Acromegaly diagnosis & next steps

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King Chuck was recently diagnosed with acromegaly via symptoms including broadened jaw, insatiable hunger, insulin resistance and elevated IGF. The vet is referring us to an oncologist a couple hours away to discuss cyber knife. She said the results are promising and quoted a 2018 study showed cats w/ acromegaly undergoing cyber knife had a life expectancy of 3 years. It kind of caught me off guard because last month she didn't mention anything related to life expectancy and this was after the procedure was quoted to be around $13,000-$15,000. Chuck is currently on 8.5 units of Lantus and is still steadily over 250+. It seems like the insulin is working but not getting him to where he needs to be. He's more lethargic these days and I'm not sure if that's related to the higher BGs or something else. Does anyone have experience with acromegaly or cyber knife? What is the life expectancy for cats that don't receive radiation?

@Wendy&Neko
 
Neko lived a little over 4 years past her SRT (stereotactic radiation therapy). And it cost WAY less money than Cyberknife cost at the time and then was only available at Yonkers. You know that saying ECID or every cat is different. It's even more so with acrocats. The best outcomes for acrocats is a surgery called hypophysectomy, or removal of the pituitary gland. But you only want that done by a very experienced surgeons as the risk is also higher. The best most experienced are at the Royal Vet Clinic in London. There are only two that I know of that do it in the US, one at AMC in New York, the other at Washington State University Vet School. The prices I've seen for WSU are very high ($17-20K). For the price you were quoted, you might get a nice holiday in London at get surgery done there.

If you don't have that sort of coin hanging around, there are other options. SRT is still a valid option for less money. More details and outcomes expected in this paper. Note, I was told an average of over two years when Neko had her SRT, but that also included some cats who died of other conditions, such as cancer, in that time period. This paper by the folks at CSU where Neko had her SRT says 2.9 years. In Neko's time, SRT or Cyberknife were the only treatments available.
he said the results are promising and quoted a 2018 study showed cats w/ acromegaly undergoing cyber knife had a life expectancy of 3 years.
Any chance you could get the vet to give you a copy or link to the study? I like to collect that sort of information for the next person asking questions such as yours. Besides life expectancy, are questions like insulin dose changes, quality of life, and possible side effects from the treatment.

Another option a lot of people here are pursing is a drug called cabergoline. It's a drug given either daily or every other day at home. It's the cheapest of all the treatment options and requires no travel. Lots of posts about cabergoline in our Acro/IAA/Cushings forum. If you want to read a good paper on it, and pass it onto your vet, see the paper attached to this thread. You can read some of the posts in the Acro forum from people whose cats were on it. It's the one a lot of people here now use due to cost while still helping the symptoms and giving better quality of life. I think there've been 4-5 cats go OTJ on it too.

What is the life expectancy for cats that don't receive radiation?
Do you mean, what is the life expectancy for cats that receive no treatment? There are other options as I listed above. But there is no one answer to life expectancy with or without treatment. Besides the possibility of other diseases, there is just a lot of variability. The longest I've seen is a couple cats at 4-5 years, but also more at less than 1.

You may with to post in the acro/iaa/cushings forum, as a lot more people with experience in those conditions monitor it for traffic.
 
Neko lived a little over 4 years past her SRT (stereotactic radiation therapy). And it cost WAY less money than Cyberknife cost at the time and then was only available at Yonkers. You know that saying ECID or every cat is different. It's even more so with acrocats. The best outcomes for acrocats is a surgery called hypophysectomy, or removal of the pituitary gland. But you only want that done by a very experienced surgeons as the risk is also higher. The best most experienced are at the Royal Vet Clinic in London. There are only two that I know of that do it in the US, one at AMC in New York, the other at Washington State University Vet School. The prices I've seen for WSU are very high ($17-20K). For the price you were quoted, you might get a nice holiday in London at get surgery done there.

