Atypical Cortisol Estrogen Imbalance Syndrome Protocol

Posted on January 27th, 2017

*SARDS (Sudden Acquired Retinal Degeneration Syndrome) UPDATE

Unfortunately, since I have had to retire from my veterinary practice in California because of an injury, my son has asked me to live with him and his family in Idaho. Because I am not licensed in Idaho, by law, I am not allowed to consult or even share my opinions with you, which is unfortunate.

For those pet owners that do have canines that are afflicted with SARDS, I have included the following articles, which should help your veterinarian decide on a proper treatment for this autoimmune disease.

However, if your veterinarian feels unqualified to treat SARDS, please contact National Veterinary Diagnostic Services for a possible referral at

SARDS is an autoimmune disease, and the sooner that SARDS is diagnosed and treated, the better the chances for sight return. Conversely, the longer it takes to properly diagnose and treat a SARDS patient, the better the chances for permanent retinal damage that may not be correctable.

It is important to understand that SARDS is an autoimmune disease, which comes from an imbalance of both the endocrine and immune systems. Even if it might be too late for the treatment to provide for eye sight to return, if it is left uncorrected, other autoimmune diseases and cancer may occur.

Hopefully this information will help you keep your pet healthy, happy and live a long, successful life.

I wish you and your pet, the very best.


Dr. AL Plechner

The following test is necessary to diagnose the cause of allergies and autoimmunity (including SARDS and cancer):

EI-1 Blood Test at National Veterinary Diagnostics Services

Total Estrogen








The test should be done 3 to 4 hours after eating or taking any medication.

The repeat test panel should be done at the same time of day in order to reduce any variations that might occur.

Alcohol should not be used on the patient's skin before taking the blood sample because it causes HEMOLYSIS.

If alcohol is used, please wipe off as much of the alcohol as possible before introducing the needle.

The sample should go into a serum separator blood tube.

Once the blood draw has been completed, the blood sample must be placed on its side in a refrigerated unit for 10 to 15 minutes. This procedure is done to enhance the surface area of the sample in order to help create better clotting. Once this has been completed, the blood sample is centrifuged for 5 to 10 minutes and refrigerated immediately.

If the sample is sent unspun, please send it in a refrigerated state, not frozen.

If the sample has been centrifuged and the serum is clear, it is ok to send the serum sample in a frozen state.

If the centrifuged sample has hemolysis in the serum, please do not freeze it, but send the sample in a refrigerated state.

Please put the sample in a plastic bag which separates the sample from the paper work.

The sample should then be sent refrigerated by overnight delivery service, Monday through Thursday, to National Veterinary Diagnostic Services, 26856 Clark Rd, Waller, TX 77484. A submission form can be downloaded at  Please make sure the carrier will deliver the sample by the afternoon of the next day.

Note: The serum sample MUST be mailed, and processed in a cooled state otherwise the test results may be inaccurate.

The samples are processed on Saturday and Sunday. The sample should be delivered no later than Friday, if it’s to be processed that weekend.

The test results will be e-mailed to you from NVDS on the following Tuesday or Wednesday.

For further information, please e-mail NVDS at


When shipping a sample from a country other than the United States, please direct the company you ship with to create a “Commercial Invoice”. On the Commercial Invoice you will need to make the statement “Non-Infectious Canine/Feline Serum for Diagnostic Purposes”. On the shipping label, there may be a place for “Recipient, Tax ID #”. If there is, please use 27-4548333.

NOTE: I have listed this veterinary laboratory for your convenience. I have NO affiliation with this veterinary laboratory, and at this time, this is the only veterinary laboratory in the United States, that can test for total estrogen, which includes adrenal estrogen.

I have contacted the other various veterinary laboratories, and there is on interest, because they are making huge amounts of money, without investing in doing my protocol


What is the ACEIS syndrome?

The ACEIS syndrome identifies the presence of an inactive or defective cortisol which allows for the production of excessive amounts of adrenal estrogen. The excessive amounts of adrenal estrogen not only bind the thyroid hormone receptor sites, but also deregulates the immune system, which no longer protects the patient.

