10/11 Eddie AMPS 223 +8 320 PMPS 317 +8.5 238

Hello, well, for and by now, I imagine an increase is in order.

@Wendy&Neko I thought I'd let you know that the IM vet at Washington State University Vet Teaching Hospital wrote in response to my query to them about Eddie and Cabergoline (I also sent them the ss and they have all of Eddie's records):

I think we could consider cabergoline for Eddie. The only thing I would hope to see is an increased IGF-1 prior to starting it – and I apologize if it is somewhere, and I am not seeing it. I checked in the Excel spreadsheet and didn’t see a recent one. It isn’t a perfect indicator of regrowth, as you know, but if the IGF-1 is low or zero, there really isn’t any point in starting cabergoline.


If his IGF-1 is increased, I would go with 10 ug/kg Q48 hours like they did in the paper. I have only tried this approach with one cat with HST and that patient had no other therapy other than insulin (no surgery, RT, etc.). That patient is doing well, although it has been a few months since I checked in on them. Cabergoline is very affordable in the US right now, but I’m not sure what it costs in Canada. Anyway, if Hans is on board to RX it for you, we usually just monitor all the usual things you are already checking and we would expect the insulin requirement to start decreasing before the 3 month time point, so you need to keep a close eye on BG during that time because he is on such a large dose, as I know you will.


I also want to emphasize that perfect glycemic control can never really be the goal in these cases, but that we want to help control clinical signs as much as possible. If he is having poor signs of regulation, then I think checking IGF-1 +/- cabergoline would be a good solution.
 
The results in both the South American study (done over 50 cats now) and the small study at RVC did not show consistent changes across all cats with IGF-1 when on cabergoline. Also, SRT does not impact IGF-1 numbers, so I don't know what conclusion you can make about IGF-1 being up now, if it was. I think it's a waste of time, blood and money to test IGF-1 now.

We have WAY more experience that WSU does with cabergoline. A lot of people start with dosing every other day, a lot switch to every day after a period of slow action. RVC folks started with every other day, and then recommended every day as the way to go. You can start with every other day, as it may reduce GI side effects - though not all cats experience them.

I agree with the statement that controlling blood sugars should not be the goal, but rather controlling any acro side effects/clinical signs. Of which it sounds like Eddie isn't seeing much of?

My biggest hesitation with starting cabergoline with Eddie is that you will have to seriously up the amount of testing you do. And I don't know if that's something you can do with your schedule. There have been some cats (small but signficant #) that have shown an amazing response to cabergoline. And one took as little as 5 days after starting cabergoline to go into dose freefall. That was Mr. Kitty, OTJ after 14 days. Melissa was testing a lot to keep him safe. Marvin, first kitty here on cabergoline, had a similar experience. It took him 10 days to start dose freefall and he did go OTJ. After a few weeks with a ton of testing, skipped shots, BCS etc. Not to say the same will happen with Eddie, but it could, so you should only start cabergoline if and when you could monitor a lot more if needed. And I'd also keep the dental issue in mind. Maybe pulse dosing with antibiotics.

Yes on the dose increase.
 
Wendy&Neko said:
The results in both the South American study (done over 50 cats now) and the small study at RVC did not show consistent changes across all cats with IGF-1 when on cabergoline. Also, SRT does not impact IGF-1 numbers, so I don't know what conclusion you can make about IGF-1 being up now, if it was. I think it's a waste of time, blood and money to test IGF-1 now.

We have WAY more experience that WSU does with cabergoline. A lot of people start with dosing every other day, a lot switch to every day after a period of slow action. RVC folks started with every other day, and then recommended every day as the way to go. You can start with every other day, as it may reduce GI side effects - though not all cats experience them.

I agree with the statement that controlling blood sugars should not be the goal, but rather controlling any acro side effects/clinical signs. Of which it sounds like Eddie isn't seeing much of?

My biggest hesitation with starting cabergoline with Eddie is that you will have to seriously up the amount of testing you do. And I don't know if that's something you can do with your schedule. There have been some cats (small but signficant #) that have shown an amazing response to cabergoline. And one took as little as 5 days after starting cabergoline to go into dose freefall. That was Mr. Kitty, OTJ after 14 days. Melissa was testing a lot to keep him safe. Marvin, first kitty here on cabergoline, had a similar experience. It took him 10 days to start dose freefall and he did go OTJ. After a few weeks with a ton of testing, skipped shots, BCS etc. Not to say the same will happen with Eddie, but it could, so you should only start cabergoline if and when you could monitor a lot more if needed. And I'd also keep the dental issue in mind. Maybe pulse dosing with antibiotics.

Yes on the dose increase.
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Hi Wendy, thanks for sharing your thoughts. Probably the challenge with the IGF-1 is that it's seen as protocol and should we go towards Cabergoline, the test will probably be "required" by the vet here given standard practices.

Should we actually go for Cabergoline, I will engage the services of the vet tech who sometimes comes to give sub-q fluids. I would just have to suck it up, so to speak and figure out what to do re: work/sleep/monitor balance.

Do you know with Cabergoline, how long cats keep taking it? Is it in perpetuity or what?
 
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