Acromegaly

I went back to the vet today just to show her the insulin and my syringes, and to have her observe my drawing up. I really was hoping I was doing it a little off. I got two results in the 300s and was so ecstatic, but not since then. But, she said my administration was fine. Even though Scarlette shows no sign of acromegaly, she is like me. Something is preventing the insulin from doing its job. She wants to send a blood sample out to test for acromegaly, and she suggested a possible GI possibility, namely pancreatitis. That would be more la s, another send out. What do you guys think? She also mentioned the possibility of GI bleed. If both negative, we could possibly go up a unit, but she does not want to do that. At all. It would then be a decision time. I am going to research it, but I wanted info from anyone who went through it firsthand. Thanks.

 

Hi Laurie,

Have you had a chance to read the thread on Acromegaly? Lots of good info here - I was thinking I gave it to you already, but just in case I hadn't, here ya go.

If I were you, I'd do 3 things:

1. I'd always get at least one mid-cycle test each day - the before bed test is ideal - so that you can have confidence that there are no lower numbers there. If you're going to increase the dose, you really need to get in the habit of doing it even if it seems stupid because she's always high. As you change her dose she won't always be high.

2. I'd get the acro test (IGF-1) and the insulin auto antibodies test both done. Vets seem to think that iaa is rare, but we see it fairly often here. The main cost to the testing isn't the test, it's the blood draw and shipping and vet fees - so doing the iaa test in addition won't cost much extra.

3. I'd read up on the link I gave you above.

Pancreatitis can raise blood sugar, as can hyperthyroid and infections/inflammation. But I doubt they would be responsible for the numbers you are seeing. I'd spend my money on the acro/iaa tests first and if negative, then look at other options. Typically cats with pancreatitis act/feel sick, so usually there are more signs besides just a larger insulin dose. Pancreatitis is common in diabetic cats, but usually people notice other symptoms.

Glad you had the vet check your shooting technique. If you are using the pen needles, you will likely want to switch to syringes instead so you can have more control over the size of the dose. Have you watched the video on how to draw up your insulin so you don't contaminate it? It's a little ways down the page on that link. I'm just wanting to verify that your Lantus is still good. How old is the vial/pen you are using?

edited to add - i just saw you are using syringes, so that's good. I wouldn't increase the dose by an entire unit at a time at this point.

 

I have some more labs I plan on entering today around lunchtime. They did a UA C&S and all was clear. No UTI. I will probably have all the labs drawn; for acromegaly and the GI labs. The acromegaly is sent off to one place, and the GI labs (amylase, lipase, and one other, are sent to another). This is my concern. The vet thought she had ascites, and with ultrasound found she did not. The other possibility is pancreatic cancer, which will also cause insulin resistance. Since we have abdominal distention, I am wondering if more likely to be GI. However, why not be on the safe side and test both. One has to be fasting so I will have to either wait until Saturday and go when I get up in the morning, then come home and test and feed, or schedule for a Thursday right after work. She is booked this Thursday. Also, another problem. If both are negative, then what? Or, even positive, then what? I read there is no treatment for pancreatitis. With people we make them nothing by mouth as eating causes intense pain. We put them on antibiotics. If it turns out to be a mass I doubt I can afford to even treat. My thinking is that at least test to rule out or confirm. Then, I can decide if I need to let her go. I do not think now is the time because the labs are not horrendous. May try to go ahead and post...

 

The vet has not said acromegaly is rare. She said it happens more with cats getting large amounts of insulin. On my way there, that is for sure. Even though no physical sign at this point, that does not mean she isn't on her way. Also, I remember President Lincoln had acromegaly.

 

I went ahead and updated labs but I need to check her glucometer for recent results.

 

By far the most likely culprit is acro or iaa. I'd check those first and save the other possibilities for a plan b. It would be easier on Miss Scarlett to start there first.

 

Hi Laurie,

Question...Scarlette has her tongue out in her avatar...is it often/always like that?

 

Laura, there is treatment for pancreatitis. I don't know if there is for pancreatic cancer though. The blood work would confirm or eliminate some of the possibilities.

