8/17 Doodle 1ps =340 (questions answered)

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Michelle and Doodle

Michelle and Doodle

Member Since 2009
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1ps = 340

Hi guys,
I'm feeling a bit more optimistic today. After doing more research and talking to the endocrinologist at Michigan State I don't feel as though things are quite as bleak.
DH and I talked a lot last night about our options and we are (for now) leaning towards continueing to treat Doodle's symptoms and not even getting a CT scan. The endocrinologist says that it is possible to medically manage this (with drugs) for quite some time. ( no one can say how long... but it's not an irresponsible choice) A scan would let us know more clearly what we are dealing with... but it would honestly be a waste of money unless we are 100% sure we'd want to proceed with surgery - if it was warranted.

I feel as though in my distress I've made this seem more dramatic than it is... So please don't think I'm saying that Doodle is going to die any moment -- I'm just rawly relaying what i'm being told and trying to work all this out.
And i realize I'm talking about something somewhat OT - since this isn't diabetes related - and I can't expect everyone here to know a lot about this.
Here's a link describing Hyperaldosteronism for anyone who's interested.
http://www.vetstreamfelis.com/ACI/March ... s60674.asp


WCF and Meowzi said:
(((doodle))) (((michelle)))

pls forgive my ignorance, but without surgery, what would kill him? the high aldosterone levels? CRF?
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This is a good question.
My vet said the high aldosterone level would make the hypertension and electrolyte imbalance increasingly difficult to treat and that it would accelerate the CRF. She said, "this is what will kill him" - "if we don't take care of this, this will kill him faster than the CRF or diabetes ever could"
The endocrinologist, on the other hand, said "true... but maybe a little dramatic - he's not likely to die next week..."

has he responded at all to spironolactone? how's his potassium now? and sodium? i'd think surgery risk would be increased if his electrolytes are out of whack - if they will even do surgery then.
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He HAS responded! I swear that stuff has made an amazing difference! His potassium level is now 4.1 and he's only getting 6mEq (down from 15mEq) His sodium is still high (157) but it is not as scary as it was. And you're right they wouldn't do surgery if the lytes are too out of balance.

if he's having surgery, who'll be doing it? surgery isn't a given, until the CT scan is done, right?
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Yes, Surgery is NOT a given until a scan is done.
He'd need the scan to see if this was a tumor or if it is hyperplasia - if they don't see a tumor (or adenoma) then they wouldn't do surgery. I have no idea who I'd get to do the procedure - but it would need to be someone with experience - not just my regular vet!

have you seen this? http://www.ncbi.nlm.nih.gov/pubmed/15922224
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Yes! which is what prompted my call to Michigan State - I saw that the medically managed cats survival rates didn't significanly differ from the ones who had surgery...
Which is good news!
 
Great post Michelle....thanks for updating us...so glad you and DH have had a good talk about your options. We are with you all the way...sending healing vines to Doodle and hugs to you all! :YMHUG: :YMHUG: :YMHUG:
 
I'm glad for the better news Michelle! I haven't heard back from Dr. Lunn yet (sometimes it takes a while), but I'll let you know if she has any suggestions.
 
Michelle and Doodle said:
The endocrinologist says that it is possible to medically manage this (with drugs) for quite some time. ( no one can say how long... but it's not an irresponsible choice).
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Well, this is more optimistic than yesterday's thread :)

My vet said the high aldosterone level would make the hypertension and electrolyte imbalance increasingly difficult to treat and that it would accelerate the CRF. She said, "this is what will kill him" - "if we don't take care of this, this will kill him faster than the CRF or diabetes ever could"
The endocrinologist, on the other hand, said "true... but maybe a little dramatic - he's not likely to die next week..."
Click to expand...
From the 13-cat study:

"Three cases underwent medical treatment only with amlodipine, spironolactone and potassium gluconate; two cases survived for 304 and 984 days until they were euthanased because of chronic renal failure, whilst the third case was euthanased at 50 days following failure of the owner to medicate the cat. "

You're going to hate me for writing this. This is just my personal opinion, based on what I *may* do for my own kitty.

I would think about putting him on a renal diet if he'll willingly eat it. Or even half-renal diet, i.e. mix half with regular food. Yes, I know it's high in carbs, but FD isn't going to be what kills him. So it raises his BG - you can manage FD - you've done it so well these last few years. My reasoning: of the two cats above on medical treatment sans surgery, *both* the cats succumbed to CRF. This is not a clear-cut progresive CKD issue, IMO, and I don't know if I would want to toy around with lower-phos food, like what we're currently doing with Meowzi, to see if it works. His phos isn't the problem here anyway. Renal diets are more than lower-phos, they're also lower in sodium, and higher in potassium and B vits. With his sodium also elevated, and if hypertension may eventually become harder to control b/c of the aldosterone levels, if I understand you correctly (note that there is as yet no evidence, IIRC, that sodium is a factor in feline hypertension, but no evidence yet doesn't mean there's no link), I'm not sure I would want to gamble. These are very high stakes here, and he's too precious to take chances on. JMHO. I know many would disagree with me here. (On the other hand, if he goes above his renal threshold, i.e. if you can't manage his FD as well, then there may be a risk to his kidneys too. I don't want to come across as advocating a renal diet - I'm on the fence about it - but you and B may want to discuss and evaluate.)

He HAS responded! I swear that stuff has made an amazing difference! His potassium level is now 4.1 and he's only getting 6mEq (down from 15mEq) His sodium is still high (157) but it is not as scary as it was. And you're right they wouldn't do surgery if the lytes are too out of balance.
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Very relieved to read this! :) That's one less thing to worry about for now. He's on the dose recommended in the link? 2.5 mg/kg orally once daily? I've seen 1-2 mg/kg as well, not sure what dose you're on. http://wvc.omnibooksonline.com/data/pap ... 7_V120.pdf

Yes, Surgery is NOT a given until a scan is done.
He'd need the scan to see if this was a tumor or if it is hyperplasia - if they don't see a tumor (or adenoma) then they wouldn't do surgery. I have no idea who I'd get to do the procedure - but it would need to be someone with experience - not just my regular vet!
Click to expand...
I would have only a board-certified surgeon do it, no other. And preferably one with experience in that area - although that may be difficult. But start talking to vets and specialists, look around for a boarded surgeon. Compile a list of possible surgeons. Doesn't mean you'll eventually do surgery, but it never hurts to be prepared. Finding a surgeon for a complicated procedure like this isn't something you want to rush into if you can help it.

Another thought - if you talk to surgeons or even vets, ask if laser surgery instead of traditional surgery could reduce the risk. Meowzi's surgeon used laser surgery, to reduce bleeding - I think the laser seals blood vessels as it cuts - and shorten recovery time.
More info on laser surgery here

Of the five cats that did not survive surgery in that study, three did not make it because of surgical-induced haemorrhage. You can't do much about sepsis, but you may be able to reduce the risk of haemorrhage with laser surgery. I don't know. It would not hurt to ask.
 
you must be relieved to have a plan that makes sense and is doable. That sounds pretty much like the way I'm approaching Jazzy's acro. I know that SRS is not within my means or the rescue's, but I'll stay on top of any symptoms as they arise and keep her happy. Your plan sounds like a good one to me.
 
I'm relieved to hear that you feel like you have options. Maybe the vet from Michigan State can recommend a colleague in your area who you can consult with. I also like what CF had to say. The FD is reasonably manageable whereas its critical to get blood pressure and lytes under control.
 
Hugs to you and Doodle. Not used to seeing pink here, hope he is feeling better. Sounds like you've got a great specialist involved, very encouraging.
 
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