7/28 Bronx going backwards and some good acro talk

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Bronx's dad (GA)

Bronx's dad (GA)

Member Since 2016
Got notice I have to go to CA tomorrow for 4 nights and Bronx hasn't bounced back since the last time I traveled. His tumor must be active again, as he is eating too much and even drinking more than normal too. He is basically stuck in the pinks and I have been using a pretty heavy hand hand with the R to get him lower. Worst possible time to travel since the pet sitter will only be able to test at shot time, so can't be as aggressive as I have been with the dosecreases.

On a positive note, I have scheduled an MRI of his tumor/brain and an echocardiogram with the same doctor @Amanda & Shmee is using for Shmee's surgery. Doctor said it may not be possible to do surgery since Bronx had SRT, there may be too much tissue damage from the radiation that will cause excessive bleeding. Doc is very interested in seeing if it possible but does not know of any kitty having this surgery after radiation. If the doctor gives the green light, I am probably going to take that risk. Bronx told me he's tired of the headaches and is all in!
 
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I didn't look at Bronx' chart for a few weeks. Holy smokes, he is even bouncier than Leo. What a challenge these acro boys are giving us. Travel is such a challenge too. I'm lucky - since I trained Theresa with Leo.

I hope the doctor approves Bronx for the surgery. It has been real disappointing that the SRT had so little affect on his tumor. I can't remember if you had the IGF-1 retested, but that would be another verification pre-surgery. Poor Bronx.
 
JeffJ said:
. I can't remember if you had the IGF-1 retested, but that would be another verification pre-surgery. Poor Bronx.
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I may do that as well since my local vet will allow tech to just draw blood so price will not be too bad. Doctor is hoping to compare the cat scan results from the SRT place with the MRI to see how much the tumor shrunk. Bronx was at 37u at his highest, so the SRT has helped. Just not as much as I hoped, but I caught his disease late.
 
That's such a bummer about the travel notice. They rarely seem to come around at perfect times. However, very exciting about the possibility of surgery! I really do hope the doctor gives the okay to go forward. It will be very interesting to see what the MRI says after the SRT regardless.
 
Bad timing for the travel. Maybe he will miraculously come down some before you leave. Fingers and Paws crossed.

Good news about the consult appointment and I hope you get good news and a green light for the surgery. Is it soon?
 
That is great news about your appointment! I'm excited for you and Bronx, sending lots of "green light" vines. Now, Bronx, let's get off that trampoline, you don't need to be on there so much :p. I do wonder what he was up to the evenings of 23rd and 24th...maybe a late night dip in the lagoon? Safe travels for your trip, Paul.
 
That really stinks about the travel plans, I hope he becomes more stable before you leave. :bighug:
Great news about the MRI! That is so interesting about SRT possibly being a reason he couldn't have the surgery... but its good that the doctor is being cautious. They have been so thorough with answering all of my questions and explaining everything, I really liked that. Many vines your way, it would be so amazing if surgery was an option.
 
Sorry that darn work is taking you away from important things, like Bronx.

Speaking of important things, once again I am going to stress the importance of testing, getting preshot tests, and following a dosing method so you know whether you are on a good dose or not. You've gone several cycles with no tests, no preshots, and been jumping up in dose much faster than even the aggressive but safe Tight Regulation protocol would have you do. You need to hold each dose at least six cycles, some you have only held for three. You have gone from 8 units to 13 in less than two weeks. It's entirely possible Bronx is overdosed. Dosing decisions require patience. Not your strong suit. I know you want Bronx better NOW, but rushing increases isn't going to help. You also need proper data to make decisions. I see only one night time rest in the last week. Sorry about the nag, but I worry about Bronx.

Speaking of not helping, getting an IGF-1 test done will not help either. SRT does not impact IGF-1, some people even found it went up after SRT. Save your money for things that matter.

