Ladybug update and need more help | Feline Diabetes Message Board - FDMB

Ladybug update and need more help

ladybug991

Member since 2025
she does have cushings because she has one of her adrenal glands giant. So it’s adrenal cushings. They recommended surgery but I heard it’s a dangerous surgery and she has mild to moderate HCM. She is a happy cat most of the time but she’s getting worse and needs help. Also they said they didn’t have experience with cushings but they have good surgeons. However they said go to an internal medicine vet if I can afford it. They are looking into internal medicine vets that are endocrinologists. What about meds I heard they are also dangerous.
 
Thank you for the tag @Wendy&Neko

Our Roxi had adrenal-based Cushing's. We had a really good IM and surgical team work on her case. The problem, as they explained it to me, is that the tumors that cause adrenal-based Cushing's in cats are almost always malignant although they only spread locally. However, because the adrenal sits right next to both the caudal vena cava and the abdominal aorta, the tumor will grow around and into one of both of those blood vessels. So removal isn't recommended so much as required if you want to give her a good chance at survival. The meds that are used for pituitary-based Cushing's just won't work on the adrenal-based type, all concerns for tumor growth aside. And you will reach the point, as we did, where her glucose is not able to be controlled because the tumor will start to pulse production of cortisol on and off. So while it's producing cortisol, you'll need a really high dose...but it can then pulse off with no warning at all leaving you fighting super low hypo numbers for prolonged periods of time (days, not hours where you have to feed glucose every 20 minutes).

It is a fairly intense surgery though. I would want the same type of team that we had - a board-certified IM specialist plus a board-certified surgeon (a vet who specializes and has extra training specifically in surgery). In your case, I would also absolutely want a board-certified cardiologist on your team. It is significantly more expensive to go the specialist route, but her chances of making it through surgery and into a full recovery are also so much higher that way.

If you decide to go the surgical route, please let me know so I can give you more information.
 
Thank you for the tag @Wendy&Neko

Our Roxi had adrenal-based Cushing's. We had a really good IM and surgical team work on her case. The problem, as they explained it to me, is that the tumors that cause adrenal-based Cushing's in cats are almost always malignant although they only spread locally. However, because the adrenal sits right next to both the caudal vena cava and the abdominal aorta, the tumor will grow around and into one of both of those blood vessels. So removal isn't recommended so much as required if you want to give her a good chance at survival. The meds that are used for pituitary-based Cushing's just won't work on the adrenal-based type, all concerns for tumor growth aside. And you will reach the point, as we did, where her glucose is not able to be controlled because the tumor will start to pulse production of cortisol on and off. So while it's producing cortisol, you'll need a really high dose...but it can then pulse off with no warning at all leaving you fighting super low hypo numbers for prolonged periods of time (days, not hours where you have to feed glucose every 20 minutes).

It is a fairly intense surgery though. I would want the same type of team that we had - a board-certified IM specialist plus a board-certified surgeon (a vet who specializes and has extra training specifically in surgery). In your case, I would also absolutely want a board-certified cardiologist on your team. It is significantly more expensive to go the specialist route, but her chances of making it through surgery and into a full recovery are also so much higher that way.

If you decide to go the surgical route, please let me know so I can give you more information.
Thank you. I will try to find an internal medicine vet that has all of that and is highly rated. I don’t have pet insurance and I am disabled myself and working like 25 hours a week making no money. But I’m going to try so hard to make this happen. 😭 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.
 
Thank you. I will try to find an internal medicine vet that has all of that and is highly rated. I don’t have pet insurance and I am disabled myself and working like 25 hours a week making no money. But I’m going to try so hard to make this happen. 😭 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.
Costs quite often depend on where you live. We're in one of the more expensive areas, and Roxi's surgery was a lot more than $2000. But I've seen people post much lower prices for all kinds of things than we've ever been able to find, so if you're in a less expensive area I wouldn't even be able to guess at the likely cost. You could try either Care Credit or Scratchpay for spreading out payment over a longer period if that's of any help.
 