The presence of this syndrome indicates the patient has an endocrine immune imbalance which causes a deregulation of their immune system.

When this occurs, the elevated total estrogen, which includes adrenal estrogen, can cause the immune system to stop its protection of the body and at the same time cause the immune system to lose recognition of self-tissue. This immune system deregulation may lead to allergies and autoimmunity, including SARDS and cancer.

The elevated total estrogen occurs due to an imbalance of the middle layer adrenal cortex production of cortisol. This imbalance can be caused by a deficiency, a binding and inactivation of the cortisol, or an elevated level of defective cortisol.

NOTE: If the cortisol is elevated above normal, and the adrenal estrogen is also elevated, this is due to a defective, or imbalanced, inactive cortisol and not an active cortisol. If the cortisol was active, the total estrogen level would be very low, which does not occur with these patients.

ACEIS involves the production of a defective or imbalanced cortisol which can be elevated, and is not recognized by the Hypothalamic-Pituitary axis. Cushing’s syndrome involves the production of active cortisol, which is used to treat SARDS and other autoimmune diseases.

Therefore ACEIS should never be confused with Cushing’s syndrome.

Without testing the adrenal estrogen, it cannot be determined if elevated cortisol is active or inactive. Doing an ACTH Stimulation test for Cushing’s syndrome may be premature.

NOTE: SARDS is an autoimmune disease, and normally autoimmune diseases are treated with active cortisol. Since Cushing’s syndrome patients have active cortisol, autoimmune diseases like SARDS, should not occur.

Please realize that the return of sight to a SARDS patient, depends on the following;

  • How well and how long the SARDS patient adapts to their blindness.
  • How soon the owner realizes their SARDS dog has impaired vision.
  • How quickly, proper therapy is initiated by the veterinarian, once a diagnosis of SARDS,

has been made.

Please also realize that the development of SARDS in any patient, may be pre-empted by other autoimmune diseases, including cancer.

In these cases, the development of SARDS may be the last thing that happens to the patient, and not the first thing.


When the cortisol from the middle layer adrenal cortex is imbalanced, it cannot fund the negative feedback mechanism to the Hypothalamic-Pituitary axis. When this occurs, the pituitary gland continues producing its hormone ACTH in order to stimulate more cortisol release. However, this cannot happen because the imbalanced inactive cortisol cannot be recognized by the Hypothalamic-Pituitary axis.

The inner layer adrenal cortex will then respond to the ACTH in a direct feedback mechanism and produce excess amounts of adrenal estrogen.

When the adrenal estrogen is added to the total estrogen produced by the body, the following dysfunction may occur:

1) It deregulates the immune system and stops its protection of the patient.

2) It causes the immune system to lose recognition of self-tissue.

3) It binds the receptor sites of T3 and T4, and in humans, it may cause an elevation in Reverse T3, and create a state of metabolic hypothyroidism.

4) It causes the B lymphocyte to reduce the production of its protective immunoglobulins and cause malabsorption when immunoglobulin A is below 58mg/dL.

NOTE: Total estrogen is generally not measured in medical practices at this time, either for animals or for humans.


1) Because of the estrogenic binding of the T3 and T4 receptor sites, even if the T3 and T4 are normal or deficient, a T4 supplement is indicated, twice daily at .1 mg per 10 pounds of body weight for dogs.

2) A cortisol replacement is also indicated.

A) If the IgA level is at 58mg/dL or higher, oral Medrol will be absorbed and can be dosed at approximately 1 mg per 10 pounds of body weight. NOTE: If the IgA level is below 58mg/dL, oral steroids and other substances will not be absorbed. This may be the reason why many indicated supplements did not work, because they were never absorbed.

B) If the IgA is below 58mg/dL, intramuscular injections of a steroid are indicated. If the IgA is at 57mg/dL, only one injection may be needed.

If the IgA is at 55mg/dL to 56mg/dL, two intramuscular injections are indicated at a 10 day interval.

If the IgA is at 50mg/dL to 54mg/dL, three intramuscular injections will be needed at a 10 day interval.

