Cushing's Disease is a common condition in older dogs which can be mistaken for the onset of old age. A well housetrained dog can have “little accidents” and urinate in the house as well as show signs of hair loss. There are however other causes with these symptoms which are also not attributed to old age so it is important the diagnosis is correct.

Classic symptoms of Cushing’s Disease are frequent urination, hair loss and weight gain, which are similar to those of Canine Diabetes with the exception of weight loss rather than gain.

The treatments for both diseases however are very different.
Canine Diabetes is beyond the scope of this article so for more information on Dog Diabetes Symptoms visit www.DogDiabetesSite.com.

In order to understand Cushing's disease is necessary to have a basic knowledge of what should happen in a healthy dog. The pituitary gland, which is located at the base of the brain, produces ACTH (adrenocorticotrophic hormone), as directed by the hypothalamus (another part of the brain). This hormone is released into the bloodstream and stimulates the body's two adrenal glands, located near the kidneys, to secrete glucocorticoid (cortisone-like or cortisol) hormones into the bloodstream. Cortisol helps the body respond to stress and impacts a wide variety of bodily functions.

These include blood sugar levels, kidney function, fat metabolism, skeletal muscles, nervous system, cardiovascular system, and immune response.

ACTH/cortisol secretion is increased due to stress, including infection, pain, surgery, trauma and cold temperatures. When the blood cortisol levels are high enough, the pituitary stops secreting ACTH. When the blood cortisol levels dip low enough, the pituitary secretes more ACTH. The adrenals respond by secreting glucocorticoid hormones in response to the pituitary, just as the pituitary responds by secreting ACTH in response to the adrenals. The net effect is that a mildly fluctuating balance is achieved. This is an oversimplified picture of cortisol homeostasis in the healthy dog.

In Cushing's Disease: The response loop fails to function correctly for one of three reasons:

• a pituitary tumor
• an adrenal tumor
• or veterinary interference.

The result is a chronic excess of blood cortisol. In effect, the dog is being poisoned with too much cortisol and cannot rely on its own regulation to correct the blood cortisol level.

Pituitary Dependant Hyperadrenocorticism: The most common cause of Cushing's disease is a microscopic benign pituitary tumor which over secretes ACTH and ignores the adrenals' response.
The dog's pituitary continues secreting ACTH causing the adrenals to produce cortisol, yet the pituitary does not respond to the elevated blood cortisol levels by stopping its release of ACTH.

Most cases of Cushing's disease are pituitary dependent and dogs with pituitary dependent hyperadrenocorticism tend to have two very large adrenal glands; Both are constantly working to keep up production of cortisol.

These pituitary tumors are usually quite small (3mm or less) but occasionally they can be larger and their size presents challenges of their own. Larger pituitary tumors over 10mm centimeter in diameter can place pressure on brain tissue and nerves, causing blindness, circling, seizures, or other neurological problems not directly related to hyperadrenocorticism. Some of these symptoms can resemble side-effects of medications used to treat Cushing's disease, further complicating diagnosis and treatment.

Adrenal-based Hyperadrenocorticism: An adrenal tumor is responsible for secreting too much cortisol.

These can be benign (adenomas) or malignant (adenocarcinomas) and are inclined to spread to the lungs and liver. The tumor keeps secreting too much cortisol irrespective of what the brain is telling it and about 15% of Cushing's cases are adrenal-based. In these dogs, one adrenal gland tends to be extremely enlarged (due to the tumor and the overproduction of cortisol that goes with it), and the other tends to be extremely small (to try to compensate for the overactive larger one).

Iatrogenic Hyperadrenocorticism: This is a cause which we can create ourselves if we give a dog too much external glucocorticoid, especially for chronic conditions like allergies.

In doing so we do what the adrenal tumor would do by flooding the dog's body with an excess of corticosteroid. Although both the adrenals and pituitary will attempt to respond to our interference by cutting ACTH and cortisol secretion, if we continue to bombard the dog's body with too much glucocorticoid, symptoms of Cushing's disease will result.