If you don't have that sort of coin hanging around, there are other options. SRT is still a valid option for less money. More details and outcomes expected in this paper. Note, I was told an average of over two years when Neko had her SRT, but that also included some cats who died of other conditions, such as cancer, in that time period. This paper by the folks at CSU where Neko had her SRT says 2.9 years. In Neko's time, SRT or Cyberknife were the only treatments available.

Any chance you could get the vet to give you a copy or link to the study? I like to collect that sort of information for the next person asking questions such as yours. Besides life expectancy, are questions like insulin dose changes, quality of life, and possible side effects from the treatment.
Another option a lot of people here are pursing is a drug called cabergoline. It's a drug given either daily or every other day at home. It's the cheapest of all the treatment options and requires no travel. Lots of posts about cabergoline in our Acro/IAA/Cushings forum. If you want to read a good paper on it, and pass it onto your vet, see the paper attached to this thread. You can read some of the posts in the Acro forum from people whose cats were on it. It's the one a lot of people here now use due to cost while still helping the symptoms and giving better quality of life. I think there've been 4-5 cats go OTJ on it too.


Do you mean, what is the life expectancy for cats that receive no treatment? There are other options as I listed above. But there is no one answer to life expectancy with or without treatment. Besides the possibility of other diseases, there is just a lot of variability. The longest I've seen is a couple cats at 4-5 years, but also more at less than 1.

You may with to post in the acro/iaa/cushings forum, as a lot more people with experience in those conditions monitor it for traffic.

Can you share who you took Neko to in Yonkers? I’m in NJ. I posted in the acro group too, I totally missed it yesterday! I called the cyber knife office and have a phone consult Monday that will cost $295…they also do SRT and said the vet would advise which procedure was “best”.

This is the study I found which says survival was almost 80% at 5 year https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10613787/
 
We did not go to Yonkers. Did not get Cyperknife. At the time, Yonkers was the only place offering Cyberknife. We went to Colorado State University for SRT. I am west coast of Canada, east coast of US would have been way too far to go. Plus Cyberknife was about double or more the cost of SRT at the time.

The article you posted was a study of cats who had surgery first, it failed, and then had a followup Cyberknife. It is not a study of Cyperknife by itself or outcomes of Cyberknife by itself. The goal of surgery is to remove all the pituitary, but it doesn't always work, sometimes part of the pituitary is left, and the tumour can regrow. The follow up Cyberknife in the article targeted the remaining pituitary bits. To get the outcomes for the process they are talking about, you'd have to go to AMC in New York to get the surgery done, then if it failed, do the Cyberknife. Note, surgery probably costs more than Cyberknife. And a lot of times surgery succeeds. We've had two cats here go to AMC for surgery and a few go to WSU, but none of the WSU cases that I've heard of here were successful. Either not all the tumour was removed or there was a surgical complication. Three of the WSU cases had follow up SRT.
 
Can you share who you took Neko to in Yonkers? I’m in NJ. I posted in the acro group too, I totally missed it yesterday! I called the cyber knife office and have a phone consult Monday that will cost $295…they also do SRT and said the vet would advise which procedure was “best”.

This is the study I found which says survival was almost 80% at 5 year https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10613787/


Hello, I live in Yonkers. The facility mentioned here is the Animal Specialty Center. It had several top neurologists there until it changed ownership several times over the years. You can always try calling them but I don't believe they have a neurology team there anymore. Good luck.
 
Thanks for the name of the facility. I looked up the Animal Specialty Center in Yonkers. They have two neurologists on staff, one who has a special interest in endocrine disorders caused by pituitary tumours. They also have a radiation oncologist, who would be the one running the Cyberknife machine.
 
Thanks for the name of the facility. I looked up the Animal Specialty Center in Yonkers. They have two neurologists on staff, one who has a special interest in endocrine disorders caused by pituitary tumours. They also have a radiation oncologist, who would be the one running the Cyberknife machine.

