Pomeranian mix the cute and the even cutter part VI – Cushing’s disease

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Cushing’s Disease:

Cushing’s disease is one of the causing reasons for urinary incontinence in Chihuahua Pomeranian mix dogs. It is also called or commonly known as Hyperadrenocorticism; as the name suggests this disease is related to hyperactivity in the endocrine system. There is a big misconception surrounding this disease, many of its symptoms and signs could be interpreted as signs of aging, like loss of hair, loss of bladder control, and gaining weight and so on.  Part of this claim could be possible as Cushion disease is more common in middle aged dogs, yet it is treatable and does not by necessity call for euthanasia. It all begins with the endocrine system in your Chihuahua Pomeranian mix dog which is responsible for producing hormones and their right and perfect amount. One of the hormones that endocrine system is responsible for is the cortisol, which functions as a regulator for metabolism and protein creation. The cushing’s disease is simply the rise levels of this cortisol hormone, due to the inflammation of the endocrine system.

Where things go wrong?

In order to grasp the complicated nature of this type of disease let’s first understand how things go wrong with this type of disorder. There is a gland called the pituitary gland at the base of your Chihuahua Pomeranian mix dog’s brain that produces adrenocorticotrophic hormone. This adrenocorticotrophic hormone has a very crucial function; stimulating the adrenal glands to release Cortisone or cortisol hormones. You can already see there is a huge mayhem of hormones and glands related and involved with this cushing disease. This is the reason why its diagnosis is another mayhem of blood tests and blood stimulant agents, in order to determine and figure out where the problem is, your vet need to discover precisely which stimulant is the faulty one; the adrenal gland or the pituitary one.

So now we go back to Cortisol, the hormone stimulated by the adrenal gland, this hormone as you might already know or heard is not only responsible of lowering stress levels  but its role extends basically to most vital roles and functions within your Chihuahua Pomeranian mix dog’s body. The most vital role this hormone contributes to is metabolism, and this includes digestion, building muscles, blood sugar levels, organ functions (like kidney and liver), nervous system, immune system, and cardiovascular disease. How the disorder happens is a bit more complicated for example, if due to any external factor (like cold, stress, trauma, or surgery), the cortisol hormone levels got increased in the blood (remember they are produced by the adrenal glands near the kidneys), the pituitary gland reduces or stops producing adrenocorticotrophic hormone, so the hormone levels in your Chihuahua Pomeranian mix dog’s body would be balanced. On the other hand, if the cortisol hormone levels in your Chihuahua Pomeranian mix dog’s body goes down, the pituitary gland secrete more adrenocorticotrophic hormone to stimulate the adrenal gland, and so and so forth. There is a responsive mutual relation between the pituitary gland and the adrenal glands, all should result in somehow fluctuating equilibrium or balanced state in your Chihuahua Pomeranian mix dog’s blood, almost like a see saw balance.

So now that you know how things should be, here is the description of how things go the other way during Cushing’s disease:

These two hormones levels get messed up due to one of three reasons; tumor in the pituitary gland (that leads to excessive production of adrenocorticotrophic hormone whereby this act, too much adrenal is stimulated and so its levels soar up in the blood), or due to tumor in the adrenal gland itself (resulting in the same effect, soared up levels of adrenal in your Chihuahua Pomeranian mix dog’s body). With these responsive and dependent relation between the two glands and their produced hormones; this Cushing’s disease or Hyperadrenocorticism is very hard to diagnose and detect. The vet has to undergo many tests to determine exactly where the tumor is. But that is not the only reason why this Cushing’s disease is a torment in its diagnosis. By now you should have fully grasped the extent of this cortisol hormone functionality and role which if ever messed up or encountering a problem would by necessity lead to wide variety of symptoms and signs such as:

  • Excessive drinking
  • Excessive urination
  • Urinary accidents in well house trained dogs
  • Increased hunger
  • New food related behavior like begging, searching the trash, and stealing food.
  • Obesity, fat pads on certain parts (like neck and shoulders)
  • Panting, loss of breath
  • Poor muscle tone
  • General fatigue and exercise intolerance
  • Losing fat in the head region which gives a bony skull appearance to your Chihuahua Pomeranian mix dog.
  • Showing reluctance towards any activity that used to be his/ her favorite
  • Loss of hair
  • Dullness and dryness of your Chihuahua Pomeranian mix dog’s coat.
  • Slow regrowth of hair and nails after getting cut or trimmed.
  • Lack of energy
  • Insomnia (you will notice disruption in your Chihuahua Pomeranian mix dog’s sleeping pattern, with inability to fall asleep no matter how tired he is)
  • Lack of heat in female Chihuahua Pomeranian mix dogs
  • Shrinking in testicles in male Chihuahua Pomeranian mix dogs
  • The growth of huge belly (almost like beer and pot belly in humans)
  • Think skin, fragile easily bruised skin with the prevalence of minor injuries (like small cuts and knees scrapes that usually heal in a week, in this case it would take months to heal and recover).
  • The Existence of white calcified lumps on the skin.

