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Thread: Pheochromocytoma and Cushings operation advice

  1. #1
    Join Date
    Jan 2017
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    Default Pheochromocytoma and Cushings operation advice

    Hi everyone,

    My almost 9 year old shih tzu has been diagnosed with a pheochromocytoma (tumour on her left adrenal gland which has grown into her vena cava). We've just had some test results back and she's also got cushings disease, probably from the pheo releasing cortisol steroid but also possibly because she has a small brain tumour in addition which is causing the 'good' adrenal gland to release it.

    We've been referred to a specialist oncology and soft tissue surgeon who is very experienced but he said himself it's a very tough decision to make as the surgery is high risk and recovery equally critical, although he does seem to think she has a reasonable chance of pulling through. There is also a small risk that even once the pheo is removed, she could still have cushings IF it's not the pheo producing the cortisol. Or that the tumour has broken off and could potentially have started to spread to lungs/liver already.

    In herself she seems fine. She is on antisickness meds (the only reason we took her to the vet initially) and beta blockers to prepare her for surgery, but is generally very happy and you'd never really know anything was wrong, although we are aware of the risks of possible rupture/deterioration if not operated on.

    The decision we are now trying to make is whether to put a 9 year old dog through massive surgery, or to leave her and let her live out her life (whilst it's still of a good quality). But we don't know how long that will likely be. So we were looking for some opinions from others who may have been in similar situations.

    Thank you for reading, sorry it was so long.

  2. #2
    Join Date
    Mar 2016
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    Gulfport, FL
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    Default Re: Pheochromocytoma and Cushings operation advice

    Hi Hannah,

    I see that nobody has posted to you yet but I want you to know that you're not alone. I know that that there a lot of people here that know much more than myself about (ADH )adrenal. I know a bit about cushings but mainly the pituitary kind. I'm sure someone that has been in your shoes will come along soon and pick up where I lack. I have sent out a few messages to people that I would trust with my dogs life to look at your post. Your situation is complex and the decisions you make shouldn't be made without exploring every avenue of thought. You stated there was Vena Cava invasiveness which is very serious, as stated I don't know much or if there or grades of invasiveness but I do know that comes down to very serious decisions. I'll look in tomorrow and see who's responded but I do want you to know that you've come to the best place possible to find the answers.

    Darrell and Lolita

  3. #3
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    Georgia
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    Default Re: Pheochromocytoma and Cushings operation advice

    Hello Hannah, and welcome! Many thanks to Darrell for posting to you last night, and as he says, I'm sure there will be other folks joining you here today. I am going to start you off by giving you a link to another member's thread wherein you'll find a good introductory discussion of surgery to remove a pheo. Hopefully it may answer some questions, and it also may raise some new ones for you. So do take a look, and then get back to us with your thoughts, OK?

    http://www.k9cushings.com/forum/showthread.php?t=6578

    Marianne

  4. #4
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    Apr 2009
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    York, PA.
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    Default Re: Pheochromocytoma and Cushings operation advice

    Hi and welcome to you and your girl!

    I'm not intimately familiar with pheo's so I have no words of wisdom or advice to share but I am including a list of questions that one of members, Trish, (her Flynn had an adrenalectomy) compiled for owners that have decided with surgery.

    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.
    Hugs, Lori

  5. #5
    Join Date
    Jan 2017
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    Default Re: Pheochromocytoma and Cushings operation advice

    Thank you so much for your kind words and advice. Ill definitely be having a read of those other threads you've sent links to.

    There are different severities of invasion of the vena cava and thankfully we THINK that hers isn't that big, although they don't yet know (and won't until operating) how far down the vena cava it is attached. If attached only at a small area, the operation will be much easier than if it's attached the whole length of the tumour.

    It's good to get other people's opinions on what they would do if it was their little dog :'(

  6. #6
    Join Date
    Jun 2012
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    Canada
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    Default Re: Pheochromocytoma and Cushings operation advice

    Hello and welcome from me too.

    Its a tough decision to make because it is a risky surgery, but if she comes through surgery and recovery okay, then as a shih tzu she can have many good years of life ahead of her. Cushings if she does have a pituitary tumor, can be controlled with medication, but she may not need that as the tumor and invasion could be causing the elevated cortisol levels.

    Alot depends on how the surgeon answers the questions in the list that lori posted I think. How could a candidate is she for surgery (you said he thinks good) and the all important, what would you do if it where your dog is a good one .
    Sharlene and the late great diva - Molly muffin (always missed and never forgotten)

  7. #7
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    Default Re: Pheochromocytoma and Cushings operation advice

    Hi there. I feel for you for having to make this decision. While my dod didn't have a pheo, he did have an adrenal tumour and we did do the surgery. His tumour was on the right side and we were very fortunate that it had not yet invaded the vena cava. We had a lot of support from this group and the questions posted earlier helped us as we met with the surgeon, etc. Kaibo was only 5 at the time so we felt that the risks were worth taking since he was so young. I do wish you well as you journey through this. The one thing I can say (and is likely what someone here said) you have to be ok with your decision. Know that you are making what you feel is the best decision for your pup. Know that you are following your instincts and heart and trying to do what is best for her. You have to be comfortable with the decision and accept what happens either way. You can't regret your decision and deal with the what ifs. It will drive you mad. So, ask questions, sit with the information, and make the choice that feels right for you and your little gal. Hugs and good luck to you. I'm not on here much but if you private message me I will provide any support or answers I can. Take care.

    Nikki
    You never lose by loving. You only lose by holding back.

  8. #8
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    Jan 2017
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    Default Re: Pheochromocytoma and Cushings operation advice

    Thank you. Nikki, do you mind me asking how recovery was for your dog and the outcome for him? Her age is part of the worry, even though I know she could have a few more years. She is just so happy dah to day and really enjoying life right now that it seems such a. Risk to hand her over knowing I may not have her back although without the surgery she could have the vena cava rupture, not to mention the risks of spread of the cancer. So so hard to decide the best option.

  9. #9
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    Nov 2012
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    Default Re: Pheochromocytoma and Cushings operation advice

    Hi Hannah. It certainly was a difficult decision and I feel for you that you have to make it for your sweet baby. Recovery was quite good for Kaibo, although I am a teacher and we planned the surgery for summer when I was off and could be with him 24/7. The incision was very large - pretty much all of his chest and then to the side, so like a "t" shape. He was in the hospital for a few days after and I don't remember if we were allowed to see him the first day. He was on prednisone for a month or so after. Once we weaned him off, he was great. A normal dog...for a while...he makes his own rules so he decided he should have Cushing's again about a year and a half later. I certainly am glad I was off to care for him and be with him all the time. I was able to put the heat and cold on the incisions several times a day, take him for short walks when he was ready, etc. It wasn't a fast recovery but it was an invasive surgery so I guess that is to be expected. If you have any more questions, let me know!

    Nikki
    Last edited by kaibosmom; 01-31-2017 at 10:46 PM.
    You never lose by loving. You only lose by holding back.

  10. #10
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    Jan 2017
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    15

    Default Re: Pheochromocytoma and Cushings operation advice

    Thank you Nikki. I'm glad that the operation was a success for you and it's good to know what we could be in for if we do decide on going for surgery. X

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