New(ish) post from Dr. Plechner on SARDS

02/19/13

Hope everyone is doing well!  We are all great, here, including Ms. Reo, who is as sassy as ever!  I recently went on a vacation and left the dogs with Sean - I was nervous, as I hadn't left Reo in nearly a year!  I'm happy to report that she did GREAT, and Sean did a wonderful job keeping to her schedule and meal regimen.  :)

Dr. Plechner has re-worked his website.  Though it looks nicer, a lot of his resources are missing, which makes me sad.

He has written a few new articles on SARDS, for your consideration:

Three case studies:
http://drplechner.com/learn/specific-diseases/sards-clinical-case-studies/

Overview:
http://drplechner.com/learn/specific-diseases/sards/

As you might remember, my own personal opinion is that Caroline Levin knows so much about treating SARDS specifically, and her recommendations for retinal protection supplements can be of great help to newly-diagnosed SARDS dogs.  Her treatment is based off of Dr. Plechner's ideas.  For Reo, I felt that a combination of Levin's and Plechner's treatment suggestions were the very best choice for Reo, and helped restore her vision in 5 months.  If I had to go back, I would do the same treatment (albeit much more quickly).

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

Hormone replacement

12/13/11 - Some discussions I've had lately about supplements have made me want to write this post.  I've been contacted, and have posted on message boards concerning which supplements to source for SARDS dogs, and the correct dosages.

It's no shock that many SARDS dog owners have their dogs on supplements to help maintain/preserve some vision, keep the immune system healthy, slow the ageing process, etc.  But the most important part of Levin's and Plechner's treatment protocols is the low-dose hormone replacement.

Make no mistake, if your dog has adrenal exhaustion/Plechner's syndrome, no amount of antioxidant or mineral supplementation is going to get your dog healthy.  The ONLY treatment that will work is low dose cortisol replacement (methlyprednisolone/Medrol), and likely simultaneous thyroid hormone replacement (L-thyroxine/Soloxine).  Many people and vets shy away from long-term hormone replacement, but please keep in mind that the prescribed doses are not therapeutic.  They only help the dog's body replace what it can't make naturally.

A rough analogy would be your human doctor telling you that you are deficient in Vitamin D, and prescribing that you take a Vitamin D supplement.  Your body needs Vitamin D to function normally, but your doctor only wants to to consume/supplement a certain amount each day.  If you take more than you should, then it becomes therapeutic, and you can suffer ill effects due to too much Vitamin D.

I think some folks out there have tried Caroline Levin's protocol on their SARDS dog using Cell Advance, Magnesium, and Phosphatidyl Serine and proclaimed it "didn't work".  Well, if one ONLY did this, of course it would not work.  If the dog has adrenal exhaustion/Plechner's syndrome, the root cause is malfunctioning adrenal glands, and improper hormone synthesis.  This problem requires hormone replacement in order to be corrected.

Whether you choose to follow Caroline Levin's or Dr. Plechner's protocol (or do a mish mash like I did for Reo), it's up to you.  But please don't mistake anything that I've written on my blog - it's the hormone replacement that is the key to success - the most critical component of your dog's treatment.  The supplements are a great support, but only when done in conjunction with hormone replacement.

SARDS Resources

SARDS is a complicated disease, and there are conflicting theories about the causes and treatments.  I personally, subscribe to the cause of adrenal exhaustion/Plechner's syndrome (I will sometimes use the two interchangeably), and believe in treating this cause.  I follow the work of Caroline Levin and Dr. Alfred Plechner, to whom I introduced you in my "Cast of Characters" post.  When doing my research, this theory just made sense to me when I thought about Reo's symptoms.

Reo never had any allergies, skin rashes, itchy skin, food intolerances, etc. that would suggest autoimmune issues.  I believe that SARDS and IMR (Immune-Mediated Retinitis) are two different diseases.  I do not believe that SARDS is an autoimmune disease, while I do believe that IMR is an autoimmune disease.  I won't talk too much about IMR or the IVIg treatment for SARDS, as these are not part of Reo's story.

I won't lie - this is a TON of information to digest, and it is completely overwhelming.  It can be highly confusing, not to mention highly frustrating, especially if you don't have a background in science/anatomy/physiology/biochemistry/ophthalmology!  Please feel free to post questions in the comments and I will help if I can.

Please remember that I'm not a veterinarian, and in no way do I try to discredit anyone's research, theories, or experiences.  I just want to present Reo's story, from my perspective, in a way that makes sense to me, in hopes of helping others!  While I may not be an expert on SARDS, I am an expert on Reo and her treatment, and that's why I'm writing this.

