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

Page 5

Iowa State University

Recalling the article I had read earlier in the specialty clinic's office about Dr. Sinisa Grozdanic's amazing breakthrough at ISU in treating dogs with SARDS, I thought perhaps he might help us determine a proper diagnosis for Bonnie. However, because of the non-SARDS diagnosis and conflicting information I had received in Ohio, I again turned to our vet to help me sort through the confusion. After considering all the information I had provided him about Grozdanic and Levin's work, as well as his own evaluation of Bonnie, our vet felt it most likely Bonnie did have SARDS. Our vet contacted Dr. Grozdanic at ISU to determine if Bonnie might be a candidate for IVIg treatment.

Dr. "G" (as he is called by his co-workers) indicated to our vet that SARDS-affected dogs can suffer diminished hearing and sense of smell, along with retinal changes, and that it was not at all uncommon to see all these problems in the same dog. He also indicated that it was not completely true that blindness occurs suddenly in each case of dogs sufferings from SARDS. He said that it was a condition that could happen gradually, as I had witnessed with Bonnie. This was contrary to what I had been told previously by the specialists in Ohio. Dr. Grozdanic advised us to try a simple course of prednisone and doxycycline. He told our vet that this was an inexpensive therapy that sometimes worked in treating pets with SARDS, and was worth a try before bringing her to Iowa. His advice was similar to the protocol provided by Plechner and Levin because it provided for steroid treatment.

Ultimately, Bonnie was determined to be in early adrenal failure using standard blood tests. (Later we would use more specialized adrenal panels to get a better look at Bonnie's endocrine system). Her cortisol level was normal, but both her estradiol and both progestins were in the high range. This along with her high alkaline phosphatase, cholesterol, calcium and albumin levels helped to verify the diagnosis, so replacement (steroid) therapy was indicated. Following Dr. Grozdanic's advice, our vet started her on doxycycline 10 mg/kg orally for 10 days and prednisone 1 mg/kg orally twice a day for five days, then once a day for five days, and finally every other day for five days. The plan was that if her vision had improved at the end of this loading period, then nothing more was needed. If there was no improvement, then she come to ISU for further evaluation and possible IVIg therapy. Would it be too much to hope for an inexpensive answer to this problem? As it turned out, no, but it also wouldn't be as easy as I thought to determine the overall results.

At the end of doxycycline/prednisone treatment cycle, I thought Bonnie's sight might be getting better, but when our vet reexamined Bonnie and performed a thorough eye exam, he felt she had not shown any true signs of improvement. Dr. Grozdanic had affirmed to our vet that SARDS dogs have a window of time where treatment is valuable, and past that, permanent changes to the retina take place, leaving the dog without IVIg as a treatment option. No one knows exactly how long this golden window of opportunity remains open, and fearing that our time was running out, I made an appointment for Bonnie with Dr. Grozdanic.

Bonnie Visits Iowa State University

Departing from Saint Albans, West Virginia, on a crisp October morning last year, Bonnie and I headed for Ames, Iowa, more than 800 miles away. My heart was full of hope for Bonnie's restored health as we set out with my mother, Jewel, and her gorgeous Papillon, Freddie.

It was a whirlwind tour of the heartland, but the weather was great and Bonnie was all that you could hope for in a pet passenger. Freddie was good in the car, but took a bit longer to do his business at the rest stops, and I couldn't help but brag on my nearly blind and deaf Scottie for being so cooperative. Secretly, I think she enjoyed the attention and time away from our herd at home. At night in the hotel when the chore of navigating a new room and a new place were behind her, she'd settle into bed with me. She'd offer up a contented Scottie sigh and fall in to a deep sleep. Bonnie certainly seemed to have a high degree of trust in me and that made our journey more necessary than ever.

