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March 20, 2019

Obesity and Sudden Acquired Retinal Degeneration (SARD)

Many of my articles discuss estrogen levels in SARD dogs. Other sex-hormones are typically elevated as well. This article will focus on the effects of elevated androgens— testosterone and androstenedione.

As you read on, I’d like you to keep in your mind an image of the typical teenage boy. Maybe you can picture him standing in front of the refrigerator saying, “Mom, I’m starving!” He’s filling out and putting on weight. He may have acne, greasy skin or hair, maybe even body odor. These are some of the same problems we see in SARD dogs.

Other signs of elevated androgens include male and female pattern baldness. In SARD dogs we see bilateral flank alopecia (hair loss) and/or hair thinning along the spinal column.

Elevated androgens contribute to mood changes such as aggression, depression and anxiety. They may alter sleep patterns, contributing to insomnia—all problems we see in SARD dogs.

Since androgens are steroid hormones like estrogen, they too can aggravate heart disease, cause liver damage, raise serum cholesterol, blood pressure and blood sugar levels.

But perhaps the most common problem facing these dogs (second to vision loss) is the increased appetite and weight gain. Excess androgens interfere with insulin, leptin, and ghrelin activity. All of which communicate with the appetite center in the brain.

Women with Polycystic Ovary Syndrome—a condition in which women suffer elevated testosterone levels—report a constant and overwhelming urge to eat, sometimes to the point of disrupting their sleep. They share comments such as, “I’m always hungry, I never feel full,” or “I have an insatiable appetite.” They report extreme difficulty keeping their weight at normal levels saying, “I can’t get the weight off no matter what I do,” and “The struggle never ends. It is so hard to walk into the kitchen and not want to stuff myself.”

So, when a SARD dog owner asks me, “What can I do to curb my dog’s appetite?” the answer is simple. Treat the elevated sex-hormones. Dietary measures such as calorie restrictions, adding green beans or canned pumpkin are simply band-aids that don’t address the underlying problem.

Ask your general practice veterinarian to test for adrenal exhaustion here or here. The protocol is here. Odds are excellent that your dog will feel better when elevated sex hormone levels are corrected.

Effects of androgens on insulin action in women: is androgen excess a component of female metabolic syndrome? A. Corbould. Diabetes Metabolic Research Review, 2008 Oct;24(7):520-32.

Obesity and Polycystic Ovary Syndrome
S. Sam
Obesity Management, 2007 Apr; 3(2): 69–73.

Polycystic ovary syndrome: syndrome XX?
S. Sam, A Dunaif
Trends in Endocrinology and Metabolism, 2003 Oct;14(8):365-70.

Impaired cholecystokinin secretion and disturbed appetite regulation in women with polycystic ovary syndrome
A. Linden Hirschberg, S. Naessen, M Stridsberg, B. Bystrom, J. Holte
Gynecological Endocrinology 2004; 19(2): 79-87.

Sex hormones, appetite and eating behaviour in women.
A.L. Hirschberg
Maturitas, 2012 Mar;71(3):248-56.

Long-Term Testosterone Administration Increases Visceral Fat in Female to Male Transsexuals  Jolanda M. H. Elbers Henk Asscheman Jacob C. Seidell Jos A. J. Megens Louis J. G. Gooren. The Journal of Clinical Endocrinology & Metabolism, July 1997; 82(7): 2044–2047.

March 20, 2019

Addison’s vs. Adrenal exhaustion


Last week a general practice veterinarian asked me the following question. “Why is the daily replacement level dose of cortisol higher for SARD dogs than the physiological dose for Addison’s dogs?” This is a good question but I doubt it’s of interest to the average dog owner. Therefore, my comments are directed to the prescribing veterinarian.

Peripheral synthesis of glucocorticoid hormones

Because the adrenal gland is the primary producer of glucocorticoids, less attention has been paid to steroidogenesis in peripheral tissues. A wide range of peripheral tissues are reported to synthesize cortisol in humans and rodents. Mucosal, pulmonary, cardiovascular, epidermal and central nervous system tissue demonstrate local glucocorticoid production. While these levels have not been quantified, they are described in the literature as important sources of glucocorticoid synthesis.

