Tipper - adrenal tumor/breathing issues

Hi Everyone:
I forgot to answer your question Sharlene. I do not know if the right adrenal is smaller just because the left is enlarged, or if it has become smaller than it would normally be, as I did think of that and am not sure, but a great question. It is just pouring Tipper is panting a little off and on as I think she is uneasy, but by no means frantic so I think she can manage. I just keep talking to her like nothing is wrong. Water is just running down our street like a river. The yard is a lake and my fountain is overflowed. I have never seen such weather, and so much rain. A lot of my plants that should have had buds and flowered did not, and I am not sure if it has been all the water or the rough winter. At any rate I am cleaning the house up little by little. Blessings
Patti

I understand how you are thinking- list of questions one would have to think about and discuss if you are considering a surgery if Tipper did not have a pituitary tumor:

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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.

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Patti, we all know how much Tipper means to you, we know she is your life and why. Question 8 in Part one is very important. Only you can answer that.

As for confirming the pituitary tumor, for some reason I thought it has been confirmed, I must be mistaken then.

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Originally Posted by goldengirl88

Thank you Glynda. The other adrenal is a lot smaller! I am wondering if this is all she has had all this time?? I am emailing the IMS and want clarification if anyone at all has ever seen a pituitary tumor of any size on her. If this is the case she would then be cured if we got rid of this adrenal tumor, so that that does change how things were being looked at before. If no one knows the answer though then we would need and MRI to confirm that there is none. Lots of things to consider as nothing is ever as simple as it seems with this disease. Thank you for you help and I hope you are doing well. We are in for more tornado weather warnings are already coming out. Blessings
Patti

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wow this is something you definitely need to find out for sure. Keep us posted..prayer sgoing your way for Tipper and you.

Addy:
The PDH was confirmed through her testing only. Knowing that Dr. Peterson looked at all her testing and said it was PDH I asked the IMS when Tipper's CT scan was done if she had a macro tumor, because of some of some of her symptoms. She told me Tipper did not have a macro or the radiologist would have told her, but she never said whether they saw a tumor there period? I was assuming since she said it was not a macro that they saw it and it was tiny. After the neurologist put her scan up during my appointment to look at Tipper's brain because of her tremors I saw nothing, and he said her brain was fine and he said maybe her tumor was small and not picked up on the CT?? So what I am saying is all I have is the testing to confirm this, I have no MRI that says she even has this. I am wanting a definitive answer from the IMS as to was it too small to see, or could it be there is none and it has been an adrenal tumor all along? I am guessing only am MRI will give me the answer I want. I do not know how to answer 8. because if this thing grows which becomes more dangerous?? Blessings
Patti

Hi Everyone:
Well it's dark and acting kind of funny so I guess we are in for another round. I don't think I will give Tipper a pill, too iffy. Had a friend from Pittsburgh call me and we may meet for coffee next time I go to the Dr. If Tipper is ok. We were able to go out on the porch for a while, and Tipper went out once when it was raining!! Tipper never went on the porch during rain. By the time this season is over she should be storm proof. My fax is not working so I have to take a look at it tomorrow when Tipper is occupied as she will want to get in on the act and tear it up! I am taking Toby to see Delora this week. She is very lonely and her son said he arranged for someone to visit her every day, well no one has been there for three days. I am looking forward to a dry day tomorrow. Tipper did not like missing her walk. Blessings
Patti

hi patti, it is the opposite overhere....still no rain.
we could use some of your rain and send some dry weather in return......
after your frigid winter you could use some nice weather with sunshine.
it will be interesting to hear what your ims has to say about tipper.
that pain clinic cetainly knows how to occupy you.
is this the only one near you?
hope you will have some dry and quiet days till the new storms arrive....

Patti, it really sounds as if Tipper is learning that the rain poses no real threat to her.
That is wonderful!

Hi Everyone;
Yes sometimes I think that Valerie, but then some days maybe when her cortisol takes a dip she reverts back to the old stuff. Last nite I gave no meds as I was not 100% sure we were getting the storm and I am glad I did not give her any as it passed us by. She still slept in the closet though. I am not noticing the swallowing a lot the last week or so. It has really slowed down. So I am wondering if all the rain got rid of some of the pollen and it really was allergies as she is not doing it as much. Of course she is sleeping in the closet so I cannot hear her at nite either, but during the day she is not doing it a lot. I also noticed there was no goopy white mucous in her eyes either. Maybe this rain did one good thing? Also I cut out her antihistamine the last few days as she cannot take it with valium and I did not know if I was going to have to resort to the valium. I am not giving her any today to see if she starts that swallowing or mucous, as if the allergy stuff is past for the season I do not want to be giving her pills she does not absolutely need, as she is on enough stuff. I have noticed her trachea acting up outside a lot when she is smelling to go potty she is snorting like a pig and at times starts into honking. She gets Adequan next Wednesday so that is good. I will go over the antibiotic situation with my vet then so if he wants her to start oral before the operation I can get them and have them on hand. The dogs have already walked once as it is cool and was a little foggy this morning, Tipper likes the cool air. Yesterday I mentioned about her panting sometimes in the house, and I thought is was just because of the rain and it made her a little nervous. Today I saw her when we first came back into the house pant a little, and I felt it seemed stuffy in the house and kind of clammy. I think when she does not have air flow, and the temp rises just little she has become so sensitive to heat that it makes her start panting. I noticed this in my room last nite it got a little stuffy and she panted a bit, so I am not leaning towards the Cushings being uncontrolled at this juncture. Today should be a good day for the dogs if it stays cooler and no rain. Blessings
Patti

Hi Everyone:
Tipper and Toby had a wonderful day. We did bubbles, sat in the back yard and played ball. Even Elvis came out on the porch for a while!. I found a long ribbon and had the kitties running thru the house chasing it. My Tipper really enjoyed her day. I hope for another of the same tomorrow before the rain comes back. They are all tired and Tipper is laying on the floor close to the closet! She never lays on the floor in my room. She was ok today except for the snorting and honking at times in the yard. These little gnats in the grass are awful biting at your ankles and feet. It was so nice to let them enjoy a day with no rain! Blessings
Patti

Patti,
I am so sorry I rarely write on your thread, but I read it as often as I can to follow Tipper's progress. Between Lola, my job, I have no time left whatsoever!
My thoughts and prayers are with you and your babies

Nadia