Winston, 8 year old westie with adrenal tumor

[WinstonTheWestie]

Hello all,

I just wanted to take a moment and remark on how wonderful and supportive this community appears to be! My dog has not been diagnosed with Cushing's, but it has been a wealth of experience and information for me to read. I've been pouring over posts for several days now. :) I hope it is okay to post here even without the Cushing's diagnosis, but I believe some of you have been through a situation similar to what I am now.

My dog is an 8 year old neutered male Westie who was diagnosed with an adrenal nodule/mass about 18 months ago. It was an incidental finding discovered during a routine ultrasound performed while working up chronic vomiting that led to a diagnosis of presumptive IBD (no intestinal biopsies, but he completely stopped vomiting once eating a prescription hydrolyed food). The mass was off his right adrenal and measured approximately 1 cm. His left adrenal was at the small side of normal measuring about 0.45 cm. We did another ultrasound 3 months later, and things were static. Another in 9 months (so a year after initial discovery of the mass), and it was still very similar in size at 1.1-1.2 cm with the L adrenal slightly smaller at closer to 0.4cm, but this was with a new internist due to a move halfway across the country for my job. This new internist recommended continued monitoring every 6 months because things still seemed static.

A couple weeks ago, at our most recent recheck, his right adrenal mass had grown to 2.2 cm! Luckily the internist didn't think the mass invaded his vena cava. It had been a busy little thing in the last 5.5 months. Winston is still symptom free. The internist thought his liver may be very slightly more rounded on ultrasound, so she wanted to do the low dose dex supression. His other significant ultrasound findings were likely secondary to his IBD. Regular bloodwork was completely within normal limits, and his chest x-rays were considered normal overall. His low dose dex was negative, with his cortisol going from 1.3 to 0.3 and 0.4 at 4 and 8 hours, respectively, I think.

Given how fast this mass has started growing in the last few months, the internist recommended an adrenalectomy. We discussed blood testing for pheochromocytoma or continued monitoring as other options. So now I face the decision of whether to pursue this risky surgery in a dog that has no clinical signs. On one hand, he is as healthy now as he will ever be, and there seems to be no signs of tumor invasion as of now. On the other, I'm scared he is going to be one of the 10-20% that die as a result of this procedure.

I am lucky to be on staff in a large veterinary hospital, so I sought second opinions from another internist and a surgeon, both who agreed that they would recommend the adrenalectomy as the ideal choice. I had a focused ultrasound performed by a radiology resident, and he also thought that the tumor did not invade Winston's vena cava (yay!), but he was worried that it was adherent due to something he saw. I called a surgical oncologist at a former hospital I worked at (I had a close, mentor-type relationship with her and she knew my dog well), and she also thought adrenalectomy was the way to go.

So, we are scheduled for adrenalectomy with a surgeon with an interest in surgical oncology/soft tissue on August 9. I do feel fairly comfortable with our surgeon (can you ever feel 100% when it comes to this risky surgery?). She has done quite a few of these procedures successfully, including cavotomy, should that be necessary. The internist also wanted GI biopsies during surgery, but the surgeon has recommended that we skip those (or at the very most just take one biopsy instead of the usual 3-5) because anesthesia time is a negative prognostic thing and she wants Winston off the table as quickly as possible without spending 30 minutes getting biopsies for something that is stable with treatment, which makes me happy that she is looking out for his best interest. The surgeon I know personally remarked that it's often tougher on the anesthetist (who is board certified at this clinic) and internist managing the case intra- and post-operatively and she felt ok about my surgeon choice. Winston was started on phenoxybenzamine this weekend just in case the tumor happens to be a pheochromocytoma. The internist feels that it is probably a benign adrenal cortical adenoma given the slow growth and lack of vascular invasion, but of course the only way to tell is to cut it out for a biopsy.

I just pray he does well and I don't regret my decision to pursue this. Thanks for reading my non-Cushing's novel. :)

-Winston the Westie's Mom.

[molly muffin]

It sure sounds like you have a good group working for you and Winston. Surgery is always scary as there are no guarantees. The post op period, after surgery is often the riskiest time. You want to make sure there is no clots that can travel after the surgery. Taking BP into consideration is always advisable as either too low or too high and you run into problems.

I will go ahead and copy/paste in our questionaire guidelines for going into the surgery and considering it, just in case it makes you think of something you hadn't before:


This was put together by one of our members Trish whose dog Flynn under went an adrenalectomy for a pheo successfully.

Part I is for owners in the initial stages, when an adrenal tumour has been identified and they are considering if surgery is even an option for their dog.

Part II is for when surgery has been decided upon and what questions might help when they are discussing it with their 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.

That one adrenal gland is so large and the other becoming smaller usually is a sign that it is a functional adrenal tumor. The large one produces the cortisol in excess so the other one stops working. This means that after surgery you are going to want to be on a treatment plan for cortisol stabalization, but not over do it because you want the other adrenal gland to pick up the workload.

Do let us know how things are going up and including the surgery. We'll stand with you side by side, as we all understand the worry and stress associated with sending out furbabies into any kind of scary situation.

[WinstonTheWestie]

Winston had surgery today. His blood pressure before phenoxybenzamine was 190, and first thing this morning it was 105, so that was good. We decided not to do a CT before surgery. They anesthetized him about 11:20 for prep (shaving, arterial catheter placement), and rolled into surgery a little before noon. They called at 12:15 because what we thought was a previous cyst on his pancreas was a little funny looking and they wanted permission to biopsy that. They also took three biopsies of his intestines to definitively diagnose his presumptive IBD. They called at 4 pm to say he was in recovery. The adrenal tumor was "intimately associated" with his vena cava and she had to work hard to get it off, but it did not enter into the vena cava, and there seemed to be no thrombus present either. He did great under anesthesia with no hypertension, hypotension, or arrhythmias. He didn't need a blood or plasma transfusion.

