)	$23.96	$0.11	$3.30	$39.60
Nutramin (2 lb)	$21.71	$0.10	$3.10	$36.00
Welactin (480 ml)	$23.95	$0.06	$1.80	$21.60
Dasuquin (150 tablets, under 60 lbs)	$65.25	$0.05	$1.50	$18.00
TOTALS	$328.27	$2.35	$70.45	$844.20

Atypical Cushing's treatment

03/28/12 - I wanted to share a new study that Caroline Levin published recently. It is a retrospective study of 5 dogs, who had the adrenal panel run at the University of Tennessee.  Though the sample size is small, the information is still important.

UTenn calls increased sex hormones and high/low/normal cortisol "Atypical Cushing's" (which I find personally a little confusing, because a high cortisol result on a panel usually means truly low cortisol if the sex hormones are elevated at the same time, so it seems to me it should be called "Atypical Addison's" but that's neither here nor there...). The lab recommends a treatment for this condition of flax lignans, melatonin, and sometimes mitotane or trilostane.

The five dogs presented in Caroline's study underwent low-dose cortisol replacement therapy and the sex hormone levels were reduced in every case.

The PDF is below for those who are interested. As always for Caroline, she includes a plain-English translation for those who are not as scientifically inclined, which I think is great. :)

http://www.petcarebooks.com/pdf/Atypical-Cushings-treatment.pdf

Have any of my readers had the UTenn panel for their dogs?

I did for Reo at the start - and it showed elevated sex hormones, elevated cortisol.  we did the UTenn panel parallel with the NVDS blood panel, but we didn't repeat the UTenn bloodwork, once we started walking down the path of treatment (plus, I didn't like UTenn's suggestions for treatment of Reo's condition, as I felt that cortisol replacement was the right choice for Reo).

One noteworthy item that I've discussed before is that high cortisol levels can be misleading (and should be examined together with total estrogen and/or sex hormones). There is no reason for a dog to have BOTH elevated estrogen and elevated cortisol (as was true in Reo's case, initially), and so it was that Reo's cortisol number was very LOW (shown in subsequent blood testing).

More food for thought!

Vet success!

03/24/12 - Today we had an appointment with a vet in our neighborhood.  I came prepared with all of Reo's history, bloodwork, and treatment specifications.  I picked this vet's profile out of those in the office because she was pretty young, has a molecular biology background (like me!), and said she was interested in geriatric medicine and internal medicine.

She (I will call her Dr. V) was fantastic!  She was super friendly, looked over all of Reo's bloodwork, was shocked that her liver values were so high surrounding SARDS diagnosis, and then came down so drastically post injection - and have stayed that way with long-term Medrol usage, agreed that Reo was in excellent health, and said she'd have no problem continuing with Reo's treatment, as long as I understood the potential risks.

Dr. V was also interested to read more about Caroline Levin's and Dr. Plechner's work, and so I let her photocopy a big stack of papers from Reo's folder.  I will be interested to get her take on it.

HOORAY!!!!  :) 

So, we have a new vet about 2 miles from our house, who is interested in Reo's story and success, and is committed to helping me continue her treatment.  I made sure that she understood that the hormone injections were not a regular occurrence, and it had been about a year since we'd last done them, and my opinion was that it was only due to extended stressful situations that she might need "boosters".

After Reo's exam, we gave her another injection of DepoMedrol - 25 mg this time.  I decided to do another injection based on the fact that Reo is still in the throes of a lot of stress at the house (construction), the fact that it's spring, and the fact that pollen levels right now are 5 times their normal levels.  Even my other two dogs are scratching and have watery eyes.

It was the biggest RELIEF to find a vet who didn't think I was crazy, and was willing to help, on our very first try.  Reo and I are lucky-loos!

We'll see how Reo reacts to this injection, and if she has any ill-effects like PU/PD/PP.  We may consider to do another in 10 days, as we did with her first injection series in May 2011, to give her the support of an overlapping series to curb the estrogen spike.

Happy Anniversary!

03/11/12 - Today marks one year since Reo's SARDS diagnosis.  I can't believe how much we have learned in the last year, and I can't believe how brave and true Reo has been through it all.  Thinking back to how sick and miserable she was last year, it's incredible that she has bounced back so well.  She is one tough little dog!  I am amazed and inspired.  :)

Though Reo has struggled at times this year, and is currently having some issues with her vision due to stress/change/moving cross country (not to mention that it's spring, a natural period of enhanced adrenal activity in animals and humans), she is more healthy and happy than she has been in years.  There is no doubt in my mind that treating her per Caroline Levin's and Dr. Plechner's suggestions has saved her life, and most definitely restored some vision (for all of you naysayers out there...re-watch those obstacle course videos!).

