6/25 Snuggie: PMPS 402; +9.5 110!!!! (( AMPS 346; +8 279 (New acro Dx contd)

[Jay Dee]

Hi all thank you for the outpouring of support for Snuggie and me! (And hubby by proxy lol)

I’m still trying to process all of this and wondering how things like DKA and CKD will work, how this affects frequency and severity of UTIs, and if it makes him susceptible to other things - in general, I guess wondering how we evaluate quality of life now. Is it worth scheduling an appt or a call with our vet to discuss this? Or is it kind of the same thing as we are doing now? I guess i see the slippery slope of getting into increasingly pricier treatments and honestly we don’t have the budget for that.

today he seems super happy and interactive - honestly he seems to be improving every day outwardly. I just don’t know what’s going on inside. I’ve dealt with a lot of issues in my pets over the years but this one, not so much.

Happy to chat about it here or post this over on the acro board - but you guys here seem to know us well after the last month

 

[FrostD]

Hi all thank you for the outpouring of support for Snuggie and me! (And hubby by proxy lol)

I’m still trying to process all of this and wondering how things like DKA and CKD will work, how this affects frequency and severity of UTIs, and if it makes him susceptible to other things - in general, I guess wondering how we evaluate quality of life now.

today he seems super happy and interactive - honestly he seems to be improving every day outwardly. I just don’t know what’s going on inside. I’ve dealt with a lot of issues in my pets over the years but this one, not so much.

Happy to chat about it here or post this over on the acro board - but you guys here seem to know us well after the last month

So now that you have the diagnosis, you can chase an ideal dose a little more quickly than TR usually allows, because we know there's something underlying hindering things. You had asked the question last night (this morning? maybe Wendy answered, brain is foggy) about depot settling and increasing...my two cents is that Snuggie's numbers are high enough that you can afford to keep increasing more quickly. When you start to see more blues then you slow things down a bit.

If you want to look at my spreadsheet, we switched to Levemir pretty much same time I got the diagnosis, about 2 weeks ago. With Wendy's guidance I increased more quickly to get back into the better numbers I had been seeing on Lantus. Now Mr Kitty also has IAA compounding things, so it's doubly important I don't let his numbers run away, because they're that much harder to catch again.

I can't speak to UTIs, but I would imagine those hopefully wouldn't be as much if an issue if he's below the renal threshold, though some cats are just prone to them. From what I understand DKA logic still applies, just do your best to keep them in good numbers and stay on top of dose needs.

From what I've read, they are more susceptible to organ enlargement in general - heart, liver, kidneys. There's a discussion on symptoms somewhere in the acro forum but unfortunately I don't have time to dig right now, I'll try to remember later if I get a chance. Things like very sensitive legs and feet when grooming, walking oddly (many thought it was just arthritis til everyone started saying the same thing, even with younger cats).

 

[Olive & Paula]

Acro can affect all organs. Organomegaly (enlargement of organs). Soft tissue and bone over growth.
Some cats, not all, might have some, all or none of the symptoms: headaches, light sensitivity, gruntal, noisey breathing (different than snoring), strange way of walking (not neuropathy), sensitive to touch, cardiomyopathy, large spacing between teeth, chronic constipation. To name a few.

Olive had all these and some pretty severe. She also had chronic pancreatitis which could be from acro or diabetes or both. No way of knowing. Eventually started having frequent UTIs.

We addressed each symptom as they occurred the best we could.

Keeping glucoses in normal range as much as possible helps. Treatment for acro, if it's an option for you will help.

For UTIs, you can try adding d-mannose to a meal everyday. It "cleanses" the bladder and can help prevent uti.

It all depends on what outcome you are looking for AND are comfortable doing.

 

[Jay Dee]

@FrostD and @Olive & Paula thank you!

He's never had UTIs before until everything went crazy in late feb. That was his first; we treated with a convenia shot because he had SO much going on and hoped it would work. It didn't, so he went on Orbax (the culture was negative, so we went with something that treats lots of bacteria). His recheck after 2 weeks was negative so we assumed all was good... Then it came back, so we are on 6 weeks of Orbax now. He gets d-mannose daily to hopefully keep things good there...