Some of these symptoms and signs might more visible and noticeable than others, for example if your Chihuahua Pomeranian mix dog already have a sparse coat, losing hair won’t be a decisive clue along with trimming and slow regrowth. The growth of beer belly is very noticeable symptom but giving the fact that Chihuahua Pomeranian mix dogs are already petite sized, the growth may not appear as sickly as it may happen in some other bigger dogs, the belly could look cute and chubby body shape. Also take into consideration that Cushing disease is very common with middle aged dogs, so a pronounced belly is the not the red flag here. It seems like the most decisive, alarming and warning siren blowing symptoms are – in Chihuahua Pomeranian mix dogs in particular – the excessive increase in water consumption which in turn shows in excessive uncontrollable urination. Beside the physical ad tangible change Chihuahua Pomeranian mix dog’s owner notice, the excessive increase water intake is the most prevailing symptom in Cushing disease, it affects approximately 80-85% of all diseased dogs, so most probably you will see it and notice the difference in your Chihuahua Pomeranian mix dog. Studies show that Cushing disease patient dogs increase their daily water intake with rate of 2-10 times their normal and healthy amount. The healthy amount is estimated to be one ounce of water for every pound your Chihuahua Pomeranian mix dog weighs to be drunk daily, and divided through the whole day.

Despite the fact that 85-100% of the affected dogs with Cushing disease show coat and fur changes as symptoms, and approximately 80-90 % show massive change in appetite especially increasing cravings and stealing food behaviors, most of them symptoms could be excused for old age and aging problems. They are not that defining or alarming to any dog owner. In fact most of the Cushing’s disease symptoms would have made their way on your Chihuahua Pomeranian mix dog’s body by the age of 6  and 7, having Cushing disease more common in canines above the age of 10 would explain how many of these symptoms could go unnoticed or misdiagnosed.

One single spot on symptom would be having a quite old Chihuahua Pomeranian mix dog, that is known for suffering chronic allergies or bone injuries showing much better health as he/she grows older. This is one case of bliss in disguise, your Chihuahua Pomeranian mix dog is not showing improvement, it is just the unhealthy and absolutely abnormal doses of cortisol hormone in his blood stream is lessening or reducing the effects of these chronic pains.

To be able to diagnose your Chihuahua Pomeranian mix dog’s Cushing’s disease let’s take a look on each type of this disease:

  1. Pituitary Dependant Hyperadrenocorticism:
  • As the name suggest this type of Cushing’s disease happens due growing tumor in the Pituitary gland that is responsible for producing the adrenocorticotrophic hormone. This is by far the most common cause and type for Cushing disease in all canines causing more than 85% of the total Cushing’s disease cases, not only Chihuahua Pomeranian mix dogs. So just take into consideration that this should be the first case to test and roll out. The over exertion of the adrenocorticotrophic hormone in turn exhausts and drains the adrenal gland, in addition to the soaring adrenal levels in your dog’s blood stream. Here is the most complicated thing or the rub as they say when it comes to Pituitary gland tumors, more than 50% of these tumors are less than 3 mm in size, and as you should know by now this Pituitary gland is a quite small gland contained in a tiny dog frame. Scans and x rays won’t be the saving grace here nor the determinate factor your vet relies on unfortunately. The two adrenal glands should be swollen and over worked.
  • If the tumor is less than 1 mm diameter, your Chihuahua Pomeranian mix dog is susceptible to tumors causing pressure on brain nerves and tissues if left without treatment. These small tumors could easily and faster than you could think leading to blindness, seizures, or nervous deterioration along with the other Cushing’s disease symptoms.
  • The big tumors in size despite being easier to diagnose as they may appear in x rays and scans, or even in much advanced stages would be felt by your vet’s hand, they impose bigger threats and less mortality rates.

2) Adrenal gland based Hyperadrenocorticism:

Of course the other cause to the Cushing’s disease is the over growth or growing tumors in your Chihuahua Pomeranian mix dog’s adrenal gland. This is a less common reason though, representing 10-15% of Cushing’s disease cases. When the tumor exists on one of the adrenal glands or both, Cortisol hormone levels rise in the blood stream. The bad news here when it comes to Adrenal gland based Hyperadrenocorticism is that 50% of tumors found in that case are malignant and more likely to spread to the liver and lungs.

In this case, one adrenal gland would grow extremely oversized, this could be understood easily as it gets worn out by secreting an over dose of Cortisol hormone, but what is noteworthy is that the other adrenal gland shrink significantly in size to compensate the over excessive hormone ratio in blood stream.

3) Iatrogenic Hyperadrenocorticism:

This is a third type or cause to Cushing disease, however it differs from the previous two causes that is an external stimulation. Meaning that the body doesn’t fail or get sick, it is an external stimulation that pushes and sickens the body. By giving your Chihuahua Pomeranian mix dog too much glucocorticoid if they already suffer from chronic allergies. This action is pretty much similar to the failure of the adrenal gland when it over produces cortisol and rises its levels in the blood stream. When a dog is given over doses of glucocorticoid for an extended period of time, that could lead up to years of over usage, the cortisol levels are soaring up too. Despite the fact that cortisol hormone rise is not due to a failure of either adrenal glands or tumors, this has the same effect on the dog’s body and the chemical components of the blood. Unlike the two other cushing disease causatives where the adrenal glands gets swollen and grow in size, in this case they shrink because in fact they are not working, their function has been hijacked by external drug.

