My dog has adrenal gland cushings and I need help locatio vet who does keyhole srgery

[maggiesugarsmom]

Hi my dog has recently been diagnosed with adrenal gland cushings on one side (left) and we have had two ultra sounds and the vet is concerned as within 2 months it has grown very quickly .
They recommend surgery but Sugar is 14 years old and I would like to investigate keyhole surgery as a less intrusive option.

She is currently on 40 ml veteroyl and her last test suggests that this is working well.
But because the gland is growing os quickly the vet wants me to operate, but they do not offer keyhole surgery .
Can you give me some advice on how to find a vet who does in the UK and how to find out their statistics, what to ask them, where are the best places around the south east area /
Thank you

[Harley PoMMom]

Hi and welcome to you and Sugar!

I am sorry for the reasons that brought you here but glad you found us.

From a google search I found this article from Veterinary Specialist, Manuel Jiménez Peláez, DVM, MRCVS, Diplomate ECVS
Davies Veterinary Specialists, Higham Gobion, Hertfordshire, UK, regarding using laparoscopy for surgeries and an adrenalectomy is listed: http://avepa.org/pdf/proceedings/4_Cirugia_Cadiz.pdf

Hopefully this surgeon could recommend someone for you. You can also look on the The European College of Veterinary Internal Medicine - Companion Animals (ECVIM-CA) for a surgeon, here's a link to their Diplomate list:http://www.ecvim-ca.org/diplomate-list

Hugs, Lori

[molly muffin]

Oh I am sorry to hear that the adrenal tumor is growing so fast. Is Sugar a large dog or a small dog? One of the first things to make sure of is that she is a candidate for surgery.

One of our members put together a surgery questionaire to help with what 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. with some questions to ask the surgeon:

[maggiesugarsmom]

Thank you very much for your responses and invaluable information and the really good question list you have provided thank you. Sugar is an English springer Spaniel and she is medium size and a bit overweight 19 kilos but the vet still thinks she is a good candidate for surgery despite her age and weight.
My husband is really concerned with putting her through all the postoperative pain and hospitalisation for at least 2 days especially that she hates the vets and being away from home comforts , his thinking is that the cortisol is under control at the moment after medication and that she is now 14 years old and the life expectancy of singers is 15 years, but I am worried of the consequences of not doing the op and she ends up suffering from cancer.
I talked to an experienced vet in one of the large teaching hospitals and he does not think keyhole surgery is safe especially because it is on the right had side and most probably closely attached to the vena cava , but he hasn't seen her yet or her history , ultra sounds etc. so he is just giving a general observation.
Once i get a referral form my vet I will ask them all the questions you sent me and let you know how we get on , it s a very stressful time in our lives and i keep on thinking if this was me what would I decide for myself there is no way answer I'm afraid.

[Jazz]

Sometimes I really think that just because we can does not mean that we should.
I would listen to my hubby if I were you. I really think he is trying to tell you something.
It's a lot of trauma for a very old dog.

Of course you know your dog best.

Hope all goes really well for Sugar.

Christine

[molly muffin]

Yes the surgeon is correct, the right side is closest to the vena cava and you have to be very careful going in there when doing surgery to remove an adrenal tumor. They would probably want a CT scan to show how close it is.

If she is being controlled on medication, and is happy then that is the most important thing.

I do think that quality of life when you get an older dog can often be one of the most important aspects. Either way you are armed with the questions to ask the surgeon and you can make an informed decision. One of the questions that I think everyone should ask is, if this is where your dog, would you do the surgery or not, and reasons for their answer. Maybe that can help you.

It is not an easy decision to make. My heart goes out to you, as this is a very rough time. I think that once you make your decision, whichever way you decide to go, then it will all feel more balanced for you and hubby.

[Trish]

Hi, my dog had an adrenalectomy 2 1/2 years ago now. He has done very well. He was 11 at the time. He had a pheochromocytoma not a cushings tumour, hope you can find a surgeon you can trust. I did not have the option for laparoscopic surgery, but most important is finding a very experienced surgeon who has done many. Left is good, Flynns was on the right with tumour in vena cava so we were very glad it went well. It is a tricky decision with age being taken into the equation too, so I hope you find a surgeon to give you good advice. Happy to help with any questions
Trish :)

[maggiesugarsmom]

Update : I have now made an appointment with the RVC (royal veterinary college) for the end of this month.
If we go ahead with an operation they told me that she will stay in hospital post op for 4-5 days.
Trish (if I may) can you tell me how long did your lovely dog stay in hospital after the op ? And was he in a lot of pain after , were there mini crisis
Unfortunately the adrenal gland is on the right hand side which is trickier than the other side I am not sure what do decide if it ha invaded the vena cava
It is such a heart ranching time for us all