Bodie's IGF 505 nnmol

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Bodinator

Bodinator

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Hi Acrocat moms and dads, I'm a new member of the club.
Bodie's IGF on Sept 12 was 505 nnmol. I haven't been able to find too many treatment options in or around Chicago and we are scheduled for an MRI at Medvet in ten days time. The internist specialist there tells me there that radiation is the only option. Bodie's dose of insulin is at 2.5 units which we're going to increase. He already has bigger paws and until last week he was rapidly losing weight. I managed to keep him at the same weight last week by feeding him lots of cooked chicken. That was a relief. I wonder how long I can put off making a decision about radiation and increasing his insulin.
 
Hello Mary and welcome to you and sweet Bodie. One in four diabetic cats has acromegaly, according to the most recent research, so you are in good company. :bighug: Brodie is on still a relatively small dosage of insulin. That research I mentioned said the average in their test group was 7 units BID, but we have some acrokitties on much larger doses. My Neko got up to 8.75 units. As far as dosing, a cat needs as much insulin as he needs. If Brodie's not in good blood sugar numbers, increase the dose. The acro tumour can pulse up and down, so you will find his dose needs change over time. Which is why it's good you are home testing. You want to get his numbers under renal threshold as much as possible, to reduce the impact on his kidneys.

A lot of people with acros find that Levemir is a better insulin, because it is a bit longer lasting. Lantus can sting at higher doses.

First a question for you, what does the vet hope to achieve with a MRI? With the IGF number you've got, I don't think you need any further diagnostics, especailly since you are seeing some visible signs. If you were to do radiation, a CT scan is typically the first step for planning the radiation. They would do an MRI if the CT scan doesn't show enough.

As for treatments, there are a few in the US (I am in Canada so similar options). First, the gold standard treatment is hypophysectomy, or surgical removal of the pituitary. The surgery is done in a very limited number of places - Washington State U being one. There isn't much expertise in that surgery in North America but a lot in London at the Royal Veterinary Clinic (RVC) which is at the forefront of acromegaly research. I have heard of people flying their cats to London from elsewhere in Europe, but it's a long trip. The treatment that you'll most commonly seen done here to date is SRT, or stereotactic radiation therapy. That's what Neko had done at CSU or Colorado State University. There are a number of other places in North America, and growing, that do that radiation. Petcure Oncology (Milwaukee) might be your closest options. Cyperknife is a slightly more advanced type of radiation treatment, but done in fewer locations.

There are a couple of medical options, cabergoline is a new mostly experimental approach that has been quite successful in a few kitties. Pasireotide is a more successful medical approach, but rather more expensive. Other than that, the vast majority of people with acrocats don't do treatments, and rather just treat with however much insulin they need. Until the very recent cabergoline trials, most of the treatment options have been rather pricey and radiation/surgery involves travel for most. Having said that, the field of treatment for acromegalic cats has changed a lot in the last few years. But it also means most vets aren't on top of the latest treatments. Heck, a lot of vets still think it's a rare condition they'll never see!
 
Thank you so much for your information packed response, Wendy!

I have been lurking and wondering what to do because my regular vet is a bit intimidated by the diagnosis and wants to defer to Medvet (although it sounds like she better get used to seeing acromegaly!) Medvet only offers radiation treatment. I couldn't figure out how everyone else was managing. Medvet said I can increase his insulin every 2-3 weeks, but I think I have seen people on here go by cycles, what's a cycle?
 
A cycle is the time period between shots. If you give two shots a day, there are two cycles, the AM and PM cycle. I don't know much about Prozinc, but there is a Prozinc/PZI forum here that has a dosing method they follow. People on that forum can probably help you regarding how to change Bodie's dose. My familiarity is with Lantus and Levemir and we can change dose as often as every 3 days.

My vet also thought Neko was unusual and rare and didn't know much about acromegaly. She contacted the local internal medicine vet who told her we didn't need to test Neko for acromegaly until she got to 10 units. Which she never did. So Neko's vet and I learned together with the help from people here. Not long after, the vet discovered another acro in her clinic, now that she she knows what to look for.
 
Thank you Wendy, I'll go and look on the Prozinc board. The internal medicine vet said that Bodie was only the second acromegaly cat in his career (of, I'm guessing, a dozen years). He also pulled a face when I mentioned FDMB. Maybe if he read the posts on the board he'd learn something :).
 
I'm a former Chicago person and had a wonderful vet there. I truly like and respect two of the vets at Cat Hospital of Chicago -- Drs. Czerwonky and Tompkins. (There's also a new vet who I don't know.) The owner of the practice is very much involved with feline veterinary medicine at a national level. You may find they are more familiar with acro there. This is the link to their website.

It does look like MedVet does SRT. However, like Wendy noted, I don't know if an MRI is going to do much other than set you back a lot of money. It sounds like the diagnosis is pretty well confirmed by the lab results.
 
Thanks Sienne, I had forgotten about them. I have been there but not with Bodie. It looks like the second vet on the website is Thompson, is that the one you're thinking of, not Tompkins? I love that quote by the way :)
 
Bodinator said:
The internal medicine vet said that Bodie was only the second acromegaly cat in his career (of, I'm guessing, a dozen years). He also pulled a face when I mentioned FDMB. Maybe if he read the posts on the board he'd learn something :).
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Yup, way more practical knowledge of acromegaly here than most vets have. We also tend to be proactive and go hunting for solutions for our furbabies. Can I ask why your vet thought to test for acromegaly? It's unusual (but good) for vets to think of testing for cats on smaller doses of insulin.
 