Would you suggest surgery over medication? I’m nervous about putting her under with her HCM esp since the top surgeons and internal med vets in my area don’t have a cardiologist on staff. I’ve heard Tristilone can help but they must be closely monitored and it can also be dangerous. 😭 I’m so scared of making the wrong choice.
 
Thank you for the tag @Wendy&Neko

Our Roxi had adrenal-based Cushing's. We had a really good IM and surgical team work on her case. The problem, as they explained it to me, is that the tumors that cause adrenal-based Cushing's in cats are almost always malignant although they only spread locally. However, because the adrenal sits right next to both the caudal vena cava and the abdominal aorta, the tumor will grow around and into one of both of those blood vessels. So removal isn't recommended so much as required if you want to give her a good chance at survival. The meds that are used for pituitary-based Cushing's just won't work on the adrenal-based type, all concerns for tumor growth aside. And you will reach the point, as we did, where her glucose is not able to be controlled because the tumor will start to pulse production of cortisol on and off. So while it's producing cortisol, you'll need a really high dose...but it can then pulse off with no warning at all leaving you fighting super low hypo numbers for prolonged periods of time (days, not hours where you have to feed glucose every 20 minutes).

It is a fairly intense surgery though. I would want the same type of team that we had - a board-certified IM specialist plus a board-certified surgeon (a vet who specializes and has extra training specifically in surgery). In your case, I would also absolutely want a board-certified cardiologist on your team. It is significantly more expensive to go the specialist route, but her chances of making it through surgery and into a full recovery are also so much higher that way.

If you decide to go the surgical route, please let me know so I can give you more information.
The top IM vet in my area have board certified excellent surgeons and are highly rated but no cardiologist on staff. I really don’t know what to do. It’s 250$ for them to see me and feel out if they can do it. My vet says since it’s mild HCM to go with them. But I’m waiting on the vet that did her ultrasound to call me again tomorrow and get her opinion. The other vet I’m considering is outside of the city about 35 min. She is an IM specialist and one of the best in the greater area. Shes also been practicing a long time. But she would still have to refer me to a surgeon. There is a Medvet here that has mixed reviews I think some are about the nurses and office staff. They do have some good surgeons there also and good cardiologists and they are much closer. But idk something tells me to stay away from them because they aren’t rated highly enough.

Worried about which option I should choose. Maybe the first one will have a cardiologist they could consult with. But no one will really give me any answers until I meet them in person and pay them 250-500$. The one that’s a drive said she’s comfortable taking on the case but she would have to refer me out for surgery anyways. This is so confusing and I am trying so hard not to make the wrong decision. But you think surgery rather than meds is for sure the way to go?
 
Would you suggest surgery over medication?
We are not vets here, we haven't laid eyes on Ladybug. Your vets could better answer the question. Once Neko was diagnosed with HCM, I only felt comfortable going ahead with any surgery once an echocardiogram was done by a board certified cardiology vet.
 
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
 
We are not vets here, we haven't laid eyes on Ladybug. Your vets could better answer the question. Once Neko was diagnosed with HCM, I only felt comfortable going ahead with any surgery once an echocardiogram was done by a board certified cardiology vet.
We are not vets here, we haven't laid eyes on Ladybug. Your vets could better answer the question. Once Neko was diagnosed with HCM, I only felt comfortable going ahead with any surgery once an echocardiogram was done by a board certified cardiology vet.
We are not vets here, we haven't laid eyes on Ladybug. Your vets could better answer the question. Once Neko was diagn with HCM, I only felt comfortable going ahead with any
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
Thank you for your response. Ladybug is 10, has not undergone any testing for cushings diagnosis is based on her ultrasound. I am worried because they did say her one adrenal is tiny and the other is giant. I’m really worried it won’t wake up after surgery. If that happens can they still survive? She is not diabetic which is a good thing and shes a determined kitty.
 