The good news is that Iatrogenic Hyperadrenocorticism is treatable 100%, and the whole dysfunction process could be reversible. When the doses of the steroids are lowered and managed, the adrenal glands will grow back in size and your Chihuahua Pomeranian mix dog’s health will go back totally to its normal state. Needless to say he/she has to go throw a withdrawal phase, its longevity depends by necessity on the length of the steroid drug your dog was using, also how much his/her Pituitary and adrenal glands been exhausted. They need a period of adjusting to reach the “wake up” state and back to normal. However this is the easiest and most straight forward treatment plan when it comes to this Cushing disease.

Early clues:

What you need to know to cut the diagnosis journey a little bit short for as you see it is quite gruesome and long. The reason for this is, Cushing disease shares most of its symptoms and signs with normal aging signs. Add to this the fact that more than 75% of canines affected by Cushing disease are middle aged dogs, 10 years old and above. So the age is quiet the determining element here, gender on the other side is not clear whether or not it does have an effect or not. Some reports confirm that female Chihuahua Pomeranian mix dogs are more susceptible to Cushing disease more than male Chihuahua Pomeranian mix dogs, whereas others show there is no difference in the ratio of affected individuals  between males and females when it comes to Cushing disease. What is more certain than gender when it comes to Cushing disease is spaying, many studies have proving that spayed and neutered Chihuahua Pomeranian mix dogs whether males or females are more susceptible to Cushing disease more than their unsprayed or unneutered peers (these studies were based on Chihuahua Pomeranian mix groups with the same age, gender, and weight). With pituitary dependent Cushing disease more common and prevailing in smaller sized dogs, with a percentage of 75% of the dogs cases that weigh under 20 kilograms (22 pounds). Whereas bigger dogs in size like poodle, Yorkshire terrier, beagle, Boston terrier, boxer, dachshund, German shepherd dog, golden retriever, Labrador retriever, Scottish terrier and terriers showed more susceptibility to adrenal dependent Cushing disease.

 The diagnosis of Cushing disease in Chihuahua Pomeranian mix dogs:

Well, that is a tricky one. Most blood tests and scans would confirm your Chihuahua Pomeranian mix dog’s aging state, a high rise of enzymes levels in his/her blood, high cholesterol levels, and some disorder in the blood cells count (increase in the red cells due to the high level of liver enzymes, and lower levels of white blood cells due to the nymph nodes exhaustion). The urinalysis won’t be that effective either, it might show increased levels of protein in your Chihuahua Pomeranian mix dog’s urine, giving the fact that it would probably be diluted with the excessive water consumption habits, neither hormone levels (Cortisol and adrenal) would not be showing significant rise. Even the x rays and ultrasound scans would only show enlarged adrenal gland and liver. Probably these signs won’t press your vet to throw extra scans for the pituitary gland for good measures, as you can see there is no threatening or red flags in these tests that won’t be existing in another just old Chihuahua Pomeranian mix dog fighting aging.

This whole explanation of how regular and basic blood tests and scans should shed light on why your vet will have to go this extra mile of tests and procedures to confirm the Cushing disease diagnosis. In the following section we will discuss these tests; urine cortisol creatinine ratio test, ACTH Stimulation Test, Low Dose Dexamethasone Suppression Test, and another High Dose Dexamethasone Suppression Test.

Urine cortisol creatinine ratio test in Chihuahua Pomeranian mix dogs

Your vet will start off his tests journey with this test. You should know that Urine cortisol creatinine ratio test is not one of the diagnostic tests of Cushing disease, meaning  that this test does not confirm having Cushing disease but rather roll out of the equation. As you will see, sadly your Chihuahua Pomeranian mix dog will have to undergo some complicated blood tests, so what this initial urine cortisol creatinine ratio test does is only confirming the vet’s suspicion of Cushing disease, it is more or less the green light for your vet to investigate more and execute more tests in case of its positivity. If the results are negative, then his suspicion of Cushing disease should be dismissed and he has to look in different direction. To elaborate, what your vet does actually in this test is comparing one of your Chihuahua Pomeranian mix dog’s urine against a normal exerted creatinine. This test has a very important function which is control the dilution of the urine, which as previously mentioned was the reason for not depending on the urinalysis as a determining factor in diagnosing this disease. If the results show an increase level of cortisol, then the suspicion of Cushing disease is legitimate, and your vet will have to investigate more and be more advanced with his lab tests to both confirm it and figure out where exactly the tumor is. But if the results came out negative and showed normal levels of cortisol in your Chihuahua Pomeranian mix dog’s urine sample, then the suspicion of Cushing disease has no true basis, and should be rolled out when diagnosing your cute little Chihuahua Pomeranian mix dog. You might look at this urine cortisol creatinine ratio test as the first test drive, or first examination of  a car, does it look as it was advertised on the paper, if yes, you dig more and check the engine, speed, design and its durability. But if it does not on the other hand, you probably want to spare yourself lots of time and effort wasted. With this urine cortisol creatinine ratio test you spare yourself other medical insurance bills, and exhausting your Chihuahua Pomeranian mix dog with pointless tests.

