New in search of advice - Adrenal tumor removal?

[browndog]

Hello, I came upon this forum yesterday and I'm hoping some of you here can help me. Yesterday, my almost 12 year old Lab was diagnosed with an adrenal tumor. She also has a mass in her spleen but the vet seems to think it is unrelated to the adrenal tumor. Possible localized lymph node involvement but they couldn't really tell. There is a blood clot in her spleen too. He recommended surgery to remove the adrenal tumor and the spleen. She was diagnosed with ultrasound after her bloodwork came back with 2 elevated liver levels. She is otherwise completely healthy, and completely asymptomatic. We are doing x rays on Friday to determine if there are any suspicious areas in her lungs or chest cavity. He does not think the vena cava is involved at this point and thinks she has a good chance with surgery. Friday will tell us more. I would love to hear your experiences with this surgery, and from those of you that chose not to operate. I don't know what to do even if the chest x rays come back clean. She is otherwise healthy, happy and just my normal sweet pup.

Ariana and Kenya

[labblab]

Hello and welcome! Literally, I have only a moment to post :o, but I wanted you to know I have edited your thread title to include your question about surgical removal of Kenya's adrenal tumor. This way, it will be easier for folks with experience in this regard to find you and talk with you. ;)

Marianne

[browndog]

Thank you Marianne.

[Squirt's Mom]

Hi and welcome to you and your baby!

Here is an excellent list of questions one of our members put together when facing an adrenalectomy.

Questions to consider and ask the surgeon when facing an adrenalectomy -

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.

[browndog]

Thanks Squirts Mom. I am really looking for personal experiences with this as I am unsure if it's even worth putting her through it. She is healthy and happy with no symptoms at this point. Also, if anyone has any personal experience with this operation and Cornell I'd be so grateful to hear about them. Thanks.

[Squirt's Mom]

It's a long thread but well worth the read, especially when facing an adrenalectomy. Flynn had a pheochromocytoma, not a cortisol secreting adrenal tumor but the procedure is the same - an adrenalectomy.

http://www.k9cushings.com/forum/showthread.php?t=4242

[labblab]

I'm finally back again! Trish and Flynn's thread is definitely a helpful read. If you search through other thread titles containing "adrenal tumor" or "adrenal surgery," you will find additional first-hand accounts. Some of the stories are of great success; sadly, others are not. From the experiences of our members, we have learned that this is indeed risky surgery and should not be undertaken without that awareness.

As you can see, I am a Lab-Mom myself :). I can easily put myself in your shoes and understand the conflict as to what to do, especially given Kenya's age. It sounds as though, joyfully, she has been a "young" 12-year-old. But still, that is an age that is already approaching the end of her natural lifespan. So to me, commitment to surgery of this magnitude (physically for her, and emotionally/financially for you), would indeed take very serious consideration. If successful, the surgery can indeed cure her of any problems associated with these tumors. But even with successful surgery, as to how much quality time she still has ahead of her, we do not know. Will it be enough time to balance all that is involved with the surgery?

If you do opt for surgery, there are undoubtedly obvious advantages to moving relatively quickly so as not to allow the tumors in the adrenal gland and spleen to advance and become even more complicated to remove. Even if there was nothing going on in the adrenal gland, I'm guessing the tumor in the spleen may be life-threatening in its own right? So another hard part to all of this may be that you will not have a great luxury of time to reach a decision. But I hope you won't feel pushed to decide before you can take the time you need to weigh the options.

I guess one big question I would ask the vet is whether he/she believes these tumors will be life-ending for Kenya if they are not removed, and if so, in what time frame. Do you have time to wait a few weeks and perhaps re-image to evaluate changes? Having that information in hand may help you decide whether, in balance, the surgical risk is one that you wish to undertake in comparison to the risk of not intervening.

I do hope some folks with personal experience will soon be stopping by to share their thoughts. I can only imagine how hard it would be to subject your girl to such major surgery when outwardly she does not exhibit any problems. But we also know these tumors can be hidden time bombs just waiting to explode. I think the hardest part is having to make the decision on Kenya's behalf. If only you could sit down with her to talk over the options and ask her what SHE wants to do :o. But the difficult decision falls to you, and we will stick here right by your side as you weigh the alternatives and your decision is made.

Marianne

[browndog]

Thank you Squirts Mom, I will read the thread. Her vet thinks the adrenal tumor is also non-functional as she has no symptoms.

