Re: ilkovkris (New member thread started) - Bella (8 y/o Weim, adrenal mass)

[mytil]

I'm new to this forum and wanted to share my story with you in the hopes that I might gain a valuable perspective on my dogs recent diagnosis.

Bella is a 9YO Weim and has been in great health over the years, active and loving. 1mo ago I noticed a bump on her skin and after visiting the vet it was determined it was MCT which was successfully removed and curative.

I did a F/U with one of the best oncologists here in CA and after doing an ultrasound study they found 2x3 cm enlarged mass like cranial pole on her left adrenal gland.The oncologist suspected neoplasia and recommended ACTH stim test first. The test came normal but he suggested that the gland be removed surgically to ensure if cancerous the growth doesn't metastasize. He also prescribed DHA which supposedly has cancer reducing properties. I am concerned about the complexity of this surgery although I was assured by the oncologist that they have performed many of these and I shouldn't worry.

My issue is subjecting Bella to this if only to find out that was the tumor benign. As I mentioned her recent blood work and exams have shown she is in great health with occasional GI issues that we concluded were diet related.

I have been going back and forth with my vet and the oncologist about what course we should pursue and so far they are both leaning towards surgery. Coincidentally during the last visit the vet aspire 2 other bumps on her ear and vulva and they tested positive for mass cells so I need to tackle that as well through chemo per the vets recommendations. I would truly appreciate any advise or thoughts at this point. Has anyone heard about Zeolite and its cancer fighting properties? Thanks you all! Kris

[mytil]

Administrative Note:

Kris --- I have taken the liberty of starting a new thread for you and your pup. This way others will be able to see your information easier.

Terry

[Buffaloe]

Hi Kris,

I'm sorry your Bella has an adrenal tumor. My Shiloh had a very large tumor in her left gland and it was affecting her health ALOT. In our case, an adrenalectomy was necessary. Your situation sounds quite different. Bella's tumor is not large and doesn't seem to be causing her any apparent health issues. Of course, malignant adrenal tumors are worse but benign tumors can also cause serious health problems and should sometimes be removed. Every situation is different but I would be very hesitant to subject my dog to an adrenalectomy if she were doing well. It is a huge surgery with definite risks. We had a great surgeon and he said they have an 85% long term success rate with these surgeries. I don't have any experience with the other things you mentioned. Bottom line, I don't think I'd let my dog go through an adrenalectomy unless the tumor was affecting her health in a significant way. You can always monitor it via ultrasounds and if it enlarges or starts causing her serious health issues, then maybe go with an adrenalectomy. Those are just my thoughts. Good luck to you and Bella.

Ken

[Trish]

Hi Kris

I think first off I would want to speak to the oncologist about the mast cell tumours that have just been biopsied and get a handle on the treatment plans for that.

There are a few of us here that have dogs with adrenal nodules. It can be difficult diagnosing if they are malignant and going to cause problems or if they are benign and can be left alone. 19 months ago my dog had an adrenalectomy, he is doing pretty well. He also has a 1cm nodule on his remaining adrenal, it does not appear to have grown in that same timeframe so we are watching it. Have they given you any clues as to what they think Bella's one is, a 3cm nodule is getting up there in size, some studies say there is a higher chance of it spreading when it is >5cm. My dog also had normal cushings tests, his was a pheochromocytoma. I do give my dog DHA, in the form of fish oil. I don't know about the zeolite you mentioned. We have put together a list of questions for your specialists when you are considering whether adrenalectomy is the right choice for your dog.
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.

Hope this info helps,
Trish :)

[goldengirl88]

Welcome and sorry that your Bella has an adrenal tumor. My Tipper has one on her left adrenal gland . WE have been monitoring it for about a year now, she goes every three months for an ultra sound. The last one was in April did show a miniscule growth in her tumor. I am waiting until this US to see what I am going to do. It is just a shame that you can't tell if they are malignant or not until getting in there most of the time. I hope everything goes well for you and Bella, and that she has no problems from this. Blessings
Patti

[ilkovkris]

Thank you Terri, Ken, Trish and Patti for the encouraging words and support! I am going tomorrow to see another oncologyst and seek her opinion on the adrenal gland growth. I am hopeful that as the experts in their field they don't become overzelaous about proceeding with the surgery and maybe taking a more conservative approach and monitor the growth before embarking on this complex procedure. The good thing is that Bella is in good health and the last thing I want to do is for the doctor to get in and complicate her overall health or worse risk her life. It is however a double edge sword and I don't want to delay a potential surgery at the expense of Bella's life. Thank you all

[Trish]

