Quality of Life After Bilateral Adrenalectomy

[cbording]

Hi,
My name is Carson, and I am owned by two 9.5 y.o. littermate Dachshunds, Joey and Maggie. I have been reading the boards for a few weeks, and I appreciate all the knowledge here. I am looking for help.
Both of my dogs started drinking a lot of water about 3 months ago, and after a urine specific gravity, urine cortisol ratio, and ACTH stim test, it was determined that my male has Cushing's. I thought the next step, the abdominal ultrasound, would be more of a formality than anything, but it turned out that he has a tumor on both adrenal glands. One is so large that it has grown into his vena cava, and is blocking it 85%.
I had a surgery consult this last Monday, and the surgeon gave Joey maybe 6 months to live without surgical intervention.
I'm in a bit of a quandry here, obviously I want to do whatever is necessary to save my dog, and was wondering if anyone else has had a bilateral adrenalectomy done, and what the quality of life was for your dog afterwards. It seems to be a risky surgery, but treatment of Addison's seems fairly stratightforward, a shot every 4-6 weeks, and oral steroids and electrolyte monitoring.
Back to his littermate sister Maggie, she is also drinking a lot of water, but because her liver values weren't way high (although they were elevated, and I'm sorry I don't have the number), the regular vet could not determine why she was drinking so much, everything else is pretty normal with her.
If she continues to progress, my fear is that she has the same thing going on with her, and there's no way I can afford two $7,000 surgeries (coupled with thousands in tests on each dog). But I can't give one dog surgery, and not the other, you know? I'm hoping actually to talk to the vet to see if he would skip the ACTH stim test and would do an abdominal ultrasound on her before Monday to help me make a better decision with Joey's surgery.
Anyway, I know I'm a bit all over the place, but like you all, these are my kids, and, well.....you know.
So, does anyone have any experience with quality of life for a dog with a bilateral adrenalectomy?


http://farm4.static.flickr.com/3204/2990104073_7e2ebc47f3.jpg

[littleone1]

Hi Carson,

Corky and I would like to welcome you and your furbabies. You have found a very wonderful group of caring, supportive and knowledgeable people.

I can't speak personally about an adrenalectomy, as Corky is not a good candidate for the surgery, but we do have a few members who have dogs that have gone through this, and were doing very well. I'm hoping they will be along to give you more information.

I wish the best for all of you.

Terri

[apollo6]

Welcome.
I can see you are very overwhelmed. Others will post input for you.
I am still new to this. My little dachie, Apollo is 11.5 years old with Cushing. If it were me I would get a second opinion with an INTERNAL MEDICINE VET. Is the tumor benign or not?
Cann't give input on the surgery. I would research it first. and read what you can about cushing from resources.

[lulusmom]

Hi and welcome.

I have two cushdogs but neither has an adrenal tumor so I can only imagine what you are feeling right now. I'm sorry that I can't share any personal experience with you but I am providing a link below to a thread for Sammy, who had a pheochromocytoma with ultimate adrenalectomy. I am also including a word document that is a cached version of a thread on a predecessor site that someone was able to recover after that site was taken offline suddenly. It's not the neatest looking document but it's easy enough to follow. This member's dog, Maggie, had a bilateral adrenalectomy with fabulous results but unfortunately, this member is not a member here. Sammy's mom hasn't checked in for a while but I am hoping that she will pop in and see your thread. We have another member, Ken, who's beautiful girl, Shilo, also had an adrenalectomy a number of years and she is doing great. Hopefully, Ken will also drop in to share his knowledge and experience.

http://www.k9cushings.com/forum/showthread.php?p=11582#post11582

511

Glynda

[cbording]

Thanks. They won't know if it's benign or not until the surgeon gets in there, but he believes that it is not because of the way it is growing. It doesn't appear to have spread though.
I don't know if an internal med vet would help at this point, my primary vet agrees that the mass needs to come out, and surgery seems to be the only way.



Welcome.
I can see you are very overwhelmed. Others will post input for you.
I am still new to this. My little dachie, Apollo is 11.5 years old with Cushing. If it were me I would get a second opinion with an INTERNAL MEDICINE VET. Is the tumor benign or not?
Cann't give input on the surgery. I would research it first. and read what you can about cushing from resources.

[cbording]

Thanks very much Glynda.

[frijole]

As you know adrenalectomies are serious surgeries. Have you met with or interviewed the surgeon slated to do the surgery? Just going by memory on what others have done. I know they wanted a comfort level that the surgeon was seasoned in numbers of surgeries done and I believe they met to review the information gathered from ultrasounds etc to discuss what to expect etc. Only the best can handle this type of surgery and doing two at the same time would make it even more important I would think.

So what is critical is if you are using a regular vet - that vet needs to help you find the absolute best surgeon possible. And if that means travelling further than so be it.

