Introduction: Roo and Java (13 y/o Labrador retriever x) adrenalectomy advice

Hi, I'm Roo...I'm new to this board. My 13 year old labrador retriever mix Java was just diagnosed with Cushing's Disease. An ultrasound revealed that her left adrenal gland is enlarged with a tumor, and the right one has shrunk to compensate for the enlarged left one.

I am at the point now where I have to make a decision where to go with her treatment. There is a board certified veterinary surgeon locally, who can remove the adrenal gland, but the question is, do I want to put her through this? Her regular veterinarian said that she is in good shape to withstand surgery, but of course there are risks.

Right now her main symptoms are panting, seeking cooler places to lie in, sleeping very deeply and more often.(she used to wake up if the mailman put mail in the box, or if UPS knocked on the door, but now she will sleep through it. She has a ravenous appetite; she is constantly begging me for food and it's hard to get her to stop begging...she must be very hungry because she is so persistent; before the Cushing's she would give up if I ignored her, but not now. She seems pretty happy and not in pain for the time being, so I don't know if it's better to try to manage her symptoms without the surgery, or to get her the surgery and give her possibly two more years.

Currently I am feeding her The Honest Kitchen's Force, a digestive supplement, a supplement for her liver, Milk Thistle, and Vitamin E. I have noticed improvement in some of her symptoms with the change in diet (I was feeding her Orijen before this, but little did I know that the high protein was probably the worst think she could have been eating with this condition.)

Anyway, I have a hard decision to make, and I'll be reading the board so that I can know what to expect, depending on which route I go.

Hi Roo welcome to you and Java - sorry to hear Java has Cushings but you have come to the right place!! I have a shephard mix who is 11 1/2 and was diagnosed at 7 1/2 - 8ish with cushings and began treatment at 11 and is being treated with Vetoryl and is doing good -- and all my thanks goes to this forum. Roo these people know there stuff!!! I tell this story to all the new comers - if it wasnt for these Cush Angels on this forum my Penny would not be here right now - they set the right path for me and I followed and she is good right now -- they put me in touch with two vets and they were here for me every minute I need them even when it was midnite and Penny was very sick they were here for me - I know they will all be coming on soon to give you advice - Leslie - Deb - Kim - Addy - Glynda etc etc they are some of the most fantastic people around!! Penny had symptoms Java has - Penny lost her coat - drank tons of water - need to go pee all the time - was always hungry and never gave up till she got something - slept alot - panted all them time - looked for cool spots - went into deep sleeps - didnt bark like she use to - got the pot belly - but she did still seem happy and had her spunky days - she did not have surgery - I havent heard of any dog having the gland removed but that doesnt mean it hasnt been done - just the post I read didnt mention the surgery - that sounds kind of harsh for an older dog - but like I said the experts will be here to guide you soon!!!!!! Will be checking in on you and Java - if you need anything or have any quesitons I am here for you!!:)

Roo forgot to mention the members are going to ask you for Java test results - anything you have especially anything that was flagged as high or low and the results of the ACTH stim test if Java had it yet and if not they will test you that Java need to have a ACTH test to check the cortisol levels - so post what you have:)

Hi Roo,

We have a fine group of caring, knowledgeable people that will stop by and ask questions and offer comments, share experiences, etc.

We have some members that were successfull with removal of their pup's tumors. I am sure they will offer their stories and opinions.

Some of our members who were not able to consider surgery elected to treat with Trilostane.

I use Honest Kitchen Embark and just started the Zeal. I love the food!!!

Hugs,
Addy

Hi Roo,

I am sorry you have to deal with Java's adrenal tumor. My dog had a very large tumor removed from her left adrenal gland when she had just turned 12. She was doing very poorly for a couple of months prior to her surgery. Her adrenalectomy was very successful and she lived for another 3.5 years with an excellent quality of life.