Now, we've gotta avoid those pulmonary thromboemboli and deal with any possible pancreatitis now, but they think he'll be able to come home on Friday. I think they said he's continuing the phenoxybenzamine until we know what type of tumor it is, they started steroids to prevent an Addisonian crisis with his remaining adrenal since it is still possible he had very mild Cushings given the smaller "normal" adrenal, he's on a metaclopramide infusion to promote GI motility after the biopsies, and he's on fentanyl transitioning to tramadol for pain. They're getting him up frequently for walks, and plan to feed him in the middle of the night if he's willing to eat. I get to visit around lunchtime tomorrow. We'll do an ACTH stim in about ten days to assess function of his remaining adrenal. He's still only about halfway out of the woods, but at least he has made it this far!

[molly muffin]

Awesome news. Can't wait to hear that he is fully recovered from his surgery and doing well. Great team you had working for him.

Keep us posted. Sounds like for now, everything is going smoothly and he is right on schedule for recovery.

[Joan2517]

!Oh, that is such good news...I'm so happy for you!

[WinstonTheWestie]

Thank you both for your kind words.

I got to see him yesterday. He was obviously uncomfortable and really quiet, but he seemed as good as can be expected I suppose. The first time I visited about 2pm, they didn't even bring a blanket for him to lie on. He sat against my leg and would try to lie down, then it was like he would stop himself halfway down because it wasn't comfortable from his incision. I only stayed about ten minutes because I had to get back to work. They said he ate that morning, wasn't showing any signs of pancreatitis, and really hates his e-collar.

I was able to talk to his surgeon again briefly at that visit. She said she realized that after surgery she forgot to tell me that she had to increase her incision to get more room during surgery and she even had to open up his little chest and move his diaphragm up a little and resew it higher! Oh my! She said everything went smoothly with that and they got the air out of his chest before they woke him up...I hadn't even realized that was something she might have to do. But I'm glad it went well and I guess by not knowing that was happening I had one less thing to worry about.

My mother and I visited for a little bit late yesterday evening as well. This time I brought a blanket of my own for him to lie down on in the exam room. He seemed a little more comfortable and did lay down and take a little nap while I was there. His biopsies were submitted today, and they think he will be able to come home this evening if everything continues to go well.

[Joan2517]

Wow! It is good that you didn't know...that would've made me more crazy with worry. Give Winston a hug for me. One for you, too~

[labblab]

Thank you so much for this update! I'm sorry I didn't have the chance to welcome both you and Winston earlier, but I've been following your thread and I am so relieved to know the surgery is now behind you! I can surely imagine how worried you have been, and how relieved you'll be once Winston is home with you once again. What a little trooper -- he has certainly been through a lot during these past couple of days.

Anyway, thanks again for letting us know how you guys are doing, and we'll be very anxious to hear more. Keeping all fingers crossed that he'll be back home again this evening!

Marianne

[WinstonTheWestie]

This forum helped me immensely when I was deciding on surgery, what to expect, what questions to ask, etc. I spent many hours searching the forums for 'adrenalectomy', 'surgery', and reading the stories of the beloved pets shared here. I wanted to 'pay it forward' in a way and make sure people know about our experience as well, even if I wasn't actively posting the decision-making process leading up to surgery. There were definitely some nights when I was at peace with the decision and others where I was sobbing, petting him, and begging him not to die. But in the end I was pretty comfortable knowing that I was doing what was recommended by numerous vets and what seemed to be the best thing for him, even though it was scary. I'm just glad it has gone this smoothly so far (knock on wood, of course).

The surgeon just called for this morning and said he is a "rockstar" and is comfortable and eating great (so no pancreatitis!). He has been approved to come home! We're going to get him at 5 pm tonight. Luckily I live in the same town as this hospital, so I can rush him back should his condition change. I live in a second-story apartment, so carrying him up and down the stairs to go do his business while his incision heals more will be an adventure.

[Joan2517]

Great news!

[DoxieMama]

That's wonderful! I have been (silently) following along and am so happy to read these updates. Thank you for keeping us informed - and I hope his recovery continues to go well.

Shana

[WinstonTheWestie]

He's home. We arrived to pick him up about 5:30, and were on our way by 6. He got home, talked us out of a couple treats, drank some water, and wanted to go outside again fairly shortly after coming home. He had a soft but formed bowel movement. He is quite depressed with the cone on his head...it's like he is just so sad his spirit drops until the moment you take it off, then his personality is 65-70% back to normal...still just a little quieter. I took the cone off this evening while we were watching him closely and he slept well. I just gave him his pain medication...little bugger already knows that tramadol tastes nasty and he as super tentative taking the food from me so I had to force the pill. I will have to try hiding it better next time. He was taking the phenoxybenzamine so well before surgery in a little meatball of canned food.

I just moved his crate into my bedroom and put his cone back on him. It's been about 20 minutes and he still won't lay down. I thought about setting up my small air mattress on the floor so he could sleep with me rather than be in the cage, but I don't trust him not to jump on the bed (if we stay in the bedroom) or the couch/chair (if we were in the living room). It is a little bit of a tight fit in the crate with the cone, but not too bad if he'd just try it. I may have to look into other options like a bigger crate or exercise pen tomorrow.

