I'm Overwhelmed-Doc. now says surgery

[janis]

My 9 1/2 year old lab/shep mix that I rescued when she was one has recently been diagnosed with Cushings (adrenal) An ultrasound showed a large mass (4.75 cm) on her left adrenal gland.Low dose Dexa test came back abnormal & liver enzymes elevated but not to excess-she is not diabetic.Her only symptom is excessive thirst & freqent urination-otherwise a healthy dog.Yesterday the oncologist said her case is rare b/c of the size of the tumor & it's location.She said that just using medication can be a risk & possible blood clots could occur along the way.She said the best scenario would be to surgically remove the mass (they don't know if it is malignant or not)She said once the mass is removed the Cushings will go away.The surgery is $4,000. and has a 30% risk of complications or death during surgery but they are sure it would be the best route.I am meeting with the surgeon tomorrow morning to talk about surgery in more detail.I am going to a speciality clinic-thought about going to Ohio state vet. medicine school but went to a clinic that is closer to my home.HELP--- ANY THOUGHTS???? I have to make a decision soon-this has consumed me & my dog is my only family and I love her.

[doxiesrock912]

Janis,
A few members here have opted for surgery and I'm sure they'll be able to give input.

Our dog has PDH, if surgery were an option I would consider it. Especially if the dog has no there health issues. The tumor can grow and invade other areas making surgery more complicated or not plausible.
Does the surgeon worry that this could happen?

[goldengirl88]

Hello and welcome to the forum. My Tipper also has a left adrenal mass. You must be in Ohio from what I dead. My only comment on this is that if you are going to go the surgery route, you need a highly qualified surgeon who has a record of this type of operation. I would not go to am clinic near me because it is closer. I would get the best qualified surgeon at the best facility I could. This obviously increases your dogs chance of survival. Ohio State is a great hospital, I have been there many times years ago. If it were my dog my first consideration would be, do I personally feel my dog is in good enough health to under go this operation. I would make that decision of how I felt after my surgery consultation.The reason I say this to you is, bottom line it is your dog, so it will impact you the most. I am sorry you are going thru this, and I pray what ever you do it turns out ok. Blessings
Patti

[Squirt's Mom]

Hi and welcome! :)

Here is a great list of questions one of our members put together for folks considering adrenalectomy to ask the surgeon -

Part I - Questions to ask when considering if surgery is an option for your dog’s adrenal tumour:
1. What type of tumour do you suspect, ?functional, ?non-functional, pheochromocytoma, benign, metastatic
2. Expected life span for my dog in a normal situation. If your dog is close to, at or past his expected lifespan for his breed is surgery going to be of any benefit?
3. Prognosis for my dog if we treated medically i.e. with Cushings medications. AND if we do not proceed with surgery how long do you think it would be before the tumour started adversely affecting his quality of life?
4. If he is miserable now, does the benefit of potentially risky surgery outweigh his current quality of life?
5. Are there any other health problems that could impact on a positive surgical outcome, for example: if your dog is overweight or has heart, BP, liver, kidney or lung conditions
6. Is there any sign of tumour spread – imaging should be done, including ultrasound and on advice of specialists either CT or MRI to check whether there is local invasion around the tumour, into blood vessels including vena cava or spread further away in the body to lungs etc
7. Surgeon recommendations – would he/she do it for their own dog?
8. Psychological impact for the owner: It is important to understand this is risky surgery, sadly current guidelines indicate 1:5 dogs do not make it, and some recommendations are not even that high. Can you accept it if your dogs dies during or in the postoperative recovery period surgery? This is where it is important to weigh up whether the benefit of your dog being fully cured is worth the risk of possibly losing him.
9. Financially – can you afford it? Find out estimate of costs.
10. Hopefully this will not happen, but if your dog collapses, e.g his heart stops either during his surgery or afterwards what emergency measures should be undertaken, do you want your dog to have CPR, how far are you (the owner) willing to go for your dog to be saved in such circumstances