We had a great board certified surgeon. He once told me that all he cares about is the size of the tumor and its involvement with area blood vessels. Tumors in the left gland are easier to remove than in the right. At 13, Java is getting up there a little bit. However, if she is a pretty strong, healthy girl for 13 I think you should consider an adrenalectomy. All of my veterinary professionals thought Shiloh was a very good surgical candidate. As you know, it is a big surgery with risks. Your other option is to treat the tumor with Trilostane or possibly Lysodren. For me, there was absolutely no question but to proceed with the surgery and I knew if Shi knew the situation, she'd want to go for it. But it was difficult and every situation is different. I don't think you need to be in a big hurry in making your decision. Do your research and discuss it with every veterinary professional you can. All the best.

Ken

I don't have a copy of the blood results, I will have to ask for a copy.
Her liver enzymes were high at her last routine appointment. We called the vet to see her again, because she had some growths that we wanted checked out. When we mentioned the other symptoms (pot belly, panting, thirst, begging, bony appearance to head, etc.) the vet suspected Cushings and ran a full senior blood panel, they had her there all day taking blood tests. All I remember about the test is the vet saying that her adrenal levels were very high, 3 point something when they are supposed to be below one.). At that point our vet suspected a tumor on the adrenal gland so she ordered the ultrasound, and that's when they found it, on the left gland.

I talked to the vet today about our options, and she said based on the tests that she ran, Java is healthy enough to have surgery, even as a senior dog. I am a little frightened though by the procedure, it sounds dangerous; but I suppose not doing anything is also dangerous to her. I think I am going to schedule a consult with the surgeon and get his opinions.

It's so hard to know what the right decision is. I have to always ask myself am I doing this for her or am I doing it for me? If anyone out there has had experience with this type of surgery I would be interested to hear; bad or good, so I can make my decision. What Ken said is encouraging, it does give me some hope.

Right now Java is taking:

425 g Denosyl 1x per day
Vetri-Science Vetri-Liver supplement
Honest Kitchen's Perfect Form digestive supplement
Vitamin E 200 mg
Milk Thistle 3x per day

She weighs 68 pounds, which is overweight for her. She is a small lab mix, should be around 58 pounds.

Hi Roo and welcome to you and Java! :)

When I first started learning about Cushing's, I wished Squirt had ADH - the adrenal based form, meaning the tumor was on the adrenal gland instead of the pituitary gland. Why? Because that meant a cure was possible. ADH is the only form of true Cushing's that can be cured successfully via surgery here in the USA. ;)

Ken is our resident expert on adrenalectomys....he and Shi shine with what is possible with ADH. His advice to seek and talk in depth with a board certified surgeon is the most important thing you can do. Talk to several if need be in order to learn all you can about the procedure, risks, outcome expectations, and what they have to say about Java's case in particular. Dogs can and do live well after these surgeries. Dogs can, and do, live with one adrenal gland or with adrenals that don't function at all. Medications can do wonders. ;)

We have several members who are treating adrenal tumors medically with either Trilostane or Lysodren, too. Most of the pups were not candidates for surgery, tho, so this was the only choice for treatment available to them. It sounds like Java has a chance of being cured via surgery - which is a goal we would all like to have.

When you talk to the surgeons, take someone with you to help remember what is being said. Or take a recorder with you and record the conversations. If you are like me, my mind won't be still long enough to absorb and remember conversations like this because I would be so stressed. :rolleyes: If you get home and realize you have questions that weren't asked, you can start a list of those and make another appt. to discuss them or perhaps send an email if the surgeon is open to that.

We are all here with you regardless of what path you choose.

Hugs,
Leslie and the gang

Roo - leslise just made me realize why I didnt hear much about the gland being removed - its because pennys turmor is on her pituitary gland so all my discussions had to do with that. Ken is expert!! Ken so happy you shared that with us - we learn something new everyday!!! So glad you had good sucess and had 3 more years with your dog - this is really nice to hear:)

Roo - Scheduling the meeting with the surgeon is the absolute best thing you can do. And if you don't like that surgeon find out if there is another in your area.. for this surgery which is delicate you want someone who is very seasoned. A good one will review the options with you and guide you thru this. If you tell us where you are located perhaps someone can help with names if you need them. Take care, Kim

I live near Syracuse, NY. The first surgeon I want to meet with is Dr. Macdonald at Stack Veterinary Hospital. She is board certified, and graduated from Cornell. My husband visited the facility when Java had her abdominal scan and was impressed with the staff and facility. The other names my vet gave me are Dr. Bookbinder and Dr. Robinson, I don't know as much about them.