Edit: I gave him 45 minutes to settle down in the crate and he never did. I figured out a way to block him into a smaller portion of my bedroom that prevented him from having access to the bed. He thanked me by peeing on my blanket I'd put down for him. I can't be mad though, anytime he is on pred he drinks a ton and pees in the house. The IMS said it shouldn't be a problem at the low dose he is getting (in the past it was higher doses when he struggled with allergies), but it looks like even this low dose is rough. At least there are only six more days of pred. He still hasn't settled down with the cone on, but he isn't quite as upset out of the cage.

Edit #2: It took another 30 minutes and me eventually lying down on the floor with him, but he's now sleeping on a pile of my blanket and two extra pillows on the floor while wearing his cone. He sat up when I got back into bed, but he settled down again fairly quickly. Finally!

[Joan2517]

They do hate that cone, don't they? When Sibbie was fixed I found an inflatable donut for her, I think at Petco. She was much more comfortable and happier with that and even used it like a pillow.

He must be so happy to be home with his mom!

[WinstonTheWestie]

Well, he's been home a couple days now. Everything seems to be going okay.

That first night was very rough. He would only sleep a half hour to an hour at most at a time, and just as I would nod off he'd be up bonking his cone into the wall. When my mother woke up and was able to watch him a little I took the cone off and he and I slept for about three hours. Eventually I just put on a larger doggy tank top thing I had at home that he sometimes wears it when his allergies flare up and he is scratching his skin raw. It covers 85-90% of his incision. It doesn't snap closed or anything, but so far he hasn't tried to mess with the staples while he is wearing it. Last night he wore that in his crate instead of the cone and it was much better.

Today, we can tell he is feeling better. He is becoming more like himself, and he's tried jumping on the furniture twice today (and didn't like it when I told him no). He is eating about half of his normal food, but still drinking and peeing a little bit more than normal. He is still taking pain medication, an antibiotic, an anti-nausea pill, and prednisone.

[Budsters Mom]

Baby onesies work great for covering incisions. They snap around the tail. My dog wears Carters size 18 months, to cover her skin during allergy flare-ups. She weighs 14 pounds.

Kathy

[molly muffin]

How long till the stitches come out? They really do hate those cones. Soft ones work pretty well and the onesies.

[WinstonTheWestie]

They said 10-14 days after surgery for the staples to come out. So sometime between next Monday and Wednesday. I am hoping I can schedule the staple removal with the surgeon and the ACTH stim with the IMS on the same day. I'm waiting on the IMS to tell me when exactly she wants to do the stim.

Today we got great news...the adrenal tumor was benign! The intestinal biopsies showed mild IBD like we thought. The nodule in his pancreas they called about during surgery came back as an 'islet cell adenoma.' From what I was told and read, this is a benign tumor of the cells within the pancreas that make/secrete the insulin. It's apparently rare in dogs for this tumor to be benign, and it may or may not be actually secreting insulin. But it makes sense that it likely is truly benign since it has been there not changing for 18 months and he's never ever had signs of low blood sugar like the tumor was making excessive insulin. I haven't heard back from the IMS about what, if anything, we need to do about this now that we know what it is. Probably occasional ultrasounds to watch it like we did with the adrenal for a while if I had to guess. But thank goodness for good news!

Today he seems completely normal personality and activity wise. There is a little swelling along his incision, but it isn't painful, red, or weeping. Today is the last day of Cerenia...he's eating so well I don't really think it's necessary anyway but we'll finish it like prescribed.

[Squirt's Mom]

Oh what wonderful news on the pathology report!!! :cool::cool::cool: WHOOHOO!!!! :cool::cool::cool: I am so glad things have worked out this way and know your heart is lighter than it has been in some time. Take a deep breath, Mom, and let all that tension go...then love on that precious boy for a bit and do something fun, but not too strenuous, with him. You both deserve a little treat today! :)

Hugs,
Leslie

[molly muffin]

Great news on the pathology. You just never know with these tumors if they will be benign or not. Scary suckers.

So glad he is more comfortable now. First nights after surgeries always seem to be rough. The good news is that he is over that initial 24 - 48 hour period after the surgery and home. I'm sure things will just continue to improve.

[molly muffin]

How is Winston doing? Did the stitches come out today or later this week?

[WinstonTheWestie]

He has continued to do great. I was hoping to get the staples out today or tomorrow, but our surgeon is on vacation until Thursday and the IMS can't fit him in for an ACTH stim until Friday. They said it would be okay to keep the staples in a couple extra days so I don't have to make two separate trips. I will drop him off Friday morning and they'll take care of both the staples and the ACTH while he is there, since I have to work all day.

Actually, I realized I forgot part of the drama with this whole thing in our previous posts. I chose this clinic based on the recommendation to see one specific IMS. This IMS did our monitoring all last year and the workup prior to surgery. The night before the surgery I find out that our IMS had a major family emergency and will be out for over three weeks! There was another IMS (older lady but pretty new to that practice) in the hospital who was going to be handling Winston post-op! :eek: I talked them into a short 10 minute meeting with this new IMS upon dropping off for surgery to quickly recap everything and meet her, but I was nervous! Our regular IMS is still out of town, so this fill-in IMS will be doing the ACTH this week. I am glad things are going well but I am looking forward to seeing our regular IMS as soon as she is back on Sept 1. I think even if things are perfect on Friday we will still schedule with her to check in once she is back.

