Tipper - adrenal tumor/breathing issues

It's critical the surgeon has alot of experience. Ask them how many of these surgeries they've done and what the success rate has been. Ask specifically about the size and location of the tumor. Ask what the pre and post op treatment plan is (some give meds before surgery also). Ask if Tip is a good candidate based on size and location of tumor as well as other physical issues namely the breathing. Have a video on your phone ready to show a breathing episode so they can see what you are describing.

But the single most important question is to look him/her in the eyes as human being and ask if this was your dog what would you do? Then shutup and listen and look at the eyes - I'd guess that will give you your answer.

Another thing to be sure to tell this vet is just how critical Tipper is to your universe. Others that have gone through this have indicated that their vets told them they must be prepared to lose their pet in order to save them.

I highly suggest you read the threads of people that have gone through this as you will see their journey was very similar regarding research, interviewing etc. I have to leave for the day but will come back tonight and try to give you some links to others threads.

We don't expect replies to everything we say - you just take care of you and Tipper. Knowledge is power and you are doing the right thing by reading and focusing. We are here to help as needed. Kim

Patti,
I have asked the question before to a surgeon about it being his dog, would they do the surgery. This is with another fur baby I had at the time. I snuck that question calmly in, right in the middle of a bunch of technical questions and caught him off guard. Observing body language and watching the eyes is critical. His eyes darted all over, then looked down, avoiding eye contact. He shifted in his seat a couple of times. I calmly waited him out. He finally said, "No, probably not." I had my answer. Xxxxx

Kim and Kathy:
Thank you for your help. You two brought up the number one thing I always do with any of my babies. I ask the Dr. straight forward if this was your dog and knowing your abilities would you do this? I am writing down all the questions you all give me to ask. I am leaning on all of you now, as every 10 minutes I crumble. The question about are you willing to lose your dog to save it. I can't truthfully answer that because Tipper is my universe, but I do not want her to suffer and have a terrible death. Blessings
Patti

Quick comment for everyone. I have an appointment scheduled to see the surgeon with Tipper for Sept 6th at 2:00 pm. Blessings
Patti

Good! That gives us time to help you gather some questions. ;)

Leslie:
Again thank you just hearing from you seems to put me at ease. Blessings
Patti

Yes, Leslie has that same tranquil effect on all of us!;):)

Hi Everyone:
Well it has been 7 days since I started Tipper on the 20 mg Vetoryl. She is starting to show uncontrolled signs already. Some panting, hungry at nite and wanting more food, and restlessness. Actually more noise again when trying to breathe at nite. Now I am not sure what we will do. If 30 mg is driving her pre number down too far and 20 is not enough, my best guess would be a 20/10 split, because they only want Vetoryl. I asked the IMS about using the Vetoryl if this is an adrenal tumor, she said keep using it. That way she is still not getting all 30mg at once, but will have 10 at 7:00 at nite to stop the hunger etc. This will be crazy expensive. I sat here yesterday and tried to figure out how I can afford this operation if that is the decision I make. Yesterday the hospital called me and told me 2500.00 - 3500.00 would be the cost. I have no Veterinary School near me they are all many hours away. I would be afraid of the travel time on Tipper. I am just scared that a private surgeon working at a private hospital may not be as experienced as what I would get in a veterinary school. The surgeon that I am seeing is a woman, that has had 3 xtra years on top of her board certified training in tumor removal. She trained in the hospital where Dr. Bruyette is. I will shoot him an email and see what he thinks of all this. I still have not heard back from my IMS on the questions asked. I know she is really busy. This has really put me in a dark place, I am having a hard time dealing with this. I have reached out to some people in Pgh. to be on the lookout for a good motel that takes dogs close to this hospital. I will have to stay there probably a week in case Tipper would have any complications. I can't possibly think of bringing her home with no emergency place around, and they would know virtually nothing about this I am sure. I have had so many break downs over this I quit counting. I am counting on you all for surgeon questions. Blessings
Patti

Mornin' sweetie,

I'm sorry the signs are getting stronger, adding to your worries. Hopefully the 20/10 split will be acceptable and will help. If this is a cortisol secreting tumor, it often takes higher than normal doses to control the cortisol so these signs could be attributed to what is going on with her adrenals. If it is due to a pheo, you may see those signs come and go as that tumor is switching from active to non-active and back again. ;)

As you know, there have been several cases of adrenal tumors, both cushing's tumors and pheos, lately. Flynn was one of those with a pheo and based on her own experiences plus observations here Trish put together a great list of questions for us not long ago.

Part I is for owners in the initial stages, when an adrenal tumor 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 pre-operatively for dogs with pheochromocytoma, anticoagulants or anything else?
7. How will you treat to prevent clots post-operatively?
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.

For Tipper specifically, I would add to these wonderful questions some concerning her throat - how will they handle that? What will they do to monitor her breathing? What are the odds breathing tubes would be used..or other instruments that need to go down the throat? I am sure they will realize she has had an issue with this when they read her records, but I would want to be sure this was discussed. In my little mind, it is feasible her breathing issues are due to whatever is going on with the adrenals (especially if this is a pheo) and if that is corrected, her breathing will be improved as a result. ;)

I know you are having a hard time finding things to be hopeful about, to hold onto, so just know that I have hope enough for us both until you are able to have your own. ;)

Hugs,
Leslie and the gang

Leslie:
You have been my guiding light and savior thru this whole journey. I appreciate everything you have taken your precious time to do, and help me for Tipper. I am so scared for her that all I can do is cry. Some how when I hear form you it helps me get thru this. I guess knowing how strong you are and how many babies you have helped seems to bring me to a calm place. I am wondering how Squirt has done/ Is she off the antibiotic? I hope she is doing well, and can put all this behind her. Blessings
Patti