Hello. New here. I am Liz and my Shih Tzu (best friend) is Lilly

[LizandLilly]

Hi everyone.

My name is Liz, I have a beloved 10 (almost 11) year old Shih-Tzu) who was diagnosed with a tumor on her adrenal gland on 11-30-2017. We had absolutely no symptoms and she doesn’t really know she is sick. It was found accidentally when we took her in to get a tooth removed and they noticed elevated liver enzymes on her bloodwork. After an ultrasound, they found the tumor that is about 2 cm and is invading vena cava . Needless to say, I have been a mess.

Met with the surgical oncologist who said they could do surgery or not since she is not showing symptoms. I opted not to have the surgery as it is risky and I want to enjoy whatever time we have left playing in the park and snuggling together. I am taking her in today to see the vet bc she has stopped eating . I know this isn’t good. We go in at 4:00 today. I found this support group when I was online researching the heck outta this cancer and surgery.. it seemed to offer me some peace seeing other people who could relate. Lilly is my first dog so I have never had to go through losing a pet- never understood how hard it could be. As I am sure everyone can relate it’s not just a dog but a best friend. We been through it all, my multiple moves from three states, my divorce, etc.. she’s helped me get through it and is an ESA for me as I am sure I am for her. I cannot imagine life without her. It’s heart wrenching to think about.. hope you all enjoy your day.

Thanks for the support,

Liz & Lil

[molly muffin]

Hello and welcome to you and Lilly I am very sorry to hear that they have found an adrenal tumor that has invaded the vena cava.

See what the vet says today. They might want to scan to see if there has been any further invasion or how far in it is.

Surgery is risky. That is true. A tumor that has invaded though is also not good.
One thing I can do that might help you when you talk to the vet about surgery, as it might come up again, depending on Why she isn't eating. is to give your our guideline for discussion with surgeron.

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.

It might be that something else is causing her to not eat at the moment, so lets see. I assume they will do further tests today? Let us know what is goin going on.

We will be here to support you and Lilly. Deep breaths.

[Squirt's Mom]

Hi Liz and welcome to you and your sweet Lilly!

It is so tough when we have to face things like whether to have a risky surgery or not with our precious babies. An adrenalectomy is one of the more risky surgeries any dog can have and we want to be fairly sure they are excellent candidates AND that we can cope with any outcome that is the result of the surgery before going into one. You know your girl best of all and we will support your decision regardless. I do want you to have as much information as you can so here is a list of questions one of our members made up for us who faced this with her baby boy....but I see Sharlene (Molly's Mom) has already posted them for you.

Surgery is not the only option for ADH - Adrenal Dependent Hyperadrenocorticism or adrenal based Cushing's. The drugs used to treat the pituitary form are also used to treat the adrenal form. Those drugs are Vetoryl (Trilostane) and Lysodren (Mitotane). ADH is a bit more difficult to control because the tumor continues to grow requiring higher and higher doses of the med BUT treatment can give your baby, and you, some relief from the signs (symptoms) of Cushing's. Talk to her vet about which drug they would recommend and then decide if you want to treat. Again, we will support your decision regardless.

It is never easy to lose one of our babies no matter if they are the first dog ever or the 100th. They wiggle their way into our hearts and our souls, leaving marks that will never fade. They fill us with joy, they hold us together in the worst of times simply by wanting to play or go for a walk, they teach us what true love is all about, they make us laugh when we thought we would never smile again much less laugh. They become our children who just happen to have fur and four legs and bark. But let's not go there just yet, ok? Lilly is with you today and this very moment is all any of us are promised so enjoy her now. She will let you know when she is ready to leave this life and start the next phase of her journey but for now she is by your side.

I am glad you found us and want you to know you and Lilly are part of our little family here at K9C now. We will be with you every step of the way! Let us know what the vet has to say today!

Hugs,
Leslie

[WinstonTheWestie]

Welcome Liz and Lilly. I absolutely know the anguish that these dumb tumors can cause. My Winston had an adrenal tumor as well. He is a bit younger than your Lilly and did not have the vena cava invasion, and I eventually chose to do the surgery. Adrenalectomy definitely is not the right choice for every dog, and I understand the decisions you made. If you ever change your mind and have questions about things that aren't in previous posts on here, I'm more than happy to give our perspective. Do let us all know what the vet said about Lilly today. The ladies on here are very used to interpreting bloodwork and know much of the current research, which can be helpful if needed. Fingers crossed that it is good news for you both!