Published On: Wed, Aug 14th, 2013

A great story

DogsA great story (via letter from happy patient), about Dr. Plechner’s SARDS Therapy

-edited and presented by Dr. Bob Berger, MS, MVSc, PhD

August 14, 2013

Hi Dr. Plechner,

Here is a detailed summary of my dog Chip’s medical history, including his most recent SARDS (Sudden Acquired Retinal Degeneration Syndrome), diagnosis. Chip is a 12 year old (born on 8/18/2001), male mini-dachshund (double dapple).

On approximately March 17, 2013, I noticed that Chip was having difficulty navigating through the house and outside in the yard. Within two weeks, his vision deteriorated to the point that he would bump into furniture and struggle to find his food and water bowls. He became very quiet and often stared for hours on end without moving. He is normally a “vocal” and energetic pet who likes to play ball.

I made an emergency appointment with an eye specialist, Dr. K. Michael Chang of VCA West Los Angeles Animal Hospital on April 8, 2013. He performed an Ophthalmology exam including a Schirmer test. Here are the results of that exam;

Ophthalmic Examination:

Menace(-) OU; Dazzle Response (+/-) OU to (-); Mydriatic resting pupils OU with (+) PLR but sluggish OU; No conjunctival hyperemia OU; No corneal ulcer noted OU; Distichia noted OU; No aqueous flare noted OU; Nuclear sclerosis OU; Fundic exam has no significant lesion seen OU (subalbinotic fundus with focal choroid hypoplasia medial to the optic nerve head OS).

Diagnostic Tests: Schirmer tear test mm/min OD and mm/min OS

Intraocular pressure 15mmHg OD and 11mmHg OS

Fluorescein stain () 

Procedure/Surgery: Colormetric pupillary reflex test

CommentsI suspect Chip has a condition called immune mediated retinitis (IMR). IMR can cause intermittent vision  loss or complete vision loss in a short time. Long term prognosis for vision is poor. Medication canbe used to control the condition are Prednisone and Cyclosporine. Blood work and physical examination should be performed before we start the medication.

Dr. Chang confirmed a diagnosis of “Blind OU; Suspect Immune Mediated Retinitis OU“. Dr. Chang did notice some retinal activity in the right eye. He was unable to perform an Electroretinogram (ERG) due to staffing/time constraints, so I called my regular veterinarian’s office and scheduled an appointment for the following day. Before leaving Dr. Chang’s practice, I purchased a product called Ocu-Glo that I had read about and started Chip on that supplement immediately.  

Since Chip’s regular vet (Dr. Hansche), was on vacation, I made an appointment to see Dr. Barry Neichin at ABC Veterinary Hospital in San Marcos, California. He performed a full medical exam, including chest x-rays, CBC/Chem 24/Heartworm/Thyroid Evaluation, Urinalysis, Microalbumin (ERD Screen), Injection: Dexamethasone SP 4 mg/cc, 60 Prednisone, 5 mg (7.5 mg b.i.d.), 2 Atopica, 25 mg (15 capsule pack), and blood pressure monitoring. The diagnosis was IMR(Immune Mediated Retinitis). [His weight was 19.3 lbs.] Dr. Neichin then referred me to another Ophthalmologist, Dr. Nicole Roybal at Veterinary Specialty Hospital in San Marcos, California.

Dr. Roybal performed an Ophthalmology exam and Electroretinogram (ERG). Here are the results;

Diagnosis: Sudden vision loss in both eyes. An electroretinogram (ERG) was performed today and showed lack of retinal function. The ERG helped to rule out central neurologic disease (brain or optic nerve problems) as the cause for his vision loss. It also provided more information to help differentiate between the two types of retinal conditions that cause vision loss with normal looking eyes; Sudden Acquired Retinal Degeneration Syndrome (SARDS) and Immune Mediated Retinitis (IMR). The ERG test showed no retinal function which is most consistent with SARDS since IMR patients typically have at least a small amount of function. However, it is possible for IMR patients to have a flat ERG. The red/blue light pupil test that was performed by Dr. Chang also helps to differentiate between the two conditions. The fact that he had some response to the red light could be interpreted in two ways – either he has SARDS and the test was performed early enough that there was still a small amount of residual function that will soon diminish, or that he has immune mediated retinitis and could potentially regain some vision with immunosuppressive treatment. For this reason, he has been started on Prednisone and Cyclosporine to control his immune system which may be attacking his retinas. If no improvement invision is noted in 2 weeks, the medications will be tapered and discontinued. If his blood work performed today at Dr. Neichin’s office shows any significant abnormalities, the medication doses may need to be adjusted.