The adrenal pathophysiology in Addison’s disease

Autoantibodies to steroid 21-hydroxylase are characteristic of autoimmune Addison’s disease. Autoantibodies are specific to the adrenal gland unless a poly-glandular syndrome exists. In that case, antibodies may also target organs such as the thyroid, pancreas, or gonads. Celiac disease has been reported in poly-glandular syndrome. I can find no reports, however, describing peripheral tissue such as lung, cardiovascular, epidermal or other mucosa as autoimmune targets. Cortisol production in peripheral tissue may remain intact.

The adrenal pathophysiology in SARD-affected dogs

In comparison, the adrenal dysfunction in SARD-affected dogs is similar to late-onset CAH due to 11-beta hydroxylase type 1 (11-BHD1) in humans. This genetic mutation results in a failure to produce 11-BHD1— the enzyme that reduces deoxycortisol to cortisol. It’s possible that unlike Addison’s disease which specifically targets adrenal tissue, the loss of 11-BHD1 affects systemic cortisol production including that of peripheral tissue.

This difference may explain why Addison patients may be maintained on lower doses of daily cortisol replacement when compared to SARD-affected dogs. Addisonian dogs may retain some peripheral cortisol production whereas SARD-affected dogs may not. Consequently, a slightly higher dose is necessary to suppress adrenal sex hormone excess in SARD-affected dogs.


March 9, 2019

What’s in a Name?

Some people take issue with the way I describe the underlying hormone problem in SARD dogs. In this article I’m going to tell you why I use the phrase adrenal exhaustion.

Here is a graphic representation of adrenal exhaustion. Bold text indicates areas of excess activity. Small text indicates an area of insufficient activity. Please note that all of the charts on this page differ only by the lab test performed.

Altered hormone production during adrenal exhaustion.

In human healthcare there’s a condition that has some similarities to the symptoms SARD dogs suffer — fatigue, lethargy, depression, insomnia, weight gain, etc. Patients are typically middle-aged females. It was dubbed Chronic Fatigue Syndrome (CFS) in the 1980s. It has a neurological component. It has an endocrine component. And nowadays patients are treated with low-dose cortisol and thyroid hormone.

When I first began writing, I could have used this to illustrate and explain the adrenal dysfunction in SARD dogs. However, the allopathic medical community was quick to dismiss this term and these patients. Doctors told patients the problems were all in their head. They called it “a new-age illness.” They prescribed psychiatric and anti-anxiety medications. So, I couldn’t use this as a teaching tool. Your veterinarian would have scoffed at it just as MDs did in the 1980s.

We see another condition in humans that shares similarities with SARD dogs called Congenital Adrenal Hyperplasia (CAH). Specifically, it’s a version called “non-classic CAH due to 21-beta-hydroxylase deficiency”. In this condition the adrenal glands become enlarged as they fail to produce cortisol. The result is a rise in adrenal sex hormones just as we see in SARD dogs. Management consists of low-dose cortisol replacement.

As the name implies, CAH is a congenital disease and is often apparent at birth. I might have used this terminology to illustrate and explain adrenal dysfunction in SARD dogs. But veterinarians said, “CAH is congenital. These dogs were not born with SARD!” And the discussion was ended.

In the field of veterinary medicine, a general practice vet named Alfred Plechner pioneered the use of low-dose cortisol in animals without a standard Addison’s diagnosis. He developed a laboratory test that assayed cortisol and total estrogen. He dubbed the scenario of low cortisol plus elevated adrenal estrogen Plechner’s syndrome.

I might have used this terminology to describe the adrenal dysfunction in SARD dogs, but veterinarians were quick to reject it. The treatment included aggressive cortisol replacement which was objectionable to most. Concerted efforts by the mainstream veterinary community resulted in a smear campaign against Dr. Plechner.

At the University of Tennessee, a veterinary endocrinologist named Jack Oliver developed a laboratory test that assayed cortisol and adrenal sex hormones. When dogs exhibited elevated sex hormones without elevated cortisol — essentially the same scenario described by Dr. Plechner — it was dubbed atypical Cushing’s disease.

