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The dream team

  • Tiramisu the Shih Tzu

    The dream team

    Collaboration across care services at the Veterinary Medical Center helps Tiramisu the Shih Tzu overcome a series of health challenges

    Tiramisu, a 9-year-old Shi Tzu who has benefited from care across several specialty services at the Veterinary Medical Center. 

Anxiety gripped Jodi Davis as she awaited news of how her dog, a then 9-year-old Shih Tzu named Tiramisu, had fared in surgery to remove her right adrenal gland and the tumor that had developed on it. 

For months, Tiramisu (Misu) had been experiencing an increase in her liver enzymes and symptoms of extreme thirst and hunger as well as weight gain. Veterinarians at the University of Minnesota Veterinary Medical Center (VMC) had diagnosed her with Cushing syndrome, the result of the tumor interfering with the adrenal gland. These glands produce hormones that help regulate bodily functions such as metabolism and the immune system. 

When news from the operating room did come, it wasn’t good. Scans taken before the procedure had shown some overlap between Misu’s liver and the tumor. Once her surgery began, her care team discovered the liver had wrapped itself tightly around the tumor. Parting the two—a procedure called a dissection—would be a risky and tedious endeavor.

“The liver dissection was tricky because the liver is filled with a lot of small blood vessels, so it bleeds easily during dissection and impairs our visualization,” says Dr. Adrien Aertsens, an associate professor and member of the Surgery Service who led Misu’s procedure.

In the weeks following the surgery removing her adrenal gland,
Tiramisu wears a onesie that keeps her from licking her stitches. 

Misu’s surgery was being performed laparoscopically, which means the team had made small incisions to insert a camera and small instruments to locate and cut out the adrenal gland with her tumor. The procedure is associated with improved post-operative comfort, faster recovery, and shorter hospitalization time than traditional surgery, which made it appealing to Davis. To hear about this complication and its potential to convert the procedure from a laparoscopic to an open abdominal surgery was devastating. 

“I was so scared and ready to blame myself because I thought, now we've switched the odds,” she recalls. “If Misu dies, this will be all my fault. I just started crying.”

Time ticked by until another care team member approached Davis bearing news: They got it. The tumor had been successfully removed and Misu was on her way to recovery. 

The surgery itself was a historical feat. While similar procedures have occurred at the VMC before, staff believe this is the first time it was successfully accomplished through laparoscopy. The relief was palpable for both Davis and Misu’s care team. 

“After being focused and holding steady for a few hours, it felt phenomenal,” Aertsens says. “The fantastic recovery she made was worth the extra efforts in the operating room. Misu had a good night after the surgery and was trotting around happily the next day as if nothing had happened.” 

Taking care

The successful surgery is one of several examples of positive outcomes Misu has experienced since Davis began bringing her to the VMC in 2018. 

Dr. Sandra Koch, a CVM professor and head of the VMC’s Dermatology Service, has seen Misu for the past six years for several health issues. When Misu first came to the VMC, she had been experiencing frequent skin infections on her paws and in her ears likely due to allergies, so Koch developed a treatment plan to reduce her itching and discomfort. 

Over time, Misu’s paws improved but her ears were still a source of worry for Davis. And while the little dog had always snored and snorted, in 2019 Davis noted that Misu suddenly had difficulty breathing and seemed to struggle with exercise. Veterinarians speculated that her soft palate may be elongated. If this was the case, it could potentially be interfering with her breathing. 

Tiramisu as a tiny puppy. 

Surgery could be performed to trim her palate, but her care team performed a CT scan first to confirm the diagnosis. Images revealed that Misu had a normal soft palate but other issues.

“She had some abnormalities on her upper respiratory tract and that probably contributed to her ear infections along with her allergies,” Koch says. 

Among the issues the scan indicated were a deviated septum, an infection in her left middle ear, and a partially collapsed right lung. Instead of trimming her soft palate after the scan, surgeons widened Misu’s nostrils to help her breathe better. Misu’s breathing improved but in 2022 her ear infections intensified and her middle ear disease was reconfirmed. During a surgical treatment procedure, a small, benign tumor would be removed from her eardrum. 

One of the medications Misu took for managing her allergies can cause spikes in liver enzymes, which are proteins that help the liver perform its functions. These levels are monitored as part of the medication management. But when Misu was taken off the medication in 2023 and her enzyme levels remained high, Davis and the VMC care team became concerned. 

Tiramisu poses for a photo. 

“The Internal Medicine Service did all the diagnostics and they confirmed that it was Cushing's,” Davis says. “We thought we caught it early because we had been watching the liver enzymes so conscientiously.”

A large majority of Cushing’s cases in dogs—around 85 percent—are caused by tumors on the pituitary gland, which is located in the brain. In Misu’s case, an adrenal gland tumor was behind the symptoms and was removed in March 2024. 

With a successful surgery behind them, Misu’s team continues to focus on managing other ongoing health concerns, including a recently discovered tympanokeratoma—a rare type of cyst that was growing in her right middle ear but was removed by an ear flush in October 2024—and a luxating patella, a condition where the kneecap slips out of position. 

A team approach 

Through all of these challenges, Davis is grateful that veterinarians across the Primary Care, Dermatology, Internal Medicine, and Surgery services have collaborated to provide outstanding care to Misu.

“The University has an amazing coordination of care,” Davis says. “ I ask a million questions during Misu’s appointments, but the coordination is well done, and I don’t have to explain Misu’s case every time we see a different service—they already know her history and unique needs.”

With specialty and routine care from Veterinary Medical Center
clinicians, Tiramisu is living a happy life. 

With more than 15 specialty services under one roof, the teamwork between clinicians is a key element that makes the VMC a unique and effective veterinary care option for patients like Misu. 

“We want to be the dream team for our patients and clients. It's a lot of work to care for somebody special like Misu, but it’s all worthwhile,” Koch says. “Misu makes us so happy every time she comes in. She's doing well—we’ve had some scary times, but I'm very grateful for the trust that Jodi puts in us, our care, and our hospital.”

With her medical issues well cared for by Koch, Primary Care veterinarian Dr. Matthew Nelson, and other VMC specialists as needed, Misu is free to go about her life. She seems happy and enjoys meeting people while out for walks with Davis, who is extremely thankful to see her precious pup living a good life after all she’s been through.  

“I'm just very grateful for the quality of care and compassion that the VMC staff has shown us,” Davis says. The ongoing coordination of care is invaluable to me and the ‘Dream Team’ continues to help me focus priorities and treatments for Tiramisu to ensure her best quality of life.”