After leaving Dr. Roybal’s office, I kept Chip on the Prednisone (7.5mg b.i.d.) and Cyclosporine (25 mg/day) for 5 days until seeing Al Plechner, DVM, on April 14, 2013. While on the Prednisone/Atopica protocol, Chip was lethargic, had severe diarrhea, consumed a lot of water, and his vision remained the same. He was depressed, confused and would not leave the couch on his own. I had to pick him up to take him to his food and water, and place him outside to urinate and/or defecate.

After carefully reviewing options for treatment, including (IVI)g injections through Dr. Grozdanic, I made the decision to meet with Dr. Plechner to explore his protocol. After meeting with him, I was cautiously hopeful and was really just hoping to restore some vision for Chip so he could maintain a quality lifestyle.

(When Dr. Plechner took over Chip’s care)…

If you recall, you gave Chip the first of three Cortisol/Medrol injections and prescribed Medrol (4 mg once per day) and Thyro-tabs (0.2 mg b.i.d.) for 10 days until his next injection. Over a period of 4-7 days, I noticed some improvement in his tracking of my movements around him and he began to slowly move on his own throughout the house. I said nothing to my girlfriend Denice and was curious if she noticed any improvement on her own.

It became very apparent that his vision improved after 7 days, and continued to improve over the following several weeks. My girlfriend and I just looked at each other and shook our heads in amazement over his progress; 10 days earlier he was literally bumping his nose into walls and table legs.

He still has a hard time seeing things up close (i.e. 2-6 inches), but he can now track his food, his ball, and most importantly, me!

Chip can now find and use the pet ramp instead of attempting to feel the end with his paw. He is no longer running into cabinet doors or table legs and is not falling off patio steps into the bushes.

I am thrilled! His weight has dropped from 19.3 lbs. in April to approximately 16 lbs. today. His belly is no longer hanging low and his appetite has returned to normal. (These, of course, are extra benefits since he is a breed that has been known to have back problems.)

ChipI also noticed the redness in his eyes is present but not “glowing” as it was before. He is happy and now attempts to play instead of sitting on the couch whimpering.

NowMy follow-up Letter-

Dr. Plechner,
You are an amazing vet/researcher/humanitarian! I think finding you was one of the best decisions I have ever made. Thank you!!! If you need more details about Chip and his recovery to aid in your research, you can have copies of his medical records the next time I come up for prescription refills. Take care and keep on doing what you do; providing a real treatment option for dogs diagnosed with SARDS or IMR.
 
Sincerely and Respectfully,
Patrick McNamara
Newport Beach, CA
Cc:Dr. K. Michael Chang, DVM
Dr. Barry Neichin, DVM
Dr. Jonathan Hansche, DVM
Dr. Nicole Roybal, DVM
Dr. Sinisa Grozdanic, DVM
 
This e-mail also was received by Dr. Plechner on August 13, 2013
Hi Dr. Plechner-After several months of dealing with the frustrations and emotions surrounding a SARDS/IMR diagnosis, for my Dachshund, Chip, I want to thank you for preserving/restoring some of Chip’s vision! Although I put the highlights of his journey, including medical conclusions in the attached letter, I cannot adequately express my joy in the same way. Since I believe strongly in sharing hope, I have copied all of the veterinary doctors who were directly or indirectly involved in Chip’s care so they will now know there is a promising treatment option for SARDS/IMR. I hope you don’t mind me sharing your contact information with other medical professionals so other dogs could benefit from your work.
 
For any of the doctors who would like to see Chip for yourself, I will happily visit your office with Chip.
Best Regards,
Patrick McNamara

 

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