Butter Puppy has Cushing's...feeling confused and overwhelmed

[TamiSchmidt]

My 14 yr old toy poodle, Butter Puppy, had been drinking and urinating more than normal. They found a UTI (his first one ever) and gave him Clavamox. The increased urination subsided with the treatment of the UTI but he continued to drink more than normal and his urine was dilute. Those were the only symptoms but the doc suggested an ultrasound at Med Vet, a reputable clinic in Columbus, Ohio, which is fine. He's a good vet.
The ultrasound showed enlarged adrenal glands, enlarged liver with likely benign nodules throughout his liver, thick bile sludge in his liver, large fluid filled cyst in his left kidney which they didn't feel the cyst was a major concern, and a nodule within the spleen that warrants further testing. The ACTH stimulation test came back normal.
We had a low dose dex test done, which they just called and said it was positive for Cushing's and they will fax the results. Is this lose dose dex test 100% accurate?
I'd love to hear any thoughts, opinions, and suggestions on where to go from here. The dr has yet to call me and discuss options but I'm assumming he'll want to treat Butter Puppy or he wouldn't have ask for the tests. I've read pros and cons to treating vs. not treating, and I've been researching cushing's for days now and just becoming more confused...and I'm starting to feel overwhelmed. I'd like to learn as much as possible before he calls so I can ask him the appropriate questions. Thoughts please? Thank you!
Tami

[DoxieMama]

Hi Tammy, welcome to you and Butter Puppy (what a great name!). I'm happy you've found us, though I'm sorry for the reasons you're posting. Do you happen to have the results of the tests that were done (blood tests, urine (how dilute?), ACTH and the LDDS)? If so, please post the abnormal lab results as well as the numbers for the ACTH and LDDS. That information will help us provide you with the best support.

I don't believe any test is 100% accurate, especially for Cushing's. Though the LDDS test is the "gold standard" for diagnosis, it can still give a false positive result. The nodule on Butter Puppy's spleen (and maybe even that cyst on his kidney) could be causing the results to return positive, even if he doesn't have Cushing's. I'm not saying that's the case, but it certainly bears further investigation as you already mentioned.

Sorry I haven't a lot of time to respond, but I'm sure others will be by with their questions and suggestions too. Hang in there!

Hugs,
Shana

[TamiSchmidt]

Hi Shana,
Thanks for your concern and quick response. I have asked the vets to send his test results so I can share them with you. What are your thoughts with the spleen causing a possible cushing's diagnosis?
Hugs back!

[judymaggie]

Hi and welcome to you and Butter Puppy! First, I totally agree with Shana that your dog's name is fantastic. :D

To add to what Shana has advised re the results of the LDDS and to answer your question about the spleen causing a Cushing's diagnosis, the LDDS has what is called "low specificity". This means that its results can be affected by any other illnesses or issues that are going on when the LDDS test is done. Its specificity is much lower than the ACTH. That said, it is much more sensitive than the ACTH, meaning that a positive result is more reliable than the results of an ACTH assuming there is nothing else going on at the time.

One of our admins did have a dog with high cortisol who had spleen issues. Once the spleen was removed, there were no longer high cortisol readings. Please don't think that I am saying Butter Puppy's case will be the same -- I am just offering some thoughts for you to consider.

Has Butter Puppy shown any other symptoms of Cushing's other than more frequent urination/thirst? Increased hunger, panting, enlarged belly, muscle weakness, skin issues? The enlarged adrenal glands and dilute urine do support a possible Cushing's diagnosis but I think, if I were in your shoes, I would want to seek out more information about the nodule on the spleen.

[TamiSchmidt]

Hi Judy,
I totally understand that you are not giving me a diagnosis, just info about the spleen situation for which I am grateful. We go in for another ultrasound on the spleen in about 3 weeks to see if the nodule has changed.
Thanks to you and Shana mentioning that you like the name Butter Puppy. When he was a baby, about the size and color of an apricot softball, we took him camping with us. He was sitting in the middle of a little patch of buttercup flowers. This little girl came along, maybe 3 yrs old, pointed at him and said, "Mommy! Mommy! Look at the butter puppy!"
We laughed so hard, and the name stuck. :) The mom had been teaching her daughter about different flower and weed names evidentially.
When I have Butter Puppy's results I'll post them. I'm worried sick about the little guy. And praying that the nodule on his spleen is benign.
Did you notice the title of the book Butter Puppy has his paw on in my avatar? I'm not kidding you...I didn't stage the photo. I was reading the book, "How dogs think," and he put his paw on it and looked at me. I had to take the photo! Too cute!