Cricket and her Acromegaly

Teresa & Cricket

Teresa & Cricket

Member
It is official, Cricket's test came back positive for IGF and has been diagnosed with Acromegaly, as was expected.

My vet wants to chat soon and I would love to get some feedback from you all about good questions to ask, treatment pros/cons, costs and experiences.
He wants to refer me to a specialist, not sure I can actually afford much of this, especially radiation.

I am also worried about radiation and surgery because of her HCM/CHF... seems risky.

I'm going to comb thru and read all the stickies, etc, but it would be great to get some personal experiences as well.

Thanks so much,
Teresa
 
So sorry about the diagnosis.:bighug:

My Neko had Stereostatic Radiation Therapy (SRT), cause it pretty much was the only treatment option available at the time. And it then cost about half what it does now. I'm pretty sure I got a couple years longer with Neko than if I didn't have the treatment done, and the time I did have was much better quality of life than if I hadn't. She got to quite low doses and was decently regulated, didn't have many acro symptoms until much later.

Additional treatment options now are hypophysectomy surgery (removal of the pituitary) and cabergoline, a daily medication. The latter is the cheapest, but results are hit and miss. We've had three cats go off of insulin and the majority go on lower insulin doses with cabergoline. There is another drug, pasireotide, that gets much better results, but it's very expensive. Yearly costs more than the radiation or surgery. There was, or still may be a trial in New York on hypophysectomy where the majority of costs are paid by a donation. Both cats here that have had the surgery are off of insulin. Basically cured.

Have you talked to a cardiologist about the idea of surgery? Neko had some surgeries when she had HCM, but the cardkologists said no to further surgeries after her CHF started.

No matter what you do, your first priority should be to get her to a dose where she spends most of her time under renal threshold. Acromegaly is hard on kidneys, don't want to make that worse with high blood sugar.

Keep asking questions, I know I had a million of them at the point you are now.
 
Wendy&Neko said:
So sorry about the diagnosis.:bighug:

My Neko had Stereostatic Radiation Therapy (SRT), cause it pretty much was the only treatment option available at the time. And it then cost about half what it does now. I'm pretty sure I got a couple years longer with Neko than if I didn't have the treatment done, and the time I did have was much better quality of life than if I hadn't. She got to quite low doses and was decently regulated, didn't have many acro symptoms until much later.

Additional treatment options now are hypophysectomy surgery (removal of the pituitary) and cabergoline, a daily medication. The latter is the cheapest, but results are hit and miss. We've had three cats go off of insulin and the majority go on lower insulin doses with cabergoline. There is another drug, pasireotide, that gets much better results, but it's very expensive. Yearly costs more than the radiation or surgery. There was, or still may be a trial in New York on hypophysectomy where the majority of costs are paid by a donation. Both cats here that have had the surgery are off of insulin. Basically cured.

Have you talked to a cardiologist about the idea of surgery? Neko had some surgeries when she had HCM, but the cardkologists said no to further surgeries after her CHF started.

No matter what you do, your first priority should be to get her to a dose where she spends most of her time under renal threshold. Acromegaly is hard on kidneys, don't want to make that worse with high blood sugar.

Keep asking questions, I know I had a million of them at the point you are now.
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Thank for the reply, Wendy
I’m emailing my cardiologist today to ask about risks- I can’t imagine her okaying surgery.
I will look into and bring up the cabergoline- I can’t imagine being able to afford SRT, it looks like $4-5K.

Vet wants to send me to a specialist and get an MRI.
Did you have an MRI? I imagine that is also insanely expensive. Is it just to see how big the tumor is? Because it doesn’t seem like that would effect treatment if I’m not doing radiation or surgery.

We are getting closer to a working dose. Over the holidays there was one day where she was full of energy and chatty, and her nadir was in the high100s for the first time!
And I’ve been getting way more time in the 200s.

