New article discussing the Melan-100 for SARDS screening

09/07/13 - All is well in our household - I have been busy lately with Miniature Pinscher rescue activities, which is rewarding yet challenging!  I will write another post once Reo has her follow-up appointment at the ophthalomologist in a couple of weeks.

I wanted to post because there is a new article in the Journal of Veterinary Medical Science coming out from a group in Japan that discusses the Melan-100 colorimetric PLR device that is often used by ophthalmologists to help diagnose SARDS, PRA, and other eye diseases.

This is the abstract:

To determine the efficacy of a colorimetric pupil light reflex (PLR) device (Melan-100®, U.S.A.) in dogs of sudden acquired retinal degeneration syndrome (SARDS; 16 cases), progressive retinal atrophy (PRA; 10 cases) and optic pathway disease (6 cases). The colorimetric device detected PLR abnormality in 32, 16, and 9 eyes with SARDS, PRA and optic pathway disease, respectively, whereas white light detected PLR abnormality in 18, 11 and 9 eyes with SARDS, PRA and optic pathway disease, respectively. SARDS dogs displayed miosis, while optic pathway disease dogs displayed mydriasis by blue light examination. Thus, colorimetric PLR may be a useful method for determining whether electroretinography (ERG) or magnetic resonance imaging (MRI) should be performed for dogs with acute blindness.

The full text of the article is available (though because it is a pre-print copy, it does not look as pretty as a published article - there are line numbers in the left margin) at this link:  https://www.jstage.jst.go.jp/article/jvms/advpub/0/advpub_12-0363/_pdf

It looks like the authors agree that an ERG is very important for accurately diagnosing SARDS:

"Although the colorimetric PLR device is useful as a screening test, it is risky to diagnose these abnormalities with this method alone. It is necessary to diagnose SARDS, PRA, and optic pathway disease via funduscopic examination, ERG, and MRI."

Ophthalmologist visit

07/24/13 - We went to an ophthalmologist on Monday for Reo. She has been having some issues with her right eye for the past few months, and our regular vet couldn't figure out what was wrong. We tried some eye drops, an antibiotic, and did fluorescein staining - all either didn't help or show anything that could give us a diagnosis.

Her symptoms have been - "swollen" eye appearance, she is not opening her eye fully and the lower eyelid is droopy; very red white of her eye; some clear discharge; occasional itching; white cloudy area appearing in the cornea (not a cataract).

I *loved* this ophtho, as compared to the one in KY that diagnosed Reo's SARDS. He was fascinated by her case, and we are the first ones to have treated endocrine issues in SARDS that he's met. He was surprised by how good her blood chemistries looked, after being on long-term Medrol. I was careful to point out that the Medrol is not a *therapy*, it's only replacing what she can't make
naturally. We talked a lot about our experience and what we did for Reo's treatment.

He did a very thorough exam, and said that Reo's retinas were unlike any he's ever seen before in a SARDS dog, even 2.5 years later. She had a lot of weird stuff going on, apparently! That's my Reo...

After his exam, he pointed out Reo had a slight head tilt to the right, which I could see after he mentioned it. I think she has always walked like that since her diagnosis, and I didn't really think anything of it. He suspected Horner's syndrome, which is another "mystery". But essentially, one of the nerves is damaged and/or not firing properly, which leads dogs to have eye appearance
issues. He thought that because she wasn't using that eye regularly, there was a nerve atrophy of sorts. There is a very simple test used to diagnose this - he put a drop of norepinepherine in her eye. In 15 minutes, she was back to normal eye appearance! That was pretty cool.

He said that because this test is so reliable and a strong positive, there is almost no chance that it could be something more serious (i.e., a brain tumor) that is causing this issue. So, it was a huge relief to me. He mentioned that the redness of her eyeball is also an indication of lack of vascular tone in the
eye due to the Horner's (this might be of interest to some on this list, whose dogs experience very red eyes!). Anyway, there is no "treatment" for Horner's, and he said that most dogs spontaneously correct in a few months - interesting.

Finally, another tidbit he gave me was concerning minerals and lipemia. For the past 1.5 years (since we moved back to Colorado), Reo has had very lipemic blood (lipemic means fat in the blood, which can skew some blood test results). Our regular vet never really said it was a problem, since Reo's cholesterol and triglycerides are normal.

The ophtho said that he could see the lipemia in Reo's eyes, and that she should be on a low-fat diet immediately. I told him there was no chance that I was changing her diet to low fat as she is quite healthy and we do blood chemistries 2x/year to make sure. Also, she has never had pancreas issues - all levels are normal.

