It's taken me quite a while to write this post today. Before you read on, know that whatever you decide to do we'll support you. What I write is my opinion, my circumstances/experiences, not yours.
I really appreciate the support, believe me.
QUOTE="Jodey&Eddie, post: 2978128, member: 33276"]I think his acromegaly is active again
Acromegaly is the symptoms you see as a result of hypersomatotropism, which is the benign pituitary tumour. The tumour (not the acromegaly) has been there all this time. What SRT does is neuter the tumour cells so that as they die off, they do not reproduce. Until they die off, the tumour cells are still active and producing excess growth hormone, which in turn causes the acromegaly. I remember one cat (Grayson) who after SRT from around 16 units, up to 50 units before the SRT started to kick in quite a bit later. Yes, he also had IAA, which just adds another complication. At the one year anniversary of SRT, he was down to 20 units. Still above his preSRT dose, but way less than what it would have been had he not had treatment.
Well, I guess what remains of the tumour is there. That's what I'm unsure of. This is kind of like a Schrödinger's cat situation. What is going on inside of Eddie's head (in so many ways). Eddie is at his 17 month mark since SRT. I get different opinions with regard the efficacy of SRT: the radiation oncologist suggests it's 9-12 months, as do the folks at WSU, so I'm up in the air about the timeliine.
Eddie's max dose was 15 units? That's what I see on the spreadsheet. What was the max dose from the earlier days? I'm not sure his post SRT insulin dose journey is atypical. He's also a very complicated cat treatment wise so far, so not much to compare him to. I also went back to your post where you quoted that Dr. Hammond thought the CT scan showed scar tissue, not regrowth. That was less than 3 months ago.
Yes, I believe 15u was the max dose. I didn't have a SS before I joined FDMB although I did curves and sent them to the IM vet. Eddie's journey is so complicated; it's complicated by the fact he was in WSU for 28 traumatic days, came back with a feeding tube and was on a pharmacological overload including Trazadone. He wasn't using the kitty box, he was so food-driven he was scary to behold, was reactive and completely asocial. This went on for months. The journal I kept is awful and is so disturbing to read but I didn't give up on him. By the end of 2021 he was starting to regulate (that means so many things: using kitty box, not so food-driven, still a bit reactive and a-social but far, far better).
You do know that only a minority of cats that have SRT go OTJ. You have one cat that's done that already, so you've already beaten the odds. Don't expect the same of Eddie. If he does, that's a bonus. What the majority of SRT cats get is a longer life, with much reduced insulin dose, and more importantly, less excess growth hormone and it's nasty side effects. I call that a huge win. Most of these cats are older cats, and many die of other causes. The cat Grayson passed with a blood cancer, totally unrelated to the acromegaly. What the SRT does is make the life they have left much better.
I don't know what the future holds for Eddie. I do know, I'll try my best for him. And, as you see, I'm taking him for a blood panel, etc. so as to determine where he's at. "Etc" means I am going to get an IGF-1 test done.
The thing about having an acrocat, is that at some point you come to the realization that there is only so much you can do to help. The rest is literally up to the cat's body and luck. In many ways you remind me of me. My vet told a new tech that I had spent the equivalent of a brand new small car on Neko. Worth it as far as I was concerned for "the world's bestest cat". I still miss her a lot, think of her often. The music in her tribute video was fitting. I did everything I could for her,
that made sense to do. At some point, things no longer made sense and I had to let her be a cat and enjoy what time she had as much as she could, and stop subjecting her to treatments that may or may not have worked, just to keep her around for me. I also considered cabergoline, though it was brand new at the time with no experience out there. But I decided that with all she had going on, it was just one too many thing.
I guess I've yet to arrive at that realization if only because, as I've learned here, ECID. I take it as a compliment that I'm doing the best I can do for Eddie (and Blue) and so far things make sense. It's a strange journey because we have to take it with our acrocats and often be at odds with veterinarians, which is horribly ironic. It makes sense to me to investigate cab, if only because it might help with his insulin in relation to IGF-1/IAA. Eddie's medications are not all that many and he has more good days than ever. In fact, he seems unperturbed by either high or low BG. Go figure.
SRT requires sedation, at least for two days, maybe up to four depending on how the particular place treats, and other factors. Twice now Eddie has had adverse reactions to sedation. In your post after his last bad reaction during anaesthesia for a CT scan, you said Victoria uses a different sedation med, but who's to say he'll do any better on it? I strongly suggest that if you do really want to go ahead with another SRT that you get an echocardiogram done on Eddie by a boarded cardiologist, before you book SRT again. A xray or radiograph is not enough to show you whether his heart can take it. A cardiologist can also advise on anaesthesia and which meds are appropriate if any. CSU requires an echo before SRT, as well as up to date blood work, to make sure the kidneys are also OK with anaesthesia. I personally think the risk to Eddie for SRT again is pretty high. It's not something I would do, but I'm not you and you may have a different risk tolerance than I do. Neko had the all clear from her cardio vet before her second SRT, but almost didn't make it, in a teaching hospital that had all the expertise at hand (cardiologists, anaesthesia experts). Her radiation was reduced to just the one day. I felt awful afterwards and the event helped me realize that there was only so much I could do and some things no longer made sense to do as the risk outweighed the possible reward.
Eddie's sedation issues were at WSU and the last CT scan. He had
no issues at all with the sedation used by the radiation oncologist for his SRT. But your point regarding an echocardiogram done by a boarded cardiologist is well-taken. I am not entirely committed to a second SRT (Blue had 18 sessions of fractionated radiotherapy @ WSU and only one SRT session at VCA Calgary) for Eddie. In fact, I'd just like to learn more about cab in the meantime.
I think I'm echoing a lot of what Melissa has already said, plus I've walked in those second SRT shoes and regretted it. Ask yourself "what would Eddie want to do?". Cats live in the moment, day to day. Cats are so much more than his numbers. If his BG is high, increase the insulin dose. If the BG is his only acro side effect, that's not a big reason to treat.[/QUOTE]
What would Eddie want to do? Good question. His in-the-moment answer is "have a snack" or "go out onto the catio in the sun".
I'm really appreciating the support here and by that I mean the willingness to share perspectives while knowing that ECID as is every one of us. It also helps knowing I'm in this with other like-minded (as in the sense of really caring and willing to walk the walk kitty-folks) people. Thank you, Wendy.
That's why even in internal medicine there are specialists in this. All I know is that even at RVC where they have done way more hypophysectomies than anywhere else, not all the cats go OTJ. You'd think they would. But maybe not all the pituitary tumour is removed? Dunno.