ACTH Stimulation Test in Chihuahua Pomeranian mix dogs

Now that your vet probably has the green light when it comes to digging and investigating further in your Chihuahua Pomeranian mix dog’s cushing disease suspicion. He probably knows by now, it is a legitimate assumption with obvious signs and symptoms. Now he has to figure out which gland is affected, or where is the damage. Similar to the previous urine cortisol creatinine ratio test, this is a comparative test yet with blood samples this time. What happens is that your vet will withdraw a blood sample from your Chihuahua Pomeranian mix dog, this would be his guide for the next step. Then he should inject your Chihuahua Pomeranian mix dog with ACTH stimulation hormone, in turn this should stimulate the adrenal glands to produce more Cortisol in the blood stream. After one to two hours, your vet should come and check the cortisol hormone levels, giving the assumption that your Chihuahua Pomeranian mix dog’s adrenal glands are already over worked, the Cortisol hormone levels, won’t go unnoticed, in fact they will be unbelievably soaring high. This test crucial and important as it is in confirming Cushing disease; it still falls short in some areas, like determining which gland is suffering from that tumor, is it the pituitary or the adrenal glands? This ACTH Stimulation Test still requires a complimentary test like Dexamethasone Suppression Test to diagnose your Chihuahua Pomeranian mix dog’s cushing disease appropriately and starting the treatment process.

Reportedly ACTH Stimulation Test is used in diagnosing 85-90% of Cushing disease cases, however it cuts short with more than 50% of adrenal gland tumors and 155 of pituitary gland tumors, which all unresponsive to the ACTH Stimulation. In this case, your vet will have to investigate more.

Low Dose Dexamethasone Suppression Test in Chihuahua Pomeranian mix dogs

With this test, your vet is beginning more specific blood tests, which is considered to be the best and most effective when it comes to diagnosing Cushing disease in Chihuahua Pomeranian mix dogs. The core of diagnosing Cushing disease lies in measuring cortisol levels in your affected Chihuahua Pomeranian mix dog, sadly this is not as easy or simple as it may sound. So your vet has to undergo extensive comparative sample induced with external agents to reveal these hormone levels. One way to do this is by injecting your Chihuahua Pomeranian mix dog with low dose of dexamethasone, which is a suppression element. But beforehand, your vet has to withdraw a blood sample from your dog in a fasting state, this will be used as baseline for the comparative test. To have an accurate and precise blood sample, dexamethasone should be the only agent has any impact on your Chihuahua Pomeranian mix dog blood, that’s why your dog should be fasting on the blood test day. After injecting your Chihuahua Pomeranian mix dog, a follow up blood samples should be taken every 4 and 8 hours, to measure up the cortisol hormone level in the blood. From the title you should have figured out that dexamethasone is a suppression agent, so in the case of a normal healthy dog’s response should be suppressing cortisol levels. On the other hand, if your Chihuahua Pomeranian mix dog is suffering from Cushing disease, by default his responsive mechanism are all in chaos when it comes to receiving and responding to hormone levels, so if your vet found your dog’s body did not get affected at all with this low dose of the dexamethasone suppression agent, Cushing disease diagnose is confirmed then. Despite the fact that this low dose of dexamethasone suppression test is not revealing to which type of Cushing disease your Chihuahua Pomeranian mix dog is suffering from, it is very indicative for reports show that dogs which suppress their Cortisol hormone levels after 4 hours and then rise them back again after passing 8 hours, later found out to be suffering from pituitary gland tumors not adrenal one.

High Dose Dexamethasone Suppression Test in Chihuahua Pomeranian mix dogs

With the confirmation of Cushing disease in your Chihuahua Pomeranian mix dog, your vet has now one step to do to reach his final verdict. The low dose dexamethasone test is used clinically to prove and confirm the Cushing disease in your Chihuahua Pomeranian mix dog. And it may be suggestive of which tumor your dog is suffering from, yet no professional vet can go on blind or be satisfied with suggestive methods. So in this test, the same technique is followed here but in large doses. The test starts with the same way your vet started off his low dose dexamethasone test, by taking a blood sample of your Chihuahua Pomeranian mix dog to use as a baseline when comparing between all the other blood samples at the end of the day. The blood sample should also be taken from a fasting dog, any other affecting element on the cortisol level should be eliminated. Then your Chihuahua Pomeranian mix dog will be injected with high dose of this suppression agent dexamethasone, and blood samples should be taken every 4 and 8 hours too. What your vet is looking for to find, is if your Chihuahua Pomeranian mix dog suppressed his/her cortisol levels; a dog with adrenal tumor won’t be affected at all with this suppression element, his cortisol level won’t even budge. As you know, adrenal glands are the last step in the process, if they are the affected one, the responsive stimulant hormones have no there effect in that situation.

On the other hand, if the tumor is in the pituitary gland, the cortisol hormones will change as pituitary are responsible for producing the stimulant hormones, so if they get affected with a suppression element, the stimulated adrenal glands will fluctuate in its produced levels of cortisol. High dose dexamethasone suppression test, is the final and indicative test in this journey of tests and blood samples. But as it is with all things in life, there is still some exception but it is very rare, approximately 15-20% of Chihuahua Pomeranian mix dogs with pituitary tumors don’t get affected with this high dose of dexamethasone suppression agent. The reason for that would be the large size of the pituitary tumor, most probably will be shown with the scans or even felt with your vet’s manual examination.