He said he wanted to try her on EDTA drops, which will chelate/pull out extra minerals that are in Reo's eye. I asked him if mineral supplementation could cause lipemia - he said most definitely. Reo has been on the Nutramin mineral supplement, suggested by Dr. Plechner, for 2.5 years, so I wondered if it was causing an issue and leading to Reo's lipemia (maybe she just doesn't need the
supplement any more!). Previously, she was getting the Nutramin 2x/day, and I've dropped down to 1x/day for the time being. Will see how she does, and I will consider completely eliminating it in the future.

*Note - I can't find anything online concerning mineral supplementation causing lipemia in dogs, and not much reliable info in humans. I'll keep searching, and also ask my regular vet. Because the ophtho was so emphatic, it seems weird to me that my vet never said anything about the lipemia, or the supplementation maybe causing it.

We came home with EDTA drops, and cyclosporine ointment, and a re-check in 6 weeks to see how she does. Stay tuned! :)

Post-vacation trip to the ophthalmologist

07/03/13 - We had a glorious time in Europe for nearly 3 weeks!

Reo (and all the pups) did great under my brother's care - everyone was happy and healthy when we got back, and there was much rejoicing as we were reunited.

But, Reo has been having some issues with her right eye for a couple of months.  We've tried a few different things (drops, allergy meds, etc.) but nothing seems to be working.  Right around the time she was diagnosed with SARDS 2 years ago, she walked into a tree and scratched her cornea.  She's has the scratch since then and it never caused any issue.  But now, it seems to have a secondary whitish mark that is coming out from the scratch.  Our regular vet did a fluorescein stain and it didn't uptake anything (good), and it's not anything like a cataract (good), but we can't figure out what is going on.

I decided to make an ophtho appointment to see if there is anything that can be done.  It's clear that the eye is itching her, and the white of her eye is quite red.  It also looks like the lower eyelid is a bit swollen.  So, since our regular vet can't solve the puzzle, and Reo is not getting better on that front, we're going to go and get it checked out.

Fingers crossed we can get an appointment fairly soon and get to the bottom of it!  Stay tuned...

Headed overseas

06/12/13 - Tomorrow, Sean and I are headed to Europe for 3 weeks, sans dogs!  My brother is watching over our house and pack, which means I'll be separated from Reo for the first time in quite a while!!  We will have my brother pulse her Medrol dose for the first week we're gone, to hopefully help mitigate her stress.

She has been doing pretty well lately, but allergies are bugging her.  I have her on Claritin based on my vet's recommendation, though I don't think it's helping her.  She has an itchy/watery right eye, that has been bugging her for over a month.  The vet's looked at it, did fluorescin testing, and even gave her some NP Dex eyedrops to try for a week (which didn't help).  So, I think we'll go to the ophthalmologist when we get back, just to be on the safe side.

Anyway, fingers crossed all goes well and there are no issues with little miss high-maintenance.  :)

À bientôt, fair readers!

Tooth problems be gone!

05/22/13 - I went to the vet last Friday, and she said she *really* does not want to put Reo under anesthesia to clean her teeth (whew!!). But, that she has seen good success "pulsing" dogs with dental issues with clindamycin hydrochloride. She thought that with Reo's lowered immune system, her body had a hard time keeping the plaque bacteria at bay. So she has her on a low dose 2x a day until gone (I
think it will be about a 7-10 day course, given how much we've used already).

I've kept up with the Leba III spray, but haven't brushed because I wanted that little lesion to heal. Well I'll be darned...her mouth looks pretty darn awesome, to my surprise! The lesion has healed and is not painful to her anymore, and she doesn't have nearly as much plaque as she did a few days ago.

So, I'm considering doing this quarterly as "pulse" therapy like my vet suggested. Though I'm not a fan of regular antibiotic use, it might be worth it to prevent anesthesia for dental cleanings/extractions in the future.

The other interesting side effect is that she is way more perky than she has been before, which could be just because she was in pain before and isn't any more...but it's also making me wonder about dogs that are on the doxy/pred protocol and give antibiotics with cortisol replacement. I remember one of my SARDS friends saying that her dog did great on doxycycline and Medrol, but that most vets don't know why it helps SARDS dogs. Hmmm.

I also got a chemistry/CBC panel while we were there.  I decided not to do an EI-1 panel this June, and switch to yearly in December, instead of bi-annually.  I did get a T3/T4 add on, though, just to make sure thyroid was doing ok.  Everything looked good, except for elevated ALP and GGT, and elevated cholesterol.  Because she has been normal for over a year in these 3 areas, I'm not too worried (we took blood only a half hour after breakfast, and this could have an effect on her numbers).  We will repeat a more focused chemistry in July when we get back from vacation and see how she is doing.