Part II - Surgery has been recommended as treatment for your dogs adrenal tumour, here are a few suggestions on what questions you should ask your surgeon:
1. Are you board certified? How many operations of this type have you done? What complications have you experienced? What were the outcomes?
2. Please explain to me how you will do the surgery, which part would likely give you the most trouble? Will you be doing the actual surgery or a resident in a teaching situation? If so, is their close supervision?
3. Will there be a specialist anaesthetist available for the surgery?
4. If it hasn’t been done, do we need a CT/MRI scan to look at the tumour more closely to check for vena cava involvement or any other tumour spread?
5. What are the risks associated with this surgery, including
• Bleeding (including trauma to blood vessels or other organs during surgery)
• clots
• Blood pressure or heart problems such as arrhythmias
• pancreatitis
• pneumonia
• kidney failure
• infection
• wound problems
• bowel problems
• anaesthetic risks
• adrenal insufficiency or electrolyte abnormalities
• death (sorry but you have to ask that risk too)
6. If we proceed with surgery does my dog need preoperative treatment with Cushing’s meds, antihypertensive if high blood pressure is a problem – phenoxybenzamine recommended preoperatively for dogs with pheochromocytoma, anticoagulants or anything else?
7. How will you treat to prevent clots postoperatively?
8. What would you do if you found anything else during the surgery i.e. nodules in other organs e.g. spleen, opposite adrenal, liver, kidney. Would you remove them and what are the risks associated when doing additional abdominal surgery together with adrenalectomy
9. How long will it take and when will you contact me so I know all is OK, when can I visit after surgery?
10. How will the postoperative period go, how long would you anticipate he would need to stay in hospital? How will we manage pain?
11. What monitoring would be needed, e.g. heart monitoring, oxygen levels in the postoperative period
12. If your dog has an adrenocortical tumour affecting cortisol production will he need to be on steroids following surgery and for how long?
13. If there are problems when I take him home, who do I contact? Hopefully the surgical team until all is stable.
__________________

[janis]

Hi,thanks for writing to me. Yes the oncologist that I saw yesterday said there is a good possibility that the tumor has already been invasive.I see the surgeon tomorrow--it is The Great Lakes Vet. clinic in Warrensville Hts. OH They are excellent-I took my previous yellow Lab there for Lymphoma treatment.

[janis]

Hi,I understand--the clinic is the best in cleveland specializing in oncology, internal medicine,surgery & critical care.I will know more tomorrow. Thanking you.

[goldengirl88]

I am in Ohio now too, but I am up in the north eastern part. Are they going to do an MRI to see where it has been invasive? My Tipper also has a pituitary tumor so she will not be getting her adrenal tumor removed because of other health issues. I will pray for you and your baby. Blessings
Patti

[molly muffin]

Hi and welcome to the forum.

The questions that Leslie posted are great to take with you to discuss with the surgeon.
You need to know the risks and what the surgeon thinks the chances are how many of these they have done and their success rate.
Good luck with the meeting with the surgeon.

Sharlene and molly muffin

[Little CoCo Puff]

Janis, Goldengirl88 & Squirt's Mom are so right. This is a highly complicated surgery and my vet told me that most times these tumors are entwined around major vessels. I would definitely want the most qualified surgeon. We are not trying to scare you but you have to be prepared. I always say you have to be more educated about the disease then your vet because it is your dog and you want to do what is right. Good luck and let us know what happens.

[Trish]

Hi Janis (I am hoping that is your name and I am not addressing your darling girl!:))

Welcome to the forum, glad you found us!! But what a scary time for you. My dog Flynn had an adrenalectomy 16 months ago now and he is doing just fine (apart from a liver resection a few months back, but that is another story!). You have a few good things going for you if you decide to proceed with surgery for your girl.
1. The tumour is on the left side which is the easiest adrenal gland to remove! :)
2. It is <5cm, over that there is increased chance for it to spread
3. Your dog is relatively young at 9 1/2. Flynn was 11 when he had his surgery.
4. You appear to have an experienced surgeon from what you have said
5. From all the research I have done on adrenalectomy and I have done a lot! 4 out of 5 dogs survive this surgery.
6. It sounds like your girl is healthy otherwise.