Treatment and healing Cushing disease in Chihuahua Pomeranian mix dogs:

You know what is more complicated than diagnosing Cushing disease in Chihuahua Pomeranian mix dogs? You guessed right, treating it. The complications rise from the fact that Cushing disease affects middle aged dogs which by that age already have a culmination of other diseases and frailties. For this you need to state and declare your priorities and goals of this treatment. In some cases leaving the Chihuahua Pomeranian mix dog with Cushing disease is much better option for his health and life quality if he/she suffers from chronic allergies or severe arthritis that the high levels of Cortisol are actually helping and relieving its impacts on him/her

Depending on your Chihuahua Pomeranian mix dog’s tumor size, overall health, and age you should talk out your treatment options with your vet. Both medical and surgical options are available in this case. Yet in genela surgical removal of the tumor is more prescribed and recommended in adrenal dependent Cushing disease. Chemotherapy could be an option too in the case of pituitary dependent Cushing disease. So here is what you should know about each treatment option.

Surgical option:

Surgical tumor remover is the most common and recommended procedure in the case of adrenal dependent Cushing disease. One reason could be that one adrenal gland could compensate for the loss of the other one.  Also many adrenal tumors in Cushing disease were found to be benign with low are of recurrence in Chihuahua Pomeranian mix dogs. However this complicated surgery should be preceded with a period of other medical drugs to lessen the effects of Cushing disease symptoms like slow recovery and healing. One of the most common drugs used in such situations is ketoconazole.

Yet adrenal tumor surgeries in older dogs is never a smooth sailing, giving the ailing nature of your   Chihuahua Pomeranian mix dog’s health, old age, many complications may arise and follow this procedure. In fact some vets would recommend their Chihuahua Pomeranian mix dog owners to refrain from this surgery, as the side effects and complications would be much more severe than the actual symptoms of Cushing disease. In other words, in some cases the dog is so ailing and in such frail condition that suffering from Cushing disease and its effects would be much easier and better for both the dog’s quality of life and his owner’s than trying to fix this by going through this complicated and serious surgery.

Other cases with malignant adrenal tumors which may have already spread to the liver and lungs by the time the Chihuahua Pomeranian mix dog’s owner have discovered this disease.

Regarding the pituitary dependent Cushing’s disease tumors, they are rarely dealt with surgically for various reasons, one of which their extremely small size. The tumor’s small size results in a case of Cushing disease where symptoms could be treated rather than going under the knife and exposing an old Chihuahua Pomeranian mix dog for such risks. In this cases a damage assessment should be made, and you should discuss your Chihuahua Pomeranian mix dog’s quality of life and the best option for both of you. But generally your dog will have to be treated orally by medical drugs for its special case.

  1. Radiation

Radiation as a medical option in treating Cushing disease is considered a very invasive and aggressive approach. So it is only used as a desperate measure if your Chihuahua Pomeranian mix dog suffers from large sized tumors, that can’t be dealt with in any other way. Like it is with humans, radiation should be the last resort to save your Chihuahua Pomeranian mix dog’s life. Radiation will cost the dog owner thousands of dollars, and drain an already old Chihuahua Pomeranian mix dog. And the worst part is that this treatment approach is only a partial cure, what it does is only shrinking the tumor size so the neurological symptoms would be relieved a little bit. Many dogs owners choose euthanasia over this medical approach.

2. Medical drugs

While we tackle medical drugs for treating Cushing’s disease, it is fair to say that actually some vets recommend against treating it. What they see is that most dogs that suffer from canine disease are already quite old, and many of them have very frail and weak overall health. So if the symptoms are not that pressing or dangerous what is the point of putting your Chihuahua Pomeranian mix dog through hell to treat it. By doing so you are hurting him, instead of saving him. As Cushing’s disease symptoms vary its intensity and degree, some dogs would only suffer loss of hair, or coat dullness of course this won’t be calling or pressing for invasive measures to be taken. And even if your Chihuahua Pomeranian mix dog is suffering from infertility, yet she is over 10 years old and pregnancy would expose her to health risks in the first place, then infertility is not a pressing nor urgent cause to start off this serious medication plan. In 2001, a survey showed that more than 50% of vets recommend against treating Cushing’s disease.

Aside from the vet’s recommendations, many owners shy away from treating their Chihuahua Pomeranian mix dog’s Cushing disease for other reasons which is the medical bills and expenses. You have to understand that choosing to start off and begin treating your Chihuahua Pomeranian mix dog’s Cushing disease would require lots and lots of medical billing, constant daily medical drugs, in addition to regular periodic scans, and blood tests. Not to mention the time consumption and commitment here. You will need to go with your Chihuahua Pomeranian mix dog to the vet weekly at first, then once or twice a month. This is very time consuming. So back to what we mentioned earlier that treating Cushing’s disease is only decided in terms of improving your Chihuahua Pomeranian mix dog’s life quality as well as and equally important as its owners. If not treating Cushing’s disease is causing much more trouble to you and your dog’s life, then the wise and sound verdict would be to go with it. Weigh your options and see what is best for both of you. There is no one right path here, each case is variably different and unique in itself. Some owners actually go on with the decision to start treating their Chihuahua Pomeranian mix dog, but then they figure out that the treatment is causing more trouble, health problems and side effects than the disease itself. So they back off. Whereas others decide to reject the whole idea of treating Cushing’s disease due to the mild symptoms their Chihuahua Pomeranian mix dog is showing, then few weeks later their dog’s condition worsens and require a medical intervention. Don’t worry at all, you are your best Chihuahua Pomeranian mix dog’s father and sure whatever you choose will be for the perfect decision for both of you.