 

LOL. No, her tongue is not out like that. I loved that I caught her mid-yawn. That just brought back a good memory and made me laugh. When she was feeling better. No worries about me drawing up. I took the insulin and syringes in last night for her to observe. I passed that test. Am I going to need to take out another mortgage to get the acro test done?

 

Polly's tests were comparatively inexpensive. MSU where we had the testing done is very reasonable. Biggest expense was the local blood draw and the shipping. So, I guess it depends on your local vet charges for the draw.

Marilyn and Polly

 

I'm not sure what is on the GI panel that you are getting. Amylase and lipase are no longer considered diagnostic for feline pancreatitis. If the other test is a TLI, that can be diagnostic for EPI, or exocrine pancreatic insufficiency. They may also be testing B12/folate. The best test for pancreatitis is the spec fPl. There is treatment for pancreatitis, which can be chronic or acute in the cat. Treatment for chronic pancreatitis involves various medications to treat symptoms while the pancreas heals. If you look on the Health Links forum of the board and scroll down to "A Primer on Pancreatitis", there is a lot of good info there. NPO is not done for cats, nor is a low fat diet considered any longer to be effective (despite anecdotal evidence to the contrary). The goal is to keep the cat eating to avoid the development of hepatic lipidosis. Pancreatic cancer is a serious disease. If that is suspected, then an ultrasound guided needle biopsy could give you more info on what you are dealing with.

 

Sorry, hijacking ever so slightly here. Does it signify something if a cat does that often?

 

Laurie, HERE is the link to the Primer on Pancreatitis. There is a lot of really good info there. It's totally treatable. Harvey has it, as did my civvie, Minka.

It was IAA that Julie said some vets think is rare. As long as you're getting all the other tests, you should ask for that and the spec fPl for pancreatitis.

 

Pot belly or abdominal distension is a common sign of acromegaly. Neko had no signs, other than tearing eyes, until well after her acromegaly diagnosis. In the Acromegaly info link that Julie gave you is some of the recent research by he Royal Veterinary Clinic, the forefront of acromegaly. They tested every cat coming into their diabetes remission clinic, to remove acros from the cohort. They found one in four were acros, with doses ranging from one unit to 35, average dose bid of 7 units. More high dose cats are tested for acromegly than lower dose cats, so it seems like a condition of higher doses.

 

Lol....I wasn't trying to alarm anyone, but when I saw Laurie's cat with her tongue out, I just had to ask. It looked a lot like my Peek-a-Boo's tongue, except his was out 99% of the time. I have no idea why this was the case, and I can't tell you how many times I've been asked if that was normal for him by veterinarians and staff. I'm hoping Scarlette does not have the acro, but the IGF-1 test was $55 for me in Indiana...it was then sent to MSU.

 

Oh, no, I wasn't alarmed - I just wondered because it was something our Shadow started doing all the time about 3 weeks before she passed. I didn't want to say why I was asking in case it meant something bad - but if it was just a random question, I'm not too worried about saying why now. Our vet said it wasn't linked to anything at all apart from very advanced age...but I was just curious in case you knew something they didn't.

 

Laurie,

I think @julie & punkin (ga) gave good advice. I agree that pancreatitis would likely make a cat act/feel sick. My boy was diagnosed with diabetes first because I took him in due to lethargy and increased eating, drinking, and urinating, but soon thereafter he developed a pot belly, and snoring type sounds when he slept. I learned about the IGF-1 test from members on here, and am so glad I did, as it was the key to his diagnosis after 9 months of my vet scratching his head as to why we wasn't responding to insulins (we tried 3 up to 4U BID). I have a wonderful vet, don't get me wrong, but he thought all acros displayed the broad face and big paws, which we know is not always the case. I told him to please humor me and do the IGF-1 test. His results were off the charts. We then knew what was causing his issues. A CT scan was done to confirm.

His tongue was always out, and after a major dental that left him with only a few teeth in his mouth, his tongue hung out even further and the acro did make his tongue much wider .

I will be watching for future posts on Scarlette....prayers for something simple and treatable.

