Ladybug surgery

Honestly, everything sounds good overall. Agree the shaking could be a little arthritis. She may still also have some discomfort and feel like the skin is pulling from the incision. Great that she's maintaining non-diabetic glucose levels while she's on pred too! And I do know what you mean about the eating. Before her surgery, Roxi literally just wanted to eat all day, every day. If she could steal anyone else's food she would - including ours! There was one night in particular when we caught her just in time - she'd stolen an onion ring, still frozen, from a tray that was waiting to go in the oven and ran off with it. Fortunately when I caught up with her, she was still trying to figure out how to eat something that was frozen. After her surgery, pancreatitis aside which always stopped her eating completely, she was content with a normal amount of cat food. It took some getting used to for sure - we'd never known her without the Cushing's, although we didn't know she had it to begin with, so we had no idea what her normal was meant to look like.

Technically, a respiratory rate under 30 is the normal. For cats with known, pre-existing heart disease they tend to use 40 as the cut off where they need immediate attention. But you know her better than anyone else - one of my cats was in real trouble if her rate hit 27 but that was something we had to find out after she was diagnosed with heart disease. If Ladybug has always done well between 30 and 40, I would use 40 as her upper safe limit.
 
Ugh I just found out steroids can worse HCM and cause CHF. So terrified with her increased breathing and appetite and energy issues and muscle weakness I have worsened her issues by giving her steroids. :( her blood pressure and electrolytes are normal along with her lung sounds. She does have a heart murmur though she’s had that since the pancreatitis. I just want what’s best for her and idk if she should be completely weaned off steroids now they want to wait but now I’m so scared :(
 
They can; but...when she's not producing enough steroid of her own, they're actually replacing what should already be in her body. It's "extra" steroid that causes CHF in cats, so if a cat is producing normal levels but is on a steroid specifically for IBD as well, then it can cause an issue. You can't wean off steroids until her body recovers and starts producing enough on its own. Otherwise, you'll throw her right into an Addison's crisis and those can be fatal pretty quickly.
 
Ok thank you. I don’t know how long this will be. I’m just worried about my baby still. Been a month since surgery now. Also I’m worried about the heart disease because they didn’t catch the murmur when they did the echo and now she has a more consistent murmur. Appetite and energy levels breathing and meow volume still up and down. So tired of vets visits but I really want the best for her but I also want to establish new primary care. They are suggesting maybe repeat X-ray soon but her heart and lungs are clear.
 
To be honest, they recover when they recover. Roxi's remaining adrenal never did recover fully - they felt it had been switched off too long and partially shut down completely. Weirdly, she didn't need pred after the first 3 months - she did fine without it after that. But she did need Zycortal (the mineralocorticoid that the adrenal also produces) for the rest of her life. Apparently, that's not normal - usually if they need one long term, they need both. But she never did do anything by the book! And, of course, she had to pick the one that was $300 every 4 months as the one she couldn't live without.
 
manxcat419 said:
To be honest, they recover when they recover. Roxi's remaining adrenal never did recover fully - they felt it had been switched off too long and partially shut down completely. Weirdly, she didn't need pred after the first 3 months - she did fine without it after that. But she did need Zycortal (the mineralocorticoid that the adrenal also produces) for the rest of her life. Apparently, that's not normal - usually if they need one long term, they need both. But she never did do anything by the book! And, of course, she had to pick the one that was $300 every 4 months as the one she couldn't live without.
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How did you know when it was time to get off the steroid? I don’t wanna take her off it now but I’m not sure. The vet said give it a couple more weeks and they might try to get her off it. But I’m worried about that too!
 
