New User - Pomeranian with unconfirmed diagnosis

Hello! I found this forum via SCARF (Samoyed Club of America Research Foundation) website. Its one of the first places I go when one of our dogs might have a potential serious disease and I want to understand it. I was thrilled to find out that this forum/site existed and hoped I could gain more insight into what my Pomeranian might have. So, before getting into that aspect I will introduce myself and my little guy. My name is Renee and Flynn is my rescue Pomeranian of 14-15 years old who may have Cushings.

About three years ago, Flynn had to go in for some other issues regarding his teeth. He had cracked a tooth on some fish skin treat and would need to be taken in to see what they wanted to do. Initially, I found a vet close to me that I had never used just to get him on some sort of antibiotic until he had his tooth pulled. I'm going to be honest we did not go back simply because I didn't feel comfortable with them and honestly the clinic was filthy. They did put him on Simplicef and Prednisolone (for the inflammation) at that time.

Since I was not entirely happy with my experience with them I decided to get him into an emergency vet we'd used previously in rare cases when we couldn't get into our usual veterinary clinic for our dogs. We had moved recently so we had not yet established a veterinarian for him. Got him in to see the vet there; they confirmed again about his teeth and wanted to pull them ASAP which is why we were there. They said that I could opt to do a pre-anesthetic panel now or the day of. I actually opted to do it that day simply because all the time we've had him, Flynn had never had one done. As far as I know, neither had the rescue because they'd only had him for a short duration. Had them check a cough he also had, too. Next morning I got a call from them because they felt that he might having Cushings Disease and they would also like to give him an ultrasound while he was with them. Going to be honest, after asking what it all entailed I got scared because I know that little dogs have difficulties with being put under, I was already nervous about just the dentalwork. They told me he would have to be sedated for the ultrasound. So, I opted to not take him out of my own fear. At this time COVID hit, so the fear ran rampant even more with everything else going on in the wide world. At this time, they did tell me to take him off the prednisolone but maintain the antibiotic. Things were very touchy for everyone at that point. They got some things confused regarding his dentalwork appointments as well and I just once again opted to find someone else. I can't blame the clinic entirely, every other veterinary clinic in their surrounding area closed their doors due to COVID and told their patients to go there. They were swamped and it just didn't feel right to take him there at that time. However, I'm including the results from their bloodwork as I've seen in previous posts that it can be useful...

Their conclusion is his levels might've been high due to infection but wanted to re-bloodwork and ultrasound him if bloodwork did not show anything.

DATE: Jan 13, 2020
Pre-Anesthetic Panel
GLUCOSE 99 63-114 mg/dL
SDMA was labeled to be undetermined due to gross hemolysis and/or lipemia
CREATININE 1 0.5-1.5 mg/DL
BUN 32HIGH 9-31 mg/dL
TOTAL PROTEIN 8.5HIGH 5.5-7.5 g/dL
ALT 263HIGH 18-121 U/L

RESULT VERIFIED BY REPEAT ANALYSIS
ALP 433HIGH 5-160 U/L
HEMOLYSIS INDEX 4
LIPEMIA INDEX 4

WBC 15.4 4.9-17.6 K/uL
RBC 6.48 5.39-8.70 M/uL
HGB 17.5 13.4-20.7 g/dL
HCT 46.2 38.3-56.5%
MCV 71 59-76 fL
MCH 27HIGH 21.9-26.1 pg
MCHC 37.9 32.6-39.2 g/dL
% RETICULOCYTE 0.9
RETICULOCYTE 58 10-110 K/uL
RETIC HGB 28.2 22.3-29.6 pg
%NEUTROPHIL 81.6
%LYMPHOCYTE 10.8
%MONOCYTE 6.1
%EOSINOPHIL 1.4
%BASOPHIL 0.1
PLATELET 352 143-448 K/uL
NEUTROPHIL 12566 2940-12670 /uL
LYMPHOCYTE 1663 1060-4950 /uL
MONOCYTE 939 130-1150 /uL
EOSINOPHIL 216 70-1490 /uL
BASOPHIL 15 0-100 /uL