I do have a side by side of Neko's CT scans before each of her SRTs, the second being three years later. Her tumour was smaller the second time, but we have no way of knowing for sure whether it only got down to that size, or went smaller and then grew up to that size. It is WAY too early to say Bronx's tumour has come back. You need an extended time of knowing his dose needs are increasing before you can speculate it might be coming back. For one, you are only looking at two weeks worth of data, and second, you haven't safely increased. It's also possible he could have other medical things going on that impacting his dose needs. I am glad you are getting an echo to rule out anything there, and at least provide a baseline.
 
I agree with Wendy's advice about the dosing changes. The drastic recent ramp-up may cause for upcoming challenges.

@Wendy - I'm confused about the IGF-1 levels. I thought that SRT cause IGF-1 to go down. As a result, the insulin demand also goes down. As an example, in this human study, the IGF-1 levels went down by about 50%
https://www.ncbi.nlm.nih.gov/pubmed/19650358

Then I re-read some of the old threads in FDMB. In this thread, a quote of Dr. Lunn said that IGF-1 does not always go down after SRT:
http://www.felinediabetes.com/FDMB/threads/srt-treatment-facility-on-east-coast.72502/
Based on my studies I don't think that following IGF-1 is always very meaningful. Sometimes it goes down, and sometimes not. In some cats it goes up again. But it does not correlate with how they are doing clinically. They can come off insulin or be on a normal low dose of insulin and still have a high IGF-1. So presumably their GH levels have come down, but we don't know for sure because we can't measure it.

There is missing info from the thread. I think IGF-1 is being used to diagnose Acro. But GH is the problem, and the GH levels apparently can't be measured.

We do know that for Pig and also Leo, that their clinical signs have shown obvious insulin decreases. But neither Sarah, nor myself have gotten our kittehs re-tested.
 
I am also glad to see that the new policy (that I requested) is also blocking replies to old threads like the one I just quoted. We can still reference the quote, but have conversations about it in an updated thread like this.
 
I only know the very basic facts about acro, so I can't comment on the upcoming surgery, but I agree with Wendy that you need to be mindful about raising a dose too quickly. When Stu's vet raised his dose by too much too quickly Stu's bgs kept climbing. Then he crashed (that was when I found this board!). Stu wasn't acro. But the dosing protocol is something that we all must take into serious consideration.

Have a good trip, Paul, and try not to worry about Bronx. He's a strong kitty.
 
Wendy&Neko said:
It is WAY too early to say Bronx's tumour has come back. You need an extended time of knowing his dose needs are increasing before you can speculate it might be coming back.
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I will hopefully find out more after his MRI, hopefully it isn't apples and oranges comparing a pre-SRT cat scan & current MRI picture of the tumor?

He is back to ravenous eating along with rising blood glucose, signs are there the tumor is active. Sucks because he was doing so well in June.

What do you think about dose recommendations for the pet sitter? I am thinking keeping it at 13u unless he shows some lower blues at shot time.
 
I don't have enough information to comment on the pet sitter dose.

I don't think any conclusions can be made about the tumour by comparing old CT and new MRI, other than whether he could have surgery. Especially if the new pic of the tumour is smaller as expected.
 
Bronx's dad said:
Got notice I have to go to CA tomorrow for 4 nights and Bronx hasn't bounced back since the last time I traveled. His tumor must be active again, as he is eating too much and even drinking more than normal too. He is basically stuck in the pinks and I have been using a pretty heavy hand hand with the R to get him lower. Worst possible time to travel since the pet sitter will only be able to test at shot time, so can't be as aggressive as I have been with the dosecreases.

On a positive note, I have scheduled an MRI of his tumor/brain and an echocardiogram with the same doctor @Amanda & Shmee is using for Shmee's surgery. Doctor said it may not be possible to do surgery since Bronx had SRT, there may be too much tissue damage from the radiation that will cause excessive bleeding. Doc is very interested in seeing if it possible but does not know of any kitty having this surgery after radiation. If the doctor gives the green light, I am probably going to take that risk. Bronx told me he's tired of the headaches and is all in!
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Hey, I’m just wondering, did you call them, or did you email the doctor? I am wondering about a consultation for Frosty about possible surgery too. Kind of scared though so I haven’t called to set up an appt or anything. Do you know the cost of a consultation?