The reason dogs are given irregular doses of steroids like prednisone is to avoid this consequence. Dogs with this form of Cushing's tend to have two very small, atrophied adrenal glands. Nonetheless, if iatrogenic (veterinary-induced) hyperadrenocorticism develops, it is fully reversible. The external source of steroid is slowly withdrawn to allow the adrenals to "wake up" and resume functioning.

Causes: Given that tumor incidence increases with age and those tumors are the cause of Cushing's disease, it is generally a problem seen most frequently in dogs aged 8 to 10 years and can affect males or females alike.

Spayed or neutered dogs can sometimes have a slightly greater incidence of Cushing's Disease.

Although all breeds are at risk, Pituitary-dependent Cushing's is more common in small dogs, with 75% of cases being in dogs weighing less than 44 pounds (20 Kg). Adrenal-based Cushing's cases on the other hand occur 45-50% of the time in dogs weighing more than 44 pounds (20 Kg).

Symptoms: Symptoms of Cushing's disease can be vague and varied and tend to appear gradually and progressively so it is all too easy to mistake Cushing's disease for normal aging. Additionally, many of the clinical symptoms are not unique to Cushing's and could reflect a number of other health concerns.

The most common symptoms include:

• Increased urination (polyuria)
• Increased water consumption (polydipsia)
• Urinary accidents in previously housetrained dogs
• Increased appetite (polyphagia)
• Sagging, bloated or pot-bellied appearance
• Appearance of weight gain due to fat redistribution
• Exercise intolerance or general lethargy

It is generally the increased water intake and urination or the coat changes which are most noticeable although other indirect symptoms to consider are the disappearance of previous inflammatory conditions. Dogs with chronic allergies or arthritis may appear considerably better when they develop Cushing's Disease, due to the heavy doses of cortisone they are giving themselves.

Diagnosis: A urinalysis may reflect high levels of protein and low specific gravity (dilute urine). X-rays or ultrasound may show an enlarged liver or either enlarged or atrophied adrenals with half of adrenal tumors appearing mineralized. A CT scan could also be used to search for a pituitary tumor but specific lab tests are more common to pinpoint a diagnosis.

These tests include a urine cortisol and creatinine ratio test, an ACTH stimulation test, and low and high dose dexamethasone suppression tests.

NOTE: There is no single test to diagnose Cushing's, and Cushing's Disease is often difficult to accurately diagnose.

Treatment: Treatment depends on the type of Cushing's disease, as well as on the overall health of the canine patient.

Many dogs with Cushing's are elderly and may have other health problems; treatment can be complicated with no “one size fits all” remedy. The comfort of the patient should be the ultimate goal and a dog with severe arthritis may be more humane not to elect for treatment.

Surgery may be indicated for adrenal tumors and chemotherapy in the form of Lysodren or Ketaconazole may be used to treat pituitary-dependent or adrenal-based Cushing's Disease. Anipryl may also be tried to combat pituitary-dependent Cushing's. Treatment is best viewed as a means to improve quality of life, rather than increase lifespan.

Surgery: If Cushing's disease is caused by an adrenal tumor, the logical approach is to surgically remove the tumor AND the affected adrenal gland. These tumors tend not to recur on the remaining adrenal gland and the prognosis is very good for dogs with benign adrenal tumors however most owners opt for non-surgical treatment.

Pituitary tumors are not removed surgically in veterinary medicine. These tumors tend to be very small and slow-growing and cause little or no damage on their own, aside from over stimulating the adrenal glands. With these canine patients, the symptoms themselves are treated and not the root cause.

Prognosis: Left untreated, Cushing's disease will progress. As excess cortisol is immunosuppressive, it causes dogs to become prone to various infections. They are also predisposed to developing other complications such as hypothyroidism, pancreatitis, diabetes, seizures, hypertension, congestive heart failure, blood clots and liver and kidney failure.

