Dear Kim:
 
>Does anyone have statistics on right adrenalectomies?  What are the
>chances he might bleed out or that after surgery the blood wouldn't find
>another path to his extremities.  (It seems that the vena cava may
>actually have to just be done away with?  - but I'm not positive I
>understood that right).  Cost is another concern, (though minor - I'd sell
>my two front teeth to help my boy.) I'm wondering about the feasibility
>of other courses of action.  There are meds out there which could control
>the symptoms without having the tumor removed - anybody know about how
>effective they can be?
 
You actually have a couple of options here, but you need to travel.
 
First off, there aren't a lot of good stats on reight adrenaectomies - but
inmy experience, with a skilled vet who does a lot of them, the chances of
a surgical accident even in close proximity to the vena cava is remote.
The bigger problem is not getting it all.
 
I think based on your comments, it is likely we are dealing with a
malignant tumor of the right adrenal, which should come out as soon as we
can get it out.  The longer it stays in , the more it will grow, and it
is already involving the largest vein in the body!
 
Lupron will only control symptoms, and this tumor will continue to grow,
so I would advise against it in this case.
 
There are two possibilities for surgery of a large tumor on the right
side - cryosurgery (freezing it off) and vena caval resection.  The
latter surgery is generally for tumors that have encompassed the vena
cava.  You can tie off the vena cava on either side and lift the whole
tumor out in toto.  Realize that this is a last ditch salvage procedure,
and is generally accompanied with about a 15% mortality - the animals that
have not developed good collateral circulation that can carry the load once
the main vein is blocked off.  I know Mark Finkler in Roanoke can do this
for you.
 
Now cryosurgery is a newer technique, and you'll have to drive up near to
Baltimore.  Charlie Weiss has been doing that on right adrenals for a while
and he says he can freeze a tumor right off the vena cava without any
damage to the blood vessel.  Charlie could also do the caval ligation if
he thought that was the only way to help Jerry.  I think you can find
Charlie these days at http://www.ferretdoctor.com or at
[log in to unmask]
 
But the key here is get the operation done, and soon before the neoplasm
causes more problems or becomes inoperable.
 
With kindest regards,
Bruce Williams, DVM
[Posted in FML issue 3203]