Thank you for your response. Ladybug is 10, has not undergone any testing for cushings diagnosis is based on her ultrasound. I am worried because they did say her one adrenal is tiny and the other is giant. I’m really worried it won’t wake up after surgery. If that happens can they still survive? She is not diabetic which is a good thing and shes a determined kitty.
I would ask the surgeon what percentage of cats survive surgery (in general and in his particular number of cases he’s done). The younger and more healthy the cat the better the odds of surviving surgery. It’s good that she’s not diabetic yet. Methos didn’t develop diabetes until I think it was 6 months later. Erik had been a poorly (uncontrolled) diabetic for three years which didn’t help his odds of survival.

I’m pretty sure despite the sticker shock of surgery it is the most cost effective method of treatment as well as the only method that will give best quality of life (if they survive the surgery/post op). Methos was already a very senior cat when his tumor was found, and he’d been very ill with what was probably pancreatitis. Then he never quite built himself back up and just didn’t seem a good candidate. And I was afraid. I know the decision is a hard one and I send good thoughts your way
 
If the other adrenal doesn’t wake up then you will have a cat with Addisons—Google and your vet can discuss the treatment —but it is treatable (and the risks of tumor invading the vena cava has been removed). I wouldn’t let the risk of addisons keep me from having the surgery done (personally). I think generally the other glad eventually functions. It’s small now because Ladybug’s body is trying to keep things balanced and the other glad is so big.

Why did they do the ultrasound?
 
If the other adrenal doesn’t wake up then you will have a cat with Addisons—Google and your vet can discuss the treatment —but it is treatable (and the risks of tumor invading the vena cava has been removed). I wouldn’t let the risk of addisons keep me from having the surgery done (personally). I think generally the other glad eventually functions. It’s small now because Ladybug’s body is trying to keep things balanced and the other glad is so big.

Why did they do the ultrasound?
Did the ultrasound because of her symptoms. Vet originally brushed her symptoms off but I persisted and honestly lied about the amount she was drinking. Then he decided I should do an ultrasound and systo. She has increased thirst but he was saying it was still within the normal range. The other vet who did the ultrasound says her urine is also way too dilute which is another sign of cushings. She has almost every if not every symptom of cushings as well. :( 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
 
Nevermind I read your first post. With her heart issues and now this I’d try to be sure the hospital is fully capable of handling her post op care. It might need even going to a vet teaching hospital so they have enough really experienced vets and hospital staff.
 
Did the ultrasound because of her symptoms. Vet originally brushed her symptoms off but I persisted and honestly lied about the amount she was drinking. Then he decided I should do an ultrasound and systo. She has increased thirst but he was saying it was still within the normal range. The other vet who did the ultrasound says her urine is also way too dilute which is another sign of cushings. She has almost every if not every symptom of cushings as well. :( 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
That sounds like a good plan you have. I’m sorry I haven’t been to the Board lately. If I read your initial post I’d have insisted you get an ultrasound. You have been an excellent advocate for your girl
 
If you end up getting the surgery—and she sounds like a good candidate except idk about her heart—then what the tumor produces doesn’t matter.

If you decide against surgery (I don’t recall what her cardiologist thought) then you are getting it early and perhaps the drugs will help at least for a while. It’s not that vetoryl doesn’t work against adrenal Cushing’s —it’s just a drug that blocks the tumors’ production of cortisol and aldosterone—the issue there is the tumor keeps growing so more and more vetoryl is needed and it has a small (but real) risk of suddenly killing the adrenal (no matter the dose); there’s also a risk of giving too much and causing addisons but it’s a short lived drug so after a few days things go back to where they were prior to vetoryl
 
Thank you this is her cardiac report. He didn’t have any recommendations regarding surgery because I did not have her cushings diagnosed at this time. I’m going to one of two larger IM places in my city if not I can travel about an hour and a half one way to go to a vet school. Unsure if I should go that route or not.
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Did the ultrasound because of her symptoms. Vet originally brushed her symptoms off but I persisted and honestly lied about the amount she was drinking. Then he decided I should do an ultrasound and systo. She has increased thirst but he was saying it was still within the normal range. The other vet who did the ultrasound says her urine is also way too dilute which is another sign of cushings. She has almost every if not every symptom of cushings as well. :( 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
Erik’s vet yelled at me for three years that I obviously wasn’t giving his insulin right as he’d been changed to three different insulins and his diabetes wasn’t controlled. Finally he got an ultrasound in the ER when he stopped eating while on insulin so in we went.