I read you are going to a clinic nearby, like the others I would really want to know they are experienced with adrenalectomy. I had to travel about 2 1/2 hrs away from our home, I know it is a nuisance but it really is best to have a board certified surgeon do this operation. So I stayed in a motel while he had surgery and also for a couple of days after he was released, he had a checkup with his surgeon each day until we were happy to head home. Here is a pic of Flynny 22hrs following his surgery when I had him back at the motel http://www.k9cushings.com/forum/album.php?albumid=559&pictureid=4381

Re the operation being complicated by the tumour being entwined around blood vessels is certainly not always the case. It appears to be about 25% have vessel involvement and this is more common with pheochromocytoma (which Flynn had) than adrenocortical tumours which more often give abnormal LDDS tests (although be aware there can be false positives) and cushings symptoms. I have attached a summary of a few relevant research articles on this below. I would imagine your surgeon will want further imaging either a CT or MRI to have a better look at the area so they can plan surgery accordingly if you decide to proceed. Flynn's had invaded down a blood vessel into his vena cava but his surgeon was able to confidently deal with that and removed it with no problem.

I am a firm believer in surgery when it is done by experienced surgeons for the right reasons, surgeons have saved my dog 3 times now. I am off the belief if the chances are good then go for it. But this is definitely a personal decision and you know your dog and have a set of professionals to advise you. Whatever you decide we will be here to support you and I will be keen to hear what recommendations you get tomorrow. GOOD LUCK!!!! :)

______________________________________________
Research Articles
In a study of 52 dogs that had surgical removal of adrenal tumors by Massari et al, factors found to negatively affect prognosis included size of the tumor being greater than 5 cm, metastasis (obviously), vein thrombosis and combining another abdominal procedure with adrenalectomy. The median survival time was 953 days with 65% of patients surviving greater than 1 year after surgery. The intraoperative mortality was 2% and the perioperative mortality rate was 13.5%. Dogs with large adrenal masses (>5 cm) had a median survival time of 156 days and were more malignant in behavior. Although this study showed a poorer outcome with caval tumor thrombosis, two other studies did not show this to be a negative prognostic factor (Kyles and Schwartz). Caval tumor thrombus is also associated more commonly with pheochromocytomas, right-sided adrenal gland tumors and large size seems to increase the incidence of thrombosis (according to Massari).

In a study of 40 dogs by Kyles, the short-term mortality rate was evaluated in regards to the presence of caval tumor thrombus. Reportedly, tumor thrombus was seen in 25% of all dogs. Eleven percent of adenocarcinomas had tumor thrombus and 55% of pheochromocytomas had tumor thrombus. As mentioned there was no difference in the perioperative death rate regardless of presence or absence of tumor thrombus. The perioperative death rate was 21% for adenocarcinomas and 18% for pheochromocytomas. Previously, pheochromocytomas patients have a high perioperative mortality rate, but the addition of protocols that include administration of high doses of phenoxybenzamine (as high as 2.5 mg/kg twice daily) have reduced the death rate.

Swartz summarized the prognostic factors and survival of 41 patients undergoing adrenalectomy for adrenal tumors and she reported a 22% perioperative mortality rate. Overall, the median survival time was 690 days. Factors influencing shorter survival times included perioperative weakness, lethargy, decreased platelet count, increased BUN, increased clotting times (PTT), increased AST (liver enzyme), low potassium level, profuse bleeding during surgery, and the need to have a kidney removed at the time of surgery.

[goldengirl88]

Thinking of you and hoping you are able to get the correct information that will help you decide what you want to do. Praying for good things to come your way.
Blessings
Patti

[molly muffin]

Hi just checking in to see what else you were able to find out.

Hope you are doing okay
Sharlene and molly muffin

[janis]

Good Morning, Sorry I have not been on for a few days. My dog, Darby is scheduled for surgery on April 23 at a well know speciality clinic in Akron, Ohio Her surgeon is well respected & know by all the vets in Cleveland/Akron. Of course I am worried but I am trying to think positive. Right now Darby is acting like Darby-no change in behavior & habits---so with that in mind it is difficult to take a happy dog to surgery but I believe, overall, it is the best direction. Time will tell. I have my own surgery scheduled for next week so I have to try to recover before I can deal with Darby's surgery--not at all a good start to 2014!!!!

[goldengirl88]

Janis:
So glad to hear that all went well with the surgery and that your surgeon thinks everything is fine. It is great to hear good news. Blessings
Patti

[molly muffin]

It is going to be a busy month with Darby and you both having surgery.