Dawn

 

So you don't see-saw the dose between the pen and the syringe, right? The lubricant in the syringes can contaminate the insulin and become a problem. Other insulins apparently don't have as much of a problem with it as Lantus does, so your vet may/may not know that it's not recommended to squirt the insulin back from the syringe to the pen.

There's no note on your ss as to when you started new insulin. Are you still on your first pen? When did you start using it? It's helpful to make a note every time you open new insulin - it's usually not the insulin gone bad when cat's numbers are high, but we have had at least a few times when it was a problem.

When I had punkin's acro and iaa tests done in 2011 it was a little over $200, I believe. The tests themselves aren't that much, but the mailing and the vet fees added up. Some vets will double the fee that MSU charges and call that "interpreting the lab results." Your vet will determine most of how expensive it is to you to get her tested. If you click the links I've given you, you can see how much MSU charges for the actual lab tests.

 

I don't use a pen. My previous vet wrote a script for the vial. I use syringes only. The new vet told me I can get the pen for $25 or $35 at Target if Infet online and print out the Lantus coupon.

 

The labs will be less than the cost of one vial of insulin.

 

One more thought - did you buy your vial from a human pharmacy or from the vet?

Just trying to dog through all the possible reasons for not seeing a response in the insulin before you spend more $$.

 

Correct. Human pharmacy, Walgreen's.

 

And how old is the vial?

 

Thank you.

 

Couple of weeks, new.

 

So, Dawn, how do you treat the acromegaly. Other than radiation. Dr. Downes suggested we do have it run, but what then?

 

ok, so very new. Check that one off the list. It's not likely the insulin, then.

At the bottom of my signature line it says "Punkin's SRT Treatment" - you can click there are read about his treatment for acro if you are interested.

 

I looked at her labs and they look pretty good. Would you mind entering the date at the top of each column so we know when they were done. If you try to enter and can't see the print then you might need to click on the square and go up to the top, left of the pitcher, and change the fill color to black.

Linda is right that the current GI panels test for folate, cobalamin, TLI (for exocrine pancreatic insufficiency), and specfPL for pancreatitis. I also think if she had a GI bleed, you'd be seeing three things: (1) anemia, (2) dark, tarry stools, and (3) eventually low BP. I think if she had pancreatitis, you'd be seeing vomiting, nausea, abdominal pain, possibly anorexia.

 

I'm not Dawn, but the majority of people do not treat acromegaly. To quote the IM vet folks at CSU, the most important thing you can do for an acro cat is treat them with enough insulin to keep them under renal threshold as much as possible. There are three possible options for other treatments. Radiation is the most common and has been done the longest, with SRT and CyberKnife being the latest radiation technologies. There is a surgical procedure called the hypophysectomy that removes the pituitary gland. The best place to get that done is the UK and there are a couple of other places in the US, but the surgeons are not as experienced as those in the UK. It's still a fairly new procedure and the success of the result depends on the experience of the surgeon. There is also a new drug called paseriotide that has been quite successful in studies, but it's very expensive.

 

Hi Laurie,

Wendy kindly stated the options available for treating acromegaly. My cat received his diagnosis confirmation at Purdue University Veterinary Teaching Hospital, and they were willing to do both the removal of the pituitary gland, and the SRT, however, they had never done either procedure on an acromegalic cat before. I was not comfortable with giving them the go ahead, since acromegaly in general was new territory for them. They told me they had seen only 1 other cat with the condition. My boy was extremely difficult to handle when he received medical care, the trips we made to the teaching hospital were about 1 1/2 hours away, and those days would completely exhaust him...he was also born blind which added more stress...traveling farther than 1 state over seemed overwhelming.

As far as managing the acro, I agree with Wendy in that the diabetes must be controlled first and foremost. I was very lucky with Peek-a-Boo in that he finally settled into his 4U BID of Lantus. He had neuropathy, where he walked with his feet flat on the ground, and his front paws were "bent" lower on the wrists (if that makes sense?). You could actually hear him thumping down the hallway. As soon as his numbers were in control, this was completely reversed in a relatively short time. He somehow managed to stay regulated at that dose for over a year. He also consistently ate LARGE amounts of food.

