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.

There are many unseen dangers in everyday household objects which all pet owners should be aware of. Cats are often regarded as inquisitive, thus the saying curiosity killed the cat. Dogs however, particularly puppies and young dogs are also very interested in anything in there surroundings which might be new to them.

What follows is not an extensive list by any means but includes items which people often overlook.

1) Antifreeze: Common antifreeze is responsible for a lot of pet deaths every year. It smells and tastes very sweet to dogs but then rat poisons smell nice to rodents; both have the same effect. When draining a car radiator to change the antifreeze, avoid the temptation of leaving it unattended or better yet, ensure no pets have access.

2) Chocolate: Chocolate contains a substance called the obromine which is toxic to dogs. Baking chocolate and dark chocolate is especially dangerous. People often like to reward their dog with a small piece of their chocolate and whilst a tiny bit will do them little harm, they are not doing their pet any favors. There are special doggie chocolates available.

3) Pain Killers: The most common mild pain killers are Paracetamol or Aspirin based but there are many more with a higher strength available. However, as few as two regular strength tablets can kill a small dog.

4) Batteries: Watch batteries are tiny and contain lithium which can cause a potentially fatal ulceration in the stomach within 12 hours. Alkaline batteries are also toxic to dogs so always dispose of used batteries sensibly, safely and at once.

 5) Moth Balls: Not as common as they used to be in households nevertheless moth balls are very dangerous to dogs. Their function is to kill moths which eat fabric and so contain an insecticide. If any pet ingests one it can cause central nervous system excitement and seizures.

6) Electrocution: All households have electrical appliances which require a cable to be plugged into a wall socket. The cables covered in a plastic insulation are often quite thick but a dog’s teeth are no match for this and many young dogs die from being electrocuted, particularly in the holiday season from chewing through Christmas tree lights. Puppies will chew when teething but in general dogs will also chew out of boredom so give them something they can safely chew.  

7) Household chemicals: All sorts of household detergents are toxic to dogs at one level or another, but fabric softeners fall into the highly toxic category as does mouthwash which often contains boric acid. Symptoms of poisoning include vomiting, drooling, seizures, and coma.
  
9) Household Plants: It may surprise you to learn that many common and popular household plants are highly toxic to dogs. A partial list of toxic plants includes poinsettias, lilies, ferns, devil's ivy, aloe, and ivy.

If you think your dog may have eaten any of these substances, or anything else that could poison him, call a vet immediately.  It could save his or her life.

The poodle was the first to gain notoriety in grooming style and it takes little research to find the German sketch of a groomed poodle from the 1600's, as well as a well-known bronze sculpture from the late 1700's that depicts the poodle clipped in what is very similar to today's Continental show clip. The art of grooming grew during the 19th Century when Louis XV and Louis XVI of France declared the little dog the royal dog at court. Even with the fall of the monarchy, grooming parlours flourished, as did the poodle's popularity. These artfully groomed poodles became known as French Poodles despite the fact that the breed did not originate from France at all.

Examples of the English saddle clip and the Continental clips can still be seen in show rings all over the world but as the breed began to be ever more popular and moved from the aristocratic society to all classes, 'pet clips' originated. Grooming styles flourished, mostly out of the desire to keep the pets clean and tidy, but not everyone was interested in showing their dog nor was the cost of keeping a show dog within everyone’s means.

The terrier was another breed that benefited from a new look; it was discovered that the coat took on a richer color and texture if the wiry dead hair was stripped out. Note that hand stripping a terrier is a true art form and not all professional groomers have the necessary skill to do it.

Different breeds warrant different styles or cuts for showing, and woe-betide anyone straying too far from this, however breed standards as lain down are often misleading. The Pomeranian for example is described as having a long wiry coat with a recommendation only to trim to give shape and never to cut. In truth, the coat is soft and only becomes wiry when it re-grows after having been cut.

There are numerous styles around today but by far the most common is the “Pet Cut”, also termed the “Kennel Cut”. This is basically trimming the coat to a more practical length to make brushing and cleaning easier for the owner.

Many dogs are pampered and whether they see a show ring or not, spend as much time at the grooming shops as humans do in styling salons of their own. Many owners are very selective about whom they chose groom their dogs too, some even insisting on a particular person rather than grooming salon. as they do for their own personal hair-stylist.