Interesting about noisy breathing - he's been noisy for quite some time. I attributed it to his recent URIs but he's kicked those and is still pretty noisy. And about the foot sensitivity. He was getting "litter paw" from stepping in his wet litter and had been REALLY good about letting me pick it out, until one day he was having absolutely NONE of that. NONE. Somehow i managed to clip his back claws the other day, and that was fine, but i went to trim his paw fur and same thing.

It really sounds like this Dx comes with a lot of complications. I had a long talk with my vet and my hubby about everything he's got going on. We are going to look at our budget and how much we spend per month on his med and come up with a plan that makes sense for everyone. In the meantime, we have marshmallow bacon flavored cabergoline coming from Westwood (Wedgewood?) pharmacy - 2 month supply for what my local place was charging for a one month. I was tempted to keep the business local but that's too much of a price difference given what we're spending on this boy!

 

[FrostD]

Makes sense!

I think that's what we all do. I ran over our budget to see what we could fit in... ultimately we didn't want to treat just the diabetes because the IGF still causes issues elsewhere, and he's still a fairly young cat. So we decided to give the cabergoline a try to hopefully keep things at bay and keep him comfortable as long as possible (SRT was a very slim possibility until we found out our dog has cancer).

And I'll be totally honest, we did have a brief discussion about rehoming while waiting for results. We have a lot on our plate right now, and the poor guy is stuck in the basement because he pees and poops everywhere if I can't keep him under 200. We love him to death, but it was a question of can we provide him the quality of life, or is there maybe someone out there who can do better for him? Ironically about that time we broke through into some pretty solid blues and greens and he started acting like his old self, so I took that as the universe giving it's sign.

 

[FrostD]

Oh I just saw your edit as far as slippery slope. That's a really hard thing and decision to make. I agree with Paula, we just take each thing as it comes. As long as he seems relatively comfortable and content we'll keep on, and cross the bridges as they come.

 

[tiffmaxee]

I just saw the dx. You are n the right place to control this.

 

[Jay Dee]

YOU GUYS - thank you!!
This is exactly what all just went thru my mind and what I needed to hear. Such a relief to read your experiences here too! I’ll peek at spreadsheets to see doses etc.

Ok crawling out of the dark hole!! Thank you!

 

[Wendy&Neko]

The link to yesterday's post: https://felinediabetes.com/FDMB/threads/6-24-snuggie-pmps-342-amps-336-7-320-new-acro-dx.249010/ where you asked me:

@Wendy&Neko regarding the bit about testing times - so that’s where I get a little “lost” with TR… and maybe a little is getting lost due to method of communication and not chatting live but - if the depot takes a few days to build (thinking few days = 3
days = 6 cycles) and TR is saying increase dose after 6 cycles if not enough blues, how is there any time to develop a “routine”? Feel free to direct me back to the TR stickies; I really only skimmed them when I joined bc the dry food dictated I went SLGS.

So the depot can take 3 days to build, but sometimes they have an earlier reaction to the new dose. Especially if you are starting to see better numbers, you don't want to stop testing. and six cycles is usually enough time to see what sort of nadirs a dose is giving you, provided you have that second test every cycle. With TR, we only hold the dose for 3 days/six cycles if you aren't seeing anything under 200. You can slow down how long you hold the dose once you start seeing blues/greens. In fact, if all kitty is seeing is 300's and above, there is provision for faster increases. Otherwise, I'd stick to what TR suggests.

UTI's - Neko never had them. Though my vet for some reason thought I should keep testing for them. Those urine cultures were darn expensive tests! After a couple years I got wiser (and Neko was mostly under renal threshold), so I said no to that test unless there were other signs.

CKD, yes, that is something that can be accelerated by acromegaly. If you are interested, I can post an article on that. Thought I had posted it on this thread, Acromegaly - the basics, which has links to lots of articles but evidently not. The one I have talks about the mechanism of acromegaly and how in impacts kidneys, but in humans. Proteinuria is more common in acros, so you do want to keep an eye on his urine protein numbers and get a urine protein/creatinine ratio test done if it's creeping up. It can be controlled with meds, but uncontrolled can worsen kidney disease. Neko had proteinuria and was on benazapril.