To this day, endocrinologists at the University of Tennessee’s College of Veterinary Medicine do not supplement the cortisol in these dogs. Instead, they recommend therapies that further disrupt adrenal function. General practice veterinarians dutifully follow these recommendations. If I had used this terminology to describe the adrenal problem in SARD dogs, dogs would have received cortisol-reducing therapies rather than cortisol-replacing therapies.

In yet another camp of veterinarians — primarily holistic veterinarians — the very same adrenal condition garnered a third name. Atypical Addison’s disease. Practitioners realized that unlike typical Addison’s patients that exhibited low cortisol plus low aldosterone, these dogs exhibited low cortisol only, earning the atypical Addison’s label.

Atypical Addison’s might be a good description of the adrenal problem that SARD dogs experience. However, the veterinary establishment was quick to dismiss this phrase, claiming, “there is no such thing.” So, once again, the terminology was not entirely useful in securing treatment for these dogs.

So, to recap
• Chronic Fatigue Syndrome was written off as bogus.
• Congenital Adrenal Hyperplasia was too dissimilar to accept.
• Plechner syndrome was written off as bogus.
• Atypical Cushing’s disease results in treatments that further disrupt cortisol production.
• Atypical Addison’s disease was written off as bogus.

With veterinarians at such odds with each other, I returned to research done in human medicine. Hans Selye MD, famed author and the “father of endocrinology” detailed various phases of adrenal gland activity in his book, “The Stress of Life” (1956). In the phase called adrenal exhaustion, he described a failure of cortisol production.

This phrase carried with it the least baggage, was instructive, and offered the best chance for securing a dog’s treatment. I hope you now understand why I use this phrase. I also hope you’ve come to understand that institutional, mainstream medicine periodically promotes a false narrative.

If the phrase I’ve chosen still bothers you, simply refer to the problem in its simplest form. Call it “elevations-in-adrenal-sex-hormones-resulting-from-insufficient-cortisol-production.” That would do it.

I wish you and your dog all the best,

February 7, 2019

Steroids—a Dirty Word, Part 4

I received this note recently from the owner of a darling little dog named Milo. You can read our conversation below and you can read more about Milo’s recovery here.

January 29, 2019

Hi Caroline,
Our dog has been on the SARD protocol since August and regained vision in his left eye soon after the treatment started. Within the last week I noticed he now has some vision in his right eye as well! The vet said structurally his eyes still appear normal. I would like to start weaning him off the steroids, but I’m worried about him having a rebound reaction. Do you have any advice for long term therapy maintenance?

This was my reply:

Hi Janet,

I’m happy to hear the good news!

The short answer is that the underlying adrenal condition does not repair itself. The adrenal exhaustion — the low cortisol production — is a lifelong problem that requires lifelong treatment (i.e. low-dose daily cortisol replacement via either low-dose Medrol or low-dose prednisone.)

It is not an anti-inflammatory medication. It is not an anti-inflammatory dose. It is a hormone replacement for a hormone that is no longer being produced.

There is every chance that if you wean off the hormone replacement therapy that your dog will experience a rise in the adrenal sex-hormone steroids (including estrogen) and will experience a resurgence of all his original symptoms including vision loss.

Hormone replacement — low dose prednisone or Medrol— is simply replacing what his body would make if it were healthy. This is why the treatment does not require “weaning off”.

Please, please read the following three articles carefully.

Steroids Part 1

Steroids Part 2

Steroids Part 3


Here’s another way to think of this. Perhaps you know someone who is an “insulin diabetic”, a person who takes insulin injections to treat his or her diabetes. Insulin is a hormone that controls blood sugar. That person takes insulin daily because the pancreas no longer makes it. Once the blood sugar is controlled, the insulin is NOT discontinued. Similarly, low-dose cortisol replacement is typically NOT discontinued because it is simply replacing what the body can no longer make.

Another example is thyroid hormone. Perhaps you know someone who takes a small daily dose of thyroid hormone each day. Once the symptoms improve, the hormone is NOT discontinued, it is necessary for life just as cortisol is necessary for life.

Remember, the typical result of discontinuing low-dose cortisol replacement is a rise in sex-hormone STEROIDS.