We'll be crossing our fingers that everything goes fine for both of you :)

Sharlene and Molly muffin

[doxiesrock912]

Praying for both of you Janis!

[janis]

Saturday morning 4/5/14 My Darby is sick! When we got up yesterday morning she seemed OK and ate her breakfast but then as the morning progressed her behaviors changed-she just laid there & looked sad and unhappy. I called my Vet & got her over there. They did a physical exam & a ton of blood work-some of the blood work had to be sent out & will come back this AM. But what they did get results on did not show much that would raise a red flag.So I brought her home. Three hous later she vomitted all over my bedroom carpet and seemed worse -had no interest in anything. so I rushed her back to the vet-another physical exam but this time she showed some abdomen pain on the examination. They gave her an injection for nausea & an antibiotic injection. Sent me home with antibiotic pills to start today after they get the rest of the blood work results back.She seems the same if not a bit worse this morning-just laying there-no interest in a treat or anything else.I will call the vet again this morning-they work a half day on saturdays. My own surgery is Friday next week-it has been scheduled for one year because I had to have my left shoulder replaced & have been recovering from that. But now I am afraid to go for my surgery if my dog is this sick as home & I won't be there. I am so distraught and afraid. I wonder if the cushing's has advanced a lot in the past month since her diagnosis and it is causing this new proplem. My vet does not know what is wrong. I have spent $2,000. in one month and her surgery on april 23 is $4,000. I had to take out a loan for all of this. Plus I know they weill not do her surgery if she is sick. Where do I turn??

[Iraklis]

Do the vets suspect an enlarging tumor?

The symptoms you describe point more to a tumor enlarging than symptoms of excess cortisol (cushings)

Is Darby on prednisone? If not can you call the vets to ask of that would help and what dose?

[Trish]

Hi Janis

Sorry to hear Darby is not feeling so well today. Could she have eaten something she shouldn't? Her poops OK? Is she on any medications other than what she has received yesterday at the vet? I usually go for easy to fix things first, hopefully they have taken bloods to check for pancreatitis as well. I think ring them first and see what results they have and go from there. Is your specialist open on the weekend? Would be great if you could get her in to see them, she may need some imaging to check if anything is going on in her tummy.

[Trish]

Do the vets suspect an enlarging tumor?

The symptoms you describe point more to a tumor enlarging than symptoms of excess cortisol (cushings)

Is Darby on prednisone? If not can you call the vets to ask of that would help and what dose?

Darby's symptoms could be related to any number of conditions. My dog has been treated and had surgery for three abdominal tumours - adrenal and two in liver. Never once has Prednisone been prescribed for enlarging abdominal tumours which he had. Her vets need to assess and rule out the simple causes before jumping to the conclusion of an enlarging tumour and it sounds like they are doing just that. Have they checked her BP Janis? I am just wondering if she is having any spikes that are associated with some adrenal tumours that could make her feel poorly. The nausea injection from yesterday can also make them quiet and if it's cerenia lasts 24hrs, plus the antibiotic could also be affecting her today. I am hoping it is just something like an upset tummy Janis. I have to go to bed now but will check in tomorrow and hopefully your girl will be feeling better.

[Squirt's Mom]

If they have not tested for pancreatitis have them do so immediately. This is a condition that is not at all uncommon in cush pups. What you described sounds a great deal like pancreatitis to me. How is Darby feeling now? Is he walking with his back arched a bit?

Let us know how things are going.
Hugs and prayers for all,
Leslie and the gang

[goldengirl88]

I am so sorry for your situation. I know how you feel as I have some medical issues that need taken care of and will not go and do it because of my Tipper. As previously mentioned an adrenal tumor, or liver tumor is certainly a possibility. Has your dog been checked for Pancreatitis? That would be something I would suspect, especially with the vomiting. Has the dog had any fatty foods lately? Please ask the vet about this, as it can make for a tender abdomen. Have you seen your dog arching its back? That too is a symptom, and they can get real sick all of a sudden with this, unlike Cushing's that does not progress as quickly as what you are asking about. Sorry about repeating what Leslie said, but she and I were typing answers to you at the same time and obviously had the same concerns. Blessings
Patti

[molly muffin]

How is Darby doing? Did you call to get some of the results yet? I hope some are in. Or get her to the IMS to check out. Seems like something going on in the abdomen doesn't it. :(

Let us know
Sharlene and Molly muffin

[Trish]

Hi Janis

Hope Darby perked up today, just checking in and hopefully you can update us later on :)

[goldengirl88]

They have a funny stool when they get pancreatitis too so watch the stool.