The regular vet suggested I go to Medvet and have him checked for everything because we just couldn't get Bodie regulated. Everything came back OK except the IGF. My regular vet is supportive but likes to be conservative with the insulin. Which would have been great if he hadn't had acromegaly.
 
Sorry -- I only saw her once with my kitties so no surprise, I butchered her name. Czerwonkly is there only part-time now given she has young kids. I really like the practice.

I loved the quote, too. I came across it a few days after Gabby crossed the Bridge.
 
Bodinator said:
My regular vet is supportive but likes to be conservative with the insulin. Which would have been great if he hadn't had acromegaly.
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No surprise, most caregivers don't test much if at all. It's really key with acros, as the tumour can pulse up and pulse down over time, changing their insulin needs. But count yourself lucky you have a diagnosis, most cats don't get tested until they are on much higher doses, so there are probaby lots of other small dose acros out there. Now you have a path forward.
 
Hi Mary and the Bodinator

Agree with the comments above. I responded to another thread with the info about Leo. You can read thru his thread. He was treated with SRT last Sept (2016) and it was successful. He was at 18 units/dose at the time. Now he is around 4-5 units/dose, but that is partly affected by the prednisolone he gets for small cell lymphoma.

While there is no requirement to get radiation, SRT is a pretty precise method. But it is expensive.
 
Thank you Wendy, You've melted a lot of my anxieties. The impatient internist called me today and, after I asked him directly, admitted that an MRI might not be necessary. Baby steps.

Jeff, I followed posts about Leo with a lot of interest. I wondered what it was like in the six months (?) between his diagnosis and getting the SRT. Bodie gets very hungry and can be quite a pain in the neck. Although right now he's lying peacefully on the floor by me. It's his 10th birthday today. :cat: I'm full of admiration to all the people who got SRT for their cats. We have already had a lot of conversations about what to do and the cost etc. I think we need to ease into it/save up. It seems like I don't have to rush into a decision.
 
Happy birthday Brodie!

Glad I saved you the cost of the MRI. :) You can put it into the treatment find. Do ask around for SRT costs, they do vary quite a bit, though it's better if you don't have travel costs on top.

Although the acro tumour is slow growing, the longer you wait, the more damage the growth hormone can do. So I wouldn't wait overly long, if you are thinking of treatment. I know of a couple of people who put SRT on Care Credit. Cabergoline is a less expensive treatment option, though it's early days and results are mixed.

The voracious hunger is a pain, which gets somewhat better when the blood sugar number are more controlled. I got an automatic feeder, the Petsafe 5, and fed Neko some of her meals out of that. Several mini meals seemed to help, and as soon as the feeder was on the floor, her attention went to that instead of me. :)
 
Thanks for reading Leo's thread. I hope it was helpful.

We used Care Credit to pay for the SRT, but paid it off pretty quick. We live debt free...maybe that is a niche role in America these days.

Leo's brief history:
2015 diabetes diagnosis, ~9/2015 insulin started
8/20/2016 Acro diagnosed - IGF high value confirmed
9/21/2016 SRT started

For the 6 months pre-SRT, his BG ramped up quickly.
- May 2016 -> 4 units/dose
- 8/1/2016 -> 8.5 units/dose
- 9/16/2016 -> 18 units/dose

He was impossible to regulate. Also impossible to get below 200. I was so afraid of a hypo. Symptoms:
- hungry all the time, begging, wailing for food a lot (not fun)
- neuropathy
- drank and peed a lot.

At the high dose period he looked "washed out" and limp. He was in a pretty bad state. I bet if we had waited, he would not have made it 2 more months. We absolutely made the right decision. It was expensive though.

Question: Is De Bodinator supposed to be pronounced with an Austrian accent like The Terminator?
 
Haa, I didn't think of an Austrian accent but I did want him to feel fierce and brave. Rraaarr!
Yes, that's my Bode, the food beggar, pees like a champ, some neuropathy, and mostly lies on the floor but can still jump up on the counter if there's food.
I have insurance but last year the premiums were so high I decided to cap bennies at $5,000. D'oh. Also we just bought a house and are moving in a couple of weeks. Thanks for the timeline and info, Jeff. Everything always works out OK in the end, right.
 
I remember those days (i'm almost retired). We have an orange cat too - Little Dude. Not as fierce, but very sweet.

Bodie is unregulated. I recommend you strive for nadirs of 120-150. Still in the safe range but that will help his kidneys and should help his neuropathy. I also dosed Leo with crushed Zobaline B12. It helps with the neural sheath rebuild that occurs with neuropathy. The key though, is BG regulation and getting better nadirs.

I agree on the budget. Overall, it is very easy to drop a lot of money on vet bills.
 
Hi Mary and Bodi!! Just trying to catch up here. Sorry to hear the DX but you're in the right place for answers on how to treat our special kitties.
:bighug:
 
JeffJ said:
I remember those days (i'm almost retired). We have an orange cat too - Little Dude. Not as fierce, but very sweet.

Bodie is unregulated. I recommend you strive for nadirs of 120-150. Still in the safe range but that will help his kidneys and should help his neuropathy. I also dosed Leo with crushed Zobaline B12. It helps with the neural sheath rebuild that occurs with neuropathy. The key though, is BG regulation and getting better nadirs.

I agree on the budget. Overall, it is very easy to drop a lot of money on vet bills.
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Little Dude is sooo cute! I love gingers. We're almost retired too, just late bloomers! He is already taking Zobaline and amlodipine for hypertension.
 
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