The murmur might be because her body has been stressed over the last few months. It may not be super indicative of the heart disease becoming an issue. Again, because cats are weird and a murmur just isn't always significant for them. Honestly, recovery can be rough for a little while for them. You might see all kinds of weird things as her body tries to readjust to not having all that steroid floating around all the time. You're doing the right thing in monitoring all her symptoms, and you're getting her rechecks when they're due. I feel like it took Roxi about 4 months to recover to the point of being truly "normal" (obviously with the Zycortal added). She went through weird phases with her moods, and eating, and just about everything else. She always seemed happy enough. But it is a pretty big surgery, with effects on every system in her body, so it takes time for everything to level out.
 
ladybug991 said:
How did you know when it was time to get off the steroid? I don’t wanna take her off it now but I’m not sure. The vet said give it a couple more weeks and they might try to get her off it. But I’m worried about that too!
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We weaned down super, super gradually under instruction from her IM. Eventually she was on a dose that the IM said probably wasn't doing anything much anyway. At that point, we took her off and monitored her really closely for a week or so to make sure she didn't show signs of having an issue from taking her off. That took about 3 months total.
 
I think time and rest are the key. We tend to think that, once the sutures are out after 2 weeks, they're recovered. But they're really not from something as big as this - they're still very early in the recovery process. And there's often a lot of adjusting to be done with steroids, and the secondary issues with pancreatitis etc. 2.5 mg isn't a huge dose of pred - I'd guess her remaining adrenal is doing something...it's just not ready to take on all the work just yet.
 
Now im freaking out because I saw a mosquito on her sucking blood she’s indoor and not on heartworm meds I feel like a horrible mom idk what to do :(
manxcat419 said:
I think time and rest are the key. We tend to think that, once the sutures are out after 2 weeks, they're recovered. But they're really not from something as big as this - they're still very early in the recovery process. And there's often a lot of adjusting to be done with steroids, and the secondary issues with pancreatitis etc. 2.5 mg isn't a huge dose of pred - I'd guess her remaining adrenal is doing something...it's just not ready to take on all the work just yet.
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ladybug991 said:
Now im freaking out because I saw a mosquito on her sucking blood she’s indoor and not on heartworm meds I feel like a horrible mom idk what to do :(
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Ok I did just give her revolution I thought it was just for fleas but even regular revolution should help. The mosquito was biting an area where they shaved her :( and I killed it and there was blood I’m assuming it got her but I don’t see a bite.
 
ladybug991 said:
Ok I did just give her revolution I thought it was just for fleas but even regular revolution should help. The mosquito was biting an area where they shaved her :( and I killed it and there was blood I’m assuming it got her but I don’t see a bite.
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The Revolution has her covered. Even if she did get bitten, she won't get heartworm while she's on it. And as that's the only big risk from a mosquito, she's good. Don't ever apologize for being stressed - you and Lady Bug have been through a lot. It would be a miracle if you weren't stressed. And often we stress the little things because the big ones are things we can't do much about.
 
manxcat419 said:
The Revolution has her covered. Even if she did get bitten, she won't get heartworm while she's on it. And as that's the only big risk from a mosquito, she's good. Don't ever apologize for being stressed - you and Lady Bug have been through a lot. It would be a miracle if you weren't stressed. And often we stress the little things because the big ones are things we can't do much about.
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I do think she needs to see a cardiologist again soon because I think her shaking is her breathing heavy and she’s been breathing heavy. Or at least get an X-ray from a vet sooner than her current Feb X-ray appt.
 
I am honestly pretty concerned as her breathing rate is significantly faster than it should be it has been for a while but I think it’s gotten worse.
 
OK. 40 is heading into the danger zone. Personally, I would want that assessed now, not in a few days when your regular vet can fit you in. If she's heading into a CHF episode, hours can be critical. Do you have an ER in your area that you can get her to?
 
manxcat419 said:
OK. 40 is heading into the danger zone. Personally, I would want that assessed now, not in a few days when your regular vet can fit you in. If she's heading into a CHF episode, hours can be critical. Do you have an ER in your area that you can get her to?
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Ok I will take her in tomorrow morning or maybe tonight. It’s been below 40 today when she was actually sleeping. I’m not sure how long to wait to measure resting rate and she’s purring a lot too. I’m just sad to bring her back for a 5th time but I want her to be ok
 
If she's purring, the rate may read higher than it actually is - some cats put a huge amount of effort into purring and breathe pretty fast as a result. Maybe try to get a rate just after she falls asleep, but before she starts dreaming, to see what it looks like then. If it's below 40 at that point, you can wait. If it still comes up as 40 or over, I'd take her in.
 
