Healthy Pet Network

Portions of this article appeared in a two-part series in GREAT SCOTS MAGAZINE, Aug. - Sept., Vol. 13, No. 4 , and in Oct.-Sept. Vol 3., No. 5: "A Stone's Throw: Ripples Across Time with Scottish Terriers."

Bonnie Sue: One Scottish Terrier's Experience with Adrenal Exhaustion and SARDS

By Russie McDement-Fogarty

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Examination Results Disappointing

In midsummer, our vet gave Bonnie a thorough exam. He suggested that in order to have her eyesight properly assessed, we should take her to a specialty practice that offered ophthalmology services, MedVets of Ohio. We both felt that might give us a better idea of whether SARDS could be responsible for her decreased vision. In July 2007, Bonnie and I were off to get advice from the experts.

At the specialty clinic in Ohio, Bonnie underwent a neurologic assessment for her hearing. She was given a Doppler blood pressure test to see if any undue pressure might be causing her sight problems. An ocular examination was also performed, including a Schirmer tear test, and an electroretinogram (ERG), which tests retinal function. In this test, special contact lenses were placed on Bonnie's eyes, and a series of flashing lights were directed toward them. A graph of the electrical impulses recorded electronic signals detected by the electrodes. In Bonnie's case, the ERG recorded barely any electrical responses, which meant her ERG was flat. When this happens and the blood pressure is normal, as it was with Bonnie, SARDS is the likely diagnosis. As I was waiting on Bonnie's tests to be completed, I spent my time reading in the lobby, and was amazed to discover a timely article about a new and promising SARDS treatment for dogs that was being overseen by Dr. Sinisa Grozdanic at Iowa State University College of Veterinary Medicine.

AS ISU, an intravenous treatment of immunoglobulin (known as IVIg, a human blood component that contains antibodies from the plasma of thousands of blood donors) was being used successfully to treat SARDS in dogs. This treatment was developed because Dr. Grozdanic believes that the sudden and painless onset of blindness is much like human antibody-mediated retinopathies. Dr. Grozdanic had already successfully restored limited vision to several canines.

This treatment was quite new and could have side effects to dogs with pre-existing heart or kidney problems because IVIg is produced with human plasma instead of canine plasma. I was completely thrilled to find this possible treatment for Bonnie and was eager to discuss it with the doctors, certain as I was they would find Bonnie to have SARDS. But when I received the summarization of Bonnie's test results from the specialists, I learned that the Ohio group felt that Bonnie was not a candidate for SARDS treatment because she still retained some functional vision, and SARDS dogs, they told me, had none.

Her patient evaluation note from the ophthalmic group read: "Bonnie presented to the service for evaluation of profound visual deficits. She appears to have primarily lateral visual field deficits with preservation of vision in the central visual fields. She did have flat ERGs but does have some vision. Bonnie is poorly attentive to auditory stimuli with decreased attention to sound and localization of sound." The neurologist wrote: "I cannot find any neurologic deficits which would explain the visual loss. It is odd that she appears to have both visual and auditory changes, since these are both Special Somatic Afferents . . . . [h]owever, I know of no degenerative processes in dogs with a preferential effect on SSA fibers. If the auditory changes are real, a degenerative process would make the most sense, since there is not any evidence of vestibular dysfunction . . . I can't think of any additional testing to perform on Bonnie right now, but BAERS [Brainstem Auditory Evoked Response, used to detect retrocochlear pathology] would be interesting to perform to see if they show the same changes as the ERG. Nor can I think of any appropriate therapy for Bonnie."

These veterinary ophthalmologists said Bonnie's symptoms fit no particular category and felt her situation defied diagnosis. They called another veterinary ophthalmologist in their group to take a look at Bonnie because they found her symptoms and exam so perplexing. They all agreed that SARDS fit better than any other diagnosis but argued that she would be a very atypical case. Her ERG was flat but she still retained a small amount of functional vision that allowed her to navigate an exam room set up with obstacles. The neuro assessment pointed toward a degenerative process, but the veterinary ophthalmology team was not swayed toward the SARDS diagnosis. They pointed out that Bonnie's eyesight diminished over time, not overnight as they said is found in dogs with SARDS.

They could not offer any hope or treatment for her condition, but did suggest Occuvite as a nutritional supplement to slow down the loss of vision. They attempted to encourage me by saying that Bonnie would "adapt to her circumstances."

I'd found that annoying quote in much of the SARDS information I'd read and didn't enjoy having it repeated to me. I felt like it was just a way of excusing the absence of a diagnosis or treatment. I found myself lingering in the specialist's office, trying to gain more understanding and information. I just wasn't willing to accept that Bonnie would go blind--especially in light of the fact that she had been given no particular diagnosis. I protested that with neither sight nor hearing, it would be a difficult life for Bonnie. A blind dog can use its hearing to help navigate, and a deaf dog can use its sight to do the same-but a deaf and blind dog? I wondered aloud how happy Bonnie's future could be if she was isolated in her own little world, especially for a dog like Bonnie who had become so bonded to her humans and so dependent on that contact for her sense of security.