I wish you all the best,

January 20, 2019

Steroids—a Dirty Word, Part 3

In this article I’d like to discuss some finer points of adrenal activity. If you haven’t read Part 1 and Part 2 of this series, please do.

Also, please remember I am not dispensing veterinary advice. I am sharing my observations with you. And I’m sharing information that my holistic veterinarian once shared with me. If you find this information to be complex and counterintuitive, you’d be right. I’ll try to explain it all in plain English and I’ve made some graphs to help, as well.

The Graphs

The center portion of each graph represents normal hormone activity. The top third represents abnormally high activity. The bottom third represents low activity. Sex-hormone activity is represented via estrogen.

Please note that “activity” does not necessarily equate with blood test results, especially in terms of cortisol. Lab tests often lump precursor hormones into the “cortisol” reading, pushing it into the normal range or even above normal when in fact, true cortisol production (activity) is low. For further reading, click here and scroll to page 8.

In addition, most cortisol readings do not identify prescription cortisol replacements. Consequently, even with therapy it’s common for cortisol readings to remain low for the duration of the dog’s life despite obvious clinical improvement. This is why it is more important to evaluate adrenal estrogen levels rather than cortisol levels.

Patterns of Adrenal Activity

Concept 1

Insufficient cortisol production increases adrenal sex-hormone production. For further reading, click here and scroll to page 6.

Concept 2

When these dogs are provided low-dose daily cortisol replacement, sex-hormone levels and clinical symptoms begin to normalize. For further reading, click here, here, here, and here.

Concept 3

The adrenal glands periodically experience spikes in activity. If an adrenal gland can no longe
r produce cortisol, it produces a surge of sex-hormone steroids at such times.

Concept 4

Even dogs receiving appropriate hormone replacement therapy may show an increase in steroid signs/symptoms during these spikes.

Concept 5

Some dog owners and practitioners assume that the increase in steroid signs/symptoms is a result of the daily low-dose cortisol replacement when in fact, it is a spike in sex-hormone steroids that’s to blame.


Twice a year there can be noteworthy spikes in adrenal activity. Not all dogs experience these spikes but many do. Those that do may experience varying degrees of severity.

The first spike occurs in autumn when the adrenal glands prepare an animal for winter—colder temperatures, fewer calories, hibernation, etc. The body does this by increasing cortisol production. Individuals that cannot produce sufficient cortisol however, experience a spike in sex-hormone levels instead. In the northern hemisphere this spike often occurs around late November and then subsides.

A secondary, smaller spike in adrenal activity occurs in early spring when the adrenal gland increases sex-hormone production. This is meant to help an animal shed its winter coat and enter breeding season. In the northern hemisphere this often occurs around mid-February and then subsides.

Perhaps you’ve recognized seasonal problems in your own dog. Problems such as seasonal skin and eye allergies, seasonal ear or bladder infections, seasonal hair loss on the flanks. Perhaps your dog was diagnosed with SARD during one or the other of these spikes.

In addition to seasonal cycles, activities of daily life may also cause smaller spikes in adrenal sex-hormones. Stressors such as home remodeling or adding a new family member may increase stress and sex-hormone steroids. Such events are not the cause of SARD, but these events may be more apparent in dogs already suffering adrenal exhaustion.

Estrogen is a catabolic steroid that breaks down organs such as the liver, kidneys, and cardiac muscle. It damages ligaments and tendons. It raises blood glucose levels initiating the equivalent of gestational diabetes. It raises cholesterol and triglyceride levels. It increases mast cell activity, histamine levels, and allergies. It suppresses immunoglobulin levels and the immune system. It is an excitotoxin that causes seizures, tremors, and head tics.

During such a spike, dog owners may report that the treatment doesn’t seem to be working as well as it did initially. Or, they may assume that the therapy is the cause of the problems. If it is wrongly assumed that the steroid signs are from the low-dose cortisol replacement, a practitioner may discontinue therapy. In that case, one of two things may happen:

  • the dog may deteriorate rapidly. Cortisol is, after all, necessary for life and its absence is akin to an Addisonian crash.
  • more often, the dog will ride out the seasonal spike of sex-hormones and the natural decline that follows the spike. Steroid signs/symptoms will dissipate. This may lead the practitioner and owner to believe that terminating the low-dose cortisol replacement was the correct course of action. The long-term outcome, however, is a different story. Untreated adrenal exhaustion (elevated sex-hormone production) contributes to long-term physical deterioration.