Other organs - of most concern is the heart. If he ever gets to the point where his CKD means regular fluids, I'd get his heart checked out first. Heart issues can go mostly hidden for a while. If your vet ever hears a murmur, and you can spring for an echocardiogram by a cardio specialist, I'd do it. I've seen a number of members here find their acros have heart issues, when it's quite late in the disease. Again, finding early means it can be managed by meds. Next set of issues I've seen most often is the GI system, whether it be inflammation of the bowels, megacolon, etc. Just keep an eye on his poops for an significant changes. And remember, not all acros get these issues, just these ones are on the top 10 list so you should be on the lookout for them.

Other changes are those caused by soft tissue growth and bony growth. Neko had one eye that teared - caused by blockage of her tear duct by soft tissue growth. It was an acro symptom, but not a big deal. The noisy breath is caused by soft tissue growth in the throat. Again, not a Neko symptom until 5 years in. Neko had some soft tissue growth on her gums, causing one of her canine teeth to rub on that gum. Regular vet thought it was a bad tooth, dental specialist realized it was soft tissue growth issue due to acromegaly. Her tooth was saved but shaved. The bony growths caused the arthritis, and later on a bony growth on her jaw. Same dental specialist thought the jaw growth was cancer, thankfully he was wrong, Neko was one of the 1% percent of benign growth cases.

today he seems super happy and interactive - honestly he seems to be improving every day outwardly

Yes!! This is what counts the most. He will get even better as you can get him under renal threshold more of the time. That plus hopefully cabergoline will help some of the acro symptoms like the breathing. Neko got to a place where she had pretty good quality of life. Some of it needed medical help, especially the arthritis which was getting bad in later years, but with that help things were pretty good. At some point you may have to add gabapentin and/or buprenorphine (Neko was on) to help with pain, but doesn't sound like he's there yet. So in the mean time, just be aware of what could be there, but it doesn't mean he will get all these issues. And keep on snuggling!

 

[Olive & Paula]

I forgot about the proteinurea. Olive had that. She was on benazepril for hcm which is also used for proteinurea.

I got insulin from Marks in Canada. Ollie was up to 9 units twice a day, not knowing how high she would go, I always had 2 boxes of pens in the fridge. Marks will not ship if destination temperature is freezing or to hot.

Box of pens is more economical than the bottles. You get more volume (15 cc vs 10 cc) if one goes bad or breaks you have back up for next dose.

The 1st time I ordered, I got 2 boxes. Then after that when I started 2nd box I would order one more. I also timed it to order in April and November where I live to avoid the extreme temps.

Got her meds on auto refill which saved shipping costs. Take advantage of the Supply closet here. People will offer supplies, meds etc if you pay shipping cost.

Any repeat orders I made sure I met the free shipping requirements. So yes maybe I had to pay a bit more for strips but it was for higher quantity. Also searched Amazon and ebay for better deals. Found another food that had better quality and cheaper than fancy feast. Only problem was I could only get it in one grocery store. With 4 cats that $0.05 per can adds up in savings.

I came out of retirement just to pay for the cabergoline and her Buprenorphine when she started on that.

We (FDMB) have many tips and ideas for making the journey a bit easier.

Soooo, anytime you get stuck, have a bad day, want to know where to get something, or what to get...just ask in your daily thread. That includes needing to vent.

We have all been there. We are not shy about discussing poop, vomit or impacted anal glands.

You, Snuggie, and husband are not alone in this.

 

[Jay Dee]

@Wendy&Neko thank you for posting yesterday’s post - I had it copied but got carried away in my words hahaha!

you and @Olive & Paula raise some great issues. Yes please post the article about renal disease and acro.

I will take it a day at a time. Snuggie gets 50mL subQ fluids per day. Vet never mentioned a heart issue among all his other ailments so I’ll ask (dang it I forgot to ask about the labs when we talked today and when I was there - shoot!) but I’ll start making a list. My head is swimming.

I got a second box of 5 pens from marks when we blew thru the first pen in under a month, I didn’t realize they won’t ship if it’s too hot which is good to know where I live. I wasn’t going to look into the supply closet yet til I knew if cabergoline worked but I may need to for where I live…

 

[Olive & Paula]

Where do you live?

Nice yellow on ss. So much better than the red and pink.

Olive's ss was accidentally deleted and we can't get it back.

 

[Wendy&Neko]

Marks is 20 minutes drive from me. We are in a hot spell. Forecast next few days is mid 80's to mid 100's F. (ugh!) Not sure if that means they'll hold the shipment until mid next week when we are supposed to get back to normal.