Another point that needs to be discussed if you went with the decision of treating your Chihuahua Pomeranian mix dog’s Cushing’s disease is stabilizing and deal with all his chronic health problems, before beginning the journey of Cushing’s disease treatment. If your Chihuahua Pomeranian mix dog suffers from any chronic allergies, diabetes, heart problems, muscle or joints problems, thyroid dysfunction and disorder, and so on. The treatment journey may have side effects, their severity is variable, so you need to start with everything in order before starting a chaos storm within your Chihuahua Pomeranian mix dog’s body.

  • A) Lysodren:

Lysodren is the most common drug used in treating Cushing disease. It is quite invasive and many vets don’t agree or recommend prescribing it for its side effects. It goes with the generic name mitotane. Though it is not as invasive as radiation, it has some serious, damaging side effects. It has the longest medical credibility for it has been used and recommended for curing pituitary gland disease in addition to Adrenal gland tumors but with a little bit less effective power. It is successful in destroying the adrenal gland tissues, so even when the pituitary gland releases or produces much ACTH, the adrenal would still be unable to respond effectively with releasing high levels of cortisol.

Cortisol levels in your Chihuahua Pomeranian mix dog most probably would be in normal condition after one week of using this drug on daily basis. The first two weeks will be the test drive when it comes to the lysodren dosage, if after two weeks the Chihuahua Pomeranian mix dog did not show any improvement or initial response, the dosage might need to be increased, and the opposite is also true. If your Chihuahua Pomeranian mix dog showed hyper or exaggerated response to lysodren, then your vet will need to take the dosage down a little bit. The dosage will be reduced and regulated according to how he/she responds to it. The general rule with this Lysodren, is daily dosages for the first week, then one or twice weekly. Some Cushing’s disease have reported relapse, where the affected dog has to go back on daily basis drug usage every now and then, then reduce the dosage once again to weekly ones.  Some other cases failed from the very beginning to initiate any response to this drug, while other cases showed early and initial signs of improvement that soon dropped down again. If you have someone with diabetes in your family you could understand this more, if you looked at Lysodren as a type of insulin that sometimes has to be changed every now and then to have an effect on the patient.

  • The whole treatment plan should take from 4 to 6 months, to erase all Cushing’s disease symptoms from your Chihuahua Pomeranian mix dog’s body. The first two symptoms to show improvement would water related symptoms like water retention and urination habits. The last one to show improvement is the coat related symptoms, like hair loss, coat dullness and skin condition (white patches, calcified lumps, and bald spots).
  • To be well prepared you have understand that your Chihuahua Pomeranian mix dog will experience horrible initial side effects especially the very first few days. This is not an indicative of total rejection or allergy towards Lysodren, it is simply a reaction to the sudden drop in Cortisol levels in his blood. Some of these side effects could be fatal if not treated early on, you should have your vet prescribe emergency tablets for your Chihuahua Pomeranian mix dog, in case he / she experience a rapid and sudden reaction to the decline of cortisol in their blood stream.
  • To avoid the previous dangerous and threatening phase, your vet should start with Chihuahua Pomeranian mix dog with an introductory dose to get his/her body prepared for the change in cortisol levels.
  • The first two weeks are the induction phase, when you are required to give lysodren doses twice a day. For sure this new medication would your Chihuahua Pomeranian mix dog’s diet. Only fatty well absorbed food is allowed, so feed him/her when you present the drugs.
  • After the first two weeks or the end of the induction phase, your vet shall recommend an ACTH stimulation test to determine how well or bad your Chihuahua Pomeranian mix dog is responding to the lysodren dosages. During this period you should be able to notice an improvement in your dog’s water related and stomach habits, like water retention and excessive urination caused by Cushing’s Disease. Also his/ her appetite should be back to its normal condition, the excessive, devouring, stealing food behavior should cease, yet if you have noticed a rejection to food altogether you should stop lysodren and consult your vet immediately. Food rejection is a sign of lysodren toxicity.
  • A personal advice, only start this lysodren treatment plan when you are quite free and committed to your Chihuahua Pomeranian mix dog. Also make sure your vet will be available at all times during the first two weeks or the induction phase in case anything goes wrong. Lysodren dosage and doses are very particular and unique to very single Chihuahua Pomeranian mix dog, it should be customized according to its age, gender, weight, overall health, and its sensitivity to it. So if you could hold off for couple weeks till you are completely free to your Chihuahua Pomeranian mix dog, or your vet is, that would be better and make a significant difference.
  • Once your Chihuahua Pomeranian mix dog passes this induction phase, and most hormones are restored to its natural levels. Your vet will carry out last check tests to make sure everything is ok, then your Chihuahua Pomeranian mix dog will be prescribed a lysodren dose once or twice a week.
  • The cons and disadvantages of this drug could be that your Chihuahua Pomeranian mix dog will have to get dependent on this drug for the rest of his life. This is not a permanent cure, or a perfect solution. Your Chihuahua Pomeranian mix dog hormone levels will have to be monitored regularly, and be checked with ACTH stimulation tests on regular basis. The other con would be its invasive and destructive nature, yes it is a selective destruction drug (meaning it only targets the cortex tissues of the adrenal glands, and does not have any other effect on any other tissues or organs), its destructive nature still considered a threat.
  • Sometimes, Lysodren destroys too much of the adrenal gland tissues, which by necessity would create another health problem. The medical name for this case is Addison’s disease also known as hypoadrenocorticism, and this is the total opposite of Cushing’s disease, where your Chihuahua Pomeranian mix dog’s body fails to produce Cortisol at all. This situation could happen by incident, but some vet actually give the treated dogs high doses of lysodren on purpose to stop producing cortisol at all. In their view, the side effects of lack of cortisol are much more tolerable than going on and off the lysodren. Addison’s disease (hypoadrenocorticism) is treated by daily drugs. The chances of having all your Chihuahua Pomeranian mix dog’s adrenal glands completely destroyed on cautions use of lysodren is very rare though, the rate does not exceed 5%. It is more common if your vet actually intends it. Yet your Chihuahua Pomeranian mix dog can’t be left untreated while suffering from Addison’s disease (hypoadrenocorticism), the side effects are much tolerable but can deteriorate easily, it starts with the inability to deal with stress and but could lead to shock and heart failure as a result of your dog’s hysterical reaction to moderately stressful situations. Cortisol is not only a calming hormone, it is very vital for your Chihuahua Pomeranian mix dog’s survival and well being.
  • Other Cushing’s disease cases treated with lysdren reported serious allergic reactions indicated by vomiting, diarrhea, lethargy, weakness and general fatigue. Despite having these allergic reaction common with more than 15% of all canines, less than 1% of all canines have reported sever fatal reactions to lysdren. For all these reasons you should always keep constant monitoring on your Chihuahua Pomeranian mix dog’s hormone levels, and carry out regular ACTH stimulation tests if you seek this lysdren as your treatment path.