Please sit with that last point for a moment: By discontinuing low-dose daily cortisol replacement during an estrogen spike, the typical outcome is a gradual deterioration caused by elevated sex-hormone steroids.

Rather than discontinue therapy during an estrogen spike, holistic veterinarians will initiate a slightly more aggressive approach during these times. (That’s the counterintuitive part.) Holistic veterinarians accomplish this in one of two ways. They will either:

  • repeat the initial SARD protocol injections at 70% of the original dosing. This statement applies to this protocol, no others.
  • or instruct the client to pulse the oral cortisol replacement at a slightly higher dose for 1-2 weeks. No longer.

The chart above depicts only one spike, but such spikes may reoccur year after year. SARD-dog owners are encouraged to mark their calendars and plan ahead.

NOTE: On rare occasions, a dog’s adrenal glands may heal and cortisol replacement is no longer necessary. However, this is very uncommon and it generally occurs only after many years of hormone replacement.

Let’s Review

Starting on the left side of the chart we see insufficient cortisol production resulting in rising sex-hormone levels (A). Once low-dose cortisol replacement therapy is initiated, sex-hormone levels begin to normalize (B).

As the seasons change, however, the dog may experience a seasonal spike in adrenal activity and a rise in sex-hormone levels (C). This translates to increased drinking, urination, appetite, liver enzymes, cholesterol levels, pancreatitis, blood glucose, seizures, lethargy, etc.

Concerned that it is the low-dose cortisol replacement therapy causing these signs/symptoms, the practitioner discontinues therapy. The seasonal estrogen spike naturally dissipates (D), and so do steroid signs. This may lead the owner and practitioner to believe that discontinuing the low-dose cortisol replacement therapy was the correct course of action.

Without therapy, however, sex-hormone steroids may:

  • remain just slightly elevated
  • climb gradually (E)
  • or they may exhibit repeated spikes over time (F)

Rather than discontinue therapy, holistic veterinarians will provide slightly more aggressive therapy during an estrogen spike and then continue baseline therapy thereafter (G).

Closing Thoughts

Is is possible that sex-hormone levels return to normal without intervention? Anything’s possible but observation would suggest otherwise.  SARD-dog owners generally report ongoing health concerns with their dogs…not every one, but many do. Year after year, email after email, owners from every corner of the world describe their dogs’ health problems.

Some dogs appear to tolerate the mildly elevated estrogen. Their owners report that they “have no symptoms” other than the vision loss. But if a dog has SARD it’s almost guaranteed that he/she also has some degree of elevated sex-hormone steroids.  It can be difficult to accept these connections. However, these connections still exist.

I present this information not to upset you, but rather in the hopes that every owner is made aware of their options and that every SARD dog can experience optimum health. I really do wish you and your dogs all the best.

For Part 4 click here.

November 7, 2018

Steroids—a Dirty Word, Part 2

If you haven’t read Part 1, please click here.

In that article we discussed how the term “steroid” has mistakenly come to mean cortisone and prednisone. And we noted that SARD dogs routinely develop high levels of steroids internally, called sex-hormone steroids.  Here in Part 2 we’re going to address another misconception.

A Quick History

For decades, prednisone has been typically been prescribed in what’s called an anti-inflammatory or immuno-suppressant dose. These are the large doses that suppress the immune system response.

When a dog develops sudden blindness, it’s been the standard practice to rule out inflammatory activity. Veterinary ophthalmologists prescribe oral prednisone in a large, anti-inflammatory dose. The dog generally shows no improvement and in fact, may experience MORE hunger, thirst and lethargy than before.

Why? Because not only are these dogs producing high levels of sex-hormone steroids internally, they’ve been prescribed high levels of prednisone, another steroid, on top of that. No wonder these dogs feel worse than when they started!

The Difference is in the Dose

If you’ve read any of my work you know that sex-hormone levels rise when adrenal glands can no longer make sufficient cortisol. And you also know that when these dogs are given (and I cannot emphasize this enough) LOW DOSE, DAILY REPLACEMENT-LEVEL cortisol, it corrects the over-production of those sex-hormones.

