I’m sorry to be late to this—didn’t get notified of tag.
If going with surgery you preferably want a surgeon who has done this surgery before and his hospital must be capable of handling very complicated post op care. I have a story about my first adrenal cat but that’s based on what surgery was decades ago. When I was in the ER with my second adrenal cat the ER Dr mentioned that where he trained they were doing Laproscopic adrenal removals which didn’t exist back in the day. Of course the complicated post op support still stands: electrolytes and blood pressure will likely be all over the place post op with the need to constantly juggle fluids and electrolytes and glucose. Cats can end up in adrenal crisis if the “good” adrenal is so small that it doesn’t wake up and start working once the other is removed. My cat Erik never recovered after his surgery—but again decades ago. I would suggest this though, because aside from time with him lost what years most at my heart is the last time Erik saw me it was me handing him over to strangers then them hurting him and he never woke up. If I ever have surgery on a cat again I will ask them to treat his anesthesia like it was my good bye (more like euthanasia) with me present and comforting him until asleep.
As was mentioned, if you don’t remove the tumor it is a ticking time bomb of potentially suddenly bleeding to death. This was a major motivator for me to agree to Erik’s surgery. I agonized for two years over that risk for Methos. I was terrified of an unpleasant end and I think
@JL and Chip had a Cushing’s dog and can speak to this. Even at his last US the day Methos passed his tumor had not yet infiltrated his vena cava (2.5 years after the tumor was found) but there’s no timeline—each cat is different. In the end for Methos it was not an impending bleed, it was a pancreatic cancer that had literally filled his abdomen destroying all it it’s path.
Methos was too old and too fragile for surgery even if I could bear to do it (after Erik I couldn’t but now I also question the wisdom of how I handled Methos). He was on vetoryl but it’s insanely expensive. (Google prices …chewy usually had lowest price, I bought from my vet and they price matched). He required periodic cortisol stim tests also insanely expensive. Ask your vet their going price. There is no good studies on cats on vetoryl esp for adrenal tumors so use is off label. Some research has been done on alternatives to stim tests in dogs and I will link that later. If your vet agrees to do that for monitoring after a couple of stim tests that would be some cost savings.
Because Methos’ tumor produced cortisol and aldosterone I was in constant fear of what his potassium was doing (and he needed fairly frequent lab tests for electrolytes each time any of his meds were adjusted). They also often produce progesterone (his didn’t). All theee of these hormones can lead to insulin resistance and DM. I’m late to your kitty’s story—have they done tests for cortisol/progesterone/aldosterone? Is the Cushing diagnosis based on the ultrasound and symptoms or did they do a dexamethasone suppression test?
So what was life like for me not choosing surgery: when he was just on vetoryl, then vetoryl and Bexacat it was extra time with him and I’m grateful for every second —but he kept needing more and more vetoryl. We never got to a dose that controlled his symptoms though so for 2.5 years he had very fragile skin and was too weak to jump. Only in his last few months did I find an internist to see him remotely (his diabetes was too unstable for me to take him 4 hours to the closest internist). My vet had maxed him out on as much vetoryl as she felt comfortable doing; I paid for idexx consultants but each time I got a different internist and it was a crap shoot what they would recommend. I got one small increase through that. The final one (insanely insanely expensive) that would do remote was less cautious re vetoryl and increased him and was willing to increase him more if needed—but I will say at his last ER visit the ER vet told me (admittedly since I’m an MD vets are often more open when talking to me) that he’d never seen a cat on such a high dose. There’s also a drug that rather than blocking cortisol production destroys the adrenal gland bit it’s risky and even the bold internist I found was hesitant to use it unless large doses of vetoryl failed.
I’m grateful for every extra second I had with Methos but of course agonize that maybe he would have survived surgery and if so his quality of life would have been better. I weigh that against the risk of dying. So it’s hard. I’d ask the surgeon what percentage of cats survive surgery in general and what odds he’d give considering your kitty’s health. Otoh Methos had extremely unstable glucose. It’s hard to say how much of that was because cancer was destroying his pancreas. But in theory if giving vetoryl (and it’s working) you are interfering with your kitty’s adrenal glands doing their job. So I tried to avoid getting too low a nadir because there’s no guarantee that his adrenals can help pull him back out of hypoglycemia. This meant extra sticks for him also but he was such a patient forgiving soul.
I haven’t been often here—still dealing with my loss (please NO ONE COMMENT ON METHOS) but I will try to check back a bit more often
if it’s more than a couple thousand idk what I will do. Im going to need to get the surgery. Luckily this ultrasound specialist vet did say based on the way it looks it does not look malignant but she can’t say for sure.
and oh ok that makes me feel better. I am planning on this surgery and this is a good place but they don’t have a cardiologist on staff. She has had an echo that shows mild HCM. I’m thinking about calling that cardiologist or asking if he will consult with them to approve her for surgery. I’m also so worried about the cost of surgery especially because I need to do this ASAP