Thanks.
 
Bronx's dad said:
I will hopefully find out more after his MRI, hopefully it isn't apples and oranges comparing a pre-SRT cat scan & current MRI picture of the tumor?

He is back to ravenous eating along with rising blood glucose, signs are there the tumor is active. Sucks because he was doing so well in June.

What do you think about dose recommendations for the pet sitter? I am thinking keeping it at 13u unless he shows some lower blues at shot time.
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I think it’s helpful to see if the tumor is smaller on MRI compared to pre-SRT CT. It’s not apples and oranges at all. Modern technology lets you measure the dimensions on both types of imaging, and you can compare the sizes. MRI just enhances different types of tissues to let you see more detail in things like tumors and soft tissues.

I’m really sorry you’re going through this again. Timing is always bad too, seems like it always happens around trips, but we can’t control that. Keep us posted about the consultation,
 
Ana & Frosty said:
Hey, I’m just wondering, did you call them, or did you email the doctor? I am wondering about a consultation for Frosty about possible surgery too. Kind of scared though so I haven’t called to set up an appt or anything. Do you know the cost of a consultation?

Thanks.
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Dr. McCue is super friendly, if I were you I would call asap to get more info, because you never know how long the donor $$$ is going to last :)
 
Safe travels...trips like that never come at a good time. Poor Bronx...one thing at least (not to pile on, but @Wendy&Neko is right - gotta hold those doses for longer than a day or so)...Lantus needs time to get that depot right...we're going to get together and send you a pair of guy patience pants...:D:D

Best to you and Bronx! We're all rooting for him!:bighug:
 
Ana & Frosty said:
Hey, I’m just wondering, did you call them, or did you email the doctor? I am wondering about a consultation for Frosty about possible surgery too. Kind of scared though so I haven’t called to set up an appt or anything. Do you know the cost of a consultation?

Thanks.
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No idea what the consultation cost is. Bringing him in for the first time on the 17th for MRI and Echo. I will bring a credit card with a high limit lol. Sent the doctor an email and he responded in the eve asking when he could call me. I told him anytime and he called on the following eve. He will be off next week so you should get in touch with him this week.
 
Sue and Luci said:
Safe travels...trips like that never come at a good time. Poor Bronx...one thing at least (not to pile on, but @Wendy&Neko is right - gotta hold those doses for longer than a day or so)...Lantus needs time to get that depot right...we're going to get together and send you a pair of guy patience pants...:D:D

Best to you and Bronx! We're all rooting for him!:bighug:
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Thanks Sue! I should be better at this by now, but have a real hard time getting into those patience pants!
 
JeffJ said:
I agree with Wendy's advice about the dosing changes. The drastic recent ramp-up may cause for upcoming challenges.

@Wendy - I'm confused about the IGF-1 levels. I thought that SRT cause IGF-1 to go down. As a result, the insulin demand also goes down. As an example, in this human study, the IGF-1 levels went down by about 50%
https://www.ncbi.nlm.nih.gov/pubmed/19650358

Then I re-read some of the old threads in FDMB. In this thread, a quote of Dr. Lunn said that IGF-1 does not always go down after SRT:
http://www.felinediabetes.com/FDMB/threads/srt-treatment-facility-on-east-coast.72502/
Based on my studies I don't think that following IGF-1 is always very meaningful. Sometimes it goes down, and sometimes not. In some cats it goes up again. But it does not correlate with how they are doing clinically. They can come off insulin or be on a normal low dose of insulin and still have a high IGF-1. So presumably their GH levels have come down, but we don't know for sure because we can't measure it.

There is missing info from the thread. I think IGF-1 is being used to diagnose Acro. But GH is the problem, and the GH levels apparently can't be measured.

We do know that for Pig and also Leo, that their clinical signs have shown obvious insulin decreases. But neither Sarah, nor myself have gotten our kittehs re-tested.
Click to expand...