All I want rn is sleep I’m beyond exhausted. But I’m staying up to bring her in I’m waiting for her to fall asleep she’s been purring in her sleep though too. I just got 36 she’s awake lying down still purring but then got 40 again. Im trying to give her a bit pass out and then go back in the room
 
Ugh I ended up not waking up to the alarm I set. It’s hard to measure because she’s even purring in her sleep but I’m consistently getting between 36-44 breaths so I definitely feel like I should bring her in :( I’m so beyond stressed out
 
She has mild fluid in her lungs they are giving her a little bit of meds here and want her on two meds at home for that- heart med and blood thinners. They also want to reduce her steroids to every other day which I’m nervous about . They did x rays today.
 
Did they consult the IM about the steroids? If the IM thinks it's safe, then I would do it. I would be cautious if the IM hasn't approved it though because she might still physically need those steroids at this point. It is a balancing act with her HCM and the adrenal removal.
 
manxcat419 said:
Did they consult the IM about the steroids? If the IM thinks it's safe, then I would do it. I would be cautious if the IM hasn't approved it though because she might still physically need those steroids at this point. It is a balancing act with her HCM and the adrenal removal.
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Yes the IM approved it. I’m still very concerned though.
 
As it's IM-approved, I would try it and just monitor her closely for any new symptoms that might indicate that she's becoming too low in steroids. The early symptoms are often electrolyte issues which you can't see directly, but watch for her appetite falling, weakness, lack of energy/lethargy, and increased thirst.
 
manxcat419 said:
As it's IM-approved, I would try it and just monitor her closely for any new symptoms that might indicate that she's becoming too low in steroids. The early symptoms are often electrolyte issues which you can't see directly, but watch for her appetite falling, weakness, lack of energy/lethargy, and increased thirst.
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It’s hard because she already has a lot of those symptoms somewhat but I will monitor her closely
 
ladybug991 said:
t’s hard because she already has a lot of those symptoms somewhat but I will monitor her closel
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Yeah. That was why I'd asked about her having an ACTH-stim a few days ago. A lot of what you were describing then was suspicious for Addison's. I would try to keep in your mind how those symptoms look now - maybe make notes as it's so difficult to spot small changes when we're with them so much of the time - and be aware of any worsening of them as you reduce the steroid dose.
 
Ugh idk how to do this with her high end of normal kidney values, her CHF and her adrenal issues. I am so overwhelmed and afraid of doing the wrong thing to get
 
The first thing you need to do is take a few deep breaths. You and the IM together have got this. Keep communicating with the IM. If you feel as though her symptoms are getting worse with the reduced pred, let the IM know immediately. That way, they can work on figuring out a plan to keep her as safe as possible on all levels. The high end of normal kidney values shouldn't be an issue here - Roxi was diagnosed Stage 1 CKD around the time of her surgery. She never went above Stage 1 and it never caused her a problem...for the entire 6 and bit years until we lost her. In reality, with the changes to the IRIS guidelines for cats, pretty much every cat in the world is Stage 1 their whole lives. I'm guessing that's because kidneys are a species weak point in cats, but high end of normal values don't really mean a whole lot in real terms when it comes to treating other issues.
 