Methos id been complaining for a year that his coat looked bad (which panicked me bc Erik’s coat looked bad). In my vets defense of not considering Cushing’s neither did I—in part because since this is so rare I didn’t expect I’d have a SECOND cat with it. Also he stress groomed and my other cat was in the hospital getting I 131 so we assumed he licked his belly fur and it just didn’t regrow. His water intake increased AFTER his US
 
If you haven’t yet chosen which internist you might ask your vet (if you trust their judgment). If not you might call both and explain you have a cat with HCM and an adrenal tumor and ask if the internist has experience in those areas. The internist I found near the end for methos said she had several Cushing’s cats she was treating medically because they weren’t healthy enough for surgery. I was going to hire her regardless as she was the only one I found who would consult remotely.

It’s good that you feel a sense of urgency but do take time to consider everything carefully. These tumors do grow and invade blood vessels but if her US didn’t show that was an imminent risk then it won’t happen overnight. You have time to think and decide
 
If you haven’t yet chosen which internist you might ask your vet (if you trust their judgment). If not you might call both and explain you have a cat with HCM and an adrenal tumor and ask if the internist has experience in those areas. The internist I found near the end for methos said she had several Cushing’s cats she was treating medically because they weren’t healthy enough for surgery. I was going to hire her regardless as she was the only one I found who would consult remotely.

It’s good that you feel a sense of urgency but do take time to consider everything carefully. These tumors do grow and invade blood vessels but if her US didn’t show that was an imminent risk then it won’t happen overnight. You have time to think and decide
She did say (ultrasound vet, not tech) that it looks like clean edges to her and not malignant although she didn’t wanna say for sure since she’s not experienced in cushings in cats.
 
Also noting Erik’s vet wasn’t Methos’ vet. I never went back to Erik’s vet. It’s crucial you have a vet you trust bc you will be making important decisions (hopefully for a very long time) for Ladybug. I can never say enough good things bout my current vet who has helped me make excruciating decisions for Methos for several years
 
She did say (ultrasound vet, not tech) that it looks like clean edges to her and not malignant although she didn’t wanna say for sure since she’s not experienced in cushings in cats.
They can’t tell on US and odds are high that it’s malignant because they usually are. But that shouldn’t actually be the deciding factor bc as others mentioned, the risk of the tumor is it tends to grow into the vena cava whether cancer or not. The VC is what returns all the blood to the heart. Huge blood vessel. Not good if something causes it to bleed
 
I just reread this post. I’m not sure if you’re saying your vet doesn’t have experience with Cushing’s or the surgeons’ are good but also lack experience.

If it was me I’d want a surgeon who has done this surgery before, preferably successfully—if at all possible. that tells me he can get through this complex surgery and his hospital can handle the post op care. Admittedly it was a long time ago and Erik wasn’t a great candidate for surgery. But they told me I had to do the surgery right away and that their surgeons were good. It never crossed my mind to ask if they’d done it before. And they’d panicked me into thinking it needed to be done next week. If I could do it over I’d try to have it done by someone who’d done it before. That said, it’s a rare tumor so finding someone who’s done the surgery before could be impossible depending on your location.
 
I just reread this post. I’m not sure if you’re saying your vet doesn’t have experience with Cushing’s or the surgeons’ are good but also lack experience.