Hi Kris

Hope it goes well with the oncologist tomorrow and you can hopefully get some direction and a plan to help Bella. One of my questions would be as it has been measured at 3cm, does this make it more likely to be malignant? I don't think any surgeons would be too overzealous in doing surgery when it is not warranted, the surgeons I have come across are very professional and have good rationale when suggesting surgical options. My dog would not be here without them and I have a lot of faith in our surgeons. It was maybe an easier decision for me as my dog was symptomatic and deteriorating, if I did not choose surgery he was only given perhaps a few months. He was 11 when he had the surgery. I will be interested to hear what the think the impact of the mast cell tumours will be so let us know what they recommend when you get a chance. GOOD LUCK!! :)

[goldengirl88]

Good luck at your appointment, we will be thinking of you and sending you positive energy. I hope you visit goes well. Blessings
Patti

[Trish]

Hey, what happened with the oncologist, hope it went well for you and Bella :)

[goldengirl88]

Just wondering what happened at your appointment?? Hope everything went well. Blessings
Patti

[ilkovkris]

Hello everyone...sorry for the late response but it has been rather hectic around here after more tests and several meetings. Although her ACTH test was normal the oncologyst suggested we do a blood pressure exam, Xrays and dexamethason supression test. The latter turning with increased levels of hormones secretion and a follow up with the surgeon. I take comfort that both the oncologyst and the surgeon are highly qualified and initially suggested we monitor the size of the tumor through US but after the latest findings both suggested we proceed with the removal of the adrenal gland. While under they will also remove the mass cell tumors. I remain optimistic for a quick recovery next Tuesday as she is a very healthy dog and i am sure will bounce back. Thank you all!

[goldengirl88]

I am so happy to read that you have very qualified doctors for you baby. Having confidence and trust in your doctor means everything. I pray all goes well and your baby is rid of all the tumors. Blessings
Patti

[molly muffin]

We'll all be sending our best wishes for a successful surgery and speedy recovery. It's so good to have a great team on board. It makes a world of difference.

Sharlene and molly muffin

[Trish]

So Tuesday is the big day, hoping it all goes smoothly and to plan :). Sometimes I think it is harder on the owners waiting to hear how it all went than for the dog who is oblivious to it all! Hope you and Bella are enjoying the weekend and having some fun!! It does sound like you have a good team on your side. A few of us here have had our pups go through adrenalectomy so will be happy to help if you have any questions along the way. Of course, we will all be waiting to hear how it goes on Tuesday!



GOOD LUCK TO YOU AND BELLA!!

[Buffaloe]

You and Bella will be in my thoughts and prayers, especially Tuesday! As you said, she is a young, strong girl and will handle the surgery, post-op and recovery very well. You hang tough.
Ken

[goldengirl88]

Hoping and praying that Bella goes right thru her surgery and recovery with flying colors. I will say a prayer for you both, Good luck to you Bella. Blessings
Patti

[Trish]

I think today is the big day for Bella's adrenalectomy. Fingers and paws crossed it has all gone well and she is back to bouncing around again soon!! Your in my thoughts today :)

[molly muffin]

Oh yes!! Go Bella! Everything crossed for a successful surgery and a good recovery.

Sharlene and molly muffin

[goldengirl88]

Just wondering how Bella did and how she is today. If you have time let us know if not we understand. I have been saying a prayer for her. Blessings
Patti

[goldengirl88]

Praying that Bella did well on her surgery and that you both are resting. Blessings
Patti

[ilkovkris]

Hello everyone, thank you for your thoughts and prayers! We appreciate all of you! The surgery went very well on Tuesday with successful removal of the left adrenal gland and mass. Six skin masses were also removed (potential mass cell tumors). There was no vascular invasion and clean CT scan. Both the liver and spleen were biopsied with no abnormalities. She spent 2 days at the hospital post surgery with 24 hours monitoring and had normal blood pressure and normal blood cells count. An ACTH test was performed post surgery showing normal functioning right adrenal gland. She is now home and up and about and have to restrain her from wanting to run. She is on tramadol for the pain as far as the medications. We have a follow up in 10 days. Is there anything else I need to do going forward? Change diet? Supplements to support her remaining gland? Thank you

[goldengirl88]

Oh I am just delighted to hear that Bella did so well. That must be a big worry off your mind. I am glad everything is over and that she is home recuperating. Just spoil her and give her lots of love. So great to hear good news!. Blessings
Patti

[Trish]

Hope all is going well with Bella's recovery and you are keeping her resting. I remember Flynn was not allowed to be off leash or run and jump for a couple of weeks at least postop. Hope she is eating well and bowel working OK. Tramadol is good for the pain, we used that too. I used to keep his wound clean, he was good and did not bother it but some dogs need a dressing or to wear a tshirt to keep them away from it or a cone if they start nibbling at it.