Jeff... You are right. It is the GH that is the issue, not the IGF-1, but the IGF-1 Serum Assay is the only (reasonably) reliable way to dx Acro without a CT / MRI (even those are not conclusive). DX for Acro is dependent upon the cumulation of clinical signs. So, we take the insulin resistance (which some say is not an indicator owing to the increase in Beta Cell function and of course, other high-dose conditions. But, the theory of increased Beta Cells is beginning to wane and many vets disagree with this thought, now), CT / MRI scan (also not conclusive because some cats have tumors that are so small they cannot be seen on a scan, but the tumor is VERY active while others have massive, but inactive tumors), physical symptoms (which many never show, especially if caught early), and the Serum IGF-1 Assay (which we now know is relatively inconclusive, itself, but the most definitive marker we have outside of brain scans). I think we term the IGF-1 and GH as the same thing only because they are our mark of dx. There is still a lot to be learned about Acro, but there is some amazing research on it!

Here is what Dr. Bruyette, DVM DACVIM said at the World Small Animal Veterinary Association World Congress Proceedings in 2015 on the measure of the Serum IGF-1 Assay:

Growth Hormone Assay Serum growth hormone is often measured to help diagnose acromegaly in people; however, assays specific for feline growth hormone are not widely available. An assay using ovine growth hormone as the antigen has been validated for use in cats, but it is only available in Europe. Even if an assay were available, growth hormone concentrations alone may not be a reliable diagnostic test for acromegaly since growth hormone production is cyclic and concentrations may vary throughout the day. Relying on a single growth hormone measurement can be misleading. Additionally, it has been shown that growth hormone concentrations may be elevated in diabetic cats that do not have acromegaly. This elevation may be due to the fact that the liver requires high levels of portal insulin to produce IGF-1 and in uncontrolled diabetics, portal insulin concentrations may remain low, resulting in decreased IGF-1 production and, theoretically, decreased inhibition of growth hormone release. Finally, growth hormone concentrations may not be elevated early in the course of the disease but may increase significantly later. Serum IGF-1 Serum IGF-1 measurement is the most commonly used diagnostic test for feline acromegaly and is readily available in the United States. Unlike growth hormone, IGF-1 concentrations are less likely to fluctuate over the course of the day since most IGF-1 is protein-bound, giving it a longer half-life in the body. In addition, IGF-1 concentrations increase in response to chronically elevated growth hormone concentrations and are thought to be a reflection of growth hormone concentrations over the last 24 hours. A recent study evaluating IGF-1 concentrations in confirmed acromegalic diabetic cats, diabetic cats, and healthy cats found that acromegalic diabetic cats had significantly higher IGF-1 concentrations than diabetic and nondiabetic cats. This study concluded that serum IGF-1 concentration measurement is 84% sensitive and 92% specific for diagnosing feline acromegaly. Just as with growth hormone, elevations in IGF-1 concentration alone may not definitively diagnose acromegaly in a cat. One study found that IGF-1 concentrations in non-acromegalic diabetic cats receiving long-term insulin treatment (> 14 months) had higher concentrations of IGF-1 than nondiabetic cats. It was proposed that insulin treatment allowed for beta cell regeneration and increased portal insulin, leading to elevations in IGF-1 concentrations.

In addition, another study revealed that untreated diabetic cats with acromegaly can have low to normal IGF-1 concentrations that increase after starting insulin therapy. The results of this study indicate that retesting IGF-1 concentrations a few weeks after starting insulin therapy or even after increasing insulin dosages in patients with suspected acromegaly that had low or normal IGF-1 concentrations may be warranted
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It is interesting that the IGF-1 can possibly hide in undiagnosed and untreated Acromegalic Felines....
 
Hey... I am no expert here and certainly not telling you anything that you don't already know, but I second @Wendy&Neko thought about secondary medical issues. I know that Bronx has come down quite a bit from where he was at 37u and it might even be possible that there is something else going on that is holding his dose high.

I will use Pig as an example because, well, I know him. :p

But, if you check out his SS we recently reduced (earned reductions) all the way to 18uL. However, something happened. Whether it was food or a panc flare, I am not certain. But, I ended up increasing him by 2 dose increases to meet that need, which came crashing down and fast by the time the secondary issues were resolved. Yet, the increased doses did little to effect the need he had at that time.