Tooth problems

05/16/13 - Since Reo was diagnosed with SARDS, I haven't put her under anesthesia for anything.  But, she has this little lesion on her gumline along one of her back molars that continues to not heal, and I think the tooth might have to come out.  Before we got Reo, she had many of her teeth removed due to dental disease, and it has been a struggle to keep her teeth clean (missing many teeth means that she doesn't get good chewing action to keep the plaque at bay).

I use the Leba III product, and brush her teeth with water once a week, and sometimes scale them if there is a good bit of plaque, but it is not doing the job on this one particular tooth any more, it seems.  Leba III is great, but if you forget to spray it one day, it seems like it really makes a difference!

So, I'm going to take her in tomorrow for the vet to look at her gum.  I am hoping that she'll give me some antibiotics and the tooth won't have to come out...but I fear the worst.  :(  I really don't want to have to put her under anesthesia, but we might not have a choice.

Poor little thing!

Her allergies are finally getting under control.  She has had a puffy, weepy eye for about 2 months, and she was sneezing for a solid month.  Glad that she is feeling better.  I'm fortunate that I don't have allergies, but many friends have been suffering extra this spring.

March Madness

04/08/13 - It's official.  March is not Reo's best month.  It seems every year in March, we have something going on with her.  In my last post, I mentioned her allergy symptoms - sneezing, watery eye (just one eye), general mopeyness).  The allergy symptoms continue, though more mild than before.  She's also had some GI upset lately.  Overall, she's doing fine, but definitely a little outside of "normal".

So, 3 Marches of weirdness in a row can't be a coincidence.  It makes me think about Caroline Levin's assertion that spring and fall are normal periods of increased adrenal activity.  It certainly makes sense in Reo's case, though she seems to make it through fall with no problems.  I guess I'll make sure to be extra aware come spring next year, and make sure I'm ready for some bumps in the road!

2 year anniversary

03/05/13 - Today marks 2 years since Reo lost her vision (though we're a little ahead of her actual diagnosis)!  It seems like it's been far longer than that, to be honest!  We have learned so much in the past 2 years.  Every day, I am thankful that Reo is still with us, and healthy!  I'm so proud of this little dog, I tell you.

This is a busy time of year for SARDS diagnoses, and I've noticed that Reo has some allergy symptoms (itchy eye, some sneezing).  We've had an unusually mild winter in Denver, and I think that there are already some allergens in the air.  I'm pulsing her Medrol dose this week to try and help her overcome this.

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).

Seventh EI-1 results (and happy birthday!!)

01/03/12 -

Wishing my sweet Reo a very happy 12th birthday!!  :)

I get a little overwhelmed each birthday since her SARDS diagnosis, as I'm so thankful that she is with us, and there were so many times I thought she wouldn't make it to 11, let alone 12!  :)  She got some dehydrated lobster meat treats (made by Bravo) today for her birthday.  Boy, did she LOVE those!!

Over the holiday week, I got Reo's EI-1 panel results back from NVDS.  The results are added to her master table in the far right column.

	Reference Range	16-Mar-11	30-Apr-11	15-Jun-11	4-Aug-11	4-Jan-12	25-Jun-12	10-Dec-12
Total Estrogen	30 - 35	35.19	35.15	35.11	35.06	35.04	35.05	35.02
Cortisol	1.0 - 2.5	8.43	7.03	0.97	0.82	0.68	1.4	0.96
T3	100 - 200	62.7	72.12	87.92	156.94	135.29	169.94	157.64
T4	2.0 - 4.5	0.87	1.15	1.6	3.99	3.21	7.17**	5
IgA	70 - 170	50	53	57	65	67	66	68
IgG	1,000 - 2,000	722	754	883	946	973	970	992
IgM	100 - 200	74	76	87	97	97	97	98

Overall, I am really happy with how it looks!  Her total estrogen is the lowest it's ever been (great!), and her immunoglobulins are the highest they've ever been.

Cortisol is slightly below normal (but doesn't seem to be anything to worry about, given her erratic cortisol levels in the past), and T4 is slightly elevated.  But, T3 is in the normal range, so the vet is not worried about the high T4.  Her previous high number in June of T4 was due to a course of Clavamox she was on.

Both Caroline Levin and Dr. Plechner have suggested that Reo doesn't need blood testing since she's "stable", and we should only do a panel if she seems like she's off track.  I'll admit that it's like a crutch for me, to have a snapshot of how she's doing every 6 months.  I'll see if I can limit myself to one EI-1 panel per year!  I still plan to get a CBC and chemistry panel and thyroid test every 6 months, however, because I feel it's very important to keep track of these values as she is a dog on long-term Medrol.

That's the update from here.  Happy New Year to all!