My experience at Iowa State University Small Animal Hospital was a positive one. I had a short wait before I was ushered in for Bonnie's examination. Dr. Grozdanic easily conveyed both his concern for Bonnie and his expertise. As I chatted with him and his staff, I asked lots of questions and learned that people come from all parts of the country seeking Dr. Grozdanic's help for their blind dogs, so nobody was impressed by my mileage stats. There are many pet owners who feel the same desperation I felt when thinking of Bonnie's life without eyesight. Somehow I felt happier knowing that other pets were at the top of their owner's priority list, too. Bonnie's future treatment, Dr. Grozdanic explained, would depend on the results of her extensive evaluation by Iowa State University's Small Animal Ophthalmology Service, known for its state- of-the-art equipment and thorough ophthalmic testing.

Dr. Grozdanic's Assessment of Bonnie

Bonnie's final report was as follows:

"On presentation, Bonnie was bright, alert and responsive and her physical exam was within normal limits. Ophthalmology exam revealed that there was vision present, as was demonstrated by Bonnie's ability to navigate two different obstacle courses despite absence of the menace response. Colorimetric evaluation of the pupil light reflect showed absence of pupillary light response to red light and good responses to the blue light in both eyes. Fundus examination revealed a pale optic nerve head (due to attenuated vasculature) with no hyper-reflectivity changes bilaterally, suggestive of advanced retinal degenerative changes. An electroreinogram was performed and revealed a complete absence of retinal electrical activity."

After the testing was complete, Dr. Grozdanic brought out his video camera and showed Bonnie's navigational abilities on an obstacle course and then played a video of a dog who had lost complete vision trying to do the same. Bonnie did quite well in comparison. It was not one of the more sophisticated tests Bonnie underwent, but Dr. Grozdanic finds the simple navigation test very useful. He explained that standard eye tests normally performed by vets and even specialists are not always helpful in identifying good SARDS candidates. A dog may show little or even no retinal activity, as Bonnie did with her flat ERG, but they still retain an ability to see just enough to let them get around.

Many of the dogs they evaluate have gone completely blind, but others have not. Those who receive IVIg treatment are those dogs who have lost all vision, but whose retinas haven't undergone permanent changes. Hyper-reflective areas and thinning of the retina are usually observed in dogs with SARDS and can mean that a dog is not suitable for IVIg therapy. Dogs who do receive IVIg are usually restored to the level of vision which Bonnie now possessed.

Since Bonnie was still able to see, even in a limited way, Dr. Grozdanic felt she was not ready for IVIg. Much like my oncologist told me about my oral cancer: "Let's not do radiation now when something simpler like surgery might work--let's keep it in the back pocket in case we need it in the future." Similarly, Dr. Grozdanic advised keeping Bonnie on steroid therapy indefinitely, stopping only if it ceased being of benefit or she began to suffer from side effects, at which time we could consider the IVIg therapy. He understood that some owners might be concerned about long-term steroid therapy, but further advised that when owners try to wean their dog off steroids or decrease the dosage prescribed, they find that vision decreased to an unsatisfactory level. This condition is reversed once the steroid therapy is resumed. I was pleased to also learn that Dr. Grozdanic generously offers his protocol to any vet who requests it, and had already shared it with specialists who are much closer to our home in West Virginia.

Bonnie was sent home with a prescription and instructions for prednisone. She was to receive one10 mg. pill once daily for seven days, followed by a pill every other day for 14 days, then one pill twice per week. We found that her eyesight was decreasing when we got to the maintenance dose of one 10 mg. pill twice a week, and so her prednisone was increased to one 5 mg. pill once a day. Some experts advise this schedule of steroid administration, also known as "pulsing." It is supposed to keep the body from forgetting how and why it needs to make cortisol. Other experts advise that pulsing will not prove totally successful (and in Bonnie's case, this was absolutely correct), and that regular doses of cortisol are what the body would normally produce, and therefore, what is needed as a replacement. This idea made sense to me. Would those of us who need thyroid hormone supplementation feel well if we took our Synthroid or Levoxyl every other day or twice a week? Certainly not. I believe it is the same with administration of steroids for dogs who can't make it themselves and need it.

                                                               
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