C) At the time of the last injection, an EI panel should be repeated to determine if the IgA is at 58mg/dL or higher in order to begin oral Medrol 10 days later.

NOTE: Medrol is available in a flavored liquid form at a compounding pharmacy if you find the pet owner cannot give the pet oral tablets.

D) If the medical case is acute, like with a SARDS patient, I suggest the first injection should contain Kenalog, Vetalog or Triamcinolone. A standard dose recommendation will be listed on the vial. While using this, if the patient develops PUPD within the first few days, this drug should be eliminated from any further injections. This short acting steroid is mixed with Depo-Medrol and given intramuscularly.


                  Pfizer Depo-Medrol, given at the standard dosage recommendation of 1 mg per one


pound of body weight, will no longer correctly fund the negative feedback mechanism to the hypothalamic-pituitary axis.

This dose level worked well with the Up John Depomedrol that has not been manufactured for many years.

For further information on this subject, please go to the internet and type in, Depo-Medrol. Thoughts about Different Doses for Different Diseases.

Several thousand blood test results have proven this. If you have tried to fund the cortisol deficit of ACEIS and the total estrogen remains the same, this indicates that the dose of Pfizer Depo-Medrol is too low. I am not sure if the carrier media is binding the active substance Medrol or not, but of interest clinically, I have found some patients on proper levels of injectable Depo-Medrol develop increased levels of liver enzymes and alkaline phosphatase.

These elevated enzyme levels usually will return to normal, when the patient begins oral Medrol.

If this does not occur, please go to the internet, and type in, Addendum for the Treatment of SARDS and Other ACEIS Diseases.

This article will provide you with an alternative to use a different injection that should not increase the liver enzymes.

Please remember, these enzymes will also be elevated by the original elevated adrenal estrogen, and if you have not first tested for liver enzymes in the beginning, before therapy began, it will be difficult to determine if the actual injection did this, or the elevated adrenal estrogen was the culprit

The liver elevations, may indicate the culprit is not the steroid, but rather the media the steroid is carried in. Note: Elevated total estrogen will also cause inflammation of the endothelial cells of the arteries in the patient’s body including the hepatic arteries. When this occurs the liver enzymes including alkaline phosphatase may also occur.

As soon as the elevated total estrogen decreases so does its input on the liver etc.

E) If you check the directions for use by Pfizer, their insert will indicate, only ranges, and not mg. per pound of body if body weight.

      I did check with the head veterinarian for Pfizer at the time, Dr. Hilton and she related to me, that the FDA had notified Pfizer that because Depomedrol was such an old pharmacological product, that drug trials were unnecessary.

       Even though Pfizer claims it is the same Product as Up John Depomedrol, I have not found this to be true.

       Please be aware of this.

      My suggested dose for the use of Pfizer Depo-Medrol is one and one half to three times the standard manufacturer's dosage recommendation.

      Small canines seem to respond better to the higher dose amounts of the Pfizer Depomedrol then do the larger canines, but whatever levels you decide to use, will be definitely up to you. Please always remember, I am only allowed by law, to make suggestions, and you as the veterinarian, will need to be responsible for implementing my suggestions or not.

      Checking the total estrogen and IgA levels will indicate if you are using enough Pfizer Depo-Medrol, in order to fund the negative feedback to the Hypothalamic-Pituitary axis and reduce the total estrogen and increase the B cells production of IgA. If you are using enough Depo-Medrol, there should be a decreased total estrogen level and an increased IgA level in the EI test results.

NOTE: The recommendation for the use of Depo-Medrol at 1 mg. per 1 lb. of body weight came from the Upjohn manufacturer, and has not been available for a few years. Pfizer is now manufacturing Depo-Medrol, which is not as efficient when used at the same dose recommendation, as when made by Upjohn. For further information on the use of proper Depo-Medrol doses, please see DepoMedrol: Different Dosages for Different Diseases at

NOTE: Many times a patient may experience excess appetite and water intake, and lethargy and panting at night, which usually will subside with the use of oral Medrol.