Let me be clear about one very important point.  It is highly likely that your veterinarian, and even your veterinary ophthalmologist, does not have any experience with treating SARDS.  It is also highly likely that he or she has not read any research, or is not familiar with the treatments available to SARDS dogs.  This very fact is infuriating, frustrating, and downright puzzling, but I know that veterinarians and doctors can't know everything about all diseases.  The key is, they need to be open-minded enough to educate themselves so they can help you and your dog.  It is absolutely critical that you are an advocate for your dog, and if you want to pursue treatment, you must be willing to find a veterinarian to help you.  You must do so quickly, because the health of your dog depends on you!

Please read the links below to find out more information about SARDS and IMR.

Wikipedia

Always the best place to start for a general, overview definition!

http://en.wikipedia.org/wiki/Sudden_acquired_retinal_degeneration

Caroline Levin, RN

Her site was (and still is) my bible in many ways.  There is a wealth of information and research on this site, and if you are the owner of a newly diagnosed SARDS dog, I suggest you read each and every link on this site!  Take notes, and jot down questions you may have.

http://www.petcarebooks.com/research.htm

Caroline's research articles have a "plain English" translation, and so it makes it easy to read about the symptoms, testing, and treatment that these dogs underwent.  Having this information will help you to communicate with your veterinarian.

http://www.petcarebooks.com/research_case_reports.htm

This article in particular is a nice comparison of the adrenal exhaustion vs. autoimmune theories of SARDS:

http://www.petcarebooks.com/pdf/CaseReport9.pdf

I highly recommend a consultation with Caroline, if your dog was recently diagnosed with SARDS.  She can help you understand this disease, and suggest treatment for your dog.  You may email her to set up a consultation time at consult (at) petcarebooks (dot) com

Dr. Alfred Plechner, DVM

Dr. P's site is also a wealth of information.  While both he and Caroline subscribe to similar theories about adrenal exhaustion, they sometimes use different terminology, and suggest different treatments.  Dr. P hasn't done as much research on SARDS specifically like Caroline, but Dr. P has helped over 150,000 humans and animals during his career.  He has also published several books and articles.  To me, his website helps put everything in perspective, as it is "bigger picture" than just SARDS dogs.

I do suggest that you read each and every page on Dr P's site, using the navigation links on the left.  Again, take notes, and jot down any questions you may have.

http://drplechner.com/home.php

Bonnie Sue the Scottish Terrier's mom wrote an extremely interesting article on her experiences, including Levin's and Plechner's theories, Dr. Grozdanic's theories, and IVIg information.  It is very well-written, and a great overview of Bonnie Sue's story.  It should be required reading for any dog owner, let alone SARDS dog owner!

http://drplechner.com/sards01.php

I highly suggest a consultation with Dr. Plechner, but he typically requires that your dog already have the EI-1 panel from NVDS (see next entry).  Dr. P treats Plechner Syndrome/adrenal exhaustion quite aggressively, and not all vets will be willing to undertake his protocol (this was my personal experience), so be prepared.  However, Reo is living proof that his treatment WORKS, and isn't your dog's health worth it?  You can fill out the consultation request form on Dr. P's site:  http://drplechner.com/consultations.php

National Veterinary Diagnostic Services (NVDS)

This laboratory will perform a critical blood test to help diagnose your SARDS dog's underlying adrenal issues.  Caroline Levin reports that 98% of all dogs diagnosed with SARDS have adrenal exhaustion.  Therefore, it is of utmost importance that your dog is diagnosed and properly treated!

NVDS performs the most sensitive test, and is recommended by both Caroline Levin and Dr. P (please note that neither is affiliated with the laboratory, but just endorse their testing).  The needed test is the EI-1 panel (endocrine-immune 1 panel) and reports on total estrogen, total cortisol, thyroid hormones, and immunoglobulins.  This information, taken together, will help diagnose your dog.  Your veterinarian may want to send the test out to the University of Michigan, or the University of Tennessee.  I suggest that you push for the NVDS test, as it is more sensitive, and measures all of the analytes which are important to diagnose your dog.

This lab can also be very helpful if you need to find a veterinarian in your area who may have used Dr. Plechner's or Caroline Levin's protocol in the past (some individuals have had success [like me], and some individuals haven't had much success, but it's worth a try if you are desperate to find a vet who'll help you!)