He was also diagnosed with HCM (hypertrophic cardiomyopathy- acro symptom) which we took 1 tablet of Plavix daily to ward of any blood clots. He suffered from chronic constipation as well (most likely from diabetes dehydration/acro causing enlarged organs which press on colon), but I used Miralax daily mixed in his food.

At the beginning of this year, his kidneys started to show signs of damage. His phosphorus levels were elevated so I switched to low P food, and he started spilling protein into the urine (proteinuria). This, unfortunately, was also due to the dreaded acro.

I lost him on April 13. He became constipated to the point of needing an enema after a day of producing no stool. He was sedated, treated and released to me but never fully "came out of it" after returning home. I rushed him back to the clinic, but his body was shutting down. I sadly had to have him put to sleep. He was 11.

This all occurred over the span of about 2 years...22 months to be exact.

Please feel free to ask anything....I could talk about my beloved Peek-a-Boo all day. Best wishes to you and Scarlette.

Dawn

 

Hi Laurie,

How is Scarlette doing? Did she ever get an IGF-1 test? Just wondering if her insulin has started working for her.

Dawn

 

The IGF-1 test is the bloodwork that your vet referenced. Acro is rarer than feline diabetes... but the Royal Veterinary College (RVC) has found that more than 25% of diabetic cats have acromegaly. The bloodwork is only done at Michigan State Univ Vet School. Tell your vet to call MSU and get them to send the mailer. The blood is drawn, spun, frozen and shipped overnight. The FedEx mailer costs more than the prepaid one from MSU. The testing is run only one day a week. We drew on Mon and it was run on Wed, with results on Friday... but that was a few years ago.

Grayson did not show symptoms until about 2 yrs after the FD diagnosis, and I'm certain he was FD for at least a year before the dx. He had dropped from 18 pounds to 12 pounds when we got the diagnosis and after SRT. Hard to imagine my little anorexic-looking guy was "a giant"... but then I saw his jack-rabbit legs and realized he had had a growth spurt. And he kept growing. Got up to 26 pounds. Ask questions - read the documents on the acro forum. I printed several articles, highlighted and then made a copy for my vet.

If you decide you want to treat, there are several options. We went to CSU where most of the SRT treatments in the US have been done. But there are several places now offering it around the US. And some offering cyber-knife SRT. Washington State is performing the surgery to remove the tumor in the US - RVC has done the most surgeries. They (RVC) also did a drug study on Paseriotide, that others have used as well, despite it being VERY expensive. In addition, if you get a positive IGF result, there are others who have only done palliative treatment. But don't put the cart before the horse. Get the test - it's not too much... I think about $49 and whatever your vet charges for the draw and shipping. Then you'll know what you're dealing with... and can go from there. We did the IAA test at the same time - it was about $15 and they shipped together.

Read. Ask questions. Test. Then roll with whatever the results are. And hang in there.

 

I haven't had it checked yet. It may be another couple of weeks. My father passed away last week, and we are all having to deal with what happened. It was due to a fall. He was in his 80s. COD blunt force trauma to the trunk. The ER doc said he suffered lung injury. Maybe later next week...thank you for asking.

 

(((Laurie))))

I'm so, so sorry for your loss. Please let us know if there's anything we can do.

 

Please accept our condolences.
Liz, Anne and civie Tillie

 

I'm so very sorry, Laurie...please know you are in our thoughts and prayers, and - as Sienne said - please let us know if there is any way we can help.

 

So very sorry for your loss Laurie.

 

(((Oh Laurie))),

So very sorry to hear about your father. You will be in our thoughts and prayers...big hugs to you and your family at such a difficult time.

Dawn

 

I'm so sorry, Laurie. You have my deepest sympathy in the loss of your dad. A million hugs going your way.

 

So sorry for your tragic loss Laurie. I hope you can feel the collective hug from all here. Peace.

 

My deepest condolences to you Laurie and your family on the sudden loss of your father.

 

So sorry you have lost your Dad Laurie. My deepest condolences to you and your family