The short-term prognosis is very good. Treated, one would expect symptoms of Cushing's to fully resolve over the course of 4-6 months. Excess drinking and urinating abate quickly. It may take several months for hair and coat improvement to be observed. Dogs generally are more comfortable after the disease is under control and may live happily for years.

Alternatively, some dogs become very uncomfortable if arthritis, allergies, or other inflammatory conditions are unmasked once the excess cortisol is removed, paradoxically reducing the animal's quality of life. Another consideration relates to pituitary tumors themselves. These tumors continue to be somewhat responsive to blood cortisol levels, so it is possible that controlling cortisol release at the adrenal level may hasten the growth of a pituitary tumor, as the pituitary tumor is no longer kept in partial check by excess cortisol levels. Neurologic signs from a pituitary macroadenoma may then present themselves.

What You Should Know

There are several things to consider before purchasing any dog and just because a dog is small, don’t jump to the conclusion it will mean less work for you to maintain. Admittedly you will not need exercise as much or as often, but toy breeds often come with their own problems. In the beginning there was the Wolf and this is what all our dogs are descended from. Pure Breed and Pedigree dogs are dogs which have been selectively breed to produce dogs with certain characteristics or traits. Small dogs are not a “freak of nature”. All pedigree dogs are engineered by man to fulfill a function. When Queen Victoria was presented with a small Pomeranian dog, a new fashion began to form which dog breeders’ quickly capitalized on to produce smaller and smaller dogs. These smaller breeds are known as “Toy Breeds” or “Toy Dogs” and make excellent companions.

Toy breeds sleep quite a lot, require much less exercise and feeding but they also inherit some health issues breeders seldom warn about. Many Toy Breeds have narrow tear ducts which clog easily causing the eyes to become dry. Narrow nostrils can cause breathing difficulties and hip displacement is not uncommon in old age.

They make excellent companions however, particularly for the elderly but bear in mind Toy Dogs can live to 20 years or more so it will require a long term commitment.

Adult Dog or Puppy
All puppies will need to be housebroken and given obedience training. With an older dog you can see what you are getting; you can see the coat thickness and length and the personality. An older dog is usually housebroken, has had obedience training and is less destructive.

Toy Dogs seldom consider themselves “small”. They are “big dogs” in a small body and can be extremely loyal and territorial. The Pekinese has a flat face and can often suffer from teeth and mouth problems. Emperors and dignitaries’ used the small dogs as personal bodyguards which they would carry unseen inside the sleeves their long flowing robes. These small dogs were trained to attack the throat of anyone who came close to their owner.

Small Dogs can be Delicate Booby traps
Toy dogs seldom have regard to their own safety or how delicate they really are. They may be fast movers but they might not always get out from under your feet so you need to watch where you are doing. Because they are small, they can lie down unseen on the stairs, on a chair you are about to sit on and can appear unseen from nowhere right behind you.
Small dogs and young children are not a good combination and need constant supervision. Toy dogs are not “nasty” in temperament but even a small child is bigger than them and can unknowingly hurt the dog, causing the dog to retaliate out of instinct.

If you at all put off from owning a Toy Breed, maybe a larger breed, like the well tempered Labrador may be more suitable for you.

Owning a dog is not for everyone and the decision to own one should not be undertaken lightly. A dog is not a decoration to bring out and show off to company or a fashion accessory to make the owner seem macho or loving. A dog is a pack animal and should be treated like adding a new family member to your family pack in the same way you would plan for a new child in the family.

Do You Have Time For A Dog?
Adopting a new dog or puppy is a huge commitment. It takes a lot of time to properly feed, train, play with and care for a new dog. New puppies don't always sleep through the first few nights and you may find yourself getting out of bed several times to take the puppy out for toilet training. If the puppy is quite young it will require being fed smaller meals more often throughout the day.