manxcat419 said:
The first thing you need to do is take a few deep breaths. You and the IM together have got this. Keep communicating with the IM. If you feel as though her symptoms are getting worse with the reduced pred, let the IM know immediately. That way, they can work on figuring out a plan to keep her as safe as possible on all levels. The high end of normal kidney values shouldn't be an issue here - Roxi was diagnosed Stage 1 CKD around the time of her surgery. She never went above Stage 1 and it never caused her a problem...for the entire 6 and bit years until we lost her. In reality, with the changes to the IRIS guidelines for cats, pretty much every cat in the world is Stage 1 their whole lives. I'm guessing that's because kidneys are a species weak point in cats, but high end of normal values don't really mean a whole lot in real terms when it comes to treating other issues.
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Thanks so so much. Measure her breathing rate as 60 And freaked and almost brought her in but realized she had just jumped on bed and laid down near me purring hard. Now it’s between 26-40 as she started resting then sleeping. Keeping a little journal now to track her symptoms and appetite. Was already tracking her meds. Gonna try to get a HR tomorrow AM. She’s usually sleeping away from me or at the same time as me. She lies next to me but is usually not asleep. Or she lies next to me overnight. She’s always purring too. Unfortunately maintenance is coming but it’s just one person and I will put her in my bedroom and they won’t go in there. also will send email or call update to IM tomorrow. Still wondering if I should just get her triaged tonight but since it’s gone back down and she doesn’t seem to be in distress I will see how it is tomorrow and try to only measure it when she’s really resting. I’m trying so hard to keep a level head after yesterday when I lost it. She’s still not eating well but I will let them know the breathing rate and calories consumed and symptoms. Was gonna wait a few days to email but after tonight I just wanna go ahead and do it. The front desk told me to come in and get triaged tonight but the other hospital staff was busy so I didn’t talk to them directly. Just don’t wanna force her back unnecessarily. Also have a IM follow up in addition to cardiology on the 4th.
 
OK. If she's been jumping and is then purring, you can't rely on that rate. If she's between 26 and 40 in a short space of time, it sounds as though she's actually able to maintain pretty well at the moment. I don't think she needs to be seen tonight - maybe check her rate again in the morning. And yes, a journal is a great way to track multiple symptoms without needing to worry about forgetting things or not noticing a trend that might need her to be seen.
 
what do y’all think of this/how I would respond. Maybe waiting until 12/4 and trying to get cortisol at that time too?

Or maybe starting the other drug now and seeing if it helps? Idk if I can afford ACTH ECHO AND GI testing it would probably be a few thousand because it’s 1,000 just for basic recheck lab work and echo
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I'm actually a little confused by this because we absolutely did ACTH testing while Roxi was on pred. The idea behind it being that it would let us know if she was on an appropriate dose or not while she recovered. And that was 100% the IM's call, not mine - unless they came up with something that made me go "what the h*ll are you talking about", I basically did what they said. But if you ask 10 vets the same question, you'll get 10 different answers. Sometimes the right answer for any specific vet is the method they have most experience with.

If you can hold off until the 4th, I think there would definitely be benefit in checking an ACTH for her just to make sure her other adrenal has restarted cortisol production. Things are 100% manageable in the long term whether it does or it doesn't. But in the shorter-term, you could be looking at another hospitalization to get her stable if she goes into an Addison's crisis. So that's an outcome that best avoided if possible. And the best way of avoiding it is to see it coming by testing.
 
manxcat419 said:
I'm actually a little confused by this because we absolutely did ACTH testing while Roxi was on pred. The idea behind it being that it would let us know if she was on an appropriate dose or not while she recovered. And that was 100% the IM's call, not mine - unless they came up with something that made me go "what the h*ll are you talking about", I basically did what they said. But if you ask 10 vets the same question, you'll get 10 different answers. Sometimes the right answer for any specific vet is the method they have most experience with.

If you can hold off until the 4th, I think there would definitely be benefit in checking an ACTH for her just to make sure her other adrenal has restarted cortisol production. Things are 100% manageable in the long term whether it does or it doesn't. But in the shorter-term, you could be looking at another hospitalization to get her stable if she goes into an Addison's crisis. So that's an outcome that best avoided if possible. And the best way of avoiding it is to see it coming by testing.
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It’s just frustrating because it’s like the vet wants me to send her into a crisis or something by coming off of it before she will test. I’m so upset by this. She’s supposed to come off of it completely on Tuesday and I’m really really scared to do that now without testing esp because I wouldn’t be able to get her tested until the 4th. Idk if I can even get in with them to do it beforehand and I don’t know of any other vet who would do it or is an IM specialist.