When I mentioned to the ophthalmologist the article I had just read about ISU's IVIg treatment, I was asked if I felt like I needed to be referred to Iowa. The vet said she could do that, but quickly assured me yet again that they didn't believe Bonnie to be a candidate for this therapy. I felt a little foolish for suggesting such an extreme measure. But in the end that is exactly what happened, because at least three of the things the Ohio "experts" told me turned out not to be true.

Later I would come to learn that this same specialty clinic had seen other SARDS canines and offered them little hope, as well. It is rather frustrating in retrospect to go to experts expecting expert treatment and finding they know less than most, and worse, that their animal clients suffer long-term health issues due to this lack of knowledge.

Driving home from Ohio to West Virginia, I had the same nagging feeling I'd had all along, that something was being missed. The neurologist's mention of a degenerative process kept coming back to me. So, I turned to the Scottie network for help.

West Virginia is a sort of "Scottie hinterland" so sometimes my help for our dogs comes from turning to others who might be more knowledgeable. I couldn't even wait until I was home before I called several of my smartest Scottie pals and asked if they had ever encountered such a thing with their Scots. Once home, I e-mailed other friends. Those who responded said that they knew of situations where dogs had gone suddenly blind, but many were without known medical reasons. Some felt that it was caused by diabetes or was an old age-related problem. I was determined that after the hard life Bonnie had endured, her final years would not be spent in darkness. She'd been cold, she'd been alone, she'd been chained without freedom and I'd be danged if she would be blind on top of all of that. If she still had sight, then there was hope.

Once again at home, I did what I usually do when I am feeling pressed and stressed about my pets: I said a prayer and turned to the Internet for help. It is not always a prescription for success, but this time as I surfed once more for helpful SARDS resources, I found another qualified source who showed a definite connection between SARDS and cortisol production, adrenal exhaustion and excess adrenal sex hormones. I also learned that: (1) a flat ERG with functional sight does not rule out SARDS; (2) SARDS dogs do not necessarily go blind overnight or even within a few weeks; and (3) there was a window of time where hope of restored sight was possible for SARDS- affected dogs.

The owner of the web site and Lantern Publications is Caroline D. Levin, R. N., an experienced nurse who specialized in the fields of ophthalmology, family practice nursing and endocrinology. After a long career in human nursing, she left that field to manage an ophthalmic veterinary clinic. Her veterinarian, Dr. Jim Simpson of Oregon, was deeply influenced by Dr. Plechner's theory of adrenal exhaustion, which in turn led Dr. Simpson to incorporate those beliefs into his own general practice. When one of Ms. Levin's own dogs was diagnosed with adrenal exhaustion by Dr. Simpson shortly before it expired, her views were also shaped by Dr. Plechner's theories and her own heartbreaking experience. She has gone on to publish and promote the treatment of SARDS through correction of the underlying adrenal imbalance present in affected pets.

Her background both personally and professionally provided her with insight into canine SARDS, and she has been published on this subject in The Journal of the American Holistic Veterinary Medical Association. In October 2007, she presented two reports at the 38th Annual Meeting of the American College of Veterinary Ophthalmologists, and later addressed the Golden Retriever Foundation Health Symposium, in Longmont, Colorado.

Dr. Plechner and Ms. Levin's ideas, perhaps novel to some veterinarians or specialists, are becoming better known. Still, don't be surprised if your veterinarian has never heard of the concept of adrenal exhaustion. Many have not, but they may be better familiar with the term "Atypical Cushings":

"When clinical signs of hyperestrogenism are present in conjunction with normal cortisol values, a diagnosis of atypical Cushings disease is sometimes made. The author suggests that the terms atypical Cushings, hyperestrogenism, and adrenal exhaustion may all describe a similar state."

Levin, Caroline D. Environmental Factors and Signs of Hypercortisolism in Dogs Affected with Sudden Acquired Retinal Degeneration (SARDS). The Journal of the American Holistic Veterinary Medical Association, 2006: Vol. 24 (4), 11-19

Levin has posted many articles online for the benefit of the public. Her web site included detailed case studies of dogs with SARDS, along with summaries in plain English-perfect for folks like me.

Levin puts forth the same ideas Plechner holds: that chronic irritation through commercial diet, stress and vaccinations can lead to adrenal exhaustion.

Perhaps the most useful nugget of truth she offered was a simple way to distinguish a dog with Cushings from one suffering from adrenal exhaustion (or Atypical Cushings). In either instance, the affected dog will gain weight, experience sleep pattern disturbances, suffer polyphagia, polydypsia and polyuria, show increased liver enzymes, confusion, lethargy, muscle weakness, intolerance to heat, but the dog who also has chronic irritation, i.e., itchy feet, itchy skin, irritable bowel syndrome, allergies--then that is the dog that is producing excess estrogen and therefore suffering from adrenal exhaustion. Why? Estrogen is a pro-inflammatory. If a dog were truly suffering from Cushings, it would be producing an excess of cortisol, which would soothe the itchiness and inflammation with its powerful steroidal anti-inflammatory effects. Makes a lot of sense, doesn't it?

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