Regarding your other dog - did they do the UCCR urine test which can rule out cushings (but not dx it)? Its the quickest, cheapest. I assume if the blood panel came back normal you ruled out diabetes and hypothyroidism which can mimic cushings. Lastly there is a form of cushings called atypical cushings. The only place that does the test is the lab at Univ Tenn in Knoxville. Here is a link to atypical cushings info that might help.

http://www.k9cushings.com/forum/showthread.php?t=198
http://www.k9cushings.com/forum/showthread.php?t=215

Glad you found us! Kim

[chapmandou]

Hi Carson,
Sammy's mom here. If you have looked at the link previously provided, you have seen that even Sam's complex surgery was ultimately successful. He also had vena cava invasion, nearly blocking the vein. Therefore, we were given the same grim prognosis w/o surgery, so we went ahead without delay given the potential for a catastrophic event that might result from the V/C blockage or from intermittent excessive production of catecholamines by the pheochromocytoma, resulting in serious blood pressure spikes. After the right gland was removed and blockage cleared, all was well.

Two years later, a tumor in the left gland (the easier one to access) became functional and had to be removed. At that point, we had an Addisonian dog to monitor. It does take a little getting used to, but most people have fewer problems treating Addisonian dogs than pituitary Cushinoid dogs, for example.

We recently had another dog on this list who underwent a very successful and straightforward removal of a pheochromocytoma (right adrenal gland), also with vein invasion -- very similar to Sam's. It's clear that the surgery has become more common with better results than it was just a few years ago. It's also important to emphasize, however, that your surgeon must be top-notch and well-versed in adrenalectomy. Aftercare must be the very best also -- certainly the first 48 hours. Presumably, you are dealing with a specialist? I should also think they might give you a discounted rate on an ultrasound of Joey's littermate. Given that they're brother and sister, I would imagine this would be worthwhile data for researchers to have.

So sorry you're faced with such a difficult decision, x2! Sounds like you're well on your way to becoming an informed human ;) for your kids, however. If you also have the counsel of a skillful, experienced surgeon and an internal medicine specialist, you're halfway home. Both specialists were required for Sammy's surgery.

All the best to you and Joey and Maggie.

Carol

[AlisonandMia]

Hi,

Here is another link that may also be useful: http://www.k9cushings.com/forum/showthread.php?t=220

(About a dog with bilateral adrenocarcinomas that were removed successfully. Click on the attachment with that post not the link - the link direct to Cornell didn't work for me.)

With regards to Maggie - in your position I think I'd go straight to an abdominal ultrasound. It isn't uncommon to see litter siblings sharing medical conditions (Cushing's and lots of other things too) at around the same age.

Alison

[Squirt's Mom]

Hi Carsen,

Welcome to you and your babies! :)

I can add only one thing to what has already been said - the kind of surgeon you are looking for will be called Board Certified.

Mainly I wanted you to know I am glad you found us. This is a great bunch of folks with experience and support to offer beyond comparison. You, Joey and Maggie are not alone any longer. We will be with you every step of the way.

Keep your chin up!
Hugs,
Leslie and the girls - always

[frijole]

Oops. I didn't realise they were littermates... I'm with Alison then... do the ultrasound first. Sorry if I confused you. Kim

[lulusmom]

Yay, Carol. Thanks for posting and sharing your experience!!! :D:D:D:D:D

[cbording]

Thanks very much Leslie. This is at a Veterinay Specialist hospital in Buffalo Grove, Illinois. I'm sure that the surgeon is board certified. The Dr. who did the ultrasound recommended this vet for this surgery, he has done it many times.

[cbording]

Hi Kim,
Yes, I met with the surgeon for a consult this past Monday. They did additional tests to confirm his eligibility for surgery, and the anesthesiologist also looked at him. The surgeon even called me on Friday night of last week to let me know that surgery wasn't an option for him on Monday because he needed to have some blood pressure meds first. I explained that it was going to be a consult. So, Joey is on BP meds for a week until his surgery next Tuesday.
We haven't done any further testing on Maggie. I'm hoping to get through Joey first, and then schedule her the following week for some tests.

[cbording]

Thanks so much Carol. It's so comforting to know that you've had great success with this type of surgery. I'm still on the hunt for an internal med specialist. I had asked to see one at Buffalo Grove, but they did not think it was necessary as "their surgeons work extremely close with the internal med specialists." I wanted to get the surgeon and the internal med vet in the room together. I'm sure I'll be seeing one soon however.
My primary vet mentioned the same thing to me that it's often easier to manage an Addisonian dog over a Cushing's dog. Not that either one is a walk in the park or anything here.

[Squirt's Mom]

Hey Carsen,

Sounds like you have a plan in place that makes good sense. I'm glad to hear that!

When Squirt had her tumor and part of her spleen removed, I was an absolute WRECK! :eek::eek::eek: From the moment the IMS showed the spot on the ultrasound to me and told me what it meant and what needed to be done, I lost my little mind. My twitcher went on overload.

I was terrified it would rupture before she could get in surgery; I was terrified she wouldn't make through the surgery; I was terrified, terrified, terrified! And it was all out of my hands once the decision was made....not a comfortable place for someone who likes to be in control of things important to her. :o

If not for these wonderful, loving, caring, supportive folks here, I don't know what we would have done. No matter the time of day or nite, someone was always here to hold my hand and tell me it would be ok.