If it was me I’d want a surgeon who has done this surgery before, preferably successfully—if at all possible. that tells me he can get through this complex surgery and his hospital can handle the post op care. Admittedly it was a long time ago and Erik wasn’t a great candidate for surgery. But they told me I had to do the surgery right away and that their surgeons were good. It never crossed my mind to ask if they’d done it before. And they’d panicked me into thinking it needed to be done next week. If I could do it over I’d try to have it done by someone who’d done it before
I’m not sure if either internal medicine specialist hospital here has done it before. One of my options is a medvet hospital and one is not. Another option I would consider is a drive away but if they’re the only people with experience I’d consider it. The issue is they won’t really give me 100 percent answers over the phone and I don’t want to have to pay 100s of dollars for them to tell me no.
 
I’m not sure if either internal medicine specialist hospital here has done it before. One of my options is a medvet hospital and one is not. Another option I would consider is a drive away but if they’re the only people with experience I’d consider it. The issue is they won’t really give me 100 percent answers over the phone and I don’t want to have to pay 100s of dollars for them to tell me no.
I know. I’m in the same boat with my other cat and his bladder cancer right now. I don’t know what a never hospital is. Id say though just don’t feel pressure to agree if you are uncomfortable once you see someone.
In the big scheme of how much the surgery will be, it’s worth paying for two or three initial surgical evaluations to be sure you trust the surgeon (I’m not clear who you are seeing is it a surgeon or an internist ?)
 
There’s
I know. I’m in the same boat with my other cat and his bladder cancer right now. I don’t know what a never hospital is. Id say though just don’t feel pressure to agree if you are uncomfortable once you see someone.
In the big scheme of how much the surgery will be, it’s worth paying for two or three initial surgical evaluations to be sure you trust the surgeon (I’m not clear who you are seeing is it a surgeon or an internist ?)
there’s multiple hospitals here (2 that have surgeons and internists) one is larger and has an endocrine specialist and cardiologists and like 40 vets. There’s also a teaching hospital but it’s about an hour and half away. I haven’t seen any of them in person yet.
 
The top IM vet in my area have board certified excellent surgeons and are highly rated but no cardiologist on staff. I really don’t know what to do. It’s 250$ for them to see me and feel out if they can do it. My vet says since it’s mild HCM to go with them. But I’m waiting on the vet that did her ultrasound to call me again tomorrow and get her opinion. The other vet I’m considering is outside of the city about 35 min. She is an IM specialist and one of the best in the greater area. Shes also been practicing a long time. But she would still have to refer me to a surgeon. There is a Medvet here that has mixed reviews I think some are about the nurses and office staff. They do have some good surgeons there also and good cardiologists and they are much closer. But idk something tells me to stay away from them because they aren’t rated highly enough.

Worried about which option I should choose. Maybe the first one will have a cardiologist they could consult with. But no one will really give me any answers until I meet them in person and pay them 250-500$. The one that’s a drive said she’s comfortable taking on the case but she would have to refer me out for surgery anyways. This is so confusing and I am trying so hard not to make the wrong decision. But you think surgery rather than meds is for sure the way to go?
When you look at the reviews for Medvet, you need to look at the detail of what the negative reviews were upset about. Sometimes it's not really super relevant to the reason you'd be there. It can be because of pricing. Sometimes, especially with ERs, people are upset that their pet didn't make it even when they never had a chance regardless of what was done. I would review the reviews to make sure they're relevant before assuming that mixed reviews mean somewhere isn't any good.

Absolutely, for an adrenal-based Cushing's, all the information I have says that the meds just won't really work and that surgery is the only good option.
 
If the other adrenal doesn’t wake up then you will have a cat with Addisons—Google and your vet can discuss the treatment —but it is treatable (and the risks of tumor invading the vena cava has been removed). I wouldn’t let the risk of addisons keep me from having the surgery done (personally). I think generally the other glad eventually functions. It’s small now because Ladybug’s body is trying to keep things balanced and the other glad is so big.
Yep. Roxi ended up with Addison's. We'd spent 3 or 4 years being told that she was "just a high dose cat" and that I wasn't doing things right despite the fact that I'd got my own cat (and several cats belonging to other people) into remission previously and that I'm an LVT. It was only when her tumor starting pulsing cortisol and we were dealing with hypo after hypo when it would stop production that we were taken seriously. Even then, the thought was that she had insulinoma not Cushing's - until the IM we were referred to took one look at her and diagnosed (obviously it was confirmed with testing and ultrasound, but he knew just from looking at her). With that said, Addison's is super easy to manage once you get the meds figured out (can take a couple of months). The only thing that always made me laugh was that vets new to her case were always thrown off completely by her being on DOCP because "cats don't get Addison's" and assumed she was being horribly mismanaged until they read back in her records.
 