Older dogs which are already toilet trained may also require additional training in this department. Moving from one "pack" to a new "pack" can be a stressful ordeal for them and you may find it necessary to "un-train" certain behavioral habits.

Dogs need a great deal of socialization. This means that you need to expose your dog to all kinds of sights and sounds around its home environment. It should meet children, men and other animals. Amateur dog shows are an excellent way to introduce your dog to a variety of other breeds and to interact and socialize with strangers, both human and canine. If none of this seems like too much to fit into your daily schedule, then you're probably ready for a dog in your life.

Are Your Facilities Adequate?
A well-fenced yard is an absolute MUST for anyone who owns a dog. First and foremost this is for the safety of the dog. Dogs allowed to roam free are in danger. Any stray can enter the dog's territory and unaccompanied dogs can cause havoc with traffic and even get hit by cars. Dogs that roam loose are not at fault; the owner is legally responsible.

It is also the responsibility of the owner to "clean up" after their dog. It may not be a pleasant task but it certainly is not a difficult one yet some dog owners go to great lengths to "make excuses ” from doing this very simple task yet are outraged if they stepped in something someone else failed to clean up.

If a dog is left outdoors, a kennel or adequate shelter should be provided with clean water always available. Depending upon the climate and breed, proper heating or cooling should be of prime importance. If you don't have a large yard, or you live in an apartment, you will need to make time to provide proper and regular exercise for the dog.

Find The Right Breed For You.
If you've decided that you're ready for a dog, you probably have a few breeds in mind. It is very important to learn about these breeds before you make a final decision. A breed that you find very appealing physically might not have a temperament which suited to your personality or lifestyle. If you live in an apartment you probably wouldn't want to keep breeds which require lots of regular exercise like Greyhounds, Collies or Alsatians. It is often people who buy on impulse with no intimate knowledge of the breed, who later decide that the dog has to go.

Take time to read books on breeds which interest you and talk with knowledgeable breeders and owners. Attend a few dog shows or animal rescue centers and ask lots of questions. Visit someone with an adult dog of the breed. Often the puppy is charming and cute but they can grow fast and the adult may not be at all what you had envisioned.

CAN YOU AFFORD A DOG?
Be sure you're aware of what costs are involved with the particular breed you want. All dogs require feeding, that goes without saying and the larger the dog, the more food they will consume. What new owners often misjudge is the true cost of Veterinary expenses.

Annual vaccinations are just the tip of the iceberg. There is also regular flea treatment and worming every 4 months which although some dog owners regard as non-essential, preventing a problem is often much easier than treating something more serious and cheaper too.

Some breeds, particularly long haired dogs have special grooming needs. It is not fair on the dog to allow its coat to become matted and clogged with dirt and unfair on other family members too. Many dog owners are blissfully unaware that some dog diseases can be passed on and carried by humans, putting the vulnerable like young children and pregnant women at particular risk.

Your Responsibility To Your Dog In Old Age
Just as humans are living longer, so too are our pets and Vets are seeing and treating an increasing number of geriatric illnesses. Muscular and arthritic conditions are quite common; these can also be brought on in over-weight dogs to cause complications such as canine diabetes.

If you're lucky enough to have a dog that lives into old age, the chances are that you will be faced, one day, with having to make a humane decision.

This is one of the most difficult things you will ever have to do.

You must be able to think of what is best for your dog, not what hurts you the least. It hurts deeply to hold your dearest friend in your arms and see him or her leave you, but it is selfish and wrong to allow the same dear friend to suffer. If you cannot bring yourself to be present, then at least make sure that there is someone who will help ease his or her end in the kindest way.

Children and dogs enjoy playing together but just as you would not allow a small child to play unsupervised near water, the same should be true when they play with the family pet. Play can get over zealous; a dog may knock a toddler over or a child might poke in the eye. If a child gets hurt in play it will either cry or lash out and a dog is no different. If a dog feels threatened, tormented or frightened, it will defend itself.