I hope that the meeting will provide some guidance or a better feeling of how to proceed. My vet is good about answering questions, but I sense that she is cautious and does not want to try to influence me one way or the other. I am hoping that a consultation will help to clarify some things, as I still have some reservations.

Are there any questions that you can think of that I should ask during a consultation?

I've thought of these:
What is the recovery time of this type of surgery.
Cost (I already know it will be high, but if that is the best option, we will still consider)
What is her prognosis without surgery.
What changes can I expect after surgery
What kind of medication will she need after surgery

Ask which specific surgeon would be assigned to Java and how how many of these procedures they have done.

Ask for particulars about the type of tumor, the size and their thoughts on the success rate. Not all adrenal tumors are operable due to either size or involvement with the vena cava.

Ask them for the pros and cons of doing the surgery.

Ask them, if this were your own dog what would you do.. and look them right in the eye when they answer.

After you go thru the dialogue I bet your gut will tell you what to do. Good luck - we'll be with you in spirit. Kim

I'll try to answer your questions as far as Shiloh is concerned:

Shi stayed in the hospital with 24 hour veterinary care for 3.5 days. This is probably longer than most cases. As soon as I got her home I could tell she was feeling SO much better. Full recovery took over a month.
Cost will probably be somewhere around $4500 when it's all said and done.
I don't think the prognosis w/o surgery is very good although treatment with Trilostane or Lysodren will help with the symptoms.
Shiloh was just an extremely happy and healthy girl after her surgery.
Shiloh only took a baby aspirin, prednisone and vitamin A for two weeks after I got her home.

You definitely want to get a feel for how experienced the surgeon is with adrenalectomies. Ask what kind of long term success rate they have with similar adrenalectomies. You might want to ask their opinion of medical treatment rather than surgery. Try to make sure the surgeon has a copy of the ultrasound images and the written report prior to your consultation. Make sure s/he thinks Java is a pretty darn good surgical candidate and the tumor is definitely operable.

From my experience, these board certified surgeons are highly educated and impressive people. You are going to know so much more after your consultation.

Ken

Somewhat of an update: I have an appointment on 10/17 to meet with a surgeon in Canastota, NY - Dr. Bookbinder. Wish me luck. The first surgeon we tried to consult with, Dr. Macdonald will not do the surgery because she is not in a 24 hour facility. I am hoping that he will be able to sway us one way or the other with how to proceed, after he actually sees Java.

Also thanks for the questions that I should ask, all the well wishes, and the insight into what to expect and what could happen if Java is a good candidate for surgery. I'll come back after the consultation to let you all know how it went.

Thinking of you and Java - love and prayers - let us know how the appt goes! xo

I do have Java's test results now, I had to get them for her appointment Monday. I will just list the things that she tested abnormal on:

Superchem:
AST(SGOT) 202
ALT (SGPT) 350
Alk Phosphatase 1740
GGTP 17
CPK 4647
Comment - AST may be lower than reported due to a hemolysis 22+ but is still abnormal

CBC: Platelet count 424
Platelet EST Increased

Urinalysis:
Specific Gravity 1.013 (low)
Protein 2+ (high)
Blood 1+ (high)

Endocrinology

Pre-Dex: 3.44 ug/dL
Post-Dex 1: 3.80 ug/dL
Post-Dex 2: 3.84 ug/dL

Reason for consult: encapsulated left adrenal mass by ultrasound, LDDST suspicious of ADH;

Ultrasonographic findings:
GI Tract/Lymph Nodes - no abnormalities
Urinary Bladder - normal in appearance
Kidneys - each 6.2 cm; slighly hyperechoic
Spleen - normal on appearance; pancreas - normal
Liver - increased in overall size; parenchyma homogenous and hyperechoic; minimal sludge in gallbladder..
Adrenal glands - right small 2.0 x0.3 cm. Left enlarged with heterogenous parenchyma and foci of mineralization 4 x 2 x 1.4 cm; no vacular invasion.