[janis]

Darby is much better!!! last week I spent two full days at emergency vet clinics b/c Darby didn't want to eat/drink and was very lethargic. She vomiited once & just was not acting normal--No she was not arching her back. The Vet hydrated her (she was mildly dehydrated) and put her on more antibiotics and gave her shots for nausea. By Tuesday, this week, she was feeling better & acting better so I am relieved. I have had three different Vets diagnose adrenal cushings - the last vet was a internal medicine specialist. They did another ultra sound, chest x ray (which was fine) and blood pressure which was slightly high but she was very stressed out at that point. Also extracted urine & found protein was slightly high so i will pick up meds this morning for that. Darby is still scheduled for surgery (removal of the tumor) but I have now moved it up to april 16th. Wednesday and I cancelled my own surgery and rescheduled it for April 24th. I just can't emotionally deal with Darby's situation & my own at the same time. I can wait!!!
Just wanted to let everyone know what is going on and to pray for Darby on Wednesday!

[doxiesrock912]

Praying for you both Janis. I'm glad that Darby is improving.

[molly muffin]

Oh my goodness. I am so glad to hear that Darby is doing better.

I hope the surgery is a success on Wednesday and the recovery is quick and complete in no time at all.

So they never said what was causing her to not eat, be weak and lethargic, just the mild dehydration? Or the tumor perhaps.

Sharlene and molly muffin

[goldengirl88]

I will say a prayer that your baby does well for the surgery Wednesday. Blessings
Patti

[Trish]

HI Janis
Pleased to hear from you as was wondering what was going on with Darby. With my Flynn's adrenal tumour, his BP was high, which was due to the pheochromocytoma (type of tumour) and the high BP can cause renal problems and proteinuria. Are they confident it is not a pheo, as that type of tumour needs to be premedicated with phenoxybenzamine before surgery for a couple of weeks to prevent any problems with arrhythmias, very high BP during surgery etc. Hopefully the his BP was just due to stress and not this type of tumour.

Hoping all goes well on Wednesday and please let us know how it goes! :)

[goldengirl88]

Thinking of you and your baby and praying he sails through his surgery on Wednesday. Blessings
Patti

[Buffaloe]

Hi Janis,

I wanted to briefly relate the very positive story of my dog's adrenalectomy. Shiloh was diagnosed with a 5.5 cm. tumor in her left gland at 12 years old and was doing poorly. We had an outstanding surgical team and her adrenalectomy and post-op went smoothly. Shi stayed in the hospital for three days, then came home and recovered beautifully...she was a new dog. Shiloh was an extremely happy and healthy girl for another 3.5 years.

Certainly, Darby's adrenalectomy is a very serious surgery with risks but at only nine years old, I think she will do real well. Wednesday will probably be a tough day for you. You and Darby will be in my thoughts and prayers.

Ken

[goldengirl88]

Praying for you both and will be thinking of you Wednesday. Blessings
Patti

[Trish]

Good luck for the surgery today, sending my very best wishes that all goes well for Darby, stressful for you so come in here if you want to chat while your waiting, we all understand the worry of waiting for news :rolleyes:

[molly muffin]

Thinking of you and Darby today.
Sharlene and Molly muffin

[Squirt's Mom]

Our thoughts and prayers are with you, Darby and the medical team today. The K9C angels are fluttering around you all. Let us know how things went when you can and know you are not alone.
Hugs,
Leslie and the gang

[Harley PoMMom]

You both are in my thoughts and prayers too.

Hugs, Lori

[Tina]

Me too Janis. Thinking of you both today and sending lots of positive thoughts for your sweet baby.