We found a different veterinarian that was much closer to us that we felt generally more comfortable with. She herself also had a Pomeranian so that might've also eased my comfort level to some degree. And, we'd also had used them when we lived in another location about 10 years ago for another problem regarding my previous Pomeranian. So, I was semi-established with them just not with Flynn. She had a look at him, agreed his teeth definitely needed work. I mentioned about his cough he had because we had at the other veterinary clinic and they just sluffed it off to being collapsed trachea. I had taken some video footage of him coughing this time though so the vet could visually see it and hear it, too. And, I gave her the bloodwork from the other clinic and relating what they thought he might have. So, she decided to x-ray him but no bloodwork would be done that day as what she saw on the other vets information did not feel pointed to any concern of cushings. We set up an appointment for dentalwork and we were set to go. X-rays concluded that Flynn had an enlarged heart and that is what was creating his cough.

Unfortunately, the night before his dentalwork was to take place he threw up a lot and didn't feel fantastic, hunched back etc. He'd have had episodes like this before but this one was pretty bad. That morning we took him to the clinic for the appointment not with intent on dentalwork but intent on seeing if there was something wrong. We dropped him off and an hour later they called us back. Flynn had a pancreatitis attack. They had ran some bloodwork which I'll include the results below this paragraph. He was given anti-nausea injection and probiotic supplement. At this time, we were treating it as Acute Pancreatitis. No antibiotic as he was already taking one for dentalwork upcoming anyway. So, she opted to do no dentalwork and he was to come back in a month or two.

DATE: July 23, 2020
BLOODWORK from that day
AST (GOT) 54 0-60 U/l
Amylase 995 100-1500 U/l
Lipase 633H 0-225 U/l
Magnesium 2.2. 1.5-2.4 mg/dl
Triglycerides >500H 30-130 mg/dl
Sodium 146 141-152 mEq/l
Potassium 4.5 3.8-5.3 mEq/l
Chloride 107 102-120 mEq/l
Na/K Ratio 32

BUN 25.7 9.0-29.0 mg/dl
Creatinine 0.7 0.4-1.4 mg/dl
Total Protein 7.6 5.5-7.6 mg/dl
Glucose 123 75-125 mg/dl

ALT (GPT) 162H 0-120 U/l
ALP 287H 0-140 U/l

After this we didn't really have any serious issues with Pancreatitis because I read up on it and decided I just wanted to switch Flynn to a homemade cooked diet. The vet agreed with me that it would be OK and I shared some information on how to make it balanced for him. Previously, he'd been on a kibble by Wellness for Small Dogs that was Turkey Based which I did put him back on briefly but I felt he seemed to go downhill a bit while on it which is why I made that switch. Only trouble I did have was what kind of vitamin supplement to put him on and am still undecided. More on that later.

Fast forward to two weeks ago when I got woken up about 5:40 a.m. by the sound of him throwing up. Yellow bile everywhere. My initial response is to take him outside then offer him some food. Wasn't a good idea because an hour later he had it again. So, I stopped food and he did it again an hour or so later. Vet advised me to keep him off of food and try to feed him later that evening. Did that, seemed OK kept it down alright but had Diarrhea. Put him on some electrolytes and hoped things would improve the next day. The seemed ok till I went to offer him food and he didn't want it anymore. I did have to force feed him the night before but he seemed to be ok with it. This time when I did force feed him he wouldn't hold it down at all. So, he went in.

This was his bloodwork from that visit.

DATE: July 14,2022
WBC 17.6 H 6.0 - 17.0 103/ìl
LYM 1.8 0.9 - 5.0 103/ìl
MONO 0.8 0.3 - 1.5 103/ìl
GRAN 15.0 H 3.5 - 12.0 103/ìl
LYM % 10.4
MONO % 4.6
GRAN % 85.0
HCT 49.0 37.0 - 55.0 %
MCV 71.1 60.0 - 72.0 fl
RDWa 47.7 35.0 - 65.0 fl
RDW % 16.3 12.0 - 17.5 %
HGB 17.1 12.0 - 18.0 g/dl
MCHC 34.8 32.0 - 38.5 g/dl
MCH 24.8 19.5 - 25.5 pg
RBC 6.90 5.50 - 8.50 106/ìl
PLT 257 200 - 500 103/ìl
MPV 8.9 5.5 - 10.5 fl

Comprehensive Chemistry With Electrolytes:

BUN 25.8 9.0 - 29.0 mg/dl
Creatinine 1.0 0.4 - 1.4 mg/dl
Phosphorus 4.3 1.9 - 5.0 mg/dl
Calcium 10.2 9.0 - 12.2 mg/dl
Total Protein 6.4 5.5 - 7.6 g/dl
Albumin 3.6 2.5 - 4.0 g/dl
Globulin 2.8 2.0 - 3.6 g/dl
Glucose 107 75 - 125 mg/dl
Cholesterol 181 120 - 310 mg/dl
ALT (GPT) 507 H 0 - 120 U/l
AST (GOT) 51 0 - 60 U/l
ALP 968 H 0 - 140 U/l
GGT 25 H 0 - 14 U/l
Total Bilirubin 0.1 0.0 - 0.5 mg/dl
Amylase 1516 H 100 - 1500 U/l
Lipase > 1000 H 0 - 225 U/l
Magnesium 2.4 1.5 - 2.4 mg/dl
Triglycerides 100 30 - 130 mg/dl
Sodium 146 141 - 152 mEq/l
Potassium 5.0 3.8 - 5.3 mEq/l
Chloride 99 L 102 - 120 mEq/l
Na/K Ratio 29

At this point, my vet has told me that he had another Pancreatitis attack. I'm to move him off red meats entirely so he eats now strictly chicken and fish, only dark meat she wants him eating is thigh meat from the chicken. I'm fine with this, of course, though I know how greatly disappointed he will be. But, I had mentioned the last time she'd seen him he started losing some hair on his hindquarters and hasn't really grown it back. She told me that its likely he has the starting of or has already been dealing with Cushings. This was suspected as you read above by the Emergency Vet but again they felt it might just be his infection he had at the time. Told us that she doesn't want to put him on medication if she can help it since right now his symptoms are pretty mild but would like me to try a supplement instead along with those diet changes. I also asked about a vitamin to kind of solidify something that would work ok for him while having these conditions on his plate.

So, now that I have talked a lot about his back history I have questions! My first question is whether by bloodwork would it appear to be that he is leading into and/or already has the beginnings of Cushings?

The supplement she would like me to put him on (as I haven't yet because I wanted to know from others if it is worthwhile) is called Pet Wellbeing Adrenal Harmony Gold Bacon Flavored Liquid Hormonal Supplement for Dogs & Cats. Has anyone used this and/or know anything about it?

Another minor question is the vitamin she suggested is out of stock right now but just wanted to know if anyone has given it to a dog with Cushings before that is called Pet-Tinic Liquid Vitamin-Mineral Dog & Cat Supplement ? I'm a bit wary though since I saw the first two ingredients were corn syrup and sugar and I just don't know if that's ideal for a dog with potential pancreatitis issues. What multivitamin do other uses for their dogs with Cushings Disease?


Thanks for reading my long post and I really look forward to hearing what others have to say!

Physical/Visual Symptoms: As of October 2021 Flynn has lost most of his undercoat plus some guard hair on his hindquarters including his tail and had a skin infection on one side. At the time I wrote it off as an allergic reaction to Turkey Tail Mushroom Supplement my vet wanted me to put him on for another issue she suspected he may have. It was treated and went away after treatment. But, it never fully grew back in since than even though everything we've given him has provided the ability to grow in a nice healthy coat. I made the veterinarian aware of this on July 14, 2022 when he went in with a pancreatitis attack. He does drink a bit more than he use to and does need to use the bathroom frequently but whether that's more than before or not I can not honestly say as he is a little dog and feel with them it is hard to gauge. If I was going to have to give an answer he does seem to urinate more. Has times when he is ravenously hungry but not always the case sometimes it's the opposite. He use to be a very lively little dog who would happily play with me. In the past year or year and a half he's slept a great deal more than he use to. I understand with Cushings it can seem like everything is due to old age but he is a Pomeranian and I feel this is not due to his age since he does try to play once in a while but than gets turned off within a few seconds. He doesn't seem to have weakness in his hind legs necessarily but he has been walking rather slow lately at times. And, when we got Flynn he was a very muscley boy. Use to tell him he had buns of steel lol! Those are gone and elsewhere, too.