As of today, Winston is completely off of medications. He only took tramadol for a week. We had more but he didn't seem to need them. His last dose of prednisone was on Friday, and luckily he hasn't shown any signs of Addisons. I was/am a little nervous about waiting a while week before doing the stim, but things are good so far. His last antibiotic was yesterday. I moved my mattress onto the living room floor so he could continue to sleep with me without excessive jumping on and off the bed, and though it might be a little crazy, it has worked out well. Another couple days and I can move back into my bedroom! :)

Apparently there is some concern about the accuracy of the biopsy result from the pancreas, since it is just so rare that dogs get a benign pancreas tumor. A second opinion on the histopathology has been ordered just to be sure its really benign and make sure we don't need to plan another surgery soon to remove part of his pancreas. The surgeon emailed me that she was going on vacation and we could talk about it more on Friday at the staple removal appointment.

But overall, he's done better than my wildest hopes and expectations. He's been going to work with me and no one can believe that he had this major, risky surgery less than two weeks ago! If not for the awkward shaving on all his legs and a bare belly, you probably wouldn't be able to tell at all.

[molly muffin]

Awww, that's fantastic that he is doing so well.

I would have been freaking if my IMS had an emergency right as my dog needed surgery! I practically was hyperventilating when our own IMS went on maternity leave while my molly was under her care. Luckily my IMS was just a doll and emailed and we sat up appointments to be spaced out so that she got the reports for all mollys testing, but no major changes until she got back in the clinic.

I would be on a mattress on the floor too. In fact, most all of us would be, and have been at various times with our furbabies. You got to do what you got to do after all. Bet you'll both be glad to see your bed again though once winston has full jump status back.

Lucky you that you can take him to work with you. That's wonderful!

[WinstonTheWestie]

Yeah, I seriously considered postponing the surgery (at that time the receptionist said the IMS was going to be gone 'at least a week' though now it's closer to three or four so in hindsight I am glad we didn't try to wait on the IMS to come back), but my mother had flown from Oklahoma to Florida to be there with me (especially because if he hadn't made it, I would have been an absolute wreck) and to help take care of him the first few days. She was already in the air when I was told the IMS was gone, so I didn't feel like I could reschedule since my mom had already taken off the entire week and spent money on a pretty last minute flight. Luckily it all worked out okay.

[molly muffin]

It definitely has worked out okay and I wouldn't have been able to postpone it either. Doesn't mean I wouldn't have been a wreck throughout though. hahahaha

I think you did the right thing. After all the surgeon who did the surgery was the one that you expected it to be right? It was the after care, IMS that you had to worry about and that turned out alright.

I'm hoping the pancreas is truly benign and nothing, but if they have any doubts it is good they are rechecking. You'll feel better too I'm sure with a double benign pathology.

[WinstonTheWestie]

Staples are out! The surgeon is happy with his progress so far and said he looks great.

Our second opinion on the pancreas biopsy was a bit wishy-washy...apparently they were concerned that the tumor itself looked a little more aggressive than the first pathologist said and they were concerned it was an insulinoma, but they agreed that it would be weird for this thing to be malignant if it has been there for so long and not obviously grown or caused him problems. So we still don't know about that. The surgeon and our backup IMS chatted today and tried to come up with the best way for us to monitor it. Apparently they'd prefer CT or MRI, but the surgeon had to use some sort of staple thingy inside him to seal off the blood vessels and they think that would interfere with the pictures they could get from CT or MRI. They suggested an ultrasound, and even offered one today (and it was already 6 pm!) since I was worried about it. Our regular IMS is back in a week or so though, so I just told them I'd wait until she was back before doing another ultrasound. It worked out well that way because our regular IMS did his last two scans and the backup IMS there today was really busy with a dog who was sicker than mine.

They did the ACTH stimulation today too. I guess because it was a Friday they won't have results until Monday. I think probably they'll come back tomorrow, but no one will be there until Monday to call us about them. That's frustrating! But at least they don't think he's acting like an Addisonian.

So overall, a good report. Winston seems happy he can play (still gently), jump on the furniture a little, and sleep without that tshirt on!

[Joan2517]

Yay! So happy he's feeling good!

[molly muffin]

This is the best news! I'm thrilled he is doing so good.

[WinstonTheWestie]

I realized I didn't come back and post his ACTH stim results from two weeks ago:
Cortisol (pre) 1.0 [ref range 2-6]
Cortisol (2h post) 6.8 [ref range 6-18]
The backup IMS who did this said it was a little low but not scary low since he seems to feel good and at that time his lone remaining adrenal had only had about 10 days to start 'kicking back into gear' after being a little shriveled from the tumor on the other one. I don't think we plan to recheck it unless he has problems. The regular IMS we checked in with today thought it was okay too. She pointed out that even before surgery when he had the adrenal tumor his resting/pre cortisol from the LDDS was only 1.3, so a value of 1 isn't that much lower, and he did respond to the stimulation drug. Maybe he just has lower than average cortisol like a weirdo.

Today was our consult with our regular IMS. Winston was happy to see her. She was really happy with how he looks. She hadn't seen him since the week before surgery. She did an ultrasound today to check on the pancreas nodule and it looks the same size it always has been. She thinks it's probably benign too, but we're going to keep an eye on things. Re-ultrasound and bloodwork in 3-4 months. I'm supposed to watch him for signs that his blood sugar is low (acting tired, stumbling, seizures) because of the pancreas.

Even before all this I had been wanting to get his teeth cleaned. He usually needs it every 18 months or so, and it's past that since the last one. We put it off with everything that happened in the last month (for obvious reasons). Today the IMS okayed us for anesthesia for a dental cleaning. I'm going to call to schedule one in 2-4 weeks to give him just a little more time to recover before the procedure.

I'm so happy with how he handled all this.