Ultrasonic diagnosis
1. Left adrenal mass
2. Large hyperechoic liver
3. Hyperechoic kidneys

Hi Roo

Will be thinking of you on the 17th - sending WARM THOUGHTS - SUPPORT - LOVE - PRAYERS - HUGS - STRENGTH - AND ALOT OF BIG LICKS TO JAVA FROM PENNY!!! Its alot to handle but you are doing a great job - great mom!!!

Hello!!!! First let me say you have come to the most amazing place you could ever find! People here are amazing and have and still are carrying me through some hard times! Matter of fact, i was at Gulf Coast in Houston today speaking with specialist. it took almost two hours to get there when its only 56 miles away, traffic is horrific to get there. i looked into A&M biomedical and Gulf Coast. One is a university top of line and other private practice. Scheduling, days, times etc.......we landed Gulf Coast. i wrote all my questions down, and then used cell phone to record consult.
Ken is totally correct that the left is easier for them to get to, one part of the left is 50/50 of it being cancer the other part of the left is probably (like high 90% i think...) Most time is slow in growth. So with that being said, how large did they say it was? what part is it on? is it vascular?
as a pet parent it is important heart breaking and loving to realize quanity or quality and who for.
is the tumor blocking any blood flow? is it effecting any other organs? what are the conditions of the other organs
It is a risk surgery.........hands down, and it is a difficult decision, so with your pet childs health, where would doctor place them in the risk scale. will risk be lowered since your pet is strong? and MAKE SURE the doctor has performed many many many of these surgeries and how comfortable they are with them. What type of equipment is used, how prepared for the "what ifs" during surgery, how many years have they been there themselves, and their team that works in OR with them, what are the pros of and cons of surgery, vs pros and cons of not. As far as what meds are needed after surgery, i think they are steorids until they get result back of what sort of tumor was removed, and because other gland is making up for the bad one. Then they wean them off slowly or will know how to medicate based on lab findings of tumor. Recovery in hospital is about 2 days and at home 2 weeks, Cost of surgery, not sure about there but i would GUESS between 1800-3500(?????) is there 24 hour care afterwards there? how often will they be in contact, what type of incision will they perform? plank or stomach? (i would hope stomach, plank doesnt let them see very well) This is a very difficult and stressful decision, and you have reached some amazing people here, all things aside, focus on what is truly best for your pet child, and what decision do you feel you can handle? when you make this decision, search your heart, search your pets desire, listen with your eyes............the answer hits like a brick in the stomach and not matter the answer it is stressful,
I can not even begin to express all the emotions flowing through our day here....and now my little one is vomiting all evening. However there has been slight pieces of grass in it as well.
your primary vet is intelligent to stay neutral. No one knows that pet like you do, and no one knows your heart like you do.
I hope you consult with a very detailed, experienced specialist. Hope to hear back.

i think considering the hour and all, I believe i posted on things you already had info on etc........i think i must of read your post way earlier in thread then went to end and posted on that. i am so sorry. I will try and be more careful when i post to your thread so my replies dont ramble on.

Quote:

---

Originally Posted by Skye

i think considering the hour and all, I believe i posted on things you already had info on etc........i think i must of read your post way earlier in thread then went to end and posted on that. i am so sorry. I will try and be more careful when i post to your thread so my replies dont ramble on.

---

Hey, don't worry about that. I was just reading your post about your baby girl, sending good thoughts your way. We are all in this together, we all love our dogs with all our hearts, that is why we are here. Everyone here understands what we are going through.

My husband and I took Java to Dr. Bookbinder's today for the consult. We were very comfortable with his approach, he was very open and honest. He also assured us that there is no "right" decision, as there are so many variables and we cannot predict what will happen. It was pretty clear though, with an adrenal tumor like she has and that will continue to grow, doing nothing might be worse than having her go through the surgery. The surgery can at least give her a chance. Her blood tests already indicate organ damage, considering how high her levels are.

We asked the important question, if this were your dog, what would you do. He said that if his own dog were in the same position, and knowing what he knows about Cushing's disease, that he would want to try. I was comforted by the fact that he said that he is more conservative than some other surgeons might be; he is not going to go for an all or nothing approach with tumor removal, if it compromises the chances of her survival.

