Adrenalectomy Surgery Questions (Reggie) 11 y/o Shih Tzu

Thank you all for your responses I will spend some more time reviewing and replying.:)

However several have asked for more information so here is some addtional tidbits about my dog Reggie. I will also post a corner photo of Reggie if/when I figure out how to do that. :confused:

REGGIE’S RECENT MEDICAL HISOTRY

Reggie is an 11 Year old Shih Tzu who has been relatively healthy. No major problems. He had infrequent seizures when he was younger (3 yrs) with a possible diagnosis of epilepsy. However he was not put on medication at that time preferring the wait and see method. Over time the seizures have stopped. Reggie is currently on 25 MG of cyclosporine every other day. He was put on cyclosporine to counter the effects of the steroids he was on put on due to an auto immune illness that is no longer present. (See purple font below for more information). He continues on the cyclosporine as more of a preventative measure until he has the surgery. His blood work for liver enzymes is normal now after several months of elevated enzymes due to the steroids.

Reggie is on a low fat diet consisting mainly of chicken/turkey brest, white rice and green beans. I have also been giving him ham which has higher sodium content so that may have to stop. I put him on this low fat diet about 2 years ago just because of age/weight gain no other medical reason. Reggie's weight is now good, about 20lbs which is with 1 pound of where his Vet thinks he should be given his size.

In March of 2011 Reggie had an upset stomach that lasted several days. The vet diagnosed pancreatitis. He was put on medication and then re-tested a few weeks later. The later test revealed that while the pancreatitis has cleared up he had a urinary tract infection. For several months (April – July, 2011) he kept getting infections but the cultures came back showing different organisms (E. Coli, Klebsiella etc). I was referred to an internal medicine specialist. Other than the infections no other overt Cushing’s signs were present (excessive water intake, increased appetite etc). I know some of the signs of Cushing’s as my friend’s dog was a Cushing’s dog.

The specialist did an ultra sound on the initial visit and found: The following:



ADRENALS: LEFT ADRENAL - 2.2 cm x 1.9 cm cranial pole containing 0.7 cm x 0.6 cm well defined hyperechoic nodule and second hypoechoic area, 1.1 cm x 1.2 cm caudal pole containing smaller well defined hyperechoic nodule, no evidence of vascular invasion
RIGHT ADRENAL - normal appearance, 0.35 cm width caudal pole
GI TRACT/PANCREAS: WNL's
LYMPH NODES/URINARY BLADDER: URINARY BLADDER WNL's
REPRODUCTIVE: Prostate: WNL
ASSESSMENT: Very large left adrenal gland with numerous nodules: neoplasia (adrenocortical adenoma, adrenocortical adenoCA,pheochromocytoma), granuloma, other


A low dose dexamethasone suppression test was conducted and based on that test and the ultra sound Reggie was diagnosed with Cushing’s disease. Both surgical adrenalectomy and medication were discussed as options. I decided surgery was a good option for Reggie.

Surgery was scheduled for August 5, 2011. The Friday before surgery during the pre op exam on Reggie a further complication was discovered. Reggie had a form of an auto immune disease where the immune system was hyper defensive attacking the platelets. The specialist explained that in many animals this is temporary situation and it is a matter of “resetting” the immune system. She successfully treated Reggie for this setback and we are now once again on the road to surgery.

In terms of the surgical team: Dr. Dixon surgeon: He is board certified and has done several successful adrenalectomies on small dogs. Perhaps large dogs as well but I did not ask that question. I met with Dr Dixon and I am comfortable with his knowledge and the approach he is taking for the surgery. Dr Dixon was recommended by the specialist and Dr Dixon will do the surgery in the specialist’s office with the specilist present as well. This means that Reggie’s after care will be provided by both the surgeon and the specialist and her staff who have been treating Reggie for the past 7 months. Both Reggie and I are very comfortable with the staff there.

The aftercare option and Dr Dixon’s experience were keys in my selection. In addition to Dr. Dixon and the specialist, there will be an anesthesiologist tending to Reggie during the surgery. Having the anesthesiologist there will allow Dr. Dixon to concentration 100% on the adrenalectomy.

I have not posted to you before but Have been following Reggie's story. I wanted ask, if you don't mind, is Dr. Dixon one of the surgeons at the surgery clinic at Az. Vet Specialists in Gilbert? If he is the Dr. Dixon, I can tell you he is absolutely terrific. He did the cruciate repair on my Lhasa about 18 months ago, & everything went great. If you are dealing with any of the clinics affiliated with Vet Specialists, you absolutely can't beat them. Your Reggie is definitely in good hands.

Debbie

Yes he is. :) I went to the website to make sure and saw his picture. I met him at the Scottsdale clinic so was not sure where else he worked. I know the Scottsdale clinic is not his usual practice site. I am so glad you responded makes me that much more confident.