When you look at the reviews for Medvet, you need to look at the detail of what the negative reviews were upset about. Sometimes it's not really super relevant to the reason you'd be there. It can be because of pricing. Sometimes, especially with ERs, people are upset that their pet didn't make it even when they never had a chance regardless of what was done. I would review the reviews to make sure they're relevant before assuming that mixed reviews mean somewhere isn't any good.

Absolutely, for an adrenal-based Cushing's, all the information I have says that the meds just won't really work and that surgery is the only good option.
I have a good plan now after talking to the vet that did the ultrasound. They recommended the surgeons at the non med vet surgical center as being amazing surgeons and internal medicine vets but not being endocrine experts. She said consulting with both the cardiologist who I got the echo done previously with and potentially an endocrinologist possibly from medvet would be best in this case. But that at medvet the surgery will be twice as much. I don’t know if either vet has done this surgery on a cat or not but I will see the non med vet place first and try to see about consulting with an endocrinologist first? Ugh now I’m just having doubts again because medvet has all specialists under one roof. But if I can talk to the surgical specialists I’ll have a better idea of if I like them and would be comfortable bringing in specialists or don’t feel comfortable or feel like they have done it before and I’m ok without bringing them in. But I think they might know of an endocrinologist to consult.
 
Also no one is experienced in Cushing’s cats. Welcome to an unfortunate club
Absolutely true. It just doesn't happen enough for anyone to have a ton of experience. The experience we've got is based only on the experiences we've had personally. Oh...and if you do go ahead and Ladybug does develop Addison's, you will totally need to be on the lookout for early symptoms of that. Roxi's IM had admitted that he thought she might be headed in that direction at her 2 week recheck. But when she went into an Addison's crisis, I pretty much had to have a screaming match with an ER vet who thought she 'knew it all' because she'd seen it in dogs before and Roxi didn't quite fit the pattern she was expecting. So they had her on D5W fluids (basically distilled water IV to try to control her electrolyte issues) and were watching her die slowly because they refused to contact the IM on the weekend. We ended up taking her out of there with the whole drama of signing an Against Medical Advice form and taking her to a different ER where I'd already talked to one of their IMs about starting her on the right treatment.
 
I just reread this post. I’m not sure if you’re saying your vet doesn’t have experience with Cushing’s or the surgeons’ are good but also lack experience.

If it was me I’d want a surgeon who has done this surgery before, preferably successfully—if at all possible. that tells me he can get through this complex surgery and his hospital can handle the post op care. Admittedly it was a long time ago and Erik wasn’t a great candidate for surgery. But they told me I had to do the surgery right away and that their surgeons were good. It never crossed my mind to ask if they’d done it before. And they’d panicked me into thinking it needed to be done next week. If I could do it over I’d try to have it done by someone who’d done it before. That said, it’s a rare tumor so finding someone who’s done the surgery before could be impossible depending on your location.
Yes I’m considering calling the vet school that’s about 1.5 hours away and seeing if they’ve done it but I have reservations about going that route because while that may seem like an easy commute it’s not for me for many reasons. I mean id do if they are the only people who have done this surgery in this area. Idk if they’ve even done it. And driving all the way over there and stressing her out for a consult is not something I want to do.
 
