Saving Mille: WSU veterinarians cure Maltese of Cushing’s

A rare brain surgery performed by a team of veterinary specialists at Washington State University has proven again to be a cure for Cushing’s disease – this time for a loving dog named Mille.

“I knew right away that giving my dog medication to manage her horrific symptoms would not prolong her life and it was simply not what I was willing to do when there was a potential cure to save her life,” said Dr. Jill Goldberg, a Chiropractor from Cary, N.C.

Cushing’s disease is often caused by a tumor on the pituitary gland at the base of the brain, but it can also be caused by a tumor on the adrenal gland.

The tumors increase production of the stress hormone cortisol, which results in hair loss, a distended abdomen, increased appetite and an unquenchable thirst that leads to excessive urination. Many animals are euthanized due to their poor quality of life. While the condition can sometimes be managed with medications, surgery is the only cure. WSU has been one of the only facilities offering the surgery in the United States for much of the past decade.

A rare case, Mille is one of a handful of dogs cured worldwide of Cushing’s disease after being diagnosed with an adrenal as well as a pituitary tumor, and the first to be cured at WSU.

Goldberg brought Mille to her primary veterinarian, Dr. Melissa Hudson in Cary, North Carolina, after noticing symptoms in her dog.

Further consultation by specialists revealed a tumor on Mille’s right adrenal gland next to her vena cava, one of the largest veins carrying blood from the heart to other organs. If the tumor grew too large, Mille could die.

3-D laparoscopic surgery to remove the adrenal tumor at the University of California, Davis Vet Hospital was successful, but Mille’s greatest challenge was still to come. Additional hormone testing post-surgery indicated that she also had a pituitary tumor.

If left untreated, the tumor could grow large enough to press on the brain and cause neurological symptoms such as difficulty walking or seeing, or other conditions, including diabetes or seizures. Ultimately, it could cost Mille her life.

“It was devastating news, but I had total faith in Dr. Owen and her team and was willing to take the risk and potentially give my dog her life back,” Goldberg said.

While medication is often used to treat Cushing’s, some medications may enlarge the pituitary gland, making surgery and a positive outcome more difficult.

Goldberg opted for the surgery and made the cross-country trek to WSU’s Veterinary Teaching Hospital, where the pituitary surgery team consists of veterinary surgeon Dr. Tina Owen, one of the first veterinarians in the U.S. to successfully perform the procedure; board-certified veterinary neurologist Dr. Annie Chen-Allen; veterinary internal medicine specialist Dr. Sarah Guess; and veterinary emergency criticalist Dr. Linda Martin.

The surgery is no easy feat, especially when performed on a 10-pound dog like Mille.

To remove the tumor, surgeons access the brain through the soft palate on the roof of the mouth and remove the entire pituitary gland.

If the entire pituitary gland is not removed there is no guarantee the symptoms will subside. On the other hand, going beyond the pituitary could be fatal.

“The risk is if the blood vessels that surround the pituitary and supply blood to the brain are torn or damaged and start bleeding, the animal would likely not survive,” Owen said.

To complicate the surgery further, Mille had an elongated soft palate and a congenital condition in her nasal cavity called a choanal atresia, a narrowing of the nasal passage that made breathing more difficult.

To ensure Mille’s breathing wasn’t jeopardized during her procedure or the healing process, Mille’s soft palate was shortened ahead of her pituitary surgery via laser surgery by WSU’s Dr. Bonnie Campbell.

A successful four-hour brain surgery followed to remove Mille’s pituitary gland and tumor. This time, hormone testing, a CT scan and pathology report showed Mille was cured of the disease, but unfortunately, due to her narrowed airway, her palate incision had adhered to the base of her skull in the area of the surgery, blocking most of her airway upon returning home.

Goldberg flew Mille urgently back to WSU where three more procedures led by Guess and Owen and a team of other specialists were completed using a ballooning procedure to open Mille’s airway so Mille could breathe with less distress.

Now back home, Mille has returned to her happy self with some daily breathing treatments. Her hormone levels will be monitored every three months for her entire lifetime to regulate her daily medications now keeping her alive after her pituitary gland removal.

“It was certainly a wild ride and very difficult at times but I would do it all over again. I cannot thank this incredible team of veterinarians, students and ICU veterinary technicians enough for their compassionate care and curing Mille of Cushing’s disease,” Goldberg said.