Trying to get a Diagnosis for Dandy (Possible SARDS?)

[Jillybean]

Hello everyone. I'm so happy to have found your forum!

My name is Jilly, and my dog is a 9 year-old Maltese named Dandy.
Over this long, cold, and snowy Winter, Dandy gained about 3.5 lbs, began drinking and eating excessively, and had to urinate a lot. He could no longer jump onto our bed to sleep at night. At the end of March, he went blind. It was complete and sudden.

We have been to the vet numerous times, and I have done much of my own research. I suspected Cushing's, and mentioned it to my vet. We started with a Urinalysis, which came back normal. Then Dandy had a Dental and they did blood work at that time. Still no indications of any problems (other than his symptoms, of course).

Dandy is adapting to his blindness fairly well, and we adopted a buddy for him, as a companion and helper around the house. Our new dog, Oliver, is doing great. He needed some help with house training, but he has come along quickly. Ollie and Dandy are becoming good buddies.

Meanwhile, the symptoms have not gotten any better, so our vet ran the Urine Cortisol:Creatine Ratio test. We were told it was normal, and thus very unlikely that Dandy has Cushing's. His Kidney test was on the high end of positive, so he is now taking an Antibiotic in case he has a UTI that was undetected in his urine test.

Meanwhile, Dandy is desperate for water and food. He was previously great with his house training, and now he may have two or more accidents a day. He will sometimes do it right in front of us, as if he just can't get to the door to tell us he needs to go. In the evening, we take him out once an hour, and he will still occasionally have an accident.

His weight continues to increase, up from 8.5 lbs (which he has weighed his whole life), to 13 lbs now.

He has somehow injured his hip, perhaps from falling, or running in to something. The vet has him on an Anti-Inflammatory and we are limiting his activity.

For all of you that have experience with Cushing's, do you think we should ask for additional testing at this point? Our poor Dandy has turned into a sad, lethargic little guy, and we want to help him so badly.

Thanks. I look forward to hearing from you!

[labblab]

Hello Jilly, and welcome to you and Dandy!

I am so sorry for his problems that have brought you here, but very glad that you have found us. I only have a few minutes to post right now, but I want to alert you to a condition from which Dandy may be suffering: SARDS (Sudden Acquired Retinal Degeneration). Here is a link that will explain a lot more about this syndrome:

http://www.eyevet.ca/sards.html

As you will see, dogs suffering from SARDS may exhibit a number of symptoms that overlap with Cushing's. Some dogs with SARDS will ultimately be diagnosed with Cushing's, as well. However, this is not always the case, and indeed seems unlikely for Dandy since his UC:CR urine test was "negative" for Cushing's. Unfortunately, the blindness is permanent in all cases. However, for dogs who suffer from SARDS alone, the symptoms other than blindness may actually resolve given some time. For dogs who also suffer from Cushing's, the other symptoms do not resolve without treatment.

We do have other members here with dogs who have been diagnosed with SARDS alone, and also with the SARDS/Cushing's combination. If you utilize the "Search" function for our forum and type in "SARDS" as the keyword, you should be able to locate many of these other members. Here's a search hint, though: request the search via "Posts" rather than "Threads," and it will be much easier for you find the specific replies that contain discussions of SARDS.

Please do take a look at the link above, and then we can talk some more about the specifics of Dandy's testing/situation.

Marianne

[Jillybean]

Hi Marianne, and thanks for your comments on SARDS.

I have heard of SARDS, and initially thought that might be Dandy's diagnosis. However, I expected that the other symptoms except his Blindness would dissipate over time. They have not.

I think Dandy is adapting well to the blindness, and as many have said, better than my husband and I!

Then there is the question of a cure. If it is SARDS, the treatment form Iowa State - published seven years ago, doesn't seem to be very prevalent.

I look forward to our discussion.

[labblab]

Unfortunately, I do not believe the Iowa State protocol has "panned out" as had initially been hoped. I have not heard much about it in recent years, either.

I wish I knew more about SARDS. The little I do know (or at least, think I know :o) is that adrenal hormone elevations are typically associated with SARDS, as they are with Cushing's. However, not all dogs with SARDS exhibit elevated cortisol levels, and that's where the diagnosis/treatment component becomes cloudy to me. Here's the abstract for a 2009 study co-authored by Dr. Jack Oliver of Univ. of Tennessee at Knoxville, who devoted much of the later part of his life to researching the incidence and effects of elevated adrenal hormones other than cortisol:

Elevations in sex hormones in dogs with sudden acquired retinal degeneration syndrome (SARDS).
(http://www.ncbi.nlm.nih.gov/pubmed/19723843)