Worried about the effect on her whole digestive system along with the kidneys. This morning she woke me up at 3am vomiting thick bile just after defecating with loose stools. She even went a little out of the box.

I got behind on her testing with the holidays and my birthday this week, but will get back up with it.

Xoxox
 
SRT at CSU where we went is a lot more than $4000 now. However, Sarah took Pig to Washington Srate U for a lot cheaper SRT last fall. Where do you live?

As for an MRI, heavens no, not required at all. And it requires anesthesia. Neko had a CT scan before her SRT so they could plan the radiation beams, but not otherwise. What was Cricket’s IGF-1 number? There are some small number of cases with false positive, though false negative higher chance with IGF-1 test, if the cat was tested soon after starting isulin. Some vets want the confirmation of the scan, but with clinical symptoms and high enough IGF-1, I wouldn’t bother with further scanning. Plus there is the danger of anesthesia.

Digestive issues and/or megacolon can be issues with our acros. Managing side effectss such as that and the heart are part of what you will have to do. As for blood sugar, you’ll want to start seeing the odd nadir in the high greens. That’ll bring down the whole range of numbers and be easier on the kidneys. Over in the Lantus forum we can help you with dosing if you want.

Happy birthday. :)
 
I live in Portland,OR, so WSU is not too far.

My cardiologist doesn’t seem concerned about the anesthesia, but I actually am so it is good to hear the MRI is extra—which is what I was feeling. They really like to do EVERYTHING.

I don’t know her IGF numbers, it is on my list to ask vet. Will let you know.

And thanks for he tips on dosing and digestive stuff.
At first I thought it was foods, but now weird stools just to happen randomly. I’m picking up some probiotics today.

Thanks for the dosing input, I’ll do that.

This is all quite daunting!
 
WSU wasn’t an option for me, back in the day, so it was a three day drive to Colorado. Oddly enough, we stayed our first night in Spokane near WSU.

Fo dosing, you really do want to start getting a test before every shot, to make sure it’s safe to give insulin. One of the acros on the Lantus board gave her mom a 45 this morning. :eek:

Probiotics are good. You might want to look at omega-3 or fish oil too, to help any inflammation. And keep track of what proteins you are giving and see if there is a correspondence with what Cricket is eating. I kept a “vomit log” to track allergies.:p Vet thought it was hilarious when I told her I had to consult the vomit log to answer a question.
 
Wendy&Neko said:
WSU wasn’t an option for me, back in the day, so it was a three day drive to Colorado. Oddly enough, we stayed our first night in Spokane near WSU.

Fo dosing, you really do want to start getting a test before every shot, to make sure it’s safe to give insulin. One of the acros on the Lantus board gave her mom a 45 this morning. :eek:

Probiotics are good. You might want to look at omega-3 or fish oil too, to help any inflammation. And keep track of what proteins you are giving and see if there is a correspondence with what Cricket is eating. I kept a “vomit log” to track allergies.:p Vet thought it was hilarious when I told her I had to consult the vomit log to answer a question.
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Lol The Vomit Log! I so keep track of vomits, but am now going to include the food she ate that day. I was tracking it a bit with the stools...

Yikes, 45 is scary! I’m trying to do it more, it’s hard before meals because she’s sooooo anxious to eat and she gets very aggravated when I’m doing it regularly. I have an easier time getting a read about an hour before I feed her, if I’m home. Or if she eats a little and chills, but then I wonder how accurate it is right after food.
 
Usually a test is pretty accurate if you can get it done within 15 minutes of eating. It takes 20-30 minutes for the carbs to go from the plate to the blood stream,. I made sure Neko was getting a good supply of zero carb treats when I tested before breakfast. She quickly learned that a test was part of food prep routine.
 
Wendy&Neko said:
Usually a test is pretty accurate if you can get it done within 15 minutes of eating. It takes 20-30 minutes for the carbs to go from the plate to the blood stream,. I made sure Neko was getting a good supply of zero carb treats when I tested before breakfast. She quickly learned that a test was part of food prep routine.
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That’s good to know, I’ve managed to get pulling at dinner to finally go smoothly— with the promise of food after!
 