I live within walking distance to the Aninal Specialty Center. They saved the life of one of our cats, but have been plagued with high staff turnover since covid. The vet that started the Animal Specialty Center in Yonkers is now at Guardian Vet in Brewster, NY although I don't know if they have cyberknife capabilities there. He was on an episode of the Zoo where he consulted on neurological issues for a big cat at the Bronx Zoo. We consulted with him when one of cats developed seizures. Here is his bio. He might be a good resource if they have the equipment.

Dr. Richard Joseph DVM DACVIM
Richard Joseph, DVM, DACVIM (Neurology), has been in clinical practice as a veterinary neurologist since 1989. He received his DVM degree from the University of Tennessee at Knoxville in 1984. He completed an internship in medicine and surgery, then a combined residency in internal medicine and neurology at the Animal Medical Center in New York City. He became board certified in neurology in 1989.

Dr. Joseph served as a chief neurologist and head of medical service at the Animal Medical Center from 1989 to 2000— the only practicing neurologist in New York City during that period. He not only managed a busy clinical caseload but also trained interns, residents, externs and visiting foreign veterinarians. His passion for teaching extended to giving phone consultations to veterinarians across the country through Antech Diagnostic Labs and providing online neurology services and course instruction for the Veterinary Information Network.

Dr. Joseph co-founded in 2000 Animal MR, a mobile veterinary MRI service. In 2008, he co-founded The Animal Specialty Center in Yonkers, NY where they developed the first private radiosurgery center using the Cyberknife. In 2019, he founded Vets On Call Network (VOCN), a Vet2Vet global telemedicine company to help vets with challenging cases.

Dr. Joseph has published numerous journal articles, has lectured nationally and internationally, and has been featured in various media, including New York Magazine’s Best Vets, the New York Post, Fortune magazine and CNN.

Dr. Richard Joseph DVM
 
Small world. One of the local oncologist vets who owns a specialty hospital (with her hubby) nearby, used to be on the board of the Animal Specialty Centre. Not long after Neko was diagnosed, I was helping a friend out by taking her dog to this oncologist for chemo. We got talking, she knew a lot about Cyberknife. She was also a radiation oncologist by trade.

Another connection, if you search the acro forum for the name "McCue", you'll find people who went to Animal Medical Centre in New York for pituitary surgery for acromegaly (hypophysectomy). At Animal Specialty, the neurovet interested in pituitary tumours is named McCue, who had previously spent some time in Animal Medical Centre. Maybe he works both places? Anyway, definitely knowledgeable.
 
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Small world. One of the local oncologist vets who owns a specialty hospital (with her hubby) nearby, used to be on the board of the Animal Specialty Centre. Not long after Neko was diagnosed, I was helping a friend out by taking her dog to this oncologist for chemo. We got talking, she knew a lot about Cyberknife. She was also a radiation oncologist by trade.

Another connection, if you search the acro forum for the name "McCue", you'll find people who went to Animal Medical Centre in New York for pituitary surgery for acromegaly (hypophysectomy). At Animal Specialty, the neurovet interested in pituitary tumours is named McCue, who had previously spent some time in Animal Medical Centre. Maybe he works both places? Anyway, definitely knowledgeable.
In it's heyday, the Animal Specialty Center had some of the best vets in the area, recruiting folks from the Animal Medical Center. At one point, it was sold to VCA but they didn't own it for very long. When we needed an oncologist for another cat last year, we went to Katonah Bedford Veterinary and found the Medical Director and admin team all came from ASC. His wife is "Dr Sue(Ettinger) cancer vet" of YouTube fame who is at Guardian. She's another ASC alumni.
I am familiar with Dr. McCue as I had reached out to the AMC regarding my acro cat but unfortunately I lost her to recurrent pancreatitis attacks during covid. We hospitalized her several times at ASC but despite all our efforts, she kept relapsing and her small cell lymphoma didnt help matters. I didn't realize Dr Mccue is now in Yonkers. Luckily, I haven't had to use their services recently. Fingers crossed it stays that way!
 
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