Also, if you scroll further back, you can see where we went through the EXACT same pattern every single time I switched his food (especially when I first re-transitioned over to raw). In fact, I have found out that if I even look at Venison, Pig's numbers will jump. And he will drink more water (still does when nauseated - gave Cerenia and the water drinking stopped). In fact, I am highly suspicious that this is what I saw and thought was constipation the first time I started raw. An intestinal reaction. So much so that anytime I change the slightest thing in his diet his insulin need jumps by 20-40% and he is not even full IBD, just pre-stage...

I would have never thought to look to IBD or the beginning of such if not for his US in Washington. Mayhap, check a few more things out before deciding definitively on surgery. I would still schedule, but check other things in the interim.

Either way, I certainly hope Bronx is a candidate for the surgery if he needs it! I also am sending all the well wishes yours and Bronx's way! Those headaches are no fun... :bighug::cat:
 
Bronx's dad said:
No idea what the consultation cost is. Bringing him in for the first time on the 17th for MRI and Echo. I will bring a credit card with a high limit lol. Sent the doctor an email and he responded in the eve asking when he could call me. I told him anytime and he called on the following eve. He will be off next week so you should get in touch with him this week.
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Thanks! Yes I have the CareCredit card that I use for all Frosty’s expenses.

What’s his email address? I’ll emaul him now.

Thanks!!
 
LuvinThisPig said:
Hey... I am no expert here and certainly not telling you anything that you don't already know, but I second @Wendy&Neko thought about secondary medical issues. I know that Bronx has come down quite a bit from where he was at 37u and it might even be possible that there is something else going on that is holding his dose high.

I will use Pig as an example because, well, I know him. :p

But, if you check out his SS we recently reduced (earned reductions) all the way to 18uL. However, something happened. Whether it was food or a panc flare, I am not certain. But, I ended up increasing him by 2 dose increases to meet that need, which came crashing down and fast by the time the secondary issues were resolved. Yet, the increased doses did little to effect the need he had at that time.

Also, if you scroll further back, you can see where we went through the EXACT same pattern every single time I switched his food (especially when I first re-transitioned over to raw). In fact, I have found out that if I even look at Venison, Pig's numbers will jump. And he will drink more water (still does when nauseated - gave Cerenia and the water drinking stopped). In fact, I am highly suspicious that this is what I saw and thought was constipation the first time I started raw. An intestinal reaction. So much so that anytime I change the slightest thing in his diet his insulin need jumps by 20-40% and he is not even full IBD, just pre-stage...

I would have never thought to look to IBD or the beginning of such if not for his US in Washington. Mayhap, check a few more things out before deciding definitively on surgery. I would still schedule, but check other things in the interim.

Either way, I certainly hope Bronx is a candidate for the surgery if he needs it! I also am sending all the well wishes yours and Bronx's way! Those headaches are no fun... :bighug::cat:
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Such great info, stuff I would never get by talking with a vet. This forum is so valuable.
 
LuvinThisPig said:
is interesting that the IGF-1 can possibly hide in undiagnosed and untreated Acromegalic Felines....
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Not quite. Testing before starting insulin might be fine, but a study at RVC showed that if you tested acros within 73 days of starting insulin, one third of them had normal IGF-1 numbers. Testing later showed IGF-1 that indicated acromegaly. There is something about starting exogenous insulin that interrupted IGF-1 production.
 
Wendy&Neko said:
Not quite. Testing before starting insulin might be fine, but a study at RVC showed that if you tested acros within 73 days of starting insulin, one third of them had normal IGF-1 numbers. Testing later showed IGF-1 that indicated acromegaly. There is something about starting exogenous insulin that interrupted IGF-1 production.
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Hmm.. That is interesting. I have a question. That same individual we were talking about that runs the FB group, swears that both of her Acros got sick and suddenly were not acro anymore. As in, they came off the juice. Have you ever heard of this happening before? Do you think it likely it happens and we just do not know about it or did not realize it, as in undiagnosed kitties? Could these be related? For her, she connected the administration of vaccines with the illness which is what caused him to go otj...
 