And Marianne you spoke directly to my heart and echoed my feelings exactly. She is a young 12. We walk 3+ miles a few times a week, lots of swimming and retrieving, no physical symptoms of ailment at all. We went in for her regular checkup and yearly blood work and 2 liver values plus a muscle protein (i can't remember which) came back elevated. So she had a sonogram of the liver in which they found the issue in the spleen. At first thought it was just a fatty tumor in there (she has many) but we scheduled a follow up with the specialist radiologist anyway just to be sure and they found the rest of the issues. I wasn't at all prepared to hear what the Doctor had to say. He does believe the tumors are life threatening and malignant. The one in the spleen appears to be causing hypercoagulation which he said is a hallmark of malignancy. He couldn't give me a time frame if I did nothing, or even if I did the surgery. I am hoping the specialists at Cornell can give me more definitive answers but still it's a rock and a hard place. I didn't fully grasp the severity of the surgery till I got home and started reading. Thank you so much for the support. It means more to this distraught Labmom than you can know.
Ariana and Kenya

[labblab]

Dear Ariana,

I can so easily imagine your shock and sorrow over learning this news. My older Lab girl is almost 11, and although not a Cushpup, she has had numerous other health problems throughout her life that have left her an "old" 11. So in her case, my husband and I have already steeled ourselves to knowing that should something major like this come up for her, we would not intervene. But oh, how much harder the decision would be if she was still walking and retrieving with spirit and gusto!

Until folks with personal experience join us in the conversation, here are a couple more links. In order to give you a balanced and realistic view of adrenal surgery, here's a recent thread that shows you what a wonderful gift successful surgery can be.

Amanda: http://www.k9cushings.com/forum/showthread.php?t=6731

But here's a thread that ended with heartbreak for our family here. I know it will especially tug at your heartstrings because dear Aggie was also a beloved Lab girl. I debated posting this link because I don't want to worry nor sadden you excessively. But before going forward with the surgery, I think it is only fair for you to truly know that the outcome is not always what we wish for. Post-op complications of various types seem to carry as great a risk as the surgical procedure itself. But the flip side is that if you know the tumors carry a terminal diagnosis, then as risky as it may be, surgery offers the only genuine hope for long-term survival.

Aggie: http://www.k9cushings.com/forum/showthread.php?t=7094

Cornell certainly has an excellent reputation. So I hope they will be able to answer all your questions with insight and compassion. We'll be anxious to hear all your further reports. And please give Kenya a big hug from her new Auntie Marianne, OK? ;)

[molly muffin]

I just want to say hello and welcome you to the forum.

It is definitely worth reading Flynns thread. Just as a note, it is very important that if the blood pressure is controlled prior to any surgery and that they clamp areas off as blood clot is one of the biggest risk factors post surgery.

I've messaged Trish (flynns owner) but she is I think currently on a flight and then at a conference so not available but I did give her the url to this thread. I'm sure she'll check in if she can.

And a belly rub from Sharlene and Molly for Kenya.

[browndog]

Thank you so much, Marianne. Your Lab is a beautiful girl. I read both threads, thank you for sending them. We go to Cornell the 25th so I will know more then. She had bloodwork run again and it all came back normal, even the liver values that were elevated before that brought all this on. Her vet thinks she's an excellent candidate for surgery but it doesn't make me feel any less terrified about putting her through this. We will see what happens the 25th. Again, thank you for the information and support. Kenya thanks you too :)

[browndog]

Thank you Sharlene and Molly!

[merry2day]

Hello Ariana,

Welcome! You are in the right place to learn about adrenal tumors and get great community support. Last year we faced a similar decision with our Jack, who is now 8 and a half years old. Here is a link to our story: http://www.k9cushings.com/forum/showthread.php?t=6578

We discovered Jack's tumor when he had a health crisis. Fortunately he survived with good emergency care, and we went on a fast journey from diagnosis through a successful surgery. His surgeon was very experienced, and the top-notch post-surgical care Jack received at Tuft's was key to his quick recovery. Although we were cautioned that he may not survive the surgery itself, Jack did well and was home within days. The odds seemed against us, but sometimes things do go right -- see Trish's inspirational signature line.

Jack is a big dog so he falls in the senior category although he is quite robust. I worried we were putting him through too much, but now that I've seen how he bounced back, I am glad we made the decision for surgery.

Good luck to you and Kenya! We'll be thinking of you.

[molly muffin]

Let us know what Cornell has to say. It is always scary I think. Hopeful but scary.

Hugs

[Trish]

Hi! Just wanted to pop in and welcome you! I see you have been given our Flynny's thread to read, I am very happy we did surgery as he is still here over 2 1/2 years later! He was on older dog, so other things to pop up that we have had to deal with, he is 14 now so I do not regret for one minute having it done. I am on holiday, but home this weekend so hopefully can talk to you some more then. But very happy to answer any questions :) a big decision, so vital to have an excellent and very experienced team advising you and for the surgery if you choose that path. Will keep an eye on your thread :)
Trish

[Amanda's Mom]

So sorry to hear about your dilemma. Nothing is harder
Than trying to make these decisions for our precious fur kids. If you search my posts under Amanda's Mom you can read about our experience with adrenal surgery. It was very positive despite my girl's age (12-1/2) heart disease and blood pressure issues. It was absolutely the right decision for us but sadly not all adrenal surgeries go as well. We were very lucky to have a fabulous internist and surgeon with magic hands who brought Amanda through with flying colors. Her heart disease continues to progress but she is happy and doing great nearly eight months later. If you have any specific questions please ask and I am happy to help if I can. Best of luck and positive thoughts sent your way!!