Another note to mention is that my veterinarian is connecting the pancreatitis attacks with potential underlying Cushings Disease since she explained they can make having attacks more or less possible/likely. This is being judged on the fact that Flynn has been on a low-fat diet ever since he had his first attack in 2020. Since the only other potential cause was hamburger I used to make his meals just before his attack happened and he'd been eating burger rather fine for nearly two years without incident. Despite this fact she wanted me to take him off red meat completely just to rule out that it had been the culprit but feels more strongly its just a symptom of Cushings Disease.

Hello and welcome to you and little Flynn! It’ll likely be tomorrow before I’ll have the chance to return and write a more helpful reply, but I definitely wanted to at least tell you how glad we are that you’ve found us.

So until later, welcome to our family :-)
Marianne

Quote:

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Originally Posted by labblab

Hello and welcome to you and little Flynn! It’ll likely be tomorrow before I’ll have the chance to return and write a more helpful reply, but I definitely wanted to at least tell you how glad we are that you’ve found us.

So until later, welcome to our family :-)
Marianne

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Thanks for the welcome! Flynn and I appreciate it!

And, that's no problem at all and will certainly look forward to your reply!

OK, I’m finally back again and I apologize for the delay! Thanks so much for all the great info you’ve given us, and I surely hope that Flynn is feeling better. After re-reading your post, though, I have to agree with your vet that Cushing’s would be a back-burner issue in my own mind. I’m assuming it is the elevated liver values that is triggering the suspicion of Cushing’s. But it seems to me that his other health issues (plus having been treated with the steroid prednisolone) could have been or are currently contributing to his lab abnormalities. Does Flynn exhibit any outward observable symptoms that are consistent with Cushing’s, such as excessive hunger/thirst/urination, panting, hair loss, lethargy, hind-end weakness, seeking out cool spots? Even if Flynn does have Cushing’s, at his age your primary goal is making him as comfortable as possible. Treatment cannot cure Cushing’s — its goal is to relieve symptoms. So in the absence of actual symptoms, I’d see little value in even pursuing the diagnosis right now.

As far as the various supplements that your vet has recommended, I’m afraid I know nothing about the vitamin and I’m unaware of any particular vitamin formula that is helpful for Cushpups. The underlying problem with Cushing’s is the excessive amount of cortisol that is being produced, and I’m not aware of a vitamin being helpful in that regard. As far as the Adrenal Harmony, I’m afraid we’ve seen no evidence that it is actually therapeutic in terms of Cushing’s, either. One of our staffers has contacted the maker directly to ask for evidence of any controlled clinical testing to back up their claims. We’ve not seen any such evidence provided. However, anecdotally, some members have told us that they think Adrenal Harmony has helped relieve symptoms in their dogs, at least for a time. But once again, we’re back to the question of symptoms. Unless Flynn is actually exhibiting Cushing’s symptoms, I don’t know how much value there’d be in spending the money on the supplement.

Please bear in mind that I’m not a vet, myself. Also, I’m hoping that a couple of our staffers who have been Pom-Moms themselves will be able to stop by at some point to offer their thoughts. But to return full circle, my thought is that Cushing’s is not a primary issue that needs to be addressed right now. You’re doing a great job of trying to keep him as comfortable as possible, and I surely hope that will become a lot easier once his pancreatitis quiets down. But please feel free to ask additional questions about anything I’ve written or that you’re wondering about.

Marianne

Hi Marianne,

That is quite alright! To answer more of your questions on symptoms that Flynn is showing I added it to my original post above for future reference for anyone that wants to reply to it. I will say that his liver values and I want to say another value was of concern to his veterinarian at the time. And, some of the things I also told her she expressed concern it might point to that. As for getting a confirmed diagnosis she felt that she did not wish to put Flynn through all that was required because of his age and was the same feeling about giving him any medication for it at this time. This is why she suggest a supplement instead since even though he does have symptoms they do not seem severe to her.

I appreciate knowing that others have had some relief with the supplement as I think I will go ahead and try it with him. I mainly wanted to know if anyone had and if there were any issues in using it. Always am pretty careful with things that are herbal or holistic in nature whether it be for myself or my pets.

And thank you, he is my very special little man and I just want what is best for him. If I can think of any further questions I will certainly come back here with them!

I did forget to mention that sometimes he seems unable to also get comfortable. He wants to lay down but will go from the hardwood floor to his bed/blankets and back again. Sometimes he wants to be on the hard floor and others he wants his cushy beds/blankets.

Renee