Her surgery is going to be on October 25th @ 9:45 AM.

I had a consultation yesterday with Dr. Bookbinder, and decided to schedule Java for an adrenalectomy. The date this will happen is October 25th. I have to admit that I'm very scared about this, since there is a possibility that if something goes wrong with this, I could lose her in less than a weeks time. The thing is, she does have a large tumor on her left adrenal gland, and her blood test levels are so high that it indicates damage is already done to her organs and that it will only get worse if the surgery is not done. The doctor has assured me that his approach is not agressive to the point where he is willing to remove the tumor if it would put her in jeopardy, which to me is a good thing. I think part of the reason I am scared is that right now she seems relatively happy, her biggest symptom right now is that she is hungry and thirsty all the time. The doctor has told me that with time she will develop other symptoms if we do not act, most likely kidney or liver failure. I really hope I am doing the right thing. It seems like every option has it's drawbacks. The adrenalectomy is the only option that may offer her a better quality of life but is also risky enough to possibly end her life during surgery, or afterwards if there are complications. :(

Moderator note - I have merged you post about the surgery with Java's original thread. We like to keep all the info about each pup in one thread. This way it is easy to look back at the history if needed.

Mornin',

Being scared when facing something like this is perfectly normal. If you didn't feel this way, I would have to wonder about you! :p

The surgeon said two things that would go a long way toward bringing me comfort. 1) That this is what he would do if Java were his; 2) he wouldn't take any further risks with her than he had to. You know today that this tumor is wreaking havoc in her body. This operation can give her the best chance and it sounds like Dr. Bookbinder knows his stuff. We have to trust he will do everything in his power to make sure your sweet Java gets off the table and makes a swift, uneventful recovery.

I remember when my Squirt had a tumor removed along with half her spleen. I was absolutely terrified from the time they told me about the tumor until the day she showed me she was well and back to her old self. Everything she did would cause my heart to race and my hand fly toward the phone just in case. That was in '08 and I am grateful every morning we wake up together to face another day. It is my sincerest prayer that years from now this time is just a memory and your heart is filled with wonder for each and every day you have with your Java.

Until the 25th, enjoy your baby. Go do things the both of you like to do. The decision is made and now you simply put one foot in front of the other until the surgery is over and she is back home.

We are here for you any time, sweetie - you are not alone. If you need to vent, have at it. We can take it! ;)

Hugs,
Leslie and the gang

Hi Roo,

Oh boy, October 25th is going to be a big day for you. I definitely think you have made the best decision for Java. Dr. Bookbinder sounds fantastic. Judging from all of the information you have provided, my guess is that Java's tumor is not a real bad one in terms of size, vascular involvement, or malignancy.

Shiloh's adrenalectomy was exactly 5 years ago today, October 19, 2006. Oh my goodness, it was such a difficult day for me but when my surgeon called and said the surgery went well and Shi was awake, it was total elation. I truly believe that the odds are way, way in your favor that Roo's adrenalectomy will be successful and she will make a full recovery. About a week before Shiloh's surgery, I took her to another really good gp vet I knew, just to get some confirmation that I was doing the right thing. She said the risks were "minimal." I questioned her on it and her reply was, "minimal."

You and Java will be in my thoughts and prayers.

Ken

Roo - I will be praying for Java everynite and especially on the 25th! The doctor feels very confident so I would of made the same choice especially since he said Java would only get worse -- as of the last ultra sound ( awhile ago) there was no tumor in Pennys gland so that means one in her pit gland -- the IMS today said I wish it was in her adrenal gland and she could of had it removed - so it seems like when they do see it in the adrenal gland depending on size etc they do like to remove them SENDING YOU ALL THE LOVE HUGS SUPPORT STRENGTH PRAYERS THAT YOU WILL NEED TO GET THROUGH THIS!!!!! GIVE JAVA A BIG HUG AND KISS!!! ADORABLE PICTURE - I see you are from NY - I think you are the closest neighbor to me - I am in RI

Thank you everyone for your thoughts and prayers, it really does help. Dr. Bookbinder did not over-promise, but does feel that based on where her tumor is located and the size, that there is a good chance that she will benefit from this surgery. At the time of the ultrasound, there appeared to be no vascular involvement, though there were some white spots that showed up which may indicate that the tumor is cancerous. If that is the case we can only hope that it has not spread and is still contained within the tumor. I guess we will really not know until the doctor gets in there, I know the waiting is going to be agony. I will be working that day so hopefully I will be able keep my mind occupied for a little while until I get the news (though highly unlikely...I am going to be very distracted. The good news is I don't operate heavy machinery at my job, the worst that will happen is that I will make a mistake on a spreadsheet).