[Joan2517]

I'm so happy that Winston continues to do well, Kellie!

[labblab]

Awww Kellie, we're all so happy with the way your little boy (and you!) have handled this. Kudos all the way around!!! :) :) :)

It's wonderful to read these great updates, so please keep them coming! ;)

Marianne

[molly muffin]

This is just great to hear. He sounds like he's back to his old self and doing fine. I wouldn't be too worried about that pre number either, unless the post number were to start to drop. It seems that the other adrenal gland is producing cortisol and that is exactly what you want.

Good idea to keep an eye on the pancreas and hopefully that won't change. Doesn't seem to be highly likely that it will if it hasn't but ultrasounds are a good idea to keep an eye on it.

Just excellent news for Winston.

[molly muffin]

Oh I was going to tell you and forgot, we have the annual Westie walk coming up this weekend, will be around 200 westies there. I have several friends with westies, so we're thinking of going to it.

[WinstonTheWestie]

Sharlene, I wish I was even remotely close to Canada! I've always been interested in doing a Westie meetup type thing, but I have never lived reasonably close to one. One time I considered traveling a couple hours for one, but the timing just wasn't right. Maybe the next place I end up will have one.

[molly muffin]

Oh I do hope that you get to go to one. My friends go every year. I have 3 friends with Westie's, so there are 4 dogs all together, from the same litter family.

It would be a blast I am sure. Canada is great, the only thing is the cold winters which I am Not a fan of. LOL And I really am not a fan of dog walking on icy paths.

[WinstonTheWestie]

The vet just called and Winston apparently has six teeth with "resorptive lesions"? She explained that it is basically where is tooth is disintegrating at the roots, below his gums. They found this on the xrays they took of his teeth. They recommended pulling them. I told them to do whatever they thought needed to be done.

I'm a little worried about how we'll manage. We weren't expecting having to extract anything since he's had a teeth cleaning every 1-2 years. The vet didn't say while we were on the phone, but a friend mentioned her dog had to eat soft food for two weeks after extractions. If that is the recommendation (which makes sense), I'm not sure what I am going to do. We are right in the path of Irma now and I can't order him the canned version of his special IBD food in time. The vet doesn't have any, and his IMS doesn't carry this brand either (our old IMS in Colorado did, which is why he is on this kind). I have three cans left over from his adrenalectomy hospitalization, but that certainly won't last more than three days. I can soak his kibbles, but that usually works better with hot water, and we're very worried that power/utilities will go out during this storm. Maybe I can chop up his kibble in my food processor so that room temperature water would penetrate it faster if the power does go out?

[Squirt's Mom]

The chopping sounds like a good idea to try. Do you have a camp stove of any kind or can you get one with the appropriate fuel at this late stage of the "game"? If you have one or can get one you can use that to heat food, water, etc. Annnnd with a great deal of patience, a candle can help at least warm a small amount of water. I wish you and Winston had been able to get out but know that was not possible for so many there. Please be a safe as you can and know we are with you!

[Joan2517]

And if you can heat up water, maybe mix some rice in with it. My guys just love getting rice...they think it's a treat!

[molly muffin]

If you can get hold of Any kind of can dog for just for the interim until you can acquire some that would work. Irma is an emergency situation, so I wouldn't worry too much about it being the right brand as it's only a temp measure. Did you cook up meat in your fridge? if so hamburger, or something soft that he can eat would work too. Are they doing the surgery right now? Maybe it could wait until after Irma?

[WinstonTheWestie]

He's awake, and ready to be picked up in about 45 minutes. We had figured this would just be a quick cleaning, so scheduled it today after people cancelled. It wasn't until he was already under and xrays were taken we learned he needed extractions. But I didn't want to anesthetize him again (that would have made it like three times in 6 weeks), so went ahead with the extractions today. In hindsight maybe it wasn't the best choice, but the vet seemed to recommend them so I went with it.

Thank you all for your suggestions! I did some experiments with a little dog food this afternoon while he was gone (because God forbid I get out food and not feed him any!), and I think we will be okay. I broke up the kibbles into pieces and with about a 15 minute soak they are pretty soft which I think will work. We can manage that. My downstairs neighbor does have a camp stove we could use if needed, so that's a good idea. I'll see how tonight goes and consider some of these suggestions tomorrow if needed. Irma isn't on track to arrive here until Sunday night into Monday morning so we do have a little time.

Thank you all!

[Harley PoMMom]

How are you and Winston doing?

Hugs, Lori

[Carole Alexander]

I hope Irma's turn is in your and Winston's favor; regardless, it sounds as if you have come up with a creative solution to solve the soft food issue. I just wanted to say that Winston is an incredible trooper and you are such an excellent mom. So glad you found each other. Please stay safe. Best,

Carole

[WinstonTheWestie]

I thought I'd give a quick update from us...I stop by here a couple times a week to check in even if I don't post often.

We're now about 7.5 months post surgery. We made it through hurricane Irma with no problem...never even lost power, thank goodness. Winston has continued to do well, and life with one adrenal gland is going fine. He flew home with me (in the cabin under the seat, of course) for both Thanksgiving and Christmas. We saw the IMS in December, and she did another ultrasound. She didn't see anything concerning for regrowth of his adrenal mass and the thing on his pancreas hasn't grown at all. She doesn't think it's really a tumor after all, she thinks it is just 'extra' normal pancreas tissue. I don't really care as long as it stays small! She told us to come back in 6 months for another check, which will be in early June. Last month he started to grow a little benign eyelid mass that I had removed with cryosurgery (freezing) under sedation, but other than that he's been normal. I've definitely been blessed to have him do so well.

