Cabergoline a bust - what now?

SallyGT

SallyGT

Member
Sally is about six months into Cabergoline treatment. We began with 25ug (~5ug/kg) daily (she vomited when using a larger dose every other day), and gradually increased to ~10ug/kg/day. Since commencing treatment, the Lantus dose necessary to keep her well-regulated has risen from 12.5u to 19u. We are, regrettably, coming to understand that Cabergoline may not be the miracle drug for her that it is for some cats.

We're hoping for some advice about what to do next--i.e., do we just keep giving her as much insulin as is necessary to keep her regulated, or should we consider SRT? Her quality of life is generally good, though her vitality seems to have waned somewhat in the past year. Several vets have palpated her abdomen in the relatively recent past and organ enlargement was not significant (despite outward appearance of acro "potbelly"). Appetite is strong as ever. No weight loss. She has mild hyperthyroidism that is easily regulated by a small dose of methimazole. Her most recent bloodwork (March '22) looked great. She is about 11 or 12 years old.

Cost of the procedure is not an important consideration; we're concerned with safety. People make mistakes, and we have trouble trusting any person to wield gamma radiation at Sally's brain. We're in Virginia, so we would probably bring her to NC State for the radiation therapy. She seems to be doing well for now, but we're worried that if we wait too long to do the procedure her outcome would not be as good. We just want her to live as long and as well as possible.
 
SallyGT said:
Sally is about six months into Cabergoline treatment. We began with 25ug (~5ug/kg) daily (she vomited when using a larger dose every other day), and gradually increased to ~10ug/kg/day. Since commencing treatment, the Lantus dose necessary to keep her well-regulated has risen from 12.5u to 19u. We are, regrettably, coming to understand that Cabergoline may not be the miracle drug for her that it is for some cats.

We're hoping for some advice about what to do next--i.e., do we just keep giving her as much insulin as is necessary to keep her regulated, or should we consider SRT? Her quality of life is generally good, though her vitality seems to have waned somewhat in the past year. Several vets have palpated her abdomen in the relatively recent past and organ enlargement was not significant (despite outward appearance of acro "potbelly"). Appetite is strong as ever. No weight loss. She has mild hyperthyroidism that is easily regulated by a small dose of methimazole. Her most recent bloodwork (March '22) looked great. She is about 11 or 12 years old.

Cost of the procedure is not an important consideration; we're concerned with safety. People make mistakes, and we have trouble trusting any person to wield gamma radiation at Sally's brain. We're in Virginia, so we would probably bring her to NC State for the radiation therapy. She seems to be doing well for now, but we're worried that if we wait too long to do the procedure her outcome would not be as good. We just want her to live as long and as well as possible.
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Honestly, I live with two cats who have had SRT and, believe me, they are just fine. Yes, people make mistakes, but the precision of SRT is phenomenal. One of my cats, Blue, needed only one session while his brother Eddie, whose tumour was much larger and precariously situated near the hypothalamus, had 3 fractions. Organ enlargement is certainly a concern but so is a growing tumour on the pituitary. Blue has had acromegaly since 2017 and Eddie was diagnosed in 2020. Both are still with me! Wishing you and Sally all the best...whatever you decide.
 
I had one cat who had SRT twice. That's very rare to have the tumour come back, but it did after 3.5 years. I went to Colorado State University, but the folks at NCSU are also very good. One of the leading researchers at CSU moved to NCSU, and so did some of the people trained at CSU, which was one of the first places to do SRT on cats. @Max & Lori went to NCSU recently. Without treatment, life span will be shorter. SRT also reduced a lot of the acro symptoms and gave Neko a much better quality of life. The sooner you start treatment, the better.
 
I understand your concerns. I had the same concerns as you have. I live in NC and we went to NCSU. The staff there was great. Dr. Nolan was excellent. He answered all of my questions every step of the way, and his team took great care of Max. Max is 13 years old now and had SRT in October of 2021. I am recently starting to see some of the benefits of SRT. He’s gradually coming down on his insulin requirements and he has returned to being the playful cat he always was. Acromegaly had really begun to take its toll on Max before SRT. He does have some of the organ enlargement you mentioned and he has several comorbidities. It’s helped him tremendously. We are very pleased with the outcome so far and hope to continue to see improvement in Max’s quality of life. Wishing you the best.
 
Thank you, to everyone who has responded so far. We're glad to hear that SRT had such positive outcomes for all of you!

Has anyone found a statistical description of complications associated with SRT? Like, per number of procedures performed, how many cats experienced blindness? I can find a few here and there (e.g., Colorado State published a study of 53 cats undergoing SRT w/14% experiencing hypothyroidism post-procedure), but I was hoping to find summary information integrating multiple studies.
 
I've never seen a cat here go blind from SRT. You saw the CSU study, that's probably as good as it gets for statistics as they've probably done the largest number of acrocats. I doubt there is a summary study that's been published. I keep looking for papers on acros/treatment, though probably overdue for another search. The only side effects from cats here are a couple went hypoT, and another couple with headaches the days after the procedure that were gone after a few days. One cat I remember was hoarse after due to the intubation, but again that went away in a couple days. Some cats have issues due to anaesthesia - Neko had an issue there for her second SRT, but she survived. If you want to hear more, best to write NCSU and see if they have any data. SRT is done for other conditions too, but I haven't looked for any data on those for cats.
 
Jodey&Eddie&Blue said:
Honestly, I live with two cats who have had SRT and, believe me, they are just fine. Yes, people make mistakes, but the precision of SRT is phenomenal. One of my cats, Blue, needed only one session while his brother Eddie, whose tumour was much larger and precariously situated near the hypothalamus, had 3 fractions. Organ enlargement is certainly a concern but so is a growing tumour on the pituitary. Blue has had acromegaly since 2017 and Eddie was diagnosed in 2020. Both are still with me! Wishing you and Sally all the best...whatever you decide.
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How much did you pay and did the tumour die?
 
Update. Sally had srt at NCSU in August. $15k out of pocket and her insulin requirements are still 20 bid. That's the same as they were prior to treatment, but they were up to 30 in October and are on their way down, slowly. So, we are cautiously optimistic that it's helped some.

The really bad thing was that she had a severe case of ileus after the second anesthesia application and nearly died...
 
SallyGT said:
Update. Sally had srt at NCSU in August. $15k out of pocket and her insulin requirements are still 20 bid. That's the same as they were prior to treatment, but they were up to 30 in October and are on their way down, slowly. So, we are cautiously optimistic that it's helped some.

The really bad thing was that she had a severe case of ileus after the second anesthesia application and nearly died...
Click to expand...

Hi, thanks for replying

Did they say you have to do multiple treatments ?
 
A very small percentage of cats have the tumour regrow after several years. Neko was one of them, and the first kitty, at least in North America, to have a second SRT. But more than 3 years after the first one. Jodey's kitty Eddie also had second SRT but he is an even more complicated case with surgery done first, though not successful at removing the tumour.

There was one kitty here that had SRT 3 weeks before Neko, who was around 20 units. He ended up going to around 50 units before he turned it around and started going down dose. Unfortunately he got a completely unrelated blood cancer and passed from that. :(

I hope Sally's dose trend continues down.
 
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