B) Ketaconazole (Nizoral)

This is an absolute better option than lysodren. In fact it is not originally a Cushing’s disease treatment, it is anti-fungal oral drugs which was found to be hormone suppressant drug. It treats both pituitary gland and adrenal gland tumors, and it is equally effective in both cases, not a selective drug. The good news is that it does not cause all the side effect known to lysodren usage, and it actually the second option when lysodren drug fails. If a dogs is not responsive to lysodren doses, or shows exaggerated and serious side effect then the vet would recommend taking Ketaconazole (Nizoral) instead.

There is a higher percentage of dogs that won’t respond to it, about 15-20% of them. The other reason why it is chosen second to lysodren, is its expensive price that wards many dog owners form picking it as their treatment drug of choice. Also many dogs shown improvement found to relapse again, the improvement is temporary and does not last.

Still it is a very good treatment option, equally effective as lysodren yet without the horrible side effects. Around 50% of dogs have been reported to respond positively to doses of ketaconazole (Nizoral).
Your vet should start treating your Chihuahua Pomeranian mix dog with a low dose of Ketoconazole, if he/she showed no sign of allergic reactions like vomiting or diarrhea, then then the dose will be increased accordingly. After a month, your vet will carry out an ACTH stimulation test to make sure all hormones levels are restored and well.

C) Anipryl (Deprenyl, Eldepryl, Selegiline)

Anipryl is one of the most debatable Cushing’s disease drugs. First of all like ketoconazole it was not meant to cure Cushing’s disease in the first place. In fact it was sued to cure as a brain faculty enhancer to senile dog to improve their brain clarity. While let’s go a little bit back, Anipryl is derivative drug from a human Parkinson disease drug, so it has no relation with cortisol, adrenal glands, nor pituitary glands. Its main target and effect lies in the brain and its chemical produced substance. Some scientists proved its effectiveness on rodents, then later on dogs, in treating similar symptoms like those resulted from Parkinson in humans like unclear brain, dementia, and so on.


But later on this concept was developed further, to be used to affect treating Cushing disease. It has another approach to it different from any other your vet would recommend for your Chihuahua Pomeranian mix dog’s Cushing’s disease. Most of Cushing’s disease drugs target either the pituitary gland or the adrenal gland, or affects their produced hormones. Yet, Anipryl drug has a different circle, and works on a different front. It affects the brain’s dopamine which in turn obstructs the pituitary signal of ACTH hormone production. From this you have guessed is right, it can only be used in treating pituitary dependent Cushing’s disease, it has no effect on eth adrenal tumor glands.

The argument about this drug in treating Cushing’s disease arises from the fact that two studies have shown different results when it comes to Cushing’s disease. One has showed that anipryl has shown positive results on 15% of the treated dogs. Whereas other studies proved that it was effective in more than 60% of the treated dogs. The conclusion could be drawn that not all pituitary tumors are in areas affected by dopamine production.

This article stands very neutral to both claims, but to be fair and provide our Chihuahua Pomeranian mix dog’s owners with both sides of the story you should know all the cons and pros of this anipryl drug.