[labblab]

Hello again, Kellie, and thanks so much for this wonderful update on Winston! Thank you, also, for taking the time to write such a helpful reply on our new thread about laparoscopic adrenal procedures. I think your points are well taken, and add a lot of food for thought.

Please give Winston a big hug from his family here, and definitely please keep the updates coming. It’s a joy to share in his adventures!

Marianne

[Squirt's Mom]

Hi Kellie,

So good to hear from you again and especially good to hear Winston is doing so very well!

Hugs,
Leslie

[WinstonTheWestie]

Back again...

We went to the IMS last Tuesday. She did a 'senior panel' of bloodwork (CBC, chemistry, T4, urinalysis), an abdominal ultrasound, and chest x-rays. Bloodwork was sent to Idexx but he got a good report on the x-rays and ultrasound. His xrays were normal, no heart murmur or anything, and she said his ultrasound was the same as last time with no signs of his adrenal tumor regrowing. She said the liver looked maybe a little big on ultrasound but not on the xrays but it was nothing to worry about. Her exact words were that he looked really good considering everything he's been through...

But then we got the bloodwork results and his blood sugar was pretty low. Like mid 50s and normal is closer to 80-120ish. She said it could have been an error and wanted to recheck, especially since he is acting fine. We went back on Friday for a nurse appointment and they checked his glucose with one of those immediate hand held machines. This time the readings were 38-42. I made them retest it four times because I was just so sure it had been an error at first. But no. The IMS called me later that day and we went back again to get more blood for an insulin-to-glucose ratio, which would tell us if it his sugar was low because of too much insulin production. I bought one of those glucose meters and checked him myself and it was 40 yesterday. We got the ratio test back today and it's over twice the normal range. So it looks like that thing on his pancreas all along really is an insulin-producing tumor. Luckily for us, she still thinks it's the rare benign version though since it has been there for sure about 11 months now (has it really been almost eleven months since his adrenalectomy?!) and likely longer. It seems like it has become functional and started secreting insulin over the last 6 months.

So now, she wants to put him on a really small dose of prednisone. Like 1 mg per day which is 0.1 mg/kg. She says that will help keep his blood sugar up. If it goes too low he may have seizures. She said he shouldn't have any of the side effects of prednisone at that dose, but as the tumor grows he may have to increase the dose. I so hope that doesn't happen...I don't want iatrogenic Cushings! I started giving him bedtime snacks (which he is already a fan of) to make sure he has good blood sugar at bedtime since he eats dinner at 5 pm. I may try to come home at lunchtime and feed him three meals a day instead of two. Anything to keep his blood sugar up. In theory we could do another surgery to remove the part of his pancreas with the tumor, but during his first surgery they said they'd have to take 2/3 of the pancreas to remove that nodule so I don't think that's realistic and I don't want to put him through that. We'll manage his signs and blood sugar as long as we can with food and medications and hope this thing really is benign.

Anyway, I just wanted to update our thread even though we've moved past the Cushing's scare and adrenalectomy. This forum was such a helpful resource last year when I was considering surgery I feel like I need to continue to tell our story so it's documented for people considering adrenalectomy. Hopefully that is okay. :)

[labblab]

Kellie, not only is it OK, we’re grateful to have you returning with updates! I’m very sorry that you and Winston have yet another challenge to deal with, but you are educating us right alongside yourselves. Every piece of information we can learn may end up helping us to help another dog further down the road.

We’ll surely hope this pancreatic tumor truly is benign, and that you’ll be able to continue to manage things via the pred and dietary support. Do let us know, though. We’re sticking right beside you both!

Best wishes to both you and Winston,
Marianne

[Squirt's Mom]

Oh we are delighted to hear from you and Winston again! Ya'll are family so you are more than welcome here anytime!

If you are up to it, give some serious thought to home cooking for Winston. I think you will get much better control over the BG doing that VS using commercial foods. There are several individuals who design diets for dogs as well as universities like UC Davis who has some standard menus for various conditions...or used to any way, I haven't checked them out lately. I have used other consultants but recommend Monica Segal. You can read about her here: (and not I don't get any compensation for recommending her. :D I just trust her. ;) )
https://www.monicasegal.com/

Do stay in touch and let us know how that sweet boy is doing!
Hugs,
Leslie

[Caseycase01]

Check this out

http://cancercurefordogs.com/information.htm

[WinstonTheWestie]

Just checking in with my Cushing's friends...I hope everyone is doing well! Winston is doing pretty good. He had a recheck with his IMS back in late September. No sign that his adrenal tumor has regrown! His insulinoma is still there, and I have opted not to do another surgery. I'd rather continue to manage low blood sugar than diabetes at this point, so no more surgery for him. His blood sugar has been at the low end of normal with a tiny bit of prednisone. He has always had bad side effects at higher doses of prednisone, but he's on less than the 'physiologic' dose of prednisone and his sugar is consistently between 70-80 (65-120 is normal). It seems like the prednisone might be helping his IBD too. I haven't needed to increase the prednisone yet. We just started feeding 3x per day to see if I can get his blood sugar even closer to the middle of normal.

Back in July after my last update, I decided I wanted to get a portrait painted of Winston. I found a wonderful artist who uses a photo reference to create super realistic, digital hand-drawn portraits (like she draws them into Photoshop or something similar) that she then prints on canvas. I haven't received my canvas yet, but she finished his portrait and it is amazing. I know lots of you are as crazy about your dogs as I am so thought I'd share her work in case someone was interested. The portrait was an investment, but I truly believe it was worth the cost to have this lasting momento of my beautiful Winston. The artist's name is Laura, and we website/Facebook is called the Painted K9. https://www.thepaintedk9.com/ Winston is about the 5th photo on her page...the only Westie. I am blown away at how realistic the painting is and how wonderfully she captured him! Here's the direct link to his portrait too: Winston's Portrait (https://www.thepaintedk9.com/4900487-29917-photo-4).

