05/22 Marvin- Need help making the decision

Status
Not open for further replies.
Marvin's Mom - Nat

Marvin's Mom - Nat

Member Since 2017
Hi,

I just got back from Marvin's appointment with specialist. There were so many tests they wanted to do. It was overwhelming. Since I couldn't afford to do them all at once and the recommended one was the ultrasound to check for tumors, and based on his neuropathy and current quality of life it looks like I will have to let him go. I am having a hard time giving up on him like that. Specialist felt that even smallest delays in getting the test done, and if they did determine what was causing the insulin resistance the costs would just go up from there treating any underlying cause. I asked if simply trying to increase his dose and see where that take us, they didn't seem to think that would be an option, because I had mentioned that my main concern was his neuropathy and some improvement to mobility. They didn't think even if we found a dose that worked that we would see a change, they feel it's permanent and his quality of life right now is extremely bad (mobility, covered in urine because he has to lie down in his litter to pee, or don't make it to the litter)

I am so lost again, I so don't want to lose Marvin.
 
Nat --

To my eyes, it looks like Marvin is a high dose cat. There are 2 blood tests that are not horribly expensive that can be run at the vet lab at Michigan State to determine if Marvin has either acromegaly or insulin resistance (IAA). Depending on when the sample gets to the lab, it can take around a week or less for results. The cost for surgery for acro is not cheap but it's not wholly unaffordable. We've had kitties here with both acro and/or IAA who have had the SRT treatment and some who have not. IAA is self limiting and once the insulin resistance breaks, it's gone.

Many vets regard these conditions, especially acromegaly, as rare. It's far more common than was once thought. They also tend to have very limited experience with managing either IAA or acro. We have a great deal more experience. Please pursue getting these tests done before making any irrevocable decision.

I'm going to see if @julie & punkin (ga) and/or @Wendy&Neko can stop by. They both cared for acro kitties. I'm also tagging @Sandy and Black Kitty who had the first kitty diagnosed with insulin autoantibodies (insulin resistance) on this board.

Hang in there.
 
They are willing to test for acromegaly, but the price is high here, and they didn't feel he would do well as for me radiation is not an option due to finances. They recommened to first get the ultrasound then test for acromegaly, but since I would need to wait a few weeks to save for the 2nd, well they said the longer we wait the worse it is. They had 7 tests they wanted to do right away, over 2K. I wish he waited a few months to get sick, I was about to put my house up for sell the week after he got sick, but had to put that on hold cause he wasn't doing well and trying to keep the floors clean is a major challenge. I would have had some money then, as was downsizing.
 
Tagging @Bronx's dad and @saltycat as well-- they are newer but also dealing with high dose conditions.

I agree with Sienne-- wait until you hear from folks here with hands-on experience before making any irrevocable decisions. Your vets are doing the best they can with the information they have, but they probably haven't dealt with these conditions very often personally.

:bighug::bighug::bighug::bighug::bighug:
 
Marvin's Mom - Nat said:
I asked if simply trying to increase his dose and see where that take us, they didn't seem to think that would be an option, because I had mentioned that my main concern was his neuropathy and some improvement to mobility.
Click to expand...
It is indeed an option. Marvin needs however much insulin he needs.
Marvin's Mom - Nat said:
They had 7 tests they wanted to do right away, over 2K.
Click to expand...
What else is going on with Marvin? What are those tests?
 
Here is your last post: http://www.felinediabetes.com/FDMB/threads/5-17-marvin-amps-412-pmps-342.178045/#post-1964974 where we discussed the likelihood that Marvin is a high dose cat. Many vets have not dealt with high dose cats or don not know that they have. So they have no clue what to do. An internal medicine vet may be a better option, or if your vet is willing to work with you, we can help. One in four diabetic cats has acromegaly, some of them need quite a bit more insulin than others. But once you get to a dose that mostly keeps them under renal thresholds, and treat some of the symptoms they get, they can still have a decent quality of life for a while.

Several other people here who are not treating their kitties acromegaly other than with an appropriate amount of insulin. @Adrian and Chino @Karen & Lily @saltycat @Sharon14 They can tell you how their kitties are doing. We have seen one acrocat live four years after diagnosis without treatment and pass around age 19. Treating may or may not help kitties live longer. Most of these kitties are older already. I know of a few acro cats who had SRT, then passed from unrelated cancer. Neko had acromegaly over five years, and the SRT gave her more and better years. I think it was cancer that took her too.

Summary, get the high dose tests done to start, ask your vet to humour me, that's what I had to do. After all, it's your pocketbook. Second start some arthritis medicine like Adequan.

I too would be curious what the seven tests were, but I think you can initially save your money on the ultrasound and possibly save most of the other tests for later. Sounds like this vet likes spending your money. Is there another vet in town?
 
Sandy and Black Kitty said:
It is indeed an option. Marvin needs however much insulin he needs. x 3 views
What else is going on with Marvin? What are those tests?
Click to expand...


Those test are just to find out why he is not responding to the insulin. He does have a heart murmur she said he is a 3... not sure what that means, and he's had urine infection in the past.