A LOW, DAILY REPLACEMENT-LEVEL DOSE of cortisol (prednisone or Medrol) is very different than the large, short-term, anti-inflammatory dose that SARD dogs are typically prescribed at diagnosis. The large, anti-inflammatory dose is discontinued after a couple of weeks.  In cases of adrenal exhaustion, cortisol replacement is typically necessary for life. So, the anti-inflammatory dose is both too high, and of too short a duration.

Understanding the difference in these dosages is crucial. An anti-inflammatory dose suppresses the immune system response and may worsen signs / symptoms. A low dose acts as a hormone replacement, corrects the sex-hormone problem, and improves signs / symptoms.

Some Examples

Let’s take the example of a 20-pound dog. Holistic veterinarians would typically give a 20-pound dog about 2mg of prednisone or Medrol as a daily replacement dose. On the other hand, an anti-inflammatory dose can range from 5mg-20mg per day. That’s double, triple, or even 10-fold as much as a daily replacement dose!

Here’s another way to look at it. Do you know someone who takes thyroid hormone? That person takes a tiny dose each day. It’s a lifelong treatment to replace the amount of thyroid hormone a body would normally make. If that person took 10 times what they actually needed, there would be some serious medical consequences very quickly.

So, when a SARD-dog owner says to me, “We tried the prednisone treatment and our dog felt even worse,” in all likelihood their dog was given a high, anti-inflammatory dose rather than a LOW, DAILY REPLACEMENT-LEVEL DOSE as described in the SARD protocol.

In Part 3 we will discuss some nuances of low-dose cortisol replacement therapy. I hope this has been helpful. Good luck.

November 7, 2018

Steroids—a Dirty Word, Part 1

We’ve all been taught that the term “steroid” means cortisol and its cousins cortisone, prednisone, methylpred, etc. Medical and veterinary personnel fall into this trap, as well. Doctors say things like, “I’m going to write you a prescription for a steroid.” So, we all tend to equate “steroid” with cortisone and prednisone.

When we discuss SARD dogs it becomes clear just how inaccurate and impractical this description is.

A steroid is a molecule with a particular shape — four rings of carbon atoms. More importantly, it’s a molecule with a mission. A steroid signals cells to do their work. It’s called a signaling molecule. There are hundreds of steroids produced by the body in addition to cortisol and cortisone.

Surely, you’ve heard stories of bodybuilders taking testosterone injections. They do this because testosterone is a steroid that signals muscle development. In fact, all of the sex-hormones are steroids: androgens, progesterones, and estrogens.

We know that when SARD dogs are tested, there is a high incidence of elevated sex-hormone production. These steroids signal many cells in the body. It’s the reason these dogs suffer such a wide variety of problems including hunger, thirst, obesity, lethargy, seizures, liver degeneration, etc.

So, when a SARD-dog owner says, “I would never put my dog on steroids” as though it’s a dirty word — Guess what!? — that dog is already experiencing high levels of steroids circulating through its body.

This information may make some readers angry. Other readers will ignore it. These are normal methods of coping with grief and loss of control. A few readers will have questions. Please see Part 2. And a very few will “be in a place” where they are ready to address the problem. I truly wish all of you the best.  Click here for Part 2.

November 7, 2018

How Low-Dose Cortisol Corrects SARD Symptoms

After some thought I’ve decided to write this article in plain English for the benefit of the average dog owner. If you wish to see a more thorough explanation or bibliography, click here.

As you may know, cortisol is our natural anti-inflammatory hormone. It plays a role in essentially all body functions and is necessary for the body’s survival.

Cortisol is created when the brain sends out a fancy chemical call adrenocorticotropic hormone (ACTH) into the bloodstream. ACTH stimulates the adrenal gland to convert precursor hormones (building blocks) into cortisol. It’s like an assembly line. One hormone molecule Is converted into another until it’s turned into cortisol.

When the brain senses that sufficient cortisol has been produced, it decreases ACTH production, thereby decreasing adrenal gland activity. This feedback loop is a little like the thermostat in your home. When the house is warm enough, the thermostat turns off the furnace.