Training your dog respect a child is not enough; we need to teach our children how to treat a dog as well. Dogs are pack animals and belong to a pack we call “our family”. Each pack has a hierarchy which each pack member slots into. Your dog may see the child as a playmate or underling, and not above it in the pack order.

Training a child is often easier than training a dog but the child needs to understand that a growl means, “Stop doing that!” The next step is the snarl: the dog bares his teeth, and raises his hackles to make himself look bigger and more ferocious. The snarl means, “If you don’t stop I’m going to bite you! This is your last warning!”

Children need to be taught how to approach strange dogs; their instinct is often to stroke a dog’s head but a dog’s instinct is to raise its head to follow the strange hand and if the child jumps back in alarm, the dog can see this as a form of aggression.

Simple things like high pitched screaming or squealing and even running past a dog can seem threatening to a dog. Dogs chase runners. If you want your dog to follow you, get it’s attention and run the other way, chances are it will overtake you!

Kids shouldn’t touch a dog with a bone, chew or eating. They need to be taught to respect a dog’s privacy when he is in his kennel or bed. Puppies need lots of naps during the day to give their body time to grow.

Children have little comprehension of consequence; even in their late teens they struggle to understand that each of their actions has a consequence which could have predicted if they had stopped to think. To a child, climbing a tall tree to get an apple would hardly require a second thought; they never considered how they would get down afterwards because it was not a problem at the time.

A child will see a bitch with her puppies and instinctively want to pick one up. Bitches with puppies are especially fierce and will defend their young; their instinct is that of survival so it is likely to be a “no holes barred” contest with the odds in favor of the dog. 

Once the dog and child understand each other, they will probably become the best of friends. Lonely children can benefit from having a dog to confide in because dogs keep secrets! Friends may come and go, but the dog always there, and loves us no matter what everyone else thinks of us.

A dog can help a child through stressful changes, like moving house or changing school. It gives stability to life. The love that a dog can bestow on a child gives a child a positive self-image, and can help to ward off depression and anxiety.

It can be helpful to talk to the dog instead of the child, “Come Lady, good dog, it’s bed-time story time” can be more effective than ordering a child to get to bed. If the child sees the dog obeying they may respond favorably too!
When a child and a dog understand and respect each other they can both benefit enormously and it is hoped that the child will learn that a dog can be "man's best friend."

Despite the diversity of methods, almost every successful dog training system is based on positive reinforcement techniques. Thankfully the once used techniques involving intimidation, humiliation and punishment have long been abandoned as ineffective.  All of the recommended methods of dog training share three simple secrets.

Start Young

How many times have you heard the old saying “you can’t teach an old dog new tricks.”? We know what it means and also that it is not entirely true. Any dog, regardless of age, can learn new things; all animals, humans included, are much more receptive to learning new behaviors when young. The earlier you are able to start training your dog, the more effective the training will be.

Puppies will learn at a much faster rate and often do not have ingrained behaviors that must be un-learned. Thus, any training regimen is sure to be more successful when conducted with a puppy rather than an older dog.

If you weren’t able to start training a particular dog when he or she was younger, don’t fret. Training is still effective for older animals. However, the earlier you start training the better.

Gently Does It

Dogs are social animals with their social circle being that of the pack they belong to.  A solitary dog in a family unit of just one will belong to a pack of two – the owner and the dog. The attachment, or bond, of the pack members is at the heart of successful dog training. A dog that trusts his or her owner wants to please his or her companion and is far more likely to remain attentive and compliant during the training process.

A failure to act gently undermines the quality of the dog/owner relationship.

Of course, aggressive behavior also runs contrary to the very foundations of most dog training techniques. Dog training is premised on the notion that positive reinforcement techniques best modify dog behavior.

Reward for good behavior comes out top 99% of the time. The reward can be edible in the form of small training treats or something as simple as a cuddle or making a fuss of the dog. Consistency however, should be maintained during the training. If you usually reward your dog when it asks to be let out to go to the toilet and you fail to reward, this can harm the dog’s association of “asking to be let out” is good because I get a reward for being good.  