Hugs,
Tina and Jasper

[Woodydog]

Me too. Thinking if you both today, sending positive vibes :)

[goldengirl88]

Praying for you and your baby today. Hoping all goes well.
Patti

[janis]

My wonderful dog Darby had surgery Wednesday and is now HOME with me on all fours!!! Darby's surgery took 3 hours and there were two surgeons working on her.They removed a 4 inch in diameter tumor, 8 cnm) removed her spleen, her left adrenal gland and a large muscle that was in their way of getting to the tumor.The tissue has been sent to the pathologist but the results won't come back for 6 days.We need to know if it is a slow growing or fast growing tumor. Unfortunately they got the major large part out but there are still microscopic pieces left that they could not remove. This morning she seems alert, hungry with tail wagging. I am being her vigilent nurse, giving all medications at appropriate times and placing cool compresses on her incision.She has a follow up with the surgeon in 2 weeks AND my surgery is next week Thursday but I can into my own surgery knowing that my loving dog is out of the hospital and recovering at home from a very rough time.I am still worried about the pathology report but there is nothing that I can do now until the results are in-then another conversation with Darby's internist.
Thank you so much for all of the support and well wishes. Your kind words for Darby's recovery made me cry. I sat in the waiting room for nine hours on Wednesday-waiting for news about my loving dog but I did not feel alone-I felt the warm thoughts of all of my friends and from my new K9Cusings on line friends.
I will keep everyone posted. My dog is my world-I would do anything for her!

[goldengirl88]

Janis:
I know what you mean as Tipper is my universe. I am so happy to see the post that Darby is home. I pray the parts they could not get will just be slow growing. Hogs to you and Darby for getting the in this very rough time, and good luck on your surgery. Blessings
Patti

[Squirt's Mom]

Oh, Janis, so good to hear from you this morning and especially to hear that Darby is home and doing ok! I wanted to hear from you but was afraid to ask. :o I pray the path report is good and none of those cells they couldn't get out cause any further problems. I hope this is it and Darby has a long uneventful life from here on out!

Hugs,
Leslie and the gang

[Trish]

Hi Janis

So pleased to hear Darby is home and recovering in your loving care!! Was the tumour mainly in the spleen after all? That is one big tumour, so much better out than in!! Sorry just a bit confused with how you wrote that ;) wondering if you also mean there were macroscopic tumour left behind as if they were microscopic they would not be able to see anything, it could be microscopic if they did a frozen section and margins were not clear. Nevertheless some research shows that even if the tumour has been debulked and they have most of it, depending on histology Darby could still do very well!! But your right, you cannot do anything about that so put it in the drawer for now and we can deal with that when it arises, make sure you get copies of it when you do hear so you can let us know!

Darby sounds happy :) alert and hungry are good signs!! Of course we were there with you while you waited, we will be as Darby recovers to so if you have any concerns or just want to chat pop in and see us! :)

[Harley PoMMom]

So happy to read that Darby is home and doing so well!!! Continuing to send healing and positive energy, and you both are in my thoughts and prayers.

Janis, wishing you the best of luck with your surgery and please do keep updated, as time permits, about yourself and Darby.

Hugs, Lori

[goldengirl88]

Janis:
I am hoping Darby is still improving and that you both have a blessed Easter.
Patti

[molly muffin]

Very happy to hear that Darby came through surgery like a trooper and is back home. We'll just hope that this is the end of it and nothing comes back.

I hope your surgery goes well to and that you and Darby both make quick full recoveries.

happy easter
Sharlene and molly muffin

[janis]

Happy easter to everyone! And I am the happiest because my wonderful, loving dog is home and recovering beautifully. I, of course, am concerned about getting the pathology report next week but still hopeful. I will keep everyone informed but after my surgery I will be in a chair with my leg elevated 24/7 for at least one week or longer. But I will find a way!

[molly muffin]

Janis we are so happy for you and Darby that you are both doing well. I hope that report is exceptionally good. You have both been through so much already and still more to come with your surgery.

hugs
Sharlene and molly muffin

[Trish]

Hi Janis

So pleased to read Darby is recovering so well, that is awesome news!! I am sure your surgery will go just as well and you can recover together. I always like to keep tabs on our surgery dogs so I will be keeping an eye out for your updates and keeping everything crossed for good histology results when they come in. :)

[doxiesrock912]

Janis,
It's truly amazing how resilient our furlets are! Praying for no negative surprises on the path report.