[Harley PoMMom]

Thank you for the update and I'm glad to hear that Winston is doing well! The portrait is just beautiful!!!!!

[Joan2517]

Those pictures are amazing! Thank you for sharing! Good news about Winston!

[Harley PoMMom]

How is Winston doing?

[WinstonTheWestie]

Pretty great, all things considered. He had an IMS visit back before Christmas. He had full bloodwork, an abdominal ultrasound and chest xrays. Everything came back perfect, numbers wise. She doesn't want to see him for another whole 6 months unless we have problems. There was no evidence of this adrenal tumor regrowing. The insulinoma in his pancreas is a little bigger, but we're managing that just fine. There hasn't been any evidence of spread yet, so my IMS thinks he may be a lucky dog with a more benign version of this cancer. His blood sugar is consistently at the low end of the normal range. He eats three times a day (we'll increase as the pancreatic tumor grows) and he takes a small amount of prednisone every morning. He does have side effects of the prednisone that obviously mimic the Cushbabies even though his dose is very low (1 mg once per day and he weighs 22 lbs). The IMS said that is less than they'd give a dog with Addisons, but even at that low dose he drinks and pees a lot. Unfortunately, it's necessary to keep his blood sugar up. I don't think I'll be increasing the dose though, because he is clearly very sensitive to it and I don't want to deal with iatrogenic Cushings. His fur is slightly thinner, but no one but me and the IMS can really tell. One benefit of the prednisone is that it is helping his IBD. Since starting the pred, even if he gets into human food he doesn't vomit. Today he actually got into a coworker's lunchbox in our shared office and helped himself to my coworker's lunch!

[Harley PoMMom]

I'm so glad to hear that, over all, he is doing well, you're doing a wonderful job taking care of your sweet boy!!!

[molly muffin]

Hi Kellie, Just saw you online and hope that you and Winston are both doing really well.
How did Winstons portrait turn out? I went to the artist website and those are some beautiful paintings!

hugs
Sharlene

[WinstonTheWestie]

Nice to see you back around, Sharlene! The portrait turned out amazing...the artist re-did her website since the last time I looked at it, but I checked tonight and he is the only Westie on her dog portrait page. I love it! It is hanging in my bedroom currently. From across the room it looks like a photo since it's so realistic, but once you walk up to it you can see the brushstrokes and details.

Both Winston and I are doing very well! His last IMS visit was back in December. Still no signs of his adrenal tumor growing back or spreading! His insulinoma is a little bigger, but his blood sugar has been pretty good. He got pancreatitis the first week of February and had to spend the night at the emergency hospital because he was so painful, then the IMS cut his dose of prednisone in half. He's barely on any now (0.5 mg total once a day, even less than they'd give an Addisons dog the IMS says) and the PU/PD side effects have gotten lots better. He eats four times a day plus gets treats between meals to keep the blood sugar up, but I think he's probably in hog heaven because of all that! He had an eyelid mass removed in March, then last week we removed two little skin masses that had gotten oozy/ulcerated...all benign, luckily! Our next IMS visit is in June, unless there are problems before then.

[molly muffin]

Well that is just fabulous to hear you are both doing well and the portrait definitely nice!

He sure has had his issues of up and down it sounds like but coming through them all like a trooper.

My friends westie is currently having a bout of recurring ear infections and it's just taking a real toil on her. Although she is just a sweet as every, but she's slowing down. I guess she is 15 now. Molly was about a year older than her when she came to their lives as just a wee little thing at about 8 weeks old. Luckily teeth and that ear thing is all she has had to go through but the ear is pretty bad now. The pancreatic episode is one of those that really scares me, it just hurts them so much, pain wise. Hard to see and not be able to help them. As long as his blood sugar stays fine (bet he loves the treats and 4 meals!!!) then he'll be just fine I'm sure.

[WinstonTheWestie]

Hello Cushing's friends! Just popping in, catching up on everyone's threads and thought I'd update Winston's.

Winston's most recent IMS checkup went well. Still no signs of the adrenal tumor regrowing or spreading...not that we really expect it to spread since the pathology said benign. His insulinoma is getting bigger still, but no sign's it has metastasized yet and he's doing great. Even though he's on only 1/5 the dose of prednisone you'd give to an Addison's dog his size (0.5 mg total once a day, which is 0.05 mg/kg), he has mild iatrogenic Cushings. We didn't do a Stim or anything, but his one remaining adrenal gland is smaller on ultrasound when it used to be normal size. Luckily he doesn't have many signs of it, since we can't take him off of the pred and there isn't really any room to drop the dose any more than we have. He is always hungry (but that's no change, he's always been a chowhound) and he does drink more than he used to, but he can still hold it all day. Bloodwork was perfect except for low blood sugar, which is to be expected for him. So all told, I'm happy with where we are at. It's almost been 2 years since his adrenalectomy surgery, which is crazy! It was definitely a scary time, but I'm glad we did it.

[Joan2517]

Wow! Two years already! I'm so glad he's doing well, Kellie!