• Small and fluffy
• Lively and alert
• Clever and eager to learn
• Willful and headstrong

Some Ideal Human Companions

• Singles
• Seniors
• Apartment dwellers
• Couch potatoes
• Celebrities

What They Are Like to Live With

Pomeranians are little dogs with “big dog” personalities. They are descended from the Nordic breeds which were once used to pull heavy sledges across ice and snow and although their size has been diminished, they do not regard their size as an issue.

They are lively, friendly and fun but they can be quite territorial. They grow attached to their owners and often develop a protectiveness that makes them suspicious of strangers. This not only makes for a loyal, tried-and-true companion, it makes for a superb watchdog. Pomeranians may be small but they can really deliver on the barks when a stranger approaches their territory and have little regard for their own safety.

In spite of this protectiveness, Pomeranians are not too clingy or co-dependent; they will get along with every member of the family, including other pets, providing they are introduced properly.

They are intelligent, busy and curious, with a lovable independence, but they crave your attention and playtime, sometimes responding by standing on their hind legs like a mere cat making it difficult to refuse..

Things You Should Know

Pomeranians can sometimes be stubborn and willful; they can easily dominate a weak-willed owner. A firm but friendly hand is needed day-to-day, especially when it comes to their yapping bark which although they can be taught to limit from an early age, must be reinforced on each and every occurrence lest the Pomeranian own the owner!

Like several other proud and small breeds, they are blissfully unaware of their size. They have in the main friendly temperaments but will not think twice about “taking on” larger dogs if you or they feel threatened. Give them their little bit of freedom by all means but keep them close and protect them from conflict.

Pomeranians have lots of coat so if you do not want pet hairs on absolutely every outfit you have, consider an alternative breed. They not only shed their coats quite a bit, they also require daily brushing to prevent tangling. Check their eyes and ears regularly, and make sure they get scheduled visits to the dentist—Pomeranians’ teeth tend to gather tartar easily. They are very happy living in apartments as long as they get regular exercise and human interaction.

The Look of the Pomeranian

Two Pomeranians

Pomeranians have lots of coat so if you do not want pet hairs on absolutely every outfit you have, consider an alternative breed. They not only shed their coats quite a bit, they also require daily brushing to prevent tangling. Check their eyes and ears regularly, and make sure they get scheduled visits to the dentist—Pomeranians’ teeth tend to gather tartar easily. They are very happy living in apartments as long as they get regular exercise and human interaction. Toy breeds make excellent companions for the infirm and the elderly because they require less exercise, less food, give lots of affection and are loyal. It is worth bearing in mind that toy breeds, like Pomeranians, can live to 20 years, particularly if you are considering a dog for a elderly relative.

Overall, Pomeranians have a poised and proud carriage. Compact, sturdy and fluffy with slightly rounded, wedge-shaped heads, straight muzzles and pointy ears, they sometimes have a fox-like appearance. They have dark, deeply set eyes and an overall alert and lively expression. Their undercoats are dense and soft, their outer coats rough, profuse and puffy, while their feathered tails curl over the back. Coats can be nearly any color, but the most common are red, orange, off-white, brown or black.

Other ailments, such as diabetes, trauma, inflammation, and some puppy milk replacers can also cause cataracts.

Treatment of Cataracts

Unfortunately there are no magic pills or "wonder" creams and surgery remains the only effective treatment.

Cataracts may be surgically removed in one or both eyes however, at around $1000 - $2000 per eye, cataract surgery is expensive and requires significant commitment, administering of eye drops several times daily before surgery and for about 6 weeks after surgery. Your dog must wear a protective plastic e-collar for 2 weeks after surgery, and your pet will not be able to be groomed or vaccinated during the 6 week healing period.

With early treatment, the success rate is currently OVER 90% but, as with any surgery, there are risks and your veterinary ophthalmologist will discuss theses risks with you prior to treatment. Although a cataract left untreated can lead to a spontaneous lens capsule rupture (requiring the eye to be removed) these cases are rare proportionately.

Dogs with cataracts cope surprisingly well; they soon create a mental map of their suroundings and it is often the case where the dogs' lack of sight troubles the owner more than the dog.