Wishing you a fast recovery too!

Hugs.

[goldengirl88]

Janis:
Praying for a good report for Darby. Keeping you both in my thoughts.
Blessings
Patti

[janis]

Monday-Darby still seems to be doing as well as can be expected.I'm still anxious about getting the pathology report. But--I wanted to write word for word the surgical report that my Darby's surgeon gave to me--It reads
"A ventral midline abdominal incision was made. Her falciform ligament was removed. the left adrenal mass was baseball sized with adhesions to the spleen, liver, pancreas,sublumbar musculature, aorta, vena cava and left kidney.Her spleen was removed.The majority of the mass was removed with a combination of blunt and sharp dissection. A ligasure and ligaclips were used for hemotasis. Microscopic tumor remains. One vessel was noted to have a tumor thrombus."
Any thoughts??? I am eager to get an opinion of someone who knows and or has had experience with this type of surgical report.
Thanking you in advance.

[beaglemom3]

I am so happy to hear Darby is doing well after surgery, wonderful news! I hope the pathology report is good news too!

I believe Tumor thrombosis means the tumor invaded the vein, but since the tumor was removed I would assume that is not the case anymore.

[Trish]

Hi Janis

That was one big tumour and much better out than in. It does sound like they have not got it all and I am wonder which vessel the tumour thrombus was found in and whether it was resected as it is not clear in what you have been provided. I think the pathology report will give better information. Hopefully you get that soon. For what its worth, my dog had a liver resection two years ago for a cancer, it had adhered to the tissue outside the liver. They were able to get it off and he has done well, so I am hoping that will be the case for Darby. I think when you speak to them again with the full results, you could ask whether chemo or radiotherapy would be an option to help mop up any stragger tumour cells.

Pleased to hear Darby continue to make a good recovery! :)

[goldengirl88]

Janis:
My goodness I did not think the tumor was that large. I am hoping that what they could not get will not cause any problems. How is he doing? It seems he really did well for the size and involvement of that tumor. Blessings
Patti

[janis]

Good Morning, My dog Darby is doing really good!!She is getting stronger every day. Still on 5 different meds-one being prednizone that is now getting reduced so that it can be stopped at the right time-but then it will be curious what goes on after that is stopped. Sadly, however, her pathology report came back and the tumor was malignant.Since there are still microscopic pieces in there the surgeon said that it will just be a day by day situation.They are also a bit concerned because she had protein in her urine prior to surgery so that is being treated with meds also-but I think they intend to follow that pretty close.They also have to keep check on her blood pressure.
It was one week ago that she was still in the hospital trying to recover and now she is home and so much better-I can only pray it continues.

[Squirt's Mom]

aw, Janis, that is not what any of us wanted to hear on the path report. :( Do they tell you what type it is? I so glad she is doing well and pray that "day to day" situation will add up to many more months with your sweet girl. Please keep in touch and know we are with you every step of the way, right by your side.

Hugs,
Leslie and the gang

[goldengirl88]

Janis:
You did the right thing and by doing so got yourself more time with your sweet Darby to enjoy her. We can just all pray that the pieces they could not get out, don't grow and cause trouble. There is always a miracle out there. I know this is not what you wanted to hear and my heart goes out to you as I know how I would feel. Please take care of yourself for your own surgery. Do you have someone to take care of Darby? Just think positive and pray on it, Darby came this far so don't count her out. Blessings
Patti

[Trish]

Hi Janis

Sorry to hear about the tumour malignancy. Can you type in the results of the histology? As I have said previously some types of tumour can do well with getting most of it out, so hopefully Darby will be around for quite some time! I was wondering if it was a pheo as you said you have to watch BP, that type of tumour can cause hypertension and then kidney problems with proteinuria. If it is that type, that is the one that I have read can do well even with incomplete resection. Maybe not though, as after a pheo removal they do not need prednisone replacement as the other adrenal is usually still making enough just fine. :)

[molly muffin]

Oh that is a good point Trish. Janis, do you have Darby's report that you could let us know what it says about type of tumor?

So glad she is doing well.