I have a good plan now after talking to the vet that did the ultrasound. They recommended the surgeons at the non med vet surgical center as being amazing surgeons and internal medicine vets but not being endocrine experts. She said consulting with both the cardiologist who I got the echo done previously with and potentially an endocrinologist possibly from medvet would be best in this case. But that at medvet the surgery will be twice as much. I don’t know if either vet has done this surgery on a cat or not but I will see the non med vet place first and try to see about consulting with an endocrinologist first? Ugh now I’m just having doubts again because medvet has all specialists under one roof. But if I can talk to the surgical specialists I’ll have a better idea of if I like them and would be comfortable bringing in specialists or don’t feel comfortable or feel like they have done it before and I’m ok without bringing them in. But I think they might know of an endocrinologist to consult.
Honestly, I don't recall if the surgeon who did Roxi's adrenal removal had done one on a cat before or not (it's been about 7 years now). But a board certified surgeon should be up to the task of any complex surgery. It's literally what they've done all their extra training for.
 
Honestly, I don't recall if the surgeon who did Roxi's adrenal removal had done one on a cat before or not (it's been about 7 years now). But a board certified surgeon should be up to the task of any complex surgery. It's literally what they've done all their extra training for.
Yeah I am feeling ok with these surgeons since I am certain I’m going the surgical route with this and 2 vets recommended them. I will definitely consult the cardiologist and possibly endocrinologist before the surgery and move carefully here. But I think this is a good place to start.
 
There’s

there’s multiple hospitals here (2 that have surgeons and internists) one is larger and has an endocrine specialist and cardiologists and like 40 vets. There’s also a teaching hospital but it’s about an hour and half away. I haven’t seen any of them in person yet.
The one that has endocrine and cardiology is more likely to be able to handle her than the other that does not. The teaching hospital is more likely to have the best equipment and latest technique but there’s always a tradeoff with teaching hospitals (animal or human): since it’s a teaching hospital the person holding the knife may be one in training. An experienced staff will be next to them but still…

Alternatively the surgeon in a non-teaching hospital may have recently graduated, knows the latest techniques and has done this surgery before.

If I had decided on surgery for Methos I would have driven 5 hrs to Davis (teaching hospital). But the closest hospital to me that had surgeons and internists (not even endocrine) and I felt enough staff to handle post op was 4 hours away (I’m in a rural town). I wouldn’t have considered the local hospital here (which has a bad rep anyway) or my vet/her partner because while they both do surgery (a) not a hospital (b) not surgeons let alone ones that do this sort of surgery.

if you trust your vet’s opinion ask them—I adore and trust mine 1000% and since she said the oncologist 4 hours from here is good I don’t feel the need to drive 5 hours to Davis for my cat with bladder cancer

If you don’t trust your vet opinion you may have to make two appointments, and if you’re not comfortable after the first one go to the second—and choose who you trust most. Another idea (if you’re in the US) would be post on NextDoor and ask if anyone has had a pet needing complicated surgery who they chose

Edit: I posted before I saw some “hidden” posts. It sounds like you’re comfortable with the non med vet hospital so I agree start there. You can always go somewhere else if you have reservations after the appointment. Good luck to you and Ladybug
 
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The one that has endocrine and cardiology is more likely to be able to handle her than the other that does not. The teaching hospital is more likely to have the best equipment and latest technique but there’s always a tradeoff with teaching hospitals (animal or human): since it’s a teaching hospital the person holding the knife may be one in training. An experienced staff will be next to them but still…
For a cat with HOCM, I would want somewhere that has a cardiologist available if they're needed. Endocrinology is a sub-specialty for IM anyway. So an IM specialist should have enough information overall to handle adrenal issues. The skill of the surgeon is super important though - I know we talked about the proximity of the adrenal to the vena cava for the purposes of tumor spread. But it also means that the surgeon is working right next to the vena cava during the surgery. And because cats are fairly small and compact internally, there is pretty much no margin for surgeon error at all. I would agree with caution with a teaching hospital. I know that all surgeons have to learn on live patients sooner or later, but when it's one of our own pets for such a delicate surgery, even with my years in the field I don't know that I would be comfortable with having a new surgeon still under tuition being the one holding the scalpel. Yes, whoever is teaching can usually save the situation if something goes wrong, but they can't necessarily prevent that tiny slip that can cause an emergency to happen at all. I know I'm not meant to think like that and I know we're meant to give the new people a chance...but when it comes to my own cats, I still want someone with years of doing delicate surgeries to be the one working on any of my own.
 