Adrenal exhaustion is a condition where the body can NO LONGER CONVERT the precursor hormones into cortisol. This may be due to chronic stress, chemical damage, and/or genetic abnormality. Over the years, the veterinary community has called this condition by various names: hyperestrogenism, atypical Cushing’s disease, and Plechner’s syndrome.

When the glands can no longer convert precursors into cortisol, it creates a break or interruption in the assembly line. The precursor hormones pile up behind that break. With nowhere else to go, they are rerouted down an alternate assembly line to produce hormones called adrenal sex-hormones.

Furthermore, because the glands are no longer producing sufficient cortisol, the brain never receives the message to turn off ACTH production. This causes chronically elevated sex-hormone levels. Since the sex-hormones are steroids, the resulting symptoms look almost exactly like those of cortisol excess (Cushing’s disease). This is why a dog in adrenal exhaustion can mistakenly appear to be suffering from Cushing’s disease.

Low dose cortisol supplementation can reestablish the feedback loop. The brain recognizes the presence of the cortisol replacement and reduces ACTH production. Once the ACTH production is normalized, levels of sex-hormones begin to normalize as well. This is how low-dose cortisol replacement therapy reduces elevated sex hormone levels and the symptoms so common in SARD dogs.

Because low dose cortisol replacement simply replaces what the body would normally make, we do not expect to see the side-effects produced by high, anti-inflammatory doses of prednisone or other glucocorticoids.

On the other hand, if aggressive treatments for Cushing’s disease are implemented — treatments that destroy what little cortisol production exists — there can be life-threatening results. When dealing with a SARD dog, test sex-hormone levels, especially estrogen.

I hope this helps you and your dog.

October 28, 2018

“My dog is doing great but…”

Since we’re heading into the autumn SARD season, I thought I’d try again to offer a few words of advice. I know SARD dog owners struggle emotionally with this diagnosis. There are feelings of grief and loss and anger. I know the dogs struggle, too.  For over a decade I’ve received emails or read posts that start like this.

“My dog is doing great but…”

• She was just diagnosed with an enlarged liver
• She is ravenous
• He is drinking a lot of water and has accidents in the house
• The snoring keeps me awake at night
• She’s put on a lot of weight and has trouble getting around
• He is acting kind of confused
• She is panting hard
• He’s so lethargic, he’s just a bump on a log
• She wet her bed during the night
• Her belly is so bloated
• She recently had a seizure and was taken to the emergency room
• She wakes up every 2-3 hours wanting to eat or go out
• Her liver values are high
• She constantly licks between her toes
• She’s lost her sense of smell
• She has stomach issues and diarrhea
• She’s just been diagnosed with kidney failure
• He has awful skin sores
• She gets chronic bladder infections

The list goes on and on.  Year after year after year.  These same dog owners also write:

• A few tests have ruled out Cushings
• Cushings blood work is completely normal
• ACTH and LDDS tests and are negative for Cushing’s
• They are still trying to find Cushings. She has a biopsy and an ultrasound scheduled
• We had our girl tested for Cushings. It came back negative

If you are “in a place” where you can accept that there is an underlying problem and that the problem is not Cushing’s disease [1,2], then simply ask your vet to run an adrenal estrogen level. That’s all. You don’t have to believe in my work. Just run an adrenal estrogen level and see what it says. NVDS is the more affordable option and requires only a single blood draw. UTCVM recommends an ACTH component. This can be more expensive and invasive but your general practice vet might prefer it.

Good luck.

[1] Van der Woerdt A, Nasisse MP, Davidson MG. Sudden Acquired Retinal Degeneration in the dog: clinical findings in 36 cases. Progress in Comparative Ophthalmology 1991; 1: 11-18.

[2] Gilmour MA, Cardenas MR, Blaik MA, Bahr RJ, McGinnis JF. Evaluation of a comparative pathogenesis between cancer-associated retinopathy in humans and sudden acquired retinal degeneration syndrome in dogs via diagnostic imaging and western blot analysis  American Journal of Veterinary Research 2006; 67, 5; 877-881

October 15, 2018


A woman on the east coast recently shared the following with me.  She said that when her dog was diagnosed with SARD her veterinary ophthalmologist insisted there was no known cause or cure and also issued a warning. “If you find anything on the internet to the contrary it’s a scam. Someone is just trying to make money off you.”