Sharlene and molly muffin

[goldengirl88]

Janis:
Just checking in to see how Darby is doing today. I am hoping all is still well. Blessings
Patti

[Buffaloe]

Hi Janis,

I am sorry to hear that Darby's tumor was malignant. The really big tumors are more likely to have cancer cells but the degree of malignancy of adrenal tumors is low. Shiloh's tumor was also malignant which I somewhat anticipated because it was so large. My surgeon said her tumor had clean margins and he was optimistic. I'm thinking they removed 99%+ of the malignant tissue from Darby so it is GREAT that it's out of her! I honestly believe that IF any malignancy spreads it will be a very slow process. It's in God's hands; best you can do is treasure your sweet girl every single day.

Ken

[Iraklis]

Wouldn't Lysodren be helpful in this case ,since it ''eats'' the adrenals? It is a form of chemoyjerapy after all ,isn't it?

Arte() would also help but most vets don't know about it.

[goldengirl88]

Janis:
Just checking in to see how Darby is progressing. I hope all is continuing to go well. Blessings
Patti

[janis]

Good Morning to everyone. My wonderful beautiful kind sweet loving dog Darby is still doing good.It is 3 weeks and 2 days post op.Her surgeon is amazed at how well she did with the very extensive & risky surgery and I am so thankful and so proud of her. I take her back to her surgeon and her internal medicine specialist on June 3rd. to talk about possible medication since they could not get clean margins.So I will have to see what they have to say. Again, thank you so much for your positive thoughts and support-and I will keep you posted. I love this dog more than anything in life and want her to have the best life possible, with me.

[goldengirl88]

I am so glad to hear this progress report on your Darby. It is so good to hear some joyful news. Our forum is quite sad right now on the passing of Squirt. You got a miracle so treasure it each and every day with your precious baby. Blessings
Patti

[molly muffin]

This is great news! I'm glad Darby is doing so well. :) Hope they have an plan to put in place to make sure that everything remains in good condition!
Hope your surgery went well too.
hugs
Sharlene and molly muffin

[Lucy's Momma]

Hi Janis so sorry to hear about having Surgery..I hope that my Lucy's doesn't go that far..I read up some of the Tumors on the Adrenal and that it's a very difficult surgery, they literally make a hole in the back of the upper part of their mouth to do it...so I hope that all your Decisions are the best for you...I will be Praying for you both..my best to you...

[Trish]

Hi Janis

Glad to hear Darby is doing just fine, hopefully you get some options when you take her for the checkup next month!!

Lucy's Momma, your thinking about pituitary surgery going through the mouth. Darby had adrenalectomy, through the tummy.

[doxiesrock912]

That's wonderful news. Great job Darby!

[beaglemom3]

So happy to hear Darby is doing well, great great news, we need some right about now.

[goldengirl88]

So do you have any plans laid out with the vet about Darbys future treatment if any? Hope all is still going well. Blessings
Patti

[Iraklis]

Gooo Darby!!!


Hi Janis so sorry to hear about having Surgery..I hope that my Lucy's doesn't go that far..I read up some of the Tumors on the Adrenal and that it's a very difficult surgery, they literally make a hole in the back of the upper part of their mouth to do it...so I hope that all your Decisions are the best for you...I will be Praying for you both..my best to you...

That's done for Pituitary tumors, not for the Adrenal tumors.

[janis]

Happy Holiday to everyone.
Darby is still doing great. I am so blessed! I have an appointment with her surgeon and her internal medicine specialist on June 9th. to see where to go from here. I am anxious about that but will let everyone know what they say.
Darby is the most wonderful dog and the love of my life-she is such a trooper and fought so hard to come back from that horrible surgery. what a dog!!!!!!! I love her.

[goldengirl88]

I am so pleased that your Darby has done so well. I look forward to hearing the report after she sees the IMS. Blessings
Patti

[molly muffin]

Excellent news Janis. Darby certainly is a trooper. It isn't an easy surgery and she has done so well.

Hogs
Sharlene and Molly muffin

[beaglemom3]

So wonderful to hear! Great job! Darby!!

[Iraklis]

Stay strong Darby!!!

[goldengirl88]

Just checking in to see how Darby the superstar is doing? Hope all is going well.
Blessings
Patti