Wendy&Neko said:
Usually a test is pretty accurate if you can get it done within 15 minutes of eating. It takes 20-30 minutes for the carbs to go from the plate to the blood stream,. I made sure Neko was getting a good supply of zero carb treats when I tested before breakfast. She quickly learned that a test was part of food prep routine.
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@Wendy&Neko
Cricket’s IGF-1 is 229.

My vet wants to refer me to a specialist for all other work. I mentioned clabergoline and he doesn’t feel comfortable prescribing a drug he’s never heard of. Sigh.
I’m scared to find out what the specialists actually charge just for an initial exam.
 
There is a thread on this forum that I started as a discussion of cabergoline. You might want to read it and maybe print out the linked paper for your vet. My vet tried to send me off to a specialist too after Neko’s acro diagnosis, but I declined, and kept working with her until Neko got more complicated with the heart. You can always phone the specialist and ask for a quote. My first IM vet visit was around $150, but I spent a full hour with him. Of course the ultrasound, echo and bloodwork were extra. The IM Vet was really good at balancing multiple conditions. Many people here just went to their regular vet for cabergoline.
 
Leo had SRT at CSU. Like Wendy said, WSU wasn't an option in 2016...or at least they didn't advertise enough for us to hear about it. If I did it again, I would probably drive an extra day to WSU.

You can read about Leo's SRT in his thread in my signature. He is now 2 years and 3 months after SRT, and we are so happy we did it. He is not in perfect health, but he is doing pretty darned good and gives good cuddles.
 
Wendy&Neko said:
There is a thread on this forum that I started as a discussion of cabergoline. You might want to read it and maybe print out the linked paper for your vet. My vet tried to send me off to a specialist too after Neko’s acro diagnosis, but I declined, and kept working with her until Neko got more complicated with the heart. You can always phone the specialist and ask for a quote. My first IM vet visit was around $150, but I spent a full hour with him. Of course the ultrasound, echo and bloodwork were extra. The IM Vet was really good at balancing multiple conditions. Many people here just went to their regular vet for cabergoline.
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He actually said he doesn’t feel comfortable managing the disease and wants me to go to a specialist, regardless.
I did offer to show him literature.
I actually agree that I need an IM specialist, esp because she is a year past CHF.
I’m going to call around Monday for quotes and will read the cabergoline thread, as well as threads on SRT.
I’m actually about to get a promotion at work, so I might be able to qualify for a better credit card or loan to help with all of this
 
Most vets don't know about Acro. We hear that often on this forum. As an example, my vet (female ~50 years old) has her own cat-only vet practice. When Leo was diagnosed with Acro, it was her first case. She also referred me to an IM.

- my vet told me she has over 2,500 patients/folders, and could be more
- the IM vet had only handled one other Acro case, and that IM vet was a partner who started an IM veterinary practice that employs over 10 vets

....so my point is that Acro just isn't not very well known by many vets. And I am fortunate that my vet is absolutely stellar on many other feline issues.
 
JeffJ said:
Most vets don't know about Acro. We hear that often on this forum. As an example, my vet (female ~50 years old) has her own cat-only vet practice. When Leo was diagnosed with Acro, it was her first case. She also referred me to an IM.

- my vet told me she has over 2,500 patients/folders, and could be more
- the IM vet had only handled one other Acro case, and that IM vet was a partner who started an IM veterinary practice that employs over 10 vets

....so my point is that Acro just isn't not very well known by many vets. And I am fortunate that my vet is absolutely stellar on many other feline issues.
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That makes sense, none of my friends know WTH I am talking about when I mention it!
I’m lucky in that he does know about it, he suspected it looking at her info right away. (I go to a vet hosp w/multiple DRs and my usual one just left last month). Lucky for me, he used to work at a specialist office and had a lot of experience w/ feline diabetes.
So I actually trust him in passing it on, esp w/her multiple issues, with neurologic Sx, etc.
I just need to shop around because I don’t like the recommendation he gave me —it’s a VCA hospital and in a suburb.
I’m going to look at private offices and call the non-profit hospital where Cricket was being treated for cardiology stuff.