In that person's case, her girl acro got sick and I thought she died in surgery. The second got very sick as a reaction to a vaccine shot and went off of insulin. Just because an acrokitty no longer needs insulin, it doesn't mean they are no longer acro, just no longer diabetic. That same person claims acros are not true diabetics, but every acro researcher I've talked to or paper read says they are. There have been several cases of kitties testing positive for IGF-1, but found not diabetic. There have also been cases of kitties that were diabetic, were not tested for acromeagly because their doses didn't get high, went OTJ, then came back on the juice later and were tested or found to be acro. Were they acro the first time? Who knows, testing wasn't done.

I have also seen speculation that diabetes is a later stage symptom of acromegaly. I know Neko's first acro symptoms showed up at least 6 months before she was found to be diabetic. Was she diabetic earlier? Again, who knows, but she wasn't showing diabetic symptoms that would have prompted me to take her to the vet. I have seen several members here say their cat showed acro signs well before the diabetes diagnosis. Hindsight is 20/20.
 
This is an interesting discussion. I guess most of us don't get acro diagnosed when our kittehs are showing clinical signs for diabetes. When Leo started going up in dosage, Wendy (and maybe others) said "get an IGF test done". But it is possible that the acro was manifesting in Leo and caused the diabetes in the first place.
 
Wendy&Neko said:
I know Neko's first acro symptoms showed up at least 6 months before she was found to be diabetic.
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I am glad that you mentioned this, Wendy. I think we all know that these tumors have been shown to be very long in "maturing" and the thought is that they are present long before any clinical signs present. In fact, Dr. Fidel was talking about her belief that many of these kitties have been Acro for their whole lives, but it is not until the dx of diabetes and the realization that regular insulin doses cannot control it that true testing was done.

When I think back on the past year, I can say with a certainty that I caught Pig's diabetes very early. I have always watched him like a hawk and am very aware of any changes to his norm. I also know blood tests just prior to dx showed nothing of interest. But, one day he started drinking water and in that moment, I said "that's a bladder infection". Never did I suspect diabetes, but had always worried about it in Tail. Pig never showed signs of neuropathy or anything but the thirst. It was a week later and when we were in the ER with a bladder infection that we got the dx. He could not have been diabetic for more than a few weeks, a month at the most. The BW proves that.

Yet, when I think back on it I do think about when he first started to snore. And when he first started to sleep really hard. I never even gave it a thought... It was just some snoring after all. His blood tests were always totally clean, his appetite was always insatiable, and he acted just fine... He just snored. So, the wonder is, if the Acro causes the stridor and this is what caused his snoring, why did the IGF responsible not also kick off the diabetes? I suppose for the same reason that so many of these kitties grow to be so muscular long before they grow to be so sugary.
 
LuvinThisPig said:
Dr. Fidel was talking about her belief that many of these kitties have been Acro for their whole lives, but it is not until the dx of diabetes and the realization that regular insulin doses cannot control it that true testing was done.
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That’s interesting. I had wondered if that was a possibility. Colin was always so much bigger than his siblings. I think it was 2 or 3 years before his FD diagnosis that I took him to the vet Because his mouth looked swollen. I thought maybe he had a bad tooth, but vets (3 of them) all said he was fine, just a big cat with a big jaw. But his jaw had changed in shape/size, so in hindsight that was a first sign of the acro.
 
LuvinThisPig said:
In fact, Dr. Fidel was talking about her belief that many of these kitties have been Acro for their whole lives, but it is not until the dx of diabetes and the realization that regular insulin doses cannot control it that true testing was done.
Click to expand...

I would say that is the case with Bronx, his snoring sounds were with him for as long as I know and suddenly stopped after the SRT. And his gate started changing when he was 8 or 9 and I just though he was developing arthritis early. And his pancreas is most likely damaged from working overtime his whole life to compensate. Dr who may be doing the surgery told me not to expect Bronx to go OTJ because of his pancreas. And his labs show problems in that area along with the U/S that also showed pancreas damage.
 
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