Help with Mars's acro treatment

Hello everyone, I have been spending a lot of time reading through this forum and have already learned so much. Big thank you! I'm hoping to get some advice for my boy, Mars, who is turning 10 next month. Mars was finally diagnosed with acromegaly (IGF-1=1160) last month after six months of uncontrolled diabetes. He is also IAA positive. We are seeing the internal medicine team at AMC in New York right now, but I am trying to figure out the best long term plan for him.

Surgery Options:
I know that Washington State University and AMC are no longer performing the hypophysectomy surgery. I have found three places that currently do it: the University of Florida, the Veterinary Referral Center of Central Oregon (VRCCO), and Texas A&M University.
I know that Dr. Annie Chen-Allen at the Oregon facility used to be with Dr. Tina Owen at WSU for a long time, so she clearly has a lot of experience with this. However, I haven't really heard of any cases or seen reviews for the University of Florida or Texas A&M. Does anyone here have experience with any of these three places? I am willing to travel anywhere in the US, but I want to find the place that offers the best possible outcome. Where do you think is the best place for this surgery right now?

Surgery vs. SRT
My vet at AMC thinks surgery is a better option than SRT because SRT outcomes are so hard to predict. I want to give Mars the best quality of life since he is still relatively young and has no other health issues, but I’ve seen such mixed reviews. My vet mentioned a life expectancy of 5 to 6 years with surgery, but I’ve read other reports, like from RVC, that say it is closer to 2.3 years. What do you all think about surgery versus SRT for a cat in his situation?

Cabergoline
Mars has been on Cabergoline for three weeks now, but his blood glucose is all over the place. I’ve updated his spreadsheet so you can see the trend. At 6u of insulin, he occasionally drops fast from the 300s down to the 60s, then bounces right back up to the 300s. If I try to lower the dose to 5.5u or 5.75u, he just stays flat around 300. It feels like his numbers are anchored there no matter what I do. His neuropathy is getting worse and he is walking on his hocks all the time now. I’m giving him Zobaline twice a day, but I know it won't help much until his BG is lower. I have two questions for the group here:
* Should I increase the Cabergoline to every day? He currently takes it every other day and has no side effects. My vet said not to increase it because she doesn't think it will be more beneficial and might just cause nausea. Have any of you seen better results with daily dosing?
* Any suggestions on how to handle the insulin titration? I’m really worried about the 6 unit crashes, but 5.75 doesn't seem to do anything. With him being IAA positive and having bad neuropathy, I’m feeling pretty stuck on how to get him into a safer range.

I know I just asked a lot of questions. I really appreciate any insight or personal experiences you can share. This has been such an overwhelming journey and I’ve gained so much useful information from this forum already. Thanks for helping me and Mars.

Rachel & Mars said:

Hello everyone, I have been spending a lot of time reading through this forum and have already learned so much. Big thank you! I'm hoping to get some advice for my boy, Mars, who is turning 10 next month. Mars was finally diagnosed with acromegaly (IGF-1=1160) last month after six months of uncontrolled diabetes. He is also IAA positive. We are seeing the internal medicine team at AMC in New York right now, but I am trying to figure out the best long term plan for him.

Surgery Options:
I know that Washington State University and AMC are no longer performing the hypophysectomy surgery. I have found three places that currently do it: the University of Florida, the Veterinary Referral Center of Central Oregon (VRCCO), and Texas A&M University.
I know that Dr. Annie Chen-Allen at the Oregon facility used to be with Dr. Tina Owen at WSU for a long time, so she clearly has a lot of experience with this. However, I haven't really heard of any cases or seen reviews for the University of Florida or Texas A&M. Does anyone here have experience with any of these three places? I am willing to travel anywhere in the US, but I want to find the place that offers the best possible outcome. Where do you think is the best place for this surgery right now?

Click to expand...

Hello Rachel and Mars, I been a member of this board for ages and have lived with two acrokitties, Eddie and Blue (brothers) and we have travelled to and fro to U Washington where they had hypophysectomy with Tina Owen when Annie Chen Allen was part of the pituitary team. I did not know they were no longer doing hypophysectomy? I'd be surprised if that is true. Did they confirm that? Anyway, I can speak with the highest for Annie Chen Allen. She's brilliant, knowledgeable, approachable. Don't know anything about Texas A&M or Florida.