Nice catch on the yellow. Like I said, some cat don't wait six cycles to respond.

File attached with article.

 

[Jay Dee]

Where do you live?

Nice yellow on ss. So much better than the red and pink.

Olive's ss was accidentally deleted and we can't get it back.

We are in NE Utah- not as bad as SLC temp wise but I think shipments go thru there - blah!

yes I love the yellow! Sorry about olives ss -
What happened???

 

[Jay Dee]

Marks is 20 minutes drive from me. We are in a hot spell. Forecast next few days is mid 80's to mid 100's F. (ugh!) Not sure if that means they'll hold the shipment until mid next week when we are supposed to get back to normal.

Nice catch on the yellow. Like I said, some cat don't wait six cycles to respond.

File attached with article.

Oh I’d figure if you live so close you’d drive there to get yours?

had I known we’d see temps this week below 80!!! I’d have ordered a third box - but usually we are in the 90-100 range now til sept - dammit!

I will read the article over morning coffee, thank you!!!

haha yea let’s hope he doesn’t bounce now!

 

[Wendy&Neko]

Oh I’d figure if you live so close you’d drive there to get yours?

Absolutely not! They have a huge markup from what we can get OTC at the local stores. About $40 higher per box of pens than local, and that's without the US to Canadian conversion.

 

[Chris & China (GA)]

I didn’t realize they won’t ship if it’s too hot which is good to know where I live.

They now offer the choice of adding a cooler + extra ice packs for $15 more but just FYI....when I originally found Marks, it was the end of June. I had no choice but to order China's Lantus because I had been searching for someplace I could afford it (or a pharmacy that would sell 1 pen) for months. If I wanted to keep her on Lantus, it had to be from Marks. Because it was the end of June, my first order took about 10 days because there were 2 holidays (Canada Day and 4th of July so no post office in either country) and there was a weekend thrown in for good measure. I was still able to use every drop and it had been 90+ degree's the entire time.

They will ship anytime.....they will strongly recommend the added cooler/ice packs but if you refuse them, they'll still ship....but they sure aren't going to guarantee it'll be any good when it gets to you. (can't blame them for that).

They also always put a little temperature gauge into the package. There are 3 dots on it that turn red if the interior goes over 80 degrees. I know one person who had 2 of the 3 dots turn red but the insulin was still fine.

Anyway, in a perfect world, yes, you should try to order however much insulin you're going to need in the spring to last you at least until the fall so you can ship during the cooler times of the year.

 

[Jay Dee]

They now offer the choice of adding a cooler + extra ice packs for $15 more but just FYI....when I originally found Marks, it was the end of June. I had no choice but to order China's Lantus because I had been searching for someplace I could afford it (or a pharmacy that would sell 1 pen) for months. If I wanted to keep her on Lantus, it had to be from Marks. Because it was the end of June, my first order took about 10 days because there were 2 holidays (Canada Day and 4th of July so no post office in either country) and there was a weekend thrown in for good measure. I was still able to use every drop and it had been 90+ degree's the entire time.

They will ship anytime.....they will strongly recommend the added cooler/ice packs but if you refuse them, they'll still ship....but they sure aren't going to guarantee it'll be any good when it gets to you. (can't blame them for that).

They also always put a little temperature gauge into the package. There are 3 dots on it that turn red if the interior goes over 80 degrees. I know one person who had 2 of the 3 dots turn red but the insulin was still fine.

Anyway, in a perfect world, yes, you should try to order however much insulin you're going to need in the spring to last you at least until the fall so you can ship during the cooler times of the year.

Oh thanks Chris - I forgot that you had told me that. Hopefully things haven’t changed - but luckily - I think we are reaaaal close to his dose - PM+9.5 was 110!

 

[Suzanne & Darcy]

Oh my gosh, Jill I would like to talk to you about all this …having an Acrocat myself. I am so sick amd tired with grief tonight. Hang in there. You can do this and help Snuggie.

 

[Jay Dee]

Oh my gosh, Jill I would like to talk to you about all this …having an Acrocat myself. I am so sick amd tired with grief tonight. Hang in there. You can do this and help Snuggie.

Please feel free to ask anything!!! Pm or on here! Anytime- happy to help!!