Starting off with the cons because they are anything but limited, anipryl is not an extended widely effective cure for Cushing’s disease, it is only effective on some Pituitary tumors, not even all of them. Also it is known to be very expensive probably the most expensive Cushing’s disease drug you could think of or to be recommended for your Chihuahua Pomeranian mix dog. Adrenal tumor Cushing’s disease is not affected at all with it, you have to pray that your Chihuahua Pomeranian mix dog is  having that unique and low possibility tumor location on the pituitary gland, that is responsive to and affected by dopamine. Other than that you could start this anipryl, racking up your bank account, to find out at the end that your beautiful, poor little Chihuahua Pomeranian mix dog is not responsive to it.

Another problem with Anipryl is that it takes so much time to show any improvement or visual results, almost up to three months. Taking into consideration the crucial health state your Chihuahua Pomeranian mix dog might be having and which has driven you into starting this Cushing’s disease journey in the first place, this might be the biggest drawback. Three months with sever Cushing’s disease symptoms, frail and feeble old toy dog like Chihuahua Pomeranian mix dog would be fatal. And it would crack down your bank account, as not many health insurance cover these clinical experimental new drugs.

Lastly, Anipryl affects dopamine and if you know a little bit about it or really paid attention in biology class you would know that dopamine is actually a mood changer and elevator. The same that drives humans to catastrophic and bad decisions when we are in love, it is the same dopamine produced by a similarly constructed brain’s chemical factory. So when a Chihuahua Pomeranian mix dog’s owner sees an improvement in his dog’s activity and mood, it could be the dopamine excess not the treated cushing’s disease. And sadly there is not test to figure out the validity of the anipryl and its effectiveness, the ACTH stimulation tests don’t apply here. Your best bet as a Chihuahua Pomeranian mix dog’s owner would be to examine and pay attention the change in the water intake and urination.

Let’s now move to pros, Anipryl as a Cushing’s disease treatment has one of the lowest side effects ever. Having less than 5% rate of side effects shown in all its experimental clinical trials makes one of the best solutions, and would be the one and only solution in the case of terribly frail and fragile, old toy dog breeds like the Chihuahua Pomeranian mix dog we are talking about. Even the worst side effects that were reported to using Anipryl as a drug did not go beyond gastrointestinal upset and restlessness. By comparing these simple and slight discomforts 9can’t bring myself to call them side effects) to the gruesome side effects Lysodren has, Anipryl is a total winner, actually there is no comparison at all. And as you know, mix dog breeds are known to be more susceptible to extended genetic code diseases as they have wider genetic pool both with its advantages and disadvantages, so put this into mind.

Second advantage would be that there is no introductory phase. Your Chihuahua Pomeranian mix dog will be prescribed a specific daily dose for about two months, which will be increased according to its effects if needed. Yet the increase will gradual and consistent, unlike Lysodren where the Chihuahua Pomeranian mix dog’s owner has to be ninja alert to observe the ups and downs of cortisol drop down, which could be fatal to some extent and in many cases.

Anipryl could be your last resort if your Chihuahua Pomeranian mix dog showed extreme and serious side effects while being treated with lysodren. In that case, Anipryl would be your only choice.

D) Vetoryl (Modrenal, Trilostane):

Best is kept for last as they say. This Vetoryl or Trilostane as it is commonly known is a new British drug approved recently and used in United States in curing Cushing’s disease. It is very promising as a drug and holds big claims.

The best positive thing about this drug is that it works equally effective on both Pituitary and adrenal gland tumors. This is very advanced and positive thing in any drug. The next best thing about Vetroyl is that it is as effective as Lysodren in treating Cushing’s disease. Remember Lysodren is one of the most common and most effective drugs basically due to its effectiveness; it is almost ruthless in its effectiveness. New studies show that vetoryl showed equal rates of success as lysodren. This news is big.

The cherry on top when it comes to this new vetoryl is that its side effects are million times milder than lysodren. It showed quick improvements on Chihuahua Pomeranian mix and other frail affected dogs, in exercise tolerance and water intakes, excessive urination and activity levels. The dosage of vetoryl should be divied and given like antibiotic every 8-12 hours.

As with Lysodren, all your Chihuahua Pomeranian mix dog’s health problems whether with his kidneys, liver or heart should be treated beforehand. Anothr similarity with lysodren is that ACTH stimulation tests are a major components in the treatment plan too, your vet will carry out regular ACTH stimulation tests to check the effectiveness or lack of it on your Chihuahua Pomeranian mix dog.

Though vetoryl is not as invasive and sever as lysodren, keep your eyes open on any allergic reaction like vomiting, diarrhea, or loss of appetite. Any signs like these, stop the drug immediately and consult your vet. Corticosteroids tablets should be ready and prepared with you for any cortisol sudden drop down as we mentioned its possibility with lysodren. There are two different drugs, yet they operate the same way, same mechanism but different components that is why you should be well prepared for any sudden situation that could arise.

Vetoryl drug could be the answer to Cushing’s disease in toy breeds like  Chihuahua Pomeranian mix dog that would not tolerate heavy duty drugs like lysodren. In case you decided to switch from Lysodren to vetoryl fr any reason, you have to keep one month period as a transitional phase, consecutive use of both drugs though not forbidden is absolutely not recommended.

Continue part VII of Pomeranian mix breeds; the cute and the even cuter


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