Rachel & Mars said:

Surgery vs. SRT
My vet at AMC thinks surgery is a better option than SRT because SRT outcomes are so hard to predict. I want to give Mars the best quality of life since he is still relatively young and has no other health issues, but I’ve seen such mixed reviews. My vet mentioned a life expectancy of 5 to 6 years with surgery, but I’ve read other reports, like from RVC, that say it is closer to 2.3 years. What do you all think about surgery versus SRT for a cat in his situation?

Click to expand...

That is a hard call because as you know from this forum ECID. I learned that over the years. So much depends on the location of the tumour and its proximity to other areas of the brain, for example, the optic nerve. Both Eddie and Blue had hypophysectomy. Blue was first in Feb 2018. A followup MRI six months later showed a small regrowth (I mean we are dealing with cells, so hard to ensure margins, I guess) and we went for fractionated radiothereapy in late 2018 at WSU because I didn't know if SRT was an option. That treatment took 21 days because it's low dose, and given every second day. We came home and he went into remission really. Then a couple years down the line same thing: regrowth so we went to VCA Calgary where he had one dose of SRT. Remission and he pretty much stayed in remission for a few years, although I would check his BG every now and again and then in 2024, he was back on insulin and we were hoping for one last SRT (he was deemed ok to do this, again, placement of tumour). But what happened was that the acromegaly had affected his heart and we all know about that. He went into cardiac arrest during the MRI and I had to let him go. But here's the thing: he lived a good life for 7 years as an acro-kitty. He was just amazing and I'd do all over again.

Eddie had a different story. I lost him 11 months after Blue when we went for an MRI to assess what was happening with his seeming inability to eat without gagging after a dental procedure. During the MRI it was determined that the tumour was pressing on his brain stem and causing neurological havoc. I had to let him go. He was diagnosed in 2020 and had surgery at WSU only they reported the tumour was quite advanced and they could remove only 60-65% of it, hence, travels for SRT.

There's sure no easy route so I hope you and Mars prevail.

Rachel & Mars said:

Cabergoline
Mars has been on Cabergoline for three weeks now, but his blood glucose is all over the place. I’ve updated his spreadsheet so you can see the trend. At 6u of insulin, he occasionally drops fast from the 300s down to the 60s, then bounces right back up to the 300s. If I try to lower the dose to 5.5u or 5.75u, he just stays flat around 300. It feels like his numbers are anchored there no matter what I do. His neuropathy is getting worse and he is walking on his hocks all the time now. I’m giving him Zobaline twice a day, but I know it won't help much until his BG is lower. I have two questions for the group here:
* Should I increase the Cabergoline to every day? He currently takes it every other day and has no side effects. My vet said not to increase it because she doesn't think it will be more beneficial and might just cause nausea. Have any of you seen better results with daily dosing?
* Any suggestions on how to handle the insulin titration? I’m really worried about the 6 unit crashes, but 5.75 doesn't seem to do anything. With him being IAA positive and having bad neuropathy, I’m feeling pretty stuck on how to get him into a safer range.

I know I just asked a lot of questions. I really appreciate any insight or personal experiences you can share. This has been such an overwhelming journey and I’ve gained so much useful information from this forum already. Thanks for helping me and Mars.

Click to expand...

Before his dental in June of 2025, Eddie had SRT in Victoria, BC, Canada. He had been on very high insulin dosage (I believe when we got there it was up around 28u BiD). A week after we left he's BG started dropping and it levelled off but I realized that they had to be careful with the SRT because of his optic never. We got down into 8-6iu Levemir and then went to Cabergoline. That was dramatic. After a few weeks, Eddie was even going into blues and greens and it was great to see. But then, he needed a dental because it was believe his teeth/gum health was contributing to problems. I think now, if I second gues myself on anything I've done with Eddie and Blue over the 7 years we had living with acromegaly, I would not have gone for the dental. Not that it would have saved him from the acromegaly but I think it might have been a slower decliine.

Again, I would do it all in a heartbeat. FDMB is such a wonderful community and you are in the right place with Mars, to be sure. Wishing you all good thoughts for the best possible outcome.