acro diagnosis - considering surgery or srt. anybody opinion?

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babbie & otto

babbie & otto

Member Since 2015
Hey
otto has been recently diagnosed with acro and we have had the MRI and Dr Owen in Spokane can do the surgery and now the SRT can be done at NC State as well as CSU. Considering all options. Big factor - Otto's kidneys suddenly started being affected. BUN is up and kidneys are enlarged. Having a real tough time making the decision of sedation (surgery sedation is longer than SRT) with his kidneys like this. Any experience here?
thanks
Babbie
 
You may want to find if each place has a veterinary anesthesiologist.
What are the relative costs of each procedure, including travel and hotel costs?
How far away are you from each location? Traveling can be very stressful for some cats.
 
Depending on where you are, also check with the University of Georgia. I spoke with them last fall about SRT. They are/were building a new veterinary hospital/school and we're going to start offering SRT to acrocats. It was supposed to be available this summer but I don't know where they are in their timeline.
 
Sorry about the diagnosis - but it is an explanation for his numbers and it looks like you are taking charge and going ahead with treatment. Recent studies have shown that 25% of all diabetic cats have acromegaly.

At the time Neko was diagnosed, SRT was the only option for acromegaly treatment. Transsphenoidal hypophysectomy, the surgical option, is a recent addition to the treatments. Surgery is the treatment of choice in humans, but they are much bigger. The Royal Veterinary College (RVC) in London, England, what I consider to be at the forefront of acromegaly research with their Acromegaly Cat Clinic, now recommends surgery over SRT. However, and it's a big however, only if the surgeon has experience. Apparently the success of surgery is directly proportional to the experience of the vet doing the surgery. Dr. David Bruyette in LA was the first surgeon to perform this surgery in the US and it looks like Dr. Owen may have trained with him at the VCA Hospital. You also want a vet who has done the surgery on cats, because there is a higher mortality rate with cats than dogs. I'd ask how many times she has done the surgery on cats. Since she's at a veterinary teaching hospital, I would expect you'd have specialist anesthesiologists.

The stay for surgery is longer than that for SRT. I don't know how the costs compare but would be interested in anything you find out. SRT is also performed at Yonkers and the Red Bank Veterinary Hospital in New Jersey. SRT is one day of CT scans followed by 3 days of radiation. At the time we did it CSU was far cheaper (one third) than the other locations, which was a factor in our decision. Plus we were able to drive there (3 days) and take along all of Neko's things.

If you are interested in articles, here is a good one on acromegaly and treatment and here (page 733). The outcomes for surgery are better in terms of "curing" acromegaly, but it is riskier because it is surgery. SRT may or may not lead to a cat going off insulin, and can take a couple of years to see the full effect. That said, I'm really happy we did SRT at the time. A couple of us here have contacted the RVC with questions and they've been very open to answering questions if you want to enquire further, especially about the kidneys.

As you may have guessed, this is an area of interest to me. Please keep us updated on what you decide. Good luck!
 
I think Dr Owen is married to Bruyette (I was told that by the guy that did my MRI). Cost pales in comparison to his quality of life and my time left with him. Its the anesthesia that concerns Dr Owen and his kidneys. I havent started R yet but plan to tomorrow. No vet yet that I have encountered has much experience with it. It appears shoot on the high levels like am/pm 1 hour after reg dose????? My vet said start at 2-3U and that is not what I am seeing on charts. She also said I could shoot on the rise after nadir which I am not seeing either. It would make sense to keep him from going in the 600's at pm.
 
babbie & otto said:
No vet yet that I have encountered has much experience with it. It appears shoot on the high levels like am/pm 1 hour after reg dose????? My vet said start at 2-3U and that is not what I am seeing on charts. She also said I could shoot on the rise after nadir which I am not seeing either. It would make sense to keep him from going in the 600's at pm.
Click to expand...
Is your question here all about using R?

We have an experienced R user guide anyone who wants to start using R and stay with them during the first 4 hours after shooting. Timing is everything with R - you don't want to have the nadir of the R coincide with the nadir of the Lantus.

R doses are typically started extremely low - 0.1u as the first trial, then 0.25u, then 0.5u - and that progression is dependent on the results from each of the earlier trials. It would definitely be best if an experienced R user worked out a time to be with you and check in hourly when you want to start using it. What time zone are you in?

hmmm, I'm looking at his ss and am confused. Are you using an AlphaTrak or Accucheck? Are you using Lantus (per your signature line) or ProZinc (per the ss)?