- Test FIV/FelV (cause he's never been tested for that and that would affect his immune system)
- Ultrasound to check for tumor, and I think enlarged organs
- Radiography thorox 3 views
- Insulin Growth factor IGFW
- urinanalysis and culture and sensitivity (cause it was done over a weekend, and the test we previously did may have returned a false negative)
- visit with neurogist
- arterial blood pressure
 
Wendy&Neko said:
An internal medicine vet may be a better option, or if your vet is willing to work with you, we can help.
Click to expand...

That was my appointment with the internal medicine vet. It was up to me what to do, it just they didn't think it would be probable that his mobility would improve regardless, and that treatments for underlying cause would be greater than the tests and in her opinion his quality of life was poor at the moment. they were nice, and had I had the money all of it would have been done this week, the only thing to wait on would have been the acro test to come back from the states.
 
My home vet wanted Marvin to see internal medicine vet due to his resistance to the insulin.

They did ask me to do 12 hr curve and send it to them. Going to try and do that tomorrow.
 
Jack is a high dose kitty with both Acro and IAA. When he first got the diabetes diagnosis his back legs were ok, but got noticeably weaker. His back legs would scoot out a little when he sat and he tended to stay sitting and rotate instead of getting up. He also could not sit up for treats(an old trick of his). He was also starting to use the litter box standing up which caused many misses or having to clean up back legs when he sat in his own puddle. I started him on Zobaline and he made noticeable improvements, very few accidents these days and I haven't had to clean up his back end in a long time.

Acro kitties are also more prone to arthritis, so we started him on cosequin about 4-5 months ago. Adequan would be even better, but is more expensive. Between the two, he is doing SO much better. He can stand up on his back legs to beg for treats again and can make small jumps again up onto the couch. Les's late Gussie went from hobbling to jumping up on a windowsill. It takes time, but with better BG numbers and some zobaline(or other methylcobalamine supplement) they can make a surprising recovery.

Jack is almost a year since his acro Dx and is doing better then I would have thought. He is more alert and social then even 6 months ago. Late last year, I was starting to have that "maybe the time is getting close" thought, now he seems genuinely happy and I don't even think about if it is his time yet.

In the US, acro and IAA test from MSU cost me about $225, that was the vet doing the draw, shipping and costs from MSU. It looks like you are in Canada, Wendy might have a better idea on the acro/IAA tests available in Canada if it is too difficult to ship over the border. Jack is high-dose and has had a few UTI's and the vet has never recommended a bunch of tests. Since I am not treating the acro, I know his organs will swell. An ultrasound might confirm it, but it is pointless since we are not treating the acro.

There are a few high dose cats on the boards that did not have the acro/IAA tests done. They just treat the diabetes and give as much insulin as needed. Knowing what high dose condition helps a little, but the biggest goal is getting the bg into a more normal range.

The knowledge here is incredible, even my vet now refers to the group here as my diabetes specialists. She had never treated a high dose cat or heard of the acro/iaa tests. She thought no cat ever needed more then 5u of insulin...(Jack is now down to 24u lol). Luckily she was willing to learn and we have taught each other as we go.
 
every one is so great here thanks.

Marvin's mobility is really bad, I saw a few videos on youtube and he is pretty much the same as the worse one I saw. he has to liedown in the litter box to pee so he is completely covered. I have had to use the top of a old plastic bin and he couldn't climb into a litter box any more, this way he just walks into it, well one small step. It's help a bit... well not the floors, but helps Marvin. I just put some puppy pads around and under it.

I will call my own vet tomorrow if I can stop crying long enough, as it's a holiday here and only the vet emergency hospital are open (happens to be where the specialist was and she was schedule today). I will see if she can get the acromegaly test done, and see about the arthritis meds as couldn't find Equine Adequan online for here. I will see if I can find cosequin first.

Does anyone know why only one place is able to test for this?
 
Hi Natalie, sorry you and Marvin are going through this:bighug: Its so hard to watch them struggle, but I think you're doing the right thing giving him this chance. Wendy and the others have given you great advice on arthritis treatment and will help you get Marvins BG under control. That will go a long way to making him feel better.
I just came across this post from Jill http://www.felinediabetes.com/FDMB/...europathy-weak-back-legs.178252/#post-1967581
Haven't had a chance to read it yet, but thought you might be interested.
If you have a Walmart nearby, check there for cosequin, they carry it here and at a decent price.
 
My Doodles was IAA and had bad neuropathy in 2015. They didn't think he'd recover but he did 100%. It took 6 months but that was because I listened to my vet for dosing. One I found this site and listened to the experienced on dosing, got Doodles in the normal BG range, 1.5 months and the neuropathy reversed. I also put vitamin b-12 in his food twice a day. He also had advanced HCM and recurrent CHF which took him a year after the heart issues were diagnosed.
 