Dogs diagnosed with sudden acquired retinal degeneration syndrome (SARDS) commonly are presented with concurrent clinical, physical, and historical findings consistent with hyperadreno-corticism (HAC) at the time of vision loss. Thirteen dogs diagnosed with SARDS on the basis of complete ophthalmic examination and extinguished bright-flash electroretinogram were evaluated for steroid hormonal abnormalities. Signalment, case history, physical examination, and clinicopathological findings were recorded. Serum cortisol and sex-hormone concentrations were measured before and after adrenocorticotropic hormone (ACTH) stimulation. Clinical signs of HAC, systemic hypertension, and proteinuria were commonly found in dogs with SARDS. Elevations in one or more sex hormones were found in 11 (85%) of 13 dogs (95% confidence interval [CI] 65% to 100%); cortisol was elevated in nine (69%) of 13 dogs (95% CI 44% to 94%). A minority of dogs (three [23%] of 13; 95% CI 0.2% to 46%) exhibited only an increase in adrenal sex hormones. Only one dog had completely normal ACTH stimulation test results. Symptoms of HAC were associated with abnormal ACTH stimulation results. Routine ACTH stimulation testing to evaluate cortisol and sex hormones, blood pressure screening, and urinalysis are recommended in these animals.

Since Dandy's UC:CR was normal, it seems possible that if a full ACTH-stimulated adrenal panel were to be performed on him, his cortisol level might be normal but if he does have SARDS, it is most likely that at least some other adrenal hormones would be elevated. Whether or not it would be worth the expense to you to proceed with a full adrenal panel to find out, I do not know (U. of Tenn. at Knoxville has the only lab in the U.S. that performs this analysis, but blood samples can be obtained in any vet's office and sent to UTK). I am aware of at least one other member whose dog ended up being treated with trilostane (historically a treatment reserved for dogs with elevated cortisol) after being diagnosed with SARDS and known adrenal hormone elevations other than cortisol. We've not had a recent report to know how this dog is doing, and the treatment does raise some questions since the drug itself actually increases some of the non-cortisol adrenal hormones that are associated with SARDS.

The long and the short of things is that if you have access to a veterinary ophthalmologist or internal medicine specialist, it may be well worth the expense for at least one consultation. A specialist in this area may be better aware of the most recent research findings and suggestions for treating unremitting symptoms of the syndrome other than blindness.

Marianne

[labblab]

P.S. I hope you don't mind, but I've added the possibility of SARDS to your thread title. Given Dandy's constellation of symptoms, I do think SARDS is very likely although confirmation of that diagnosis requires specialized retinal testing.

Also wanted to add that, according to that study abstract, apparently proteinuria is commonly found in dogs suffering from SARDS. When you say that his kidney test was high-normal, was it perhaps protein that was being found in the urine, or was it instead one of the kidney-related blood chemistries (like creatinine or BUN) that was elevated?

Marianne

[Jillybean]

I asked the Vet to send me all of Dandy's test results today, so that I can tell you any specifics. Looks like the kidney portion she mentioned was the AMYL (Amalyse) test, which was at 1156. The normal range listed is 290 - 1125.

Based on what you have said, we may attempt to see the Opthamology department at Purdue University, which is the closest expert available.

[lulusmom]

Hi and welcome from me too.

Marianne has given you some excellent information and I would just add that the amylase value you posted would be considered very mild. This enzyme is primarily triggered in the pancreas but can also come from the liver and intestines. It can also be falsely elevated by too much lipids (fat) in the blood. Protein in the urine is a common finding in dogs with SARDS as most, if not all, dogs with SARDS have elevations in one or more of the adrenal intermediate hormones. An excess of these hormones cause the same symptoms as cortisol, the hallmark steroid in cushing's. With symptoms commonly associated with cushing's and the sudden onset of blindness, I think you probably are dealing with SARDS so I'm happy to hear that you are considering an appointment with a veterinary opthamologist. The good news is that if it is SARDS, chances are the symptoms will resolve on their own in time.

Glynda

[molly muffin]

Hello and welcome to the forum. I too think it sounds like SARDS and Marianne and Glynda have both given excellent information.

I likely would go to Purdue to have this looked into further by a specialist.

I don't know if they have looked at any treatment for SARDS that addresses the basic sex hormone levels for those not having cortisol, such as melatonin and lignans, but I would think Purdue a good bet over all.

Dandy is quite adorable. :)

Sharlene and molly muffin

[labblab]

I agree, I'm really glad you have Purdue as an option. They will have the full range of specialties available so that the team there can even consult among themselves as to the best treatment plan to recommend to your own vet as far as taking care of Dandy going forward.

Marianne

[Jillybean]

Excellent advice Marianne, Glynda, and Sharlene! I'll get that consultation scheduled!

Meanwhile, I'm trying to get Dandy to wear a Belly Band to protect the carpet and rugs. He's very unhappy about it. He will let me put it on, and I give him especially yummy treats, but he just lays there and whines when he is wearing it.

And another meanwhile - just bought my own carpet cleaner, commercial style! :D


Jilly

[molly muffin]

I use the small bissell green machine carpet cleaner for spot cleaning, but heavy duty commercial should do the trick!

Yea, they don't like those belly bands very much that's for sure, but you got to do what you got to do. :)

Hope you can get an appt soon at Purdue.

Sharlene and molly muffin