I’m not sure if the ophthalmologist’s statements would be classified as slander or defamation, but I do know this.  As a general rule, the ophthalmic veterinary community is withholding information from you. And after hearing the comments above, it’s time to address this.

Here are the facts.

In 2003 a research paper was presented at the annual meeting of the American College of Veterinary Ophthalmologists. This study was conducted in part by the prestigious Department of Endocrinology at the University of Tennessee’s College of Veterinary Medicine.  The paper demonstrated that 9 out of 10  SARD dogs had elevated levels of adrenal sex hormones.[1]

In 2007 these findings were substantiated when the American College of Veterinary Ophthalmologists (ACVO) published two additional papers describing elevated levels of adrenal sex hormones in SARD dogs.[2][3] These papers were written and presented at the ACVO meeting by me, Caroline Levin.

In 2008 the laboratory findings of 54 SARD dogs were made public. This paper demonstrated that 53 of 54 SARD dogs had elevated adrenal sex hormone levels. Results were compiled from four laboratories: the University of Tennessee, Cornell University, Antech Diagnostics and National Veterinary Diagnostic Services.[4]

In 2009 the findings from the endocrinology services at the University of Tennessee’s College of Veterinary Medicine were updated and published in the Journal of the American Animal Hospital Association. They demonstrated that 11 of 13 SARD dogs had elevated adrenal sex hormone levels.[5]

So, for 15 years the ophthalmic veterinary community has been aware — via data published in their own academic journal and elsewhere — that an adrenal sex hormone problem exists in virtually all SARD dogs.

Did the veterinary ophthalmologist mentioned above provide such information to the dog owner? No. Not only was the client denied this information, she was warned not to investigate further.  It reminds me of the line from Shakespeare, “The lady doth protest too much, methinks.”

How about you? Did your veterinary ophthalmologist tell you there is a high incidence of elevated sex hormones in these dogs?  Did he/she suggest that you investigate this issue with your general practice veterinarian?  Did he/she suggest a simple blood test to check your dog for elevated adrenal sex hormones?

Shall I take a guess that the answer is “No.” ?

So, there you have it.  On one hand we have peer-reviewed, replicated findings, published over many years documenting an underlying adrenal problem in these dogs.  On the other hand, it is the standard practice of the ophthalmic veterinary community to withhold this information from you.

Now tell me again, who is perpetrating a scam?

[1]Carter RT, Bentley E, Oliver JW, Miller PE, Herring IP. Elevations in Adrenal Sex Hormones in Canine Sudden Acquired Retinal Degeneration Syndrome (SARDS). Proceedings of the 34th Annual Meeting of the American College of Veterinary Ophthalmologists 2003;34: 40.   (Scroll down to abstract #51 if you use the link.)

[2]Levin C. Sudden Acquired Retinal Degeneration, Associated Pattern of Adrenal Activity, and Hormone Replacement in Three Dogs – a Retrospective Study. Proceedings of the 38th Annual Meeting of the American College of Veterinary Ophthalmologists 2007; 38: 32.  (Scroll down to abstract #28 if you use the link.)  Full text available here.

[3]Levin C. Sudden Acquired Retinal Degeneration, Associated Pattern of Adrenal Activity, and Hormone Replacement in a Brittany Spaniel – Case Report. Proceedings of the 38th Annual Meeting of the American College of Veterinary Ophthalmologists 2007; 38: 33. (Scroll down to abstract #29 if you use the link.)  Full text available here.

[4]Levin C. Adrenal Exhaustion and Immunoglobulin Suppression: Common Findings in 54 Dogs with Sudden Acquired Retinal Degeneration (SARD). Copyright © 2008 Lantern Publications.

[5]Carter RT, Oliver JW, Stepien RL, Bentley E. Elevations in Sex Hormones in Canine Sudden Acquired Retinal Degeneration Syndrome (SARDS). Journal of the American Animal Hospital Association 2009; 45: 207-214.