       I am beginning to wonder if many of the side effects that are caused by the Pfizer Depo-Medrol injection, come from the adjuvants that are included in the carrier media of the injection and not the Medrol itself. If the patients is demonstrating any of these side effects including elevated liver enzymes and elevated alkaline phosphatase, you may want to switch over to weekly Vetalog injections, in order to reach an IgA of 58 mg/dL, so oral steroid absorption, can occur.

The fear of cortisol supplement therapy often comes from the fact that if the patient was not tested for normal cortisol production (which daily should be 30 to 35 units), then superimposing a steroid on a patient with normal cortisol production can certainly lead to an overdose, which may cause Cushing’s syndrome, diabetes and other negative side effects.

In dogs and in many humans, ongoing steroid therapy must be used with a thyroid supplement, otherwise the steroid will not be broken down by the liver and excreted by the kidneys in 24 hours, and will lead to a definite overdose.

Please remember patients suffering from ACEIS have damaged middle layer adrenal production of cortisol and the suggested treatment will only help fund a cortisol imbalance, or help the body reduce its production of defective cortisol, which will cause the elevated adrenal estrogen and the development of ACEIS.

In these instances, cortisol replacement is vital to the health of the patient who has ACEIS and other total estrogen induced diseases.

Also please remember, any hormone which is measured in the patient’s body and is found to be within the normal range, often means very little without comparing its impact on its end hormone effects including immune function (The B-cells, IgA, IgG, and IgM are the immune cells used as markers for immune function in this protocol).  This is because a hormone, even if present in proper amounts, is not necessarily active or can be used by the body.

If a salivary test, a serum test, or 24 hour urine test is performed, and the results indicate normal amounts of free hormone, there is no indication that these hormones can be used by the patient’s body!

To determine if a patient’s cortisol is functional or non-functional, it must be compared to the negative feedback mechanism to the hypothalamic-pituitary axis, and total or adrenal estrogen, must be measured.

Note: An Abstract mentioned in the Journal of Immunology states that free cortisol can be present and when it cannot be used by the body, it is called cortisone.   


Unfortunately at this time, the veterinary profession does not realize that there is a definite difference in effectiveness, between the Upjohn Depomedrol and the Pfizer Depomedrol

Therefore, my suggested amounts for the use of Pfizer Depomedrol, are thought to be too high, even if my recommendations are based upon 29,000 endocrine immune blood test results, from National Veterinary Diagnostic Services, I would like to suggest and alternative therapy.

Your veterinary practitioner, might feel more comfortable giving weekly injections of Kenalog, or Triamcinolone.

After 4 weekly injections, the EI test can be repeated, to determine if the IgA has reached 58 mg/dL, so oral Medrol can be given 3 days after the last injection, and if the IgA has not reached 58 mg/dL, more weekly injections, are indicated.

For further information, please see Addendum for the Treatment of SARDS and Other ACEIS Diseases.

Please remember once again, that cortisol is a natural hormone that needs to be produced everyday by the patient, whether animal and human, and if there is a deficiency or a non-functional cortisol that is being produced by the animal or human, allergies, autoimmunity and cancer may occur.

The fear of steroid use, comes from a situation when a steroid is superimposed upon a patient that is producing normal amounts of natural steroids.

The endocrine immune blood test measures natural steroids and will determine if the animals or the human, has a steroid imbalance, even before steroid therapy is suggested.


Food allergies can disrupt this entire protocol. The inflammation in the intestines, caused by the food allergies, may slow down absorption of the hormone replacement therapy. If the values in the ACEIS protocol return to normal and the clinical signs of the disease, may still exist, the patient has a food allergy.