Please know we will all be with you and Java through the whole thing. Sending strength and love, Kim

Roo -

You and Roo are in my thoughts and prayers every day!!! I am sending you LOVE STRENGTH HUGS PRAYERS SUPPORT POSITIVE THOUGHTS to help you through each day - please keep us posted and remember we are here for you - Give Roo a kiss and hug! xo

Mornin', Roo,

Well, my hat's off to you! There is NO WAY I could sit at work and do anything other than cry, call the hospital, pace, fret, cry, wring my hands, cry, call the hospital, pace, cry...until someone took mercy on my and konked me over the head to put me out of their misery. :p (Actually, I'd be standing outside the surgery unit if they let me. :rolleyes:) Tell you what, since you'll be at work and I won't, I'll go ahead and do all that for you tomorrow, 'k?

Our thoughts and prayers remain with you both.
Hugs,
Leslie and the gang

Adding my good thoughts to you and Roo tomorrow. Judi

Quote:

---

Originally Posted by Jenny & Judi in MN

Adding my good thoughts to you and Roo tomorrow. Judi

---

Me, too!!!!!!!!!!!!!!!!!!!!!!!!!!!

Marianne

Quote:

---

Originally Posted by Squirt's Mom

Mornin', Roo,

Well, my hat's off to you! There is NO WAY I could sit at work and do anything other than cry, call the hospital, pace, fret, cry, wring my hands, cry, call the hospital, pace, cry...until someone took mercy on my and konked me over the head to put me out of their misery. :p (Actually, I'd be standing outside the surgery unit if they let me. :rolleyes:) Tell you what, since you'll be at work and I won't, I'll go ahead and do all that for you tomorrow, 'k?

Our thoughts and prayers remain with you both.
Hugs,
Leslie and the gang

---

Well, I gave myself a reality check today. I will NOT be going into the office, I'm not sure what I was thinking:confused:. I'll be logging in from home instead, so if I do end up crying or getting upset, no one will see me... my manager was very nice about it, she is also a dog lover so she gets it.

Sending positive vibes your way.....we are all here.

Terry

Just stopping in again to say we are all her for you and Java- I will be checking in tomorrow if you need to vent cry scream whatever!! Are prayers are with Roo - all good thoughts coming to you!!

Quote:

---

Originally Posted by Roo

Well, I gave myself a reality check today. I will NOT be going into the office, I'm not sure what I was thinking:confused:. I'll be logging in from home instead, so if I do end up crying or getting upset, no one will see me... my manager was very nice about it, she is also a dog lover so she gets it.

---

Glad to hear that your manager understands, now, if you need to vent or just want to talk, please know we are here for you and sending tons of positive energy, our love, and we are keeping you both in our thoughts and prayers.

Love and (((hugs)))
Lori

Love and warm thoughts sent your way from Nebraska this morning. Kim

Holding your hand from Wisconsin:)

Will be with you in thought and prayer all day.

love,
addy

Hanging in there with you this morning. Positive thoughts and plenty of prayers being said in California.

((((Huge Comforting Cyber Hugs))))
Glynda

BIG HUGS AND LOTS OF PRAYERS FROM RHODE ISLAND!!! We are here for you and Java!!!!!!!!!

Still waiting for the update about Java from the surgeon...he said this morning that he should be able to call me with an update around 2 PM Eastern. I've been fairly calm most of the day but have to admit I'm very anxious because I know that she is on the operating table right now. Until I hear something I'll have to think that no news is good news. Thank you for your support, I'll be back later when I have something to report.