And I’ll read up on your experience w/Leo when I get a chance— still figuring out the forum and searching threads.
 
One in four diabetic cats has acromegaly, but most vets don’t know that yet. When Neko was diagnosed, her vet didn’t think I needed to test for the “rare” condition, or what the clinic owner called exotic tests.:rolleyes: After both the IAA and acro came back positive, I gained a lot of cred. Plus Neko’s vet realized another of her diabetic patients also had acromegaly. Neko’s acupuncture vet also thought is was rare until I helped her research, then she realized that one of the neighbourhood strays she had adopted was acro.

Good luck finding a new specialist vet.
 
Cricket has an appointment with an IM specialist this Wed, fingers crossed that they are awesome!

In other news, her BSL has gone back up to the pinks and today- the first curve I've been able to do in a bit- her level barely moved at all.
It seems to have started just a day or so after I started a new solostar pen. Could it be a bad batch of lantus? It doesn't expire til 2021, but I was given it as donation from the Diabetic Cats in Need org.
It was shipped next day with a cold pack and I put it in the fridge as soon as I got home and got it.

Also, it sort of coincided with a dose raise, but only .25 and it doesn't appear she is bouncing or anything.

My plan is to raise it starting tonight and take more samples.
She's also acting tired, as one does when BS is high like that.

But I'm also considering just keeping the dose but trying a different pen (they sent me 3)

Any thoughts?
I might also post this on Lantus forum.
 
She’s possibly bouncing today. Without preshot data you won’t get much help with dosing, but it’s unlikely a 0.25 unit increase made a huge difference, typically a pt over 5 units dose we go up by 0.5 units increases. New juice might also have been stronger causing her to go lower a5bsomenooint and bounce. How old was the old vial?
 
Wendy&Neko said:
She’s possibly bouncing today. Without preshot data you won’t get much help with dosing, but it’s unlikely a 0.25 unit increase made a huge difference, typically a pt over 5 units dose we go up by 0.5 units increases. New juice might also have been stronger causing her to go lower a5bsomenooint and bounce. How old was the old vial?
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What is "a5bsomenooint"? typo?

I don't don't remember the date on the one I bought, but I think it also expired in 2021, that one came from Vet Rx.

I'm curious how it is "bouncing" if she literally hovered 304-310 for hours?
I meant to get one this morning, but mornings have been weird where she wakes me up for food super early, so she already ate 1/2 a meal about an hour+ before I give her more food and the shot. I'm going to get a preshot tonight and will try again in the morning.
Her other recent pre-shots have all been hovering in the mid 300's, with one red, but that was right after she vomited.

I'll start doing .5 unit increases from now on.

On the plus side, I seem to have figured out her stool problem and she's had normal BMs for 2 days :)
Thanks.
 
Well, she is at least having some initial response to her evening dose-which I raised to 6U
Preshot was 374, +2 296.

Her neurological issues seem worse when her numbers are higher-her right legs (front and back) are weak, almost seems like she has either little feeling in them... or maybe pain. She responds well when I massage the shoulder joint of the front leg. But it affects her gait, ability to jump down from things, and litter box balance (she has fallen in her poop a few times :()
It seems like a whole right side thing, I noticed the other day that she won't even lay down on her right side, only left. Also, when she eats, she leans in to the food with her rt side angled down, getting food all over her rt whiskers and nose!
 
Teresa & Cricket said:
Well, she is at least having some initial response to her evening dose-which I raised to 6U
Preshot was 374, +2 296.

