News & Updates
October 28, 2018
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.
 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.
 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.
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. 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.
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.
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?
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.)
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.
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.
Levin C. Adrenal Exhaustion and Immunoglobulin Suppression: Common Findings in 54 Dogs with Sudden Acquired Retinal Degeneration (SARD). Copyright © 2008 Lantern Publications.
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.
May 13, 2017
Great question. I believe this must be addressed by dog owners and their local, home town veterinarians. Why your local vet? Because, to date, veterinary ophthalmologists maintain that they do not know the cause of SARD. Consequently, they have not identified any preventative measures.
Part 1: If you’ve been reading these pages, you are familiar with the unmistakable relationship between adrenal exhaustion (i.e.. elevated estrogen) and the onset of sudden blindness. 98% of SARD dogs tested demonstrate elevated estrogen. If the adrenal exhaustion could be promptly identified and treated, it might preempt the damage to the retina.
So, perhaps the most effective mode of prevention would be to educate general practice veterinarians and this might have to come from you, the dog owner. General practice vets should be educated:
- to recognize the signs of adrenal exhaustion and the breeds (Dachshunds, small terriers) most at risk
- how to test for adrenal exhaustion
- and how to treat it
Many dog owners make an appointment with their general practice veterinarian prior to the onset of blindness. The owners bring in the dog with signs of increased hunger and thirst, perhaps accidents in the house, and/or any of the other common signs such as, lethargy, depression, aggression, pacing, panting, etc. The general practice veterinarian may run a blood test to rule out Cushing’s disease (i.e.. a tumor growing on one of the glands that produces excess cortisol).
It seems logical to run a Cushing’s test, since the symptoms mentioned above can be signs of a tumor/excess cortisol. However, these are also signs of adrenal exhaustion (excess estrogen). How can this be? How can both excess estrogen and excess cortisol produce the same symptoms?
Both estrogen and cortisol are steroid hormones. And as two molecules go, they are very, very similar, so they both have similar effects on the body. They both cause: drinking, peeing, hunger, depression, infections, etc. So, if the Cushing’s test is negative, the veterinarian, should suspect adrenal exhaustion. And really, to prevent vision loss, the veterinarian should test for adrenal exhaustion along with, or instead of, Cushings, so that no time is wasted.
If the testing can be done and the treatment initiated immediately, how many dogs might retain their vision? How many dog owners could be spared their grief and pain!
Part 2: For your part, consider raising any future dogs in a more old-fashioned way… treating the dog as we did decades ago, before SARD first made it’s appearance. SARD was only first diagnosed in the late 1970’s-early 1980’s. Rather than type out this information a second time, I am giving you a link to another website of mine. Here, you will find information about homemade meals, why to minimize chemical exposures, and some thoughts about vaccines. We also have a DVD that covers these topics:
April 16, 2017
There are two times each year when I see an uptick in the occurrence of SARD. The first is in the fall. Around Thanksgiving. The second is in the spring. Around Valentines day. During these times, the adrenal gland typically experiences an increase in activity. Why?
In the autumn the adrenal gland helps the body prepare for the stress of the coming winter. It helps the animal grow a winter coat, deal with the cold weather and fewer calories, go into hibernation. In the spring, the adrenal gland is involved with the new seasonal changes: coming out of hibernation, preparing for breeding.
When an adrenal gland can no longer produce cortisol, it produces adrenal sex-hormones (most notably, estrogen) instead. So in the fall and in the spring, when the adrenal gland is being stimulated by the brain, it produces a spike in estrogen levels.
As you may know from my writings, my thesis is that elevated estrogen triggers a seizure in the retinas. During that seizure the retina cannot communicate with the brain. Since the brain is where visual images really occur, the dog loses vision suddenly.
As the seasons change, the spike in adrenal sex-hormone steroids may subside. Levels may drop somewhat along with the steroid signs and symptoms. This gives the false impression that the problem is over or that the dog has adapted to the elevated sex-hormone levels.
February 12, 2017
Our best understanding of Sudden Acquired Retinal Degeneration
- SARD dogs develop elevated levels of sex-hormones including estrogen.
- Excessive estrogen increases the rate of calcium entering nerve and retinal cells.
- Excessive calcium is a known seizure trigger and likely initiates a seizure in the retina (sudden vision loss).
- Death of retinal cells occurs in the weeks and months that follow. But retinal cells are not destroyed at the time of vision loss.
- Some retinal cells may be saved.
Now for further details, I’m including an excerpt from one of my papers. For those of you who want to check my references, click the link. For those of you who don’t like reading medical jargon, there is a plain English translation down below. Scroll down just a bit.
Dogs affected with SARD routinely present with signs suggestive of hypercortisolism (1,2,3,4,5) but only a minority are diagnosed with Cushing’s disease. (2,6) Early on, researchers speculated that this hypercortisolism was the physiological response to some unidentified stress. (5) SARD- affected dogs also demonstrate elevated levels of adrenal sex hormones (androstenedione, estradiol, progesterones, and testosterone) within the first year of blindness. (7,8) One explanation for this pattern of events is Selye’s model of stress adaptation, which describes the progression from adrenal gland hyperactivity to adrenal gland exhaustion (cortisol insufficiency and excessive estrogen production).
Apoptosis is a common final pathway in multiple retinal disorders including SARD. (33) It is also prevalent in other systems such as the central nervous system and immune system. Apoptosis is modulated in these systems is by steroid hormones such as cortisol and sex hormones. (34,35)
Retinal photoreceptor cell membranes contain gated ion channels, which control the influx of calcium ions (Ca++) into these cells. In photoreceptor outer segments, Ca++ controls light adaptation. In photoreceptor inner segments, Ca++ regulates cell metabolism, glutamate release, gene expression, and cell death. (36)
In pathological conditions of steroid hormone excess, Ca++ influx increases. Elevations in intracellular calcium, along with pro-oxidants, neurotoxins, and ishchemia damage the cell mitochondria. Caspases and other apoptosis-inducing factors are then released, degrading cellular components. (37) In SARD cases, retinal abnormalities typically do not develop until weeks or months after SARD onset, indicating that apoptosis is not immediate. (2,3)
Plain English translation
There are little doors into each retinal cell. These doors are called calcium channels. Normally, the doors open up for a split second, a small amount of calcium enters the cell, and the door closes. That small amount of calcium creates an electrical signal to the brain that we know as vision.
When estrogen levels are high, as they are in SARD dogs, the calcium channels remain open longer and much more calcium enters the cells. This excessive calcium causes an extensive electrical signal to move through the retina, throwing it into a seizure. This is when communication to the brain is interrupted and vision is suddenly lost. The retinal cells are not dead at that point. They are simply unable to communicate with the brain. Over time, the overabundance of calcium damages the mitochondria, the little organs inside the cell. Once the mitochondria are damaged a self-destruct message called apoptosis is initiated, and the retinal cells are finally destroyed.
There have been many documented success stories wherein retinal cells have been spared and some functional vision returned to these dogs. Therapies are designed to protect the retinal cells until estrogen levels are returned to normal.
My thesis is actually supported by much research published by the veterinary ophthalmology community, as you can see by the other works I reference. It’s likely, however, that your veterinary ophthalmologist did not inform you about my work. That will be a topic for another blog post.
I have followed hundreds of SARD cases in the past 15 years. There is a clear correlation between the incidence of SARD and elevated levels of adrenal estrogen. The estrogen levels can be brought down to normal levels with hormone replacement therapy. This offers the best chance for a comfortable life. You and your dog should not have to suffer. 20%–55% of treated dogs regain functional vision.