OPTIONS making me nervous!
So, I shouldn't say another word?
Ah, I hear I'm "mean" that way.
How old is Miss Nina?
A chest xray will rule out heart and lung issues. Depending on her age, that would give me a great deal of comfort at not too much cost. I take my seniors in for full bloodwork and exams every six months because I think that things change so fast on seniors. So if the last xray was in Jan, well that's about 5 months ago. Normally, I wouldn't put her through the radiation. But if we're looking at surgery. I don't know, it's up to you. As you know, I side so much on the side of caution, that it borders on paranoid.
Is your vet a surgeon or is this your regular vet? Since you can't get a anesthesiologist (which are really hard to find here too. The closest one has to come in from Canada. Sigh!), can you get a board-certified surgeon? They move FAST in surgeries just because that's pretty much all they do. Time is our friend, my friend. The less time under, the less anesthesia. And I do kind of trust a surgeon more to get a lump out with super clean margins. Plus, their techs are more of specialists in anesthesia .
Has Nina had surgery before? Both my surgeons (dental and regular surgeon) say that the best predictor of how a dog will deal with anesthesia is how she's experienced it in the past. If she's never had any problems with it before, then that's an excellent sign. If she comes out of it fast, recovers quickly, no issues, then no problemo. If she tends to have issues, then I'd be more nervous.
Personally, I wouldn't take my dog off any meds until I asked my vet first. The thyroid medicine, I'd be inclined to leave her on. I don't really see a reason to take her off. The tramadol? Eh, depends on the dose, depends how sedating it is on her. Depends on everything else (her bloodwork, heart, lungs, etc). Can she go a day or two without it? (Have you ever missed doses and you know what she's like when she does?) Same with the elavil (which honestly, I don't know anything about)?
A dog that's in pain going INTO surgery is going to be more stressed than one that isn't. Your vet will be able to tell you which meds that he would prefer that you don't give before the surgery. There may be some that he absolutely doesn't want her to have. In between "prefer not" and "absolutely not," you know what Nina *needs.* Yep, that's one of those dang options again.
Ooof. I know you have so much on your mind. Sorry to load more there.
That's what I do best. Just stuff to consider. Anything for Miss Nina.