Her neurological issues seem worse when her numbers are higher-her right legs (front and back) are weak, almost seems like she has either little feeling in them... or maybe pain. She responds well when I massage the shoulder joint of the front leg. But it affects her gait, ability to jump down from things, and litter box balance (she has fallen in her poop a few times :()
It seems like a whole right side thing, I noticed the other day that she won't even lay down on her right side, only left. Also, when she eats, she leans in to the food with her rt side angled down, getting food all over her rt whiskers and nose!
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Just got back from the IM, it was ahhhhhhh-lot. I’ll update youse further after I get home from work and process it all but basics:
*It’s looking like she’s not a good candidate for SRT— I’m going to still contact WSU to discuss further (details later)
*Hes worried about potential intestinal issues like IBS or lymphoma.
*Hes very worried about how fast her neuro sx are coming on
*wants me to return insulin to 5.25 and wait out 2 weeks, worried about bouncing

I’m gonna take time to process and then give you all the details- it was a lot.
 
Sorry about the worrying visit. :bighug::bighug:

Yes IBD/lymphoma or GI issues are not uncommon with acros, but can be controlled. @JeffJ Leo is getting close to two years in his lymphoma diagnosis and sounds like he is doing well on treatment.

Bouncing is not something to worry about, it’s a natural safety mechanism. Just me, but going lower in dose doesn’t seem the way to go. You also want to keep her under renal threshold as much as possible. If you lower the dose and her numbers get worse, I would be prepared to increase again.
 
For Leo, we were pretty worried about the SRT. But Leo was a good candidate. His insulin demand was increasing fairly fast - up to 18 units/dose by the time of SRT.

Leo's Small Cell Lymphoma was also very concerning. It is a devastating diagnosis. Treatment for Leo is chemo (leukeran) and prednisolone.

Leo's summary:
Leo born 6/19/2006
8/2015 Diabetes diagnosis, insulin started
8/20/2016 Acromegaly diagnosed, given SRT treatment 9/20/2016
Levemir insulin, Alphatrak2 testing with FreeStyle Lite strips
6/27/2017 diagnosed Small Cell Lymphoma, gut organs, mostly intestines
7/5/2017 started lifelong Chlorambucil chemo and Prednisolone steroid

Current health
- still ~16 pounds
- fairly good daily appetite
- hardly any muscle or bulk along his backbone
- some arthritis and now front legs a bit bowed
- very, very friendly to all kittehs and humans - Leo the loverboy

Leo loves his orange pillow (Little Dude)

Leo and LD staying warm 12-23-2018b.jpg
 
Thanks for the responses, Wendy and Jeff
And omg those cuties snuggling!!!!

I've been slow to update about Cricket bcuz I've been processing, but here are the basics from the IM specialist:

  • He's very concerned about how fast her nuerological Sx have been developing (It is affecting her whole right side. Both limbs are very weak, she only lays on her left side now, when she eats she gets food all over the rt side of her face/whiskers bcuz she leans in that way... and the doc noticed also that her right pupil is more dilated that her left so she may be losing vision). It could mean the tumor is bigger, growing super fast, or asymmetrical.
  • He appreciated the SS but was worried I overshot by going above 5.25 bcuz she seemed to be reacting well, getting her lowest lows... only to go up when I raised it 5.5 and 6. He's worried about somogyi. He advised me to go back to 5.25 for at least 10 days and I am currently trying that. He felt it was unlikely to be the insulin vial change.
  • He, like me, is concerned about putting her through a procedure involving anesthesia- or any big treatment like SRT or surgery, with her being 1 year past Congestive heart failure (general outlook for CHF is .5-2.5 yrs in good cases), but suggests the radio-oncologists are the people to ask about that. He wasn'y opposed to cabergoline, but also not enthusiastic.
  • Based on her diarrhea/soft stool Hx, he is concerned about IBS or possible lymphoma or other auto-immune issue. Would like a full xray and abdom ultra sound, plu FIV test. He mentioned the possibility that treating one disease can cause another to get worse, like if she has an intestinal disease, the Growth Hormone might be keeping it in check.
  • He also recs dietary shifts, esp a hydrolized diet and/or Rx diets with novel protein and is worried about her eating raw food while immune-compromised. I'm not too keen on Rx diets.
He is not super keen on her getting radiation, he wouldn't SAY it, but it seems he thinks she is too far along/the heart is too much of a risk. I intend on contacting some places to at least ask if they have successfully treated cats with CHF. I will look at both SRT and one-directional radiation options. (He called WSU and apparently they DON'T offer SRT).
I also feel traveling far with her would be a bad idea. She has never been in a car more than 40 minutes and it could be very bad on her heart to stress her like that.

