Mini (border collie/hound cross) 11 yo, with probable AD-Cushing's.

[mini_mum]

Hi there,
My dog Mini has just been tentatively diagnosed w Adrenal-Dependent Cushing's. We moved and she was peeing inside sometimes, but she's a stressed out dog generally (Big Huge Fears, mostly around fireworks & thunder & wind) so we thought it was about stuff being put in boxes, etc. But then the move happened and we all calmed down, but she didn't. Then she was (is) drinking buckets and peeing virtually clear urine all the time & we knew something big was up. She's been for a blood test (step one) and then a full day test (step two), which indicated likely an Adrenal-dependent Cushing's. Tuesday she goes for an ultrasound (step three) to confirm. She's having some leg-shaking and a rattley chest when she sleeps. She has a heart murmur she didn't have before. Heavy panting almost all the time, especially with any kind of excitement (which there's a lot of in our house). I can hear her snoring no matter where I am in the house, not that she seems to be sleeping much or well at all. She needs out for pee time several times per night - if we miss the desperate pee-plea she goes anyway, right on the floor, poor soul doesn't want to be doing that in the house at all, but she can't seem to help it. We're working harder at catching her before that happens. She has a little sister (same parents, different litter) who's healthy. They're very well bonded. I can't imagine one without the other. :( :(
My question: What do others think about this adrenal-gland-ectomy surgery??? Our first thought is that we'd go for it, if it turns out a possibility, as this kind of Cushing's doesn't respond well to medical treatment (or so it's been explained to me). She'll be 12 this year though. Some seem to be suggesting we'd be a bit cruel to subject her to surgery. Seems cruel not to, though! I'm a bit confused, I guess.
Sorry such a long message!

[molly muffin]

Hello and welcome to the forum.

It sounds like they did the blood test and and all day ldds test to diagnose

Can you post the results of the LDDS test? That would be a pre, a 4 hr and an 8 hr result. Also any abnormal high or low on the blood test with ranges? That will give us a better idea of what is going on and help us give you better feedback.

A follow up ultrasound is definitely the next thing that I would do too so glad you are having that done. You want to see exactly what is going on and if it is indeed an adrenal tumor and if it is, what side it is on, how large it is, and if it has invaded any other areas.

If you do elect to consider the surgery option, make sure you go with a board certified surgeon who has done many of these operations successfully. That is Very important, as it Is a serious surgery.

We have had members who have gone through the surgery option and we've had others who have chosen to treat with medicine like vetroyl or lysodren.

I'm going to post a questionaire that one of our members who dog went through surgery created to help other members speak with the vets and surgeons about the surgery.


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.

[mini_mum]

Thank you for your reply! Yes, it was the 4 & 8 hour test. I don't have results in front of me, i only spoke to our vet on telephone. When i go on Tuesday, i will request the report printed out.
That is a wonderful resource, all those questions. I tend to ask too few, so this is much appreciated. My Mini keeps going off on her own :( another new development. Poor monkey.

[mini_mum]

The Cushing's has been confirmed for my old girl, but there was no tumour on her adrenal gland after all! Instead, they found liver spots and areas and are recommending a biopsy. She's been for x-rays and more blood work to make sure she's up for the biopsy. Head spinning!
I saw her x-ray film. Her adrenal glands are enlarged. Her liver is also enlarged. (the spots they found were via ultrasound). Her lungs are clear (just a little thickening, as would be expected in older dogs).
Seems like a lot of tests and such and all she's doing is peeing lots and drinking lots and going off on her own instead of staying with us in the common room. I think if she had liver cancer she'd be far sicker, but the vets say they can't treat her for Cushing's until they rule out cancer.
But as long as we hold on to the idea that her Cushing's IS going to be treatable with Meds now (we though it wouldn't be) we are fairly hopeful. I hope her liver just had spots like the thickening on her lungs, not great, but not unheard of and of no special concern....just a part of aging.
Sorry no report numbers. I keep forgetting to ask for print-outs.

[judymaggie]

Hi! Just wanted to add a couple of thoughts re the liver biopsy. It is very difficult to get a biopsy of exactly the right spot. Also, as much as I can recall (my last beagle had liver biopsies), the dog has to be under full anesthesia for a liver biopsy. Before proceeding, I would suggest you ask the Internal Medicine Specialist (I assume that who is going to do the biopsy) what the outcome of the biopsy means. If the biopsy comes back as positive for cancer, would you consider removal of part of her liver? Would you consider chemotherapy? Keep in mind that, even if the biopsy comes back as negative, there is no way to completely eliminate the possibility of cancer.

I don't want to be such a pessimist -- I just want you to think about your options when considering whether to proceed with the biopsy. I honestly question the comment that Cushing's treatment can't proceed until they rule out cancer.