Print out the forms on the website, and bring them to your veterinarian.  Your dog's blood sample should be spun down, and the serum shipped via overnight on ice packs to be kept cold.

http://national-vet.com/

SARDS Dogs - Adrenal Exhaustion Yahoo Group 

This is a group that I started, and is intended to be a safe place to learn about and discuss adrenal exhaustion/Plechner Syndrome, and the specialized treatment for this disease, following the recommendations of Dr. Plechner and Caroline Levin.  Members are encouraged to share their own experiences and make suggestions to other members that need help (keeping in mind that we are not veterinarians, and our suggestions should be discussed with a vet!).
http://pets.groups.yahoo.com/group/SARDSdogs_AE/

SARDS Awareness

A site that talks about some of the differences between SARDs and IMR.  I personally do not agree with all of the information on this site, as it is heavily weighted toward IMR and the associated IVIg treatment from Dr. Grozdanic at Iowa State, but it is a good resource nonetheless.  Unfortunately, it is not regularly updated, but if you are interested in learning more about IVIg therapy, including Dr. Grozdanic's treatment protocol, it is on this site.

http://www.sardsawareness.org/

SARDS Dogs Yahoo Group

This site was a great support to me when Reo was first diagnosed - the members are very knowledgeable and helpful about SARDS, IMR, IVIg, and blind dogs.  If you need suggestions about how to help your blind dogs cope, this is the place to visit and pose your question!

http://pets.groups.yahoo.com/group/SARDSdogs/

Blind Dog Info
This page is a collection of stories from owners whose dogs were/are affected with SARDS.  Sometimes it helps just to read others' experiences.
http://blinddog.info/sard.htm

There is also a message board, which you could find useful.  It covers other topics than just SARDS.
http://blinddog.info/msgbd/

After spending countless hours on these sites, perhaps consulting with Caroline and/or Dr. P, and getting your dog's blood test back from NVDS, you may come to the same conclusions that I did:

My dog has adrenal exhaustion/Plechner's Syndrome.  My dog's adrenal glands are not making the cortisol s/he needs, and they're making adrenal estrogen instead.  These high estrogen levels are toxic to my dog's cells, including his/her retinal cells.  High estrogen levels also mimic the symptoms of Cushing's disease.  My dog is sick, and s/he needs help immediately!

So...forward we go!

Reo's SARDS diagnosis

03/05/11 - We went and saw Dr. N for Reo's sudden loss of vision.  Her exam revealed glaucoma negative (good), cataract negative (good), retina intact/healthy (good), and blood pressure normal (good).  They took some of Reo's blood for a CBC (Complete Blood Count) and diabetes test.  We had to wait over the weekend for the results!
03/07/11 - We got Reo's bloodwork back - most things were normal, except for a slightly elevated liver enzyme (GGT), and slightly elevated triglycerides.  Because there wasn't anything obvious going on to explain Reo's vision loss, we were referred to an ophthalmologist.
03/11/11 - By the time Reo's appointment rolled around, we think she had absolutely no vision.  Dr. C agreed that Reo's retinas looked intact/healthy, but she had no menace response, no dazzle reflex, and she would not follow a cotton ball dropped to the floor.  When placed in the middle of the floor, Reo would not take a step, seemingly fearful of unfamiliar surroundings.

We decided to get an electroretinogram (ERG) taken.  If we saw electrical activity, we might suspect something different going on, like a tumor, so we wanted to rule that out.  Reo's ERG was flatline.  Dr. C diagnosed SARDS, and told us Reo would never regain her vision.  He briefly mentioned some revolutionary work at Iowa State by Dr. Grozdanic, using IVIg treatment, but that Reo wasn't a good candidate for this.  Dr. C also gave us the name of Caroline Levin's book, "Living With Blind Dogs" to use as a resource, and mentioned that some SARDS dogs develop Cushing's disease, so we'd have to watch out for that.  But, for the most part, Reo should live a happy, healthy life once adjusted to her blindness.

We were completely devastated!  I couldn't stop thinking about all of the things Reo loved doing that now seemed impossible.  Knowing absolutely nothing about SARDS, and having far too many questions, I spent the entire weekend researching this disease, reading everything I could online, and slowly putting puzzle pieces together.  I felt at a slight advantage, having a scientific background, as it helped me understand a lot of the endocrinology I was reading.  I know that most dog owners are not so lucky.  Fortunately, many resources are written in plain English, to help anyone understand.  My next post will share the resources which I found most helpful.