I'm considering doing some of the intestinal work-up to see what's going on, but am not keen on his dietary advice--- especially because she is responding very well to what I am feeding her right now (the prob seemed to be turkey and fish)

If my search of radiation issues = no, I want to try and push cabergoline to at least mitigate the soft tissue affects and hopefully lower insulin. He doesn't recommend it, but might be sway-able.

I am attempting lowering the insulin to see if 5.25 was better. we shall see.

I am trying a little gabapentin at night to see if she stays calmer (like 1/4 normal dose). Last night was the first in 3 nights where she didn't wake me several times in the night meowlling. I might try it earlier in the eve tomorrow to see if it helps with pain (or what looks like pain w/ her neuro). I don't want her too doped up, esp because it is already a little struggle to get in and out of the box.

There were more details, but I am still processing and will start calling places on Monday.

xoxoxoxoxox
 
OK, I have to respond to this. Some things are not right.
Teresa & Cricket said:
and the doc noticed also that her right pupil is more dilated that her left so she may be losing vision
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Neko had one pupul larger than the other, more noticeable in darker light. She did not lose her vision. It may or may not be anything related to the tumour.
Teresa & Cricket said:
only to go up when I raised it 5.5 and 6. He's worried about somogyi. He advised me to go back to 5.25 for at least 10 days and I am currently trying that.
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Somogyi is one of those "old vets tales". The original study that let to this myth was a very small study on humans with fast acting insulins. Roomp and Rand has done a study showing that it's very unlikely for cats on long lasting insulin whose dose has been raised by small amounts and safely. Rebound hyperglycaemia in diabetic cats.pdf
The nature of acromegaly is that dose needs can change as the tumour waxes and wanes. Cricket has glucose toxicity in addition, cause she hasn't found a dose yet that is giving her good numbers, by which I mean, spending most of her time under renal threshold. Holding her dose back won't help. I wonder how many spreadsheets of acrocats this specialist has looked at? We usually change the dose in 0.5 unit amounts when the total dose is over 5 units. Another else is too small a percentage of the overall dose.
Teresa & Cricket said:
Based on her diarrhea/soft stool Hx, he is concerned about IBS or possible lymphoma or other auto-immune issue. Would like a full xray and abdom ultra sound, plu FIV test. He mentioned the possibility that treating one disease can cause another to get worse, like if she has an intestinal disease, the Growth Hormone might be keeping it in check.
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I agree about the abdominal ultrasound, but x-rays are a waste of your money. I wonder how he thinks growth hormone would keep lymphoma in check. Rather, I see quite a few acrocats developing GI issues. It's also an issue with human acros. Neko probably had GI lymphoma - we couldn't do a definitive test because that meant a biopsy that needed anesthesia, which her heart could not have at the time.

I completely agree with you on the diets. Many of the prescription diets are too high carb for diabetics anyway. There are quite a few novel protien options out there in either commercial canned or raw.

We have had one person here go to WSU for SRT. This thread contains links to Sarah's video logs of her trip there with Pig. I just checked Pig's spreadsheet, and he's gone from 