Scolding by way of a raised voice can help tell your dog “it did something bad” but it should be kept to a minimum and never prolonged.

However, never reward bad behavior; a gentle dog owner should be an ally for a trainee rather than a rival. Instead of a battle of the wills, training can become a cooperative exercise. Under those conditions, training tends to take less time and be far more effective.

Emphasize Prevention

Too often, training a dog devolves into a series of constant corrections for behaviors the owner finds unsuitable. The basic goal of prevention is to step in before a problem is created instead of simply responding to the problem. Instead of waiting for the dog to make a mistake to correct, the prevention-minded owner will keep close watch to see imminent difficulties and will intervene early to prevent them from arising in the first place.

By spending less time on correction you can emphasize positively reinforced training methods, keeping a program on track and accelerating its successes. It also decreases frustration throughout the training process making it more enjoyable for both the dog and the owner.

Although there is a multitude of training strategies form which one can choose, all of them can have their effectiveness increased by adhering to the aforementioned principles. By starting early, remaining gentle and emphasizing prevention, any reasonable method of dog training can yield better results.

1. Inconsistency.
2. Impatience.
3. Treating the dog as a subject instead of a training partner.

Inconsistency

Dogs thrive on predictability. In fact, their ability to grasp cause and effect is at the very root of training. Training, or conditioning, is based upon the dog associating one event with a consistent outcome. In simple terms a reward for a positive outcome.

A dog is likely to best respond to a system in which regular actions produce regular results. Too often, dog owners fail to be entirely consistent. In the dog's mind, these lapses in regularity convey a sense of randomness to the process and make it difficult for the pet to associate his or her specific behavior with specific results-the key to training. Dogs will excel when they are taught that things happen for specific reasons. When surprises occur it undermines the whole of the training process.

A successful trainer will retain consistency in their methods and will not deviate from an established course.

Impatience

There can be a great deal of frustration in dog training. Concepts we believe dogs should be able to grasp easily often escape them completely for quite some time.

We live in a world that is so often focused on immediate results. We learn to expect that our actions will be met by prompt, anticipated responses. Dog training runs counter to this societal trend toward speedy, immediate gratification. Training is an extended process that can require a great deal of patience from the trainer.

Impatience results in unpredictability on the part of the owner as they hastily cease a training session or abandon positive reinforcement techniques in hopes of finding a shortcut to desired results. Patience is, indeed, a virtue when one considers the role of the owner in a dog training situation.

A successful trainer will master developing a patient outlook throughout the extended process of dog training.

Treating The Dog As A Subject Instead Of A Partner

Dog training requires two participants: the dog and the owner. Frequently, however, owners tend to perceive the process as being uniquely about them. They fret over their techniques, equipment and strategies without giving real consideration to their training partner, the dog.

When an owner approaches the dog as a simple subject for experimentation, they lose track of what makes the dog unique and this devalues the always-important dog/owner relationship. Training becomes a chore, rather than a joint activity. What might have been a pleasurable chance for interaction for both the owner and the dog becomes an un-enjoyable task.

Dogs are sufficiently intuitive to be attuned to a trainer's attitude and are less receptive to learning when they are treated merely as a subject instead of as a complete being. Owners who fail to see their pet's identity during training are unable to pick up on subtle clues and possible means to improve their techniques.

The successful trainer will treat his dog as a full partner in training, not merely as a subject.

By avoiding these three common pitfalls, a dog owner is more likely to be able to implement a training strategy that produces results. Additionally, the training experience is likely to be enjoyable for both the dog and owner, giving them a tremendous opportunity to build a bond between them.

Regardless of the exact methodology adopted by the owner, the training process will benefit extraordinarily from avoiding the mistakes of inconsistency, impatience and treating your pet as a subject instead of as a partner.