The one that has endocrine and cardiology is more likely to be able to handle her than the other that does not. The teaching hospital is more likely to have the best equipment and latest technique but there’s always a tradeoff with teaching hospitals (animal or human): since it’s a teaching hospital the person holding the knife may be one in training. An experienced staff will be next to them but still…

Alternatively the surgeon in a non-teaching hospital may have recently graduated, knows the latest techniques and has done this surgery before.

If I had decided on surgery for Methos I would have driven 5 hrs to Davis (teaching hospital). But the closest hospital to me that had surgeons and internists (not even endocrine) and I felt enough staff to handle post op was 4 hours away (I’m in a rural town). I wouldn’t have considered the local hospital here (which has a bad rep anyway) or my vet/her partner because while they both do surgery (a) not a hospital (b) not surgeons let alone ones that do this sort of surgery.

if you trust your vet’s opinion ask them—I adore and trust mine 1000% and since she said the oncologist 4 hours from here is good I don’t feel the need to drive 5 hours to Davis for my cat with bladder cancer

If you don’t trust your vet opinion you may have to make two appointments, and if you’re not comfortable after the first one go to the second—and choose who you trust most. Another idea (if you’re in the US) would be post on NextDoor and ask if anyone has had a pet needing complicated surgery who they
For a cat with HOCM, I would want somewhere that has a cardiologist available if they're needed. Endocrinology is a sub-specialty for IM anyway. So an IM specialist should have enough information overall to handle adrenal issues. The skill of the surgeon is super important though - I know we talked about the proximity of the adrenal to the vena cava for the purposes of tumor spread. But it also means that the surgeon is working right next to the vena cava during the surgery. And because cats are fairly small and compact internally, there is pretty much no margin for surgeon error at all. I would agree with caution with a teaching hospital. I know that all surgeons have to learn on live patients sooner or later, but when it's one of our own pets for such a delicate surgery, even with my years in the field I don't know that I would be comfortable with having a new surgeon still under tuition being the one holding the scalpel. Yes, whoever is teaching can usually save the situation if something goes wrong, but they can't necessarily prevent that tiny slip that can cause an emergency to happen at all. I know I'm not meant to think like that and I know we're meant to give the new people a chance...but when it comes to my own cats, I still want someone with years of doing delicate surgeries to be the one working on any of my own.
Yes I’m planning on going to the non med vet IM and surgical specialists because my vet said she had sent people there for surgery before with cardiac issues and they consulted with the traveling cardiologist that my vet works with.
 
I would vouch for this surgeon every day, all day, because he successfully performed an insanely complex surgery on one of my dogs awhile back (removed a tumor from the liver, adrenal, and went through the diaphragm to remove a tumor from lower lung lobe, all in one session). Last I knew he was in North Carolina, the Asheville area. I don’t know if that’s close to you and don’t have current contact info on him — but maybe someone can track him down if you’re interested. A quick search found the link below. Dr Alexander Ingar Krebs.

Self Service Portal

As Colleen @SmallestSparrow mentioned, I also had a Cushings dog (not the one referenced above) who had an adrenal tumor that wrapped around and infiltrated the vena cava. By the time it was diagnosed, it was inoperable and she was bleeding internally. I would definitely look at surgery options and ask about experience. Cats are not small dogs, but I will say that surgery can be curative and medications are just trying to manage a situation that will likely continue to progress and worsen. However, surgery is not for the faint of heart and requires much consideration, medical assessment, and soul searching about what risks and outcomes you can/cannot live with. Regret is a terrible thing in both directions. Given what I’ve seen firsthand with my dogs, I would try to stack the deck in the animal’s favor and, if it seemed the odds were decent, probably do surgery. But that’s just me.

I haven’t read all of the posts in this thread so am going to circle back and catch up…
 
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