What tests would you do in this situation and what would you do now before the 4th? Would you try the new med? Would you get cardiac and GI testing done as well on the 4th? I’m just so lost and confused at this point :( :( :(
 
ladybug991 said:
It’s just frustrating because it’s like the vet wants me to send her into a crisis or something by coming off of it before she will test. I’m so upset by this. She’s supposed to come off of it completely on Tuesday and I’m really really scared to do that now without testing esp because I wouldn’t be able to get her tested until the 4th. Idk if I can even get in with them to do it beforehand and I don’t know of any other vet who would do it or is an IM specialist.

What tests would you do in this situation and what would you do now before the 4th? Would you try the new med? Would you get cardiac and GI testing done as well on the 4th? I’m just so lost and confused at this point
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This was the point in Roxi's journey where we had to switch IM specialists. The original one who oversaw her surgery was doing an ACTH every 2 weeks. On the one before her crisis, he actually said that he had a feeling she might become Addisonian because her levels weren't where he expected (she was ON pred at this point but we had to not give her morning dose until after the test was complete). As I understand it from what I've read of management protocols, this is the standard way to manage these cases. Then she went into crisis anyway...and he refused point blank to interrupt his weekend for 2 minutes to confirm to the ER vets at the same location that they should start treatment. Because her electrolytes weren't where you'd expect them to be, the ER vets wouldn't start treatment unless he confirmed it because they thought it might cause damage. They had her on IV D5W which is just 5% dextrose in water to avoid adding any electrolytes at all and were sitting on their hands watching her die slowly. We won't get into too much detail about me yelling at the ER vet over it all. So we called a different ER, less than 1/2 a mile from the first one, confirmed that they would take a chance on treating given that I knew and approved the risks. I walked into the first ER, signed an AMA, and moved her. She was already bouncing back by the next morning having started treatment immediately at the second ER.

My concern is that your IM isn't following the guidelines by not testing until she's off pred completely. Roxi managed to go into crisis while still on a low-ish dose of pred. I can't even imagine how that would have gone if she had no exogenous steroid support at that point. You might want to mention to her that the standard for testing is to test every 2-4 weeks, with the morning steroid dose withheld until after the test is done and that you would like to do that at least once before taking her off pred completely.
 
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manxcat419 said:
This was the point in Roxi's journey where we had to switch IM specialists. The original one who oversaw her surgery was doing an ACTH every 2 weeks. On the one before her crisis, he actually said that he had a feeling she might become Addisonian because her levels weren't where he expected (she was ON pred at this point but we had to not give her morning dose until after the test was complete). As I understand it from what I've read of management protocols, this is the standard way to manage these cases. Then she went into crisis anyway...and he refused point blank to interrupt his weekend for 2 minutes to confirm to the ER vets at the same location that they should start treatment. Because her electrolytes weren't where you'd expect them to be, the ER vets wouldn't start treatment unless he confirmed it because they thought it might cause damage. They had her on IV D5W which is just 5% dextrose in water to avoid adding any electrolytes at all and were sitting on their hands watching her die slowly. We won't get into too much detail about me yelling at the ER vet over it all. So we called a different ER, less than 1/2 a mile from the first one, confirmed that they would take a chance on treating given that I knew and approved the risks. I walked into the first ER, signed an AMA, and moved her. She was already bouncing back by the next morning having started treatment immediately at the second ER.

My concern is that your IM isn't following the guidelines by not testing until she's off pred completely. Roxi managed to go into crisis while still on a low-ish dose of pred. I can't even imagine how that would have gone if she had no exogenous steroid support at that point. You might want to mention to her that the standard for testing is to test every 2-4 weeks, with the morning steroid dose withheld until after the test is done and that you would like to do that at least once before taking her off pred completely.
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Just to confirm you think I should switch at this point? These are supposedly the best/only IM specialists in the city. I can see experienced vets with an interest in IM but they don’t have the certification. I still don’t know what tests should be priority or run. I know she’s just trying to preserve her heart but I’m scared. I don’t wanna burn this bridge with the only specialists in town :( I also more importantly don’t want to slowly murder my cat. But what if the steroids are what’s making her wors? Im sick to my stomach and still haven’t responded to them because I don’t even know what to say at this point. I really don’t think she has gi disease I think she might need more steroids but I don’t wanna send her into heart failure by increasing them .
 