  • Many different supplements which contain a lipid base, may cause a sludging effect in the intestines and slow down the absorption of the primary hormone replacements. NOTE: Supplements are used mainly to treat the EFFECTS of ACEIS and not the CAUSE of ACEIS. It is much better to stop all supplements, until the endocrine immune imbalance has been corrected and then, if you want to add supplements, do them one at a time for seven days each, in order to help avoid any sort of reaction that might be caused by a delayed reaction.     
  • A trypsin deficiency is a very common problem which will lead to malabsorption of the primary hormone replacement. Clinically, I have found in trying to diagnose a trypsin deficiency, the trypsin blood levels may not correlate with the amount of the trypsin produced in the intestines. Trypsin deficiency can be easily seen by the curved front wrists of a dog, which are often accompanied by a cow hocked, rear end. This seems to occur, due to lengthened ligaments, caused by a lack of absorption of calcium, due to the trypsin deficiency. If a trypsin deficiency is present, I strongly advise using a trypsin replacement for each meal, to help avoid a sludging effect of the fatty acids, which will not only reduce the absorption of the primary replacement hormones, but will also bind vitamins A, D, E and K, which will then end up in the stool, instead of the bloodstream. Many other conditions may occur due to the resulting vitamin deficiencies. Please make sure the digestive enzyme supplement is in a powdered form, because tablitizing causes heat and destruction of the enzyme. If the digestive enzyme is manufactured in a capsule, please open up the capsule and sprinkle it on the food before feeding. Remember, most capsules are made of gelatin which comes from beef, and can be allergenic.
  • Please beware of giving a SARDS patient various potentially allergenic food and snacks, because an IgA imbalance can definitely transfer to the IgA imbalance in the eye and may cause a patient whose SARDS is in remission, and develop temporary vision loss. Once the food antigen is stopped, the vision will usually return.
  • Insect repellant chemicals have been implicated in the cause of SARDS, especially those chemical insect repellants that contain ivermectin or ivermectin like chemicals. For more information on this subject go to and see the article Chemical Insect Repellants.
  • Do not use any foods or supplements that contain phytoestrogens, because they will only add to the total estrogen and make the SARDS patient worse. Often milk thistle, and products that contain milk thistle, are used to protect the liver, while therapy is being done. The milk thistle contains phytoestrogens, which can add to the elevated total estrogen imbalance and worsen the SARDS destruction.
  • Xenoestrogens are foods and supplements that contain chemical, estrogen mimickers, which may cause the same damage as phytoestrogen, but will not be measured with the total estrogen, blood test.

I do have an article, discussing xenoestrogens on my website

             For further information on foods that contain phytoestrogens, please go to and under Food and Supplements, please read the article Natural Estrogens That Occur in Nutrients. All these foods should be avoided in any patient that produces excessive amounts of total estrogen.

Please also remember that non-organic sweet potatoes, carrots and apples contain elevated amounts of pesticides that are estrogen mimickers, called xenoestrogens.

  • I am a little concerned about the use of Ocu-Glo, not because it is not a good product, but because it contains a soybean oil in its base which does contain phytoestrogens, which may add to the total estrogen that is causing SARDS. Liver is also contained in the product base and the liver is a filtration organ for pesticides, chemicals and damaging heavy metals and should be avoided. Liver may also cause an allergic reaction in canines with food allergies.

I also have different thoughts about adding B Vitamins to the diet of a SARDS patient, only because in my clinical experience with endocrine immune imbalances, I have found that B Vitamins can sometimes increase the destructive abilities of the imbalanced immune system and actually cause further harm to the patient.

I do recommend the use of products that contain astazanthin, which is found in krill (plankton).

The use of Krill, has been found to be of value in humans for treating Retinitis, Chori-Retinitis and Macular Degeneration, and may be of value for use in SARDS patients.

This document was designed to help the pet owner understand the Cause of many different chronic diseases that are being treated only for their Effects and not their Cause, including allergies and autoimmunity, including SARDS and cancer.

NOTE: Far vison will be the first vison to return.

To check if the treatment is beginning to work, please shine a light into the eyes of the SARDS patient, and if the pupils constrict, this will indicate that the retinal tissue is beginning to function.

Hopefully this will help you understand Atypical Cortisol Estrogen Imbalance Syndrome (ACEIS).

If you have any questions or need help in determining proper treatment or dose levels, please feel free to have your veterinarian contact me. Also, by law, since I have not examined your pet, I am allowed only to make suggestions.

For further information on SARDS, please see the video on You Tube by Dr. Plechner and also to see SARDS pet owners that have followed my treatment protocol, please go to


Dr. AL Plechner