I share this so you will know that the same will hold true for you and Joey. The days and weeks to come may be tough but you don't have to face them alone. We are here for you anytime for any reason...don't hesitate to reach out, honey. You will find many hands reaching back and many soft, strong shoulders to rest against. :)

Hugs,
Leslie and the girls - always

[cbording]

Hi All,
I just wanted to give an update on Joey in hopes that other folks who ever come here can know that there is hope for a dog with tumors on both adrenal glands. Today, Joey is doing remarkably well following his bilateral adrenalectomy last fall. As such, he now has Addison's disease. He gets prednisone every day, and a DOCP injection IM once a month. You would never know by looking at him today that he has gone through some pretty bad times. This is the story of his surgery and its complications:
All things told, his surgery for the actual bilateral adrenalectomy went relatively well. It is a risky surgery, and it was hard to drop him off for it, but the staff at the Buffalo Grove veterinary referral center were fantastic. The initial costs for the surgery was estimated at $3500-4000.
During his surgery, which was on a Tuesday, they noted that he had a tumor on his spleen, and as these can grow and rupture, they removed his spleen also during the surgery.
He seemed to be doing well post-op, but then the complications arose. And boy did they rise. On the day after surgery, Joey developed a pulmonary embolism, or a blood clot which had broken loose somewhere and lodged in his lungs. He basically had just one lung working because of this, and many dogs don't survive this, but Joey did. He was put on oxygen therapy and Plavix. The Plavix doesn't really break up the existing clot, but would help other clots from attaching to it. They don't really treat the clot itself, the way they would use heparin in humans to break it up.
On the second day after surgery, Joey developed severe pancreatitis as a side effect of the surgery. The pancreas doesn't like it when the organs around it are messed with. This nearly did him in. The pancreas had to rest, so he wasn't allowed to eat for 3 more days now.
By Sunday evening, he had ripped the oxygen tube out of his nose, and was doing OK without it, and was starting to eat small bites of baby food. He was weaned off his pain meds and put on a fentanyl patch. He was discharged on Monday.
I got him home, and he didn't seem to be doing good, he wouldn't eat good snacks when offered, and he was vomiting profusely. So, it was back to the veterinary referral center with 12 hours. Turns out they discharged him a little too soon.
Tests showed that his pancreas was still greatly inflamed. An ultrasound showed that it was an enlarged mess. They monitored him for a day, and on Wednesday, 8 days after surgery, I had to make a decision. He was in pain from the pancreatitis, he couldn't eat, and hadn't eaten in 9 days. I gave him one more chance, and we started him back up on pain meds, and started him on a 3 day course of TPN's to give him some nutrition.
Thanks to lots of prayers and lots of good medicine, he was able to eat something Sunday night. This time, they didn't discharge him too soon, but he came home the following Wednesday, 15 days after initial surgery.
It wasn't easy to get him eating normally again, he was still vomiting several times a day at home - sometimes 5 times a day, but the differrence is that the vomit was mostly bile, and not large amounts of fluid the way it was before. I had the vet put him on pepcid to help his stomach. This seemed to help, and every day he was vomiting a little less, and I also did my best to keep his stomach full to prevent the bile. So, I was feeding him every few hours, and also feeding him bread to keep the bile absorbed.
Every day was better and better, and now he is fine. He also developed a biliary "sludge" while in the hospital, his gallbladder wasn't so happy either, and he is still on ursodiol for this as well every day. The vet said we could stop a few months ago, but we decided to keep him on it for a few months more.
Anyway, today he is a happy healthy boy, you would never know what he went through by looking at him. I know that hair loss is one thing that Cushing's dogs suffer with - within 3 weeks after being discharged from the hospital, he grew all his hair back and then some. It's funny - he is 10 years old now, and when he was 6 he had back issues and was put on a fentanyl patch. It took 1.5-2 years for the hair to grow back where that patch was. His post-surgery patch spot grew back in 3 weeks. Which leads me to think that dogs start suffering from Cushing's a long time before they are ever diagnosed.
As an fyi - his total surgery bill was $18,500. Not the smartest choice financially for me, but what can you do? He is my charge, and that was his "college." I am quite broke. All told, in about 6 months, spent about $23,000 in vet bills and meds. If you are considering surgery for your dog, you don't have to expect that there will be such complications.
Now, his littermate sister Maggie has Cushing's as well, but hers is pituitary dependent. Hope to discuss her in a different thread today.

http://3.bp.blogspot.com/_4Buev2eybnY/THBHBm0CMeI/AAAAAAAAHRA/2tybtbjL9tQ/s1600/jj+0081.jpg
Joey about 5 days after surgery in the hospital



http://2.bp.blogspot.com/_4Buev2eybnY/TJAncq2VTFI/AAAAAAAAHVY/dWkt7wcXF84/s1600/deck+0051.jpg
Joey's triumphant return several weeks after his surgery with his sister Maggie

[StarDeb55]

What a tough little guy you have there!! This is so wonderful to hear. Thanks, so much for letting us know how well Joey is doing, even through the struggle to get him there. Congratulation to Joey, you, & his vet team! We absolutely love, love hearing good news!

Debbie