ladybug991 said:
Just to confirm you think I should switch at this point? These are supposedly the best/only IM specialists in the city. I can see experienced vets with an interest in IM but they don’t have the certification. I still don’t know what tests should be priority or run. I know she’s just trying to preserve her heart but I’m scared. I don’t wanna burn this bridge with the only specialists in town :( I also more importantly don’t want to slowly murder my cat. But what if the steroids are what’s making her wors? Im sick to my stomach and still haven’t responded to them because I don’t even know what to say at this point. I really don’t think she has gi disease I think she might need more steroids but I don’t wanna send her into heart failure by increasing them .
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I would definitely talk to the current IM first. Explain to her how the testing is meant to work and ask if she would please do a test before you withdraw the pred completely. She may not have dealt with this enough in cats to know. What I'm trying to have you avoid is reaching that crisis point. But the only way to be certain that you're not heading in that direction is to test.
 
I can't comment on this part of the conversation, but can talk about budesonide. Neko was put on it for her probable small cell lymphoma because her heart couldn't handle prednisolone. Budesonide is safer for the heart, though I've since read that it is not entirely risk free. It was fine for my cat and her heart condition. And her bowel inflammation was reduced by about 35%. She started first on a pill format of it, but I switched her to liquid as it was much easier to adjust the budesonide dose. The pills crumbled easily.
 
Wendy&Neko said:
I can't comment on this part of the conversation, but can talk about budesonide. Neko was put on it for her probable small cell lymphoma because her heart couldn't handle prednisolone. Budesonide is safer for the heart, though I've since read that it is not entirely risk free. It was fine for my cat and her heart condition. And her bowel inflammation was reduced by about 35%. She started first on a pill format of it, but I switched her to liquid as it was much easier to adjust the budesonide dose. The pills crumbled easily.
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Budesonide should be safer if the issue is specifically IBD related. However, it acts only on the small intestine when given orally, which makes it unsuitable if Ladybug is veering towards Addison's as it just isn't systemic enough in effect to deal with that which is, of course, why it's safer for heart disease kitties. If she needs steroids for intestinal issues only it would be what I would ask for. Roxi was on budesonide for IBD for 6 years after we found that she didn't actually need pred for her Addison's, just the Zycortal. That's pretty unusual though - Addison's pets generally need both types of steroid. I don't necessarily think there is Addison's here, although it's impossible to know without testing. And the budesonide might be an excellent choice if her ACTH comes back showing decent steroid production of her own.
 
manxcat419 said:
Budesonide should be safer if the issue is specifically IBD related. However, it acts only on the small intestine when given orally, which makes it unsuitable if Ladybug is veering towards Addison's as it just isn't systemic enough in effect to deal with that which is, of course, why it's safer for heart disease kitties. If she needs steroids for intestinal issues only it would be what I would ask for. Roxi was on budesonide for IBD for 6 years after we found that she didn't actually need pred for her Addison's, just the Zycortal. That's pretty unusual though - Addison's pets generally need both types of steroid. I don't necessarily think there is Addison's here, although it's impossible to know without testing. And the budesonide might be an excellent choice if her ACTH comes back showing decent steroid production of her own.
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I can’t decide here no steroids today and she’s actually eating a bit better although still meowing weird and pretty sleepy. So confused. Also her electrolytes and bloodwork were perfectly normal when on steroids every other day. I’ll ask if she feels ok testing before withdrawing steroids but I don’t think that will be possible until her appointment and idk if they will want her on them that long.
 
Any vet can actually run an ACTH. It gets sent out to the lab regardless. They would need to have Cortrosyn available, but that's easily ordered if they don't already have it. If they're not familiar with it, the best way to do it is to reconstitute it, draw the dose they need, and then use the rest of the vial to draw small-ish doses that then go in the freezer. That way it lasts ages instead of just a month so they're not having to throw out the rest of the vial after a month. As she's due to be off pred completely before you see the IM again, maybe see if her regular vet would run it for you.
 
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