Sorry, I forgot you were in Canada. Yes, they will rip you off for the prices of the MSU tests. In your favour, you are on the other side of the country and much closer to MSU. The shipping costs killed me from the west coast. Even folks in the prairies paid less than me. I would add the IAA or insulin auto antibody test to the IGF-1 or acromegaly test if you do it. It's a small price add on. There are only two places in the world that I know of that do the IGF-1 test, the other is the Royal Veterinary College in London England. The IAA test is only done in one place in the world, MSU. A special assay needs to be done to do the IFG-1 test. I know that RVC is looking at trying to find another form of diagnosis but they aren't there yet. The definitive method of testing is a CT scan, but that's huge $$$.

Getting the positive results for both tests earned me a lot of respect from my vet. And the clinic owner later admitted I knew more than him about acromegaly - admittedly a low bar. :p Stick to your guns, once you have a diagnosis, it's much easier to move ahead.:bighug:

As for arthritis, in the US they use Adequan, in Canada it's Cartrophen. Your vet should be very familiar with it for cats and dogs. And yes it's used for horses too. You have to get prefilled syringes from the vet. The vials are outrageously expensive and don't last long given the tiny doses we use for cats. I got the prefilled syringe and gave the shot myself, to save a little bit of money. You start with a loading dose of once a week, then usually once a month, or as needed. On your previous post you mentioned accupuncture was out of the question cause Marvin doesn't like travel. At least in Vancouver, there are vets that will travel to the home for treatments.

Cosequin you can sometimes get from the vets (not all carry it). Petsmart had it on their on line store, but very rarely in stock. You can buy it from Amazaon.ca. If it's not easy to get, I used Recovery SA with a couple of pets, and it's almost the same ingredients, just easier to find in most pet stores. I also started adding a couple of drops of fish oil (Nordic Naturals is one brand), to help with inflammation.

ETA: One last request, could you remove the 911 from the subject line - you have some answers and it's not a medical emergency.
 
I'm one with a higher dose cat that hasn't had the tests done yet. Chuck is on 11 units twice a day right now. I am saving for the tests. I have a family member willing to help with the costs which is a blessing but I'm trying to save as much as I can before getting them done. I use b12 with folic acid and glucosamine/chondroitin for his arthritis and mild neuropathy. He seems to be doing fine on them. It's not getting worse but any improvements are very small so not easily noticeable.
I agree with the others that you should continue to increase the dose until you get better control of his numbers and go from there. It is a hard decision to make in the end and I hope whatever you decide you'll be ok.
 
Thank you for all the information, I ordered the Cosequin online about an hour ago. I am familiar with cartrophen, my last dog had severe arthristis at 15yrs and it worked miracles for him. He lived till he was 17yrs, him and Marvin were buddies, well sort of... Marvin loved to swat him in the face and lick his ears when he was sick....

I am off for a nap, my head is splitting, my eyes are all puffy, and just tired. Thanks for the support everyone.
 
i have a bottle of methyl b12 I can send to you.....

I would also like to suggest to call around to other vets to ask their price for the two tests that Wendy said.
We have a lot of price variation here from one vet to another.....


and one place charged over $1000 for an ultrasound and another charged me $350. They can charge whatever they want to.
I would personally want the two high condition tests firsts....
and meanwhile continue increasing the dose incrementally with guidance here.
 
I also added many litter boxes around the house because Doodles couldn't get around much. Ended up using non clumping clay litter for a while because the clumping litter stuck to his feet like glue. Washing his feet hurt him but the non clumping did help with that.:bighug::bighug::bighug:
 
First of all, b-i-i-i-i-g (((hugs))). You have been dealing with a lot! I agree with everything all the others have recommended. Going forward, if he still has problems with UTIs, you can try giving him a little bit of d-mannose with his meals. Squallie used to get UTIs very regularly but since I started the d-mannose he has not had a single one. I think it's pretty widely available; I get the Now brand from amazon.com. :bighug::bighug::bighug:
 
Marvin's Mom - Nat said:
I am so lost again, I so don't want to lose Marvin.
Click to expand...

My dad (a diabetic) keeps bringing up the money and time I'm spending on treating Chino's diabetes (secondary to acromegaly), but I'm not going to kill my cat for having an expensive disease... If his QOL were low, that would be one thing, but he doesn't know that he's sick. He's hungry ALL THE TIME and that's hard to watch, but he loves having his chin scratched and he frequently cuddles up with my other cat on the couch. If you're able to afford the insulin/food/testing supplies, don't let the vet convince you that it's not worth paying for.

I know it can be hard to see the same numbers all the time, despite the dose increases, but you will get there! Chino bounces a lot, so I saw occasional greens and blues long before we reached an effective dose, but he was mostly showing red and pink until we got up to 10 units. I kept him on 10 units for 3 weeks, seeing at least 2 green nadirs each week, but I was losing sleep from the way he dives around PM +4, so I decreased the dose and ended up having to go even higher to find a good dose again. This is the 3rd week at 10.75 units and we're still seeing improvement :) (IF you get to 10 units, dose increases go by 1 unit at a time from there, but decreasing by 0.5 was enough to lose effectiveness, which is why I went back to 0.25 unit changes.)
 
Status
Not open for further replies.
Back
Top