Special thank-yous to Caroline and Dr. P, as well as Dr. Lanz (our acupuncturist) and Dr. O (Reo's treatment vet).  We could not have gotten to this point without all of your care and support - thank you!

I'd also like to thank my readers, several of whom have shared their stories with me.  I am inspired by you and your dog's journeys, and wish you all the best!

"Booster" shot, and a happy liver

02/18/12 - Went to our vet yesterday for Reo.  I had to stock up on her meds, since we are in the midst of a cross-country move.

I also wanted to get a CBC and thyroid test to see how she was doing (it has been about 6 months since her last CBC, which was normal).  Reading other lists and groups makes me a little paranoid sometimes, like Reo's liver is going to fail for being on Medrol long-term (been almost a year).  I've also heard people complain that the NVDS blood lab that I use for Reo is "inaccurate, particularly in thyroid testing".

It's no secret that the treatment we pursued for Reo is controversial - and some people have had extremely averse reactions to her success.  Because I read a lot of views/treatments/theories about SARDS, I do question myself sometimes, even though Reo is healthy and she regained her sight.

As our vet says "the proof is in the pudding!" - kind of hard to argue with that!

Anyway, our vet does the basic blood testing right in his office, so it didn't take very long to find out her status.  I'm very pleased to report that Reo's thyroid is normal (confirmed NVDS normal result), and all of her liver and kidney values are normal, and her blood glucose is normal!  :)  

If her dose of Medrol was a therapeutic dose (as many people and vets feel is the case) - there is definitely concern that there can be long term liver or kidney problems, and high blood sugar.  In my mind, this proves that Reo is not on a therapeutic dose of Medrol - her daily dose is only replacing what her body cannot produce naturally (again, making her like an atypical Addison's dog).

Because she has had a decline in vision the past 2 weeks (stress of me being gone on a trip, coupled with stress of the house packing/chaos), I had contacted Caroline Levin and Dr. Plechner to see what they suggest.  They both suggested a "booster" shot of cortisol hormone.

Caroline cites her experience in that spring and fall are natural periods of enhanced adrenal activity in pets and people (allergies, anyone?), and so sometimes dogs with adrenal exhaustion have challenges during this time.  Take this, coupled with stress, and it can have an effect - it seems to have had an effect on Reo.

So, I talked about a "booster" with our vet, and agreed on a dosage.  We went with 15 mg DepoMedrol, which was less than Dr. P suggested to me, but a dose with which my vet and I felt comfortable.  I am interested to see how this helps with Reo's stress, and if her vision will improve again.

NOT phasing out PS

02/12/12 - As I mentioned in my previous post, I dropped Reo's dosage from 100 mg/day to 50 mg/day last week.  That same day, even before her first PS dose in her breakfast, we noticed some decline in her vision - thinking there was no possible way it could have been from the reduced dosage (since she got 50 mg that morning as she always does, just not the other 50 in her evening meal).  We also noticed some watery discharge from Reo's eyes, which is new. 

We went the whole week with Reo at 50 mg/day of PS, and didn't notice any chance in disposition, clarity/confusion, etc., but her vision seems to be poor lately.  I truly don't know if it's a result of PS (since the onset of declining vision seemed to overlap with the drop in dosage, and it seems unlikely to me that PS would have such a direct effect on vision?), but I bumped her back up to 100 mg/day on Saturday (so there was 5 days of a decreased dosage), just in case.

Her watery eyes continue, as well as greatly decreased vision lately, unresponsive PLRs to normal light (flashlight), but do respond in sunlight.  I'm not sure if she has allergies, or really what is going on at the moment, but this seems to be a long period (for Reo) of struggling with sight.  Otherwise, she's doing great in terms of disposition, etc.  

Hopefully it's just another "blip" like we've encountered before, but gets better soon.  This seems to be the longest period of time she's gone with diminished vision, so I'm a little concerned.  We're also in the midst of packing up our house for a cross-country move - I'm sure this could be a stressful situation for her, too, even though she is navigating the house just fine and not bumping into things/getting lost (which makes me wonder if her vision is really diminished or if she's faking!!).

We had an hour-long walk today, and she did really great, but it was the first time in over a week that the dogs got a walk because it's been pretty cold!

Anyway, I won't be tinkering around with the supplement dosages any time for the foreseeable.  We're in unchartered territory, but we need to stick to what we know has worked for Reo!  Additionally, after speaking with Caroline Levin, I am considering pulsing her Medrol dosage, to help her get through this time of stress for the move.