We did the SRT with punkin - it was relatively easy for him. I'm glad we did it because it got rid of many of the symptoms, but he died before going OTJ. He had a lot of other health problems as well, including anemia and a galloping heart rhythm. I don't have any advice between the SRT/surgery option. I think what Wendy said above about the skill of the surgeon would matter a lot to me. I wouldn't want anyone doing it who hadn't done it multiple times before and I'd want to know what their success rate was.
 
Sorry about the Dx. I have no experience w/ Acro, but we have been using R for Tess for several months. She was DKA from not eating and her whole response to Lev seems to have changed. W give R when we see the rise, usually about +10 works for us. For Tess it's pretty much a daily thing now, but it is heading off her bounces. Talk to Marje about using R this way, she does it for Gracie, although it's less often necessary. The ER vet who suggested R suggested a full unit. we went w/ .1u and it brings her down 100 to 150 point, nadir is about 4 hours, but you will need to experiment to see how it effects Otto and watch closely until you know his reaction.
 
Interesting on the Bruyette/Owen connection. I just mentioned cost because it pays to check out more than one place if they do the same thing (SRT).

I notice that the SS says a new kidney food - what are you feeding? Most people here with cats with diabetes and kidney issues feed a low carb/low phosphorus food. Ann has put a tab on Tess's spreadsheet that lists available foods.

Proteinuria is also common with acrocats. Neko has it (diagnosed with a urine protein/creatinine ratio test) and takes benazapril for it.

As for R, the experience here is using it with Lantus or Levemir. A fair number of the acrocats end up on Levemir. I second Julie on having an experienced person be with you the first few times.
 
Hi Babbie, welcome to the acrocats club, not a place I'm sure you wanted to be but great advice and first hand experience from members. No advice from me as i'm still a relative newbie but I am using the R insulin fairly aggressively for Crystal to try to keep her BGs low. She's on Levemir and we haven't opted for surgery or SRT (not available here in France). Just wanted to wish you good luck with whatever treatment you decide on for Otto.
 
I was using Lantus and am now on Prozinc. I picked up a new bottle of Levemir yesterday for longer lasting insulin - also picked up R. Dont know how to make the switch to Levermir - cannot start low!! I know my ss looks crazy on the alpha vs accutrak. I was stritkly alpha then it went kaputz so I got a accutrak. Back to the alph and sometimes do a dbl test to see the dif. Wow, is that nutty. Yesterday 100 on alpha and 180 on the accutrak. Such BS on the accuracy! I do prefer the alphatrack. Someone mentioned a drug for acro - anybody know what that is??
 
Babbie - the transition rate from Lantus to Lev is usually about 2/3 dose. I went from ProZinc to Lev and we went back to 3u. I DO NOT recommend starting so low. Probably 2/3 to 3/4 dose would be advisable.

As for R, we started off with 1/4 unit. Those of us that have used R may have reached 3 or more units, but that's ONLY after extensive monitoring and gradual increases.

Also, when you do the switch, I would NOT recommend using R unless he's completely on the moon - like 450+ - and then still just a small dose. You will need to see how Otto is responding to the Lev.
 
If you have a good Lantus or ProZinc dose, then we suggest starting Lev at 70% of the dose. Some cats seem to need less Levemir (and some don't). At 7.5U, a 70% dose would be 5.25 units of Levemir. Hold for at least 6 cycles and post here. We can help you decide if you need to fast track going up.

Here is the link to the paper on the Pasereotide trial. Again, only at the Royal Veterinary Clinic and they are now recommending surgery over pasireotide due to cost of the drug, plus a number of the cats in the trial had to discontinue due to to GI side effects.
 
None of us would suggest you start over when you switch to Lev. I'd do the 70% that Wendy mentioned, of whatever dose you are at when you switch.

The thing about making lots of changes in what you're doing (ATrak, Accucheck, insulin switches) is that it can make deciphering what's going on on the spreadsheet into a bit of a nightmare. Especially the switching between meters. Once you get the hang of "reading" a spreadsheet, the colors become extremely important, and if you're switching between meters it's comparing apples to oranges. The colors of the numbers would be on 2 different scales. It also increases the chance of someone thinking you're using one insulin/meter and giving advice based upon that, when you're really using the other.