[Squirt's Mom]

Winston is showing how it's done! Way to go, Winston! Ya'll keep up the good work and let us hear from you any time you can.
Hugs,
Leslie

[WinstonTheWestie]

Almost exactly 4 years after discovery of his adrenal tumor...2.5 years after his adrenalectomy for his adrenal tumor and subsequent diagnosis of an insulin-secreting pancreatic tumor...20 months spent battling hypoglycemia as a result of that tumor...Winston's journey ends in a few short hours.

In the end, it wasn't the adrenal tumor or the insulinoma that got him. He was completely normal most of the day yesterday. Spent it at doggie daycare and seemed normal when I picked him up at 4:30. At 6:30 he was still normal. By 7:20 I knew something was suddenly very wrong. Gave him an hour to settle down hoping it was early pancreatitis. I gave him some anti-nausea meds and pain meds, but within 20 minutes he started vomiting them up. Vomited 5 times, got super painful. We went to the ER, they hospitalized him overnight. At 2 am last night they woke me up with a call saying he is worsening and needs blood pressure support medications and artificial glucose because his blood pressure and blood sugar were low. At 6 am I was told his bloodwork suggested an overwhelming bacterial infection. At 9 am, they called and said he had a septic abdomen (fluid in his belly with bacteria in it) and they think they saw an intestinal mass where the fluid was accumulating. He needs emergency surgery where the odds at best are 50/50 for survival, or euthanasia. I just can't make him go through another surgery. I visited him around 10:30 and I don't think he was even aware I was there. My mom dropped everything and is flying here. When she arrives around 6 pm central time, we're going to the emergency clinic he's been hospitalized at and letting him go. Then tomorrow my mom and I are making the 10 hour drive with his little body that failed him and burying him on my parents' land.

I'm absolutely devastated but know in my heart it's the right choice, even as hard as it is. Light the candle for Winston, my little "westie bestie". Life won't be the same without you in it, bud. Until we meet again, my friend.

Thank you all for being here for us throughout the years. I'll try to come back from time to time, when it doesn't hurt quite so much.

[Joan2517]

Awww Kellie...I am so sorry. What a nightmare for you. I wouldn't put him through anything else either. I'm crying I'm so upset for you. You both put up such a good fight. I remember being so anxious when he had the adrenalectomy and how happy that he pulled through. You're a good mom and Winston knows how much you love him.

[labblab]

Oh Kellie, I join Joan with tears flowing. I'm so grateful that I'm seeing this a few minutes before 6:00 central time, because I hope it means that you'll see our notes here, and carry our hearts and our hugs along with you and your mom as you prepare to release Winston's spirit from his ailing body. If you can, please give Winston a tender pat and a special kiss from his K9C family here. What a brave boy, and what a dog-worthy life he has led! I'm so sorry for the pain you now must bear. But Winston, himself, will be making the magical passage from sickness to health, from physical presence to shining spirit. Fare thee well, sweet little boy, on your newest journey. Bless you, and bless all who love you so dearly.

Sending my hopes for peace and comfort flying across the miles to you all,
Marianne

[molly muffin]

I am so very sorry Kellie. Know that you are not alone, that so very many of us have walked this road and it hurts something awful, even when you know its the right decision to make. My heart goes out to you during this most heart breaking time and in the days and months to come.

I'll say my goodbyes here tonight as the tears run down my cheeks.

Good night dear Winston. Another start will burn brighter in the sky when you are gone

[Budsters Mom]

Oh Kellie, I am so very sorry. I have followed Winston's story. You have been through so much. Winston's true hero!
FLY FREE WINSTON, FLY FREE!

[Squirt's Mom]

Dear Kellie,

My tears join yours, your mom's, and all here as we say farewell to our little warrior. Winston has given so much hope to others thru the years simply because of what he faced and overcame. His spirit has been indomitable and has won the heart of every one who has read his story. I have no doubt he left this life with his heart full of love and gratitude as he moves on to the next phase of his journey. It is my firm belief that we will see our beloved babies who have gone before some day and when that day comes, we will never again be parted from them. Until that day, Winston will be watching over you just as you have watched over him all his life...with love and pride and joy. Meanwhile, we must learn how to live with the gaping hole they leave behind. Please know we are here anytime you need to talk, cry, scream, or simply say hi to others who understand so well the loss and pain you carry.

Thank you for sharing your precious baby boy with us all these years and for coming back to tell us this news, as hard as it is to hear.
Go in peace, Winston, and know you are loved by many.

My deepest sympathies,
Leslie



I walk with you

I stood by your bed last night, I came to have a peep.
I could see that you were crying, You found it hard to sleep.

I whined to you softly as you brushed away a tear,
“It’s me, I haven’t left you, I’m well, I’m fine, I’m here.”

I was close to you at breakfast, I watched you pour the tea,
You were thinking of the many times, your hands reached down to me.

I was with you at the shops today, Your arms were getting sore.
I longed to take your parcels, I wish I could do more.

I was with you at my grave today, You tend it with such care.
I want to reassure you, that I’m not lying there.

I walked with you towards the house, as you fumbled for your key.
I gently put my paw on you, I smiled and said “it’s me.”

You looked so very tired, and sank into a chair.
I tried so hard to let you know, that I was standing there.

It’s possible for me, to be so near you everyday.
To say to you with certainty, “I never went away.”

You sat there very quietly, then smiled, I think you knew …
in the stillness of that evening, I was very close to you.

The day is over and I smile and watch you yawning
and say “goodnight, God bless, I’ll see you in the morning.”

And when the time is right for you to cross the brief divide,
I’ll rush across to greet you and we’ll stand, side by side.

I have so many things to show you, there is so much for you to see.
Be patient, live your journey out . then come home to be with me.

Author unknown