Re supplements to support the remaining gland. I never had to give Flynn anything, his adrenal tumour was a pheo so his opposite gland produced enough cortisol on its own so did not need supplementing. Some don't and they need prednisone but it sounds like Bella has been checked with ACTH test and is doing OK there. It will be interesting to hear what the histology was on her adrenal tumour.

Sounds like she is doing great which is good to hear!! :)

[goldengirl88]

Hope your Bella is still recovering well and that things are slowly improving. Blessings
Patti

[molly muffin]

Great to hear that surgery went well. Hoping for a speedy recovery!

Sharlene and molly muffin

[ilkovkris]

Hello all, Bella is doing well but I noticed today that her appetite is not as robust as yesterday or the day before...is this normal post surgery or am I way too concerned? Prior to the surgery she has always been a picky eater with occasional GI issues. Thankfully they have tested her GI track and it was all normal. Appreciate any suggestions/thoughts.

Thank you

[Harley PoMMom]

Appetite waning, I would be concerned too. Does the vet know that Bella's appetite is not as good as it was? Although her post surgery ACTH stim test results were good, it could be that her right adrenal gland, for some reason, isn't functioning as well as it should. If it turns out to be that she is not producing enough cortisol, prednisone should perk up her appetite, but I wouldn't give her any until you can talk to the vet.

Please keep us posted, ok ;)

Hugs, Lori

[Trish]

Hi - I don't think you are too concerned, that is our job!! :) But my first thought was the same as Lori's. Depending on the type of tumour that has been removed the cortisol production may not be sufficient yet. If that is the case, there is the potential for Addison's when the dogs cortisol drops too low which as you know is tested by the ACTH. Decreased appetite, nausea, vomiting, wobbliness are all signs of that. So if it was not coming right quick smart, I would be taking her back to the vet for testing too. Hopefully it is just her GI tract protesting at all she has been through lately, but keep her under close watch and any sign of further deterioration I would take her in. Hope she is feeling better tomorrow.

[goldengirl88]

Hope you talked to your vet and told them of Bella's decrease in appetite. I am glad other wise things are progressing as they are supposed to. Just keep a watchful eye out as everyone said for the low cortisol. Blessings
Patti

[ilkovkris]

We went to the vet today and he looked at Bella check her incisions, temp and vitals and said that she looked great. Her energy is good, almost took him for a run...lol and he suggested that maybe she is getting bored with her hypoallergenic diet and to try some boiled chicken. Her ACTH test was normal and he wasn't concerned. Interestingly enough she reacted very favorably to the chicken and ate great...and asking for more. But now she is not interested in her prescription food so I need to figure something out. The vet even suggested that maybe her adrenal gland tumor may have been the reason for her GI issues. I will keep monitor her.

[Trish]

Hi! So pleased to read Bella checked out so well today!! That is a relief, also to hear the ACTH was normal :). I am really wondering about the histology of this tumour, considering she has not needed prednisone to supplement at all. Hopefully you get the results back soon.

My dog also has gut issues and it was eventually confirmed IBD with biopsy. All good in that department now **touch wood** :) and I keep him on a novel protein to keep it at bay, plus a probiotic and Metamucil. He has been on the hypoallergenic food in the past, I must say he was not too keen on it!! So it probably quite likely she prefers tasty chicken, I know Flynn would! The removal of Flynn's pheo adrenal tumour did not settle down his gut unfortunately, but you never know as these pups are all so different!!

Hope she continues doing well! :)

[goldengirl88]

So glad to hear that all was well on Bella's visit. I would give her the chicken for now. I would just be careful where you buy it as all the chicken is pumped full of saline now and that is not good. Tipper eats some chicken with her kibble and I buy it special with nothing in it at all. It is killed, cleaned and frozen. Blessings
Patti

[molly muffin]

So glad she is eating the chicken. I use ground chicken breast with my molly when her digestive system gets dicey. That and mushy rice as usually helped get her through some rough patches.

Sharlene and molly muffin

[ilkovkris]

Hi all, wanted to update you on Bella's recovery. She is doing great, eating well and back to her own playful self, although still restricted by her doctor due to the incision. Interestingly we are 2 and half weeks post surgery and it seems part of her incision hasn't quite healed yet and it looks to leak a bit. We met with her vet and he looked it and said that it wasn't infection but probably due to her active movements (short of putting her in a cage it's impossible to completely restrain her). He prescribed her antibiotic for 10 days and asked to restrict her activities and wear the collar. Has anybody else had similar experience?

Thank you