Quote:

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Originally Posted by Skye

Mobility: He likes to jump up on couches stools etc.
No jumping for at least TWO WEEKS, take all cushions off furniture and put on floor, that way they can step on cushions and then onto furniture if they need to. If you are on furniture and have cushion, if they need up where you are, carefully lift, but remember....NO jumping UP or DOWN
His diet should remain same unless the stomach gets bothered then you might want to have on hand for just in case, white boneless skinless chicken breast NO RIB MEAT, simmer in pan or boil, only add water...NOTHING else use water that chicken is in for broth, canned broth even low sodium has salt.....so try to NOT use that. also have white long grain minute rice.
follow up and such.......well it depends.......we went back couple days later....dirreaha happened, she got checked, gave meds, after a surgery like that, guess that can happen, but you dont want that to continue...hers started that morning, by late afternoon it had not subsided so we went in. About 10-14 days after surgery, doctor will probably want to see him, and do a check on him, likely be on prednisone for couple of weeks give or take couple. low dose, slowly reduced giving other adrenal time to respond. would recommed if he sleeps with you...take mattress off frame and put on floor. lol matter of fact we just put ours back on.......lol, i dont think we needed to wait that long, just now got to it. lol, but for 2 weeks very strict on that, and no running playing type stuff either. they may want to but cant. they start to feel better fairly soon, but they have just gone through something huge and need to take it easy. incision is long, but remember they heal side to side not up down. i would recommed blood work to be redone 6-8 weeks after unless of course depending on details that i dont know....needs are different.
is this tumor bi-lateral or lateral?
is it a active tumor?
what are symptons now?
what tests have you have done?
how was tumor found?
what meds is he currently taking?
have you found a SEASONED specialist? this is a MUST i can not stress this enough
is it attached to the vena cava?
how large is the tumor?
is it right or left adrenal?
does this surgeron do flank or abdominal incisons?
is it vascular?
this may answer some of your questions, if not i am here if you need and several others as well.
will be thinking of you and Reggie, i hoped this helped. (((((((((((hugs)))))))

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Hi Skye;

I not sure of all the answers but here are some.

Reggie's normal diet is what you recommended if he gets an upset stomach so that is good. No need to change.

With the exception of the UI infections Reggie has very few symptons of cushings. He is still eating/drinking normaly has not gained weight same energy level etc. In fact he just came in from running along the fence in the back yard he was chasing dogs that are on the other side of the fence.

The tumor was found via ultra sound and then the LDST confirmed the cushings. It is not attached to the vena cava and both the surgeon and internal specialist feel that the size and location of the tumor is such that surgery is a good option for Reggie. The tumor is on left adrenal gland and approx 2cm. I have a board certified surgeon and an anesthesiologist on board.

Waht I am not sure of is does this surgeron do flank or abdominal incisons?
is it vascular?

I am meeting with the specialist and suregon again on Monday afternoon to take another ultra sound and do preop workup. I will be asking these questions. Thanks !

OMG Reggie is so cute!!! Look at that face!! :):)

xo

Hi Barton,

I'm just saying hello mostly...........

My Kira (siberain husky) had this surgery too a year ago. There is a rather active thread on the whole thing here. Mostly entered by me, all the useless stuff posted by me... But there you go. Anyway, my memory isn't the best so I'm not going comment too much but from what I can tell there haven't been any complications from the surgery mentioned here. I think todays specailist have a pretty good handle on that now. Risky of course but maybe not like it was at one time. My Kira handled it great. It was when we stopped the prednizone that it turned bad for her. A lot of lameness showed up. She is currently having therapy sessions that include a water treadmill. I don't know that it helps with the regaining strength but it sure boosts her spirits!

Anyway, I know this is a scary time. And that date is not so far away. But trust me you are in good hands here. The Cush Angels float around almost around the clock. I'll be thinking of you and wishing you well.

Thanks Janis;

I hope Kira does get better with the therapy. What a beautiful dog. When Reggie was on steroids he developed muscle weakness and I started nightly massages. Not sure it really helps but it makes me feel better. Since he has been off the steriods he no longer shows the muscle weakness but I still do the rub downs because he loves it.

Lucky well loved dogs... LOL

My Shiloh had her adrenalectomy in 2006 at the age of 12. She had a very large adrenal tumor removed from her left adrenal gland. We had a highly skilled and experienced board certified surgeon, also in Scottsdale, perform her adrenalectomy. He was assisted by another wonderful bcs. Shiloh lived for another 3 1/2 years with a wonderful quality of life. Prior to her surgery, she was just hanging on.

I will try to answer some of your questions from our experience. There will be so much serious healing going on, you do not want to let Reggie run or jump, at all, for ten days or so. I think you should have him on his leash anytime he goes outside for the first several days he is home. My surgeon just had Shi take prednisone, a baby aspirin and vitamin A for two weeks after her surgery. No pain meds or anything else. After I got Shi home, she just kept getting better and better every day. A month post surgery, she was doing great, just a very healthy and happy dog...long walks, frequent trips to the park, surf trips, etc.

As you know, this is a very major surgery. My surgeon told me they have an 85% long term success rate with surgeries similar to Shiloh's. February 2 will probably be a very emotional day for you. You and Reggie are already in my thoughts and prayers. Hang tough.

Ken

God bless.

Scott