I'd suggest you insert a horizontal row to the ss, make it really clear that all tests below are x meter and x insulin, then if you switch to the other kind of meter, insert another horizontal row and say what is below that line. If you've said that you're using an AT, then have all the tests recorded in the ss be only AT, and any human glucometer tests either put in the comments or in a separate tab. That's the best way for us to see the picture clearly enough to help you if you need help with dosing. And when it comes to using R, you are going to want help developing an R scale. It's going to be very important that you stick with one kind of glucometer.

Does that make sense? I'm not sure if I'm explaining it well, so if it's muddy, please ask.

There are several of us that have used R who could help you. What we've done with other people is to have you decide in advance when you want to try the R (probably at the same time as one of his shots) and then we can figure out who can stay with you through the 4 hours of the trial. Choose a time that you can test hourly for 4 hours. If you want to make the Lev switch first, that's fine. Let's don't make both changes at the same time - go with one then the other.
 
Hi Babbie and Otto!
As Suki said, welcome to the acro cat club! You have found a wonderful place to be. I cannot give any advice as I am relatively new to the whole Acro/sugar kitty dance.
I have been pretty lucky so far and my Tennie has been doing pretty well on a relatively low dose of Lantus (currently 8.75 U BID). We have not have to use any R yet. But I realize that R could be in our future.
How wonderful for Otto that you are considering surgery or SRT!
I just wanted to welcome you and wish you luck in Otto's treatment.
 
Looking into the drug. I talked to a vet yesterday that said there is no way she would do surgery due to the sudden kidney failure indications. His BUN increased dramatically over a 2 week period and he wet his favorite rug. No further signs except he keeps missing the cat box (every day a few times a day). He's also getting larger by the minute. Gained weight this week. This decision making sucks. I dont want to lose him to surgery!!!!!! The surgeon said there was a good chance if he did survive the surgery, his kidneys could get worse. By the way, has anyone used slippery elm? His glucose levels dropped in 1 day significantly (supposed to be used for kidneys).
 
Babbie,
Please share what ever info you get about the drug.
I was not aware, until now, that there were any other options other than surgery or SRT.
I have heard of people using slippery elm, but I dont have any experience there.
 
I just added a recent published study this morning to the thread about acromegaly and it specifically said remission was likely for cats treated with hypophysectomy (surgery), radiotheraphy (SRT), or somatostatin treatment. I think octreotide was the drug being studied at the time punkin was treated with SRT. The study was discontinued because of the side effects. Wendy linked the Pasireotide study for you above. I'm curious about their comments about cat being likely to go into remission after treatment because we haven't seen it to happen exactly easily. Punkin died about 20 months after SRT, and while his dose had greatly decreased, i think he was around 4-5u down from 15.5u, he certainly wasn't OTJ. The folks at CSU told me it could take as long as 2 years, so maybe it still was working. I don't know.

Indeed, should the HS be diagnosed and treated, most cats will enter a state of diabetic remission [16]. If the HS remains undiagnosed, these diabetic cats tend to be difficult to regulate glycaemically. Given the financial limitations in veterinary medicine, lack of prompt glycaemic control often results in euthanasia. If kept alive, acromegalic cats will, in the long-term, suffer from other growth hormone-induced negative sequelae, as well as pituitary tumour induced central nervous signs [16].

It could be argued that the DM was in fact a co-morbidity of the patients who happened to also be diagnosed with acromegaly. Nevertheless, the authors deem it more likely that the DM seen in these cats was induced by acromegaly. This is substantiated by the fact that the DM often disappears if the acromegaly is effectively treated through hypophysectomy, radiotherapy or somatostatin treatment [16, 31, 32, 33]. Furthermore, the diabetes-type that the acromegalic cats suffer from seems to be more insulin-resistant than non-acromegalic diabetic cats, as illustrated by the significantly higher exogenous insulin requirements among acromegalic cats found in this study.​
 
Hi Babbie and Otto. I've been hopscotching through condos and have missed your story 'til now.

Lots of excellent perspectives and information on this board. Wendy and Julie were my touchstones when my Polly was diagnosed acro back in July '14. I opted for SRT at CSU. Different personnel than Wendy and Julie experienced, but basically same procedure.

Polly's done great. Very minimal affects from the acro. Down from 10.5 U twice a day to 2.0 U currently. We were lucky; she had no other impacting health issues at the time and none now.

I credit this board, especially Wendy and Julie with guiding us through the process from initial diabetes diagnosis through SRT 'til today when my girl continues to wobble about earning reductions from time to time.

No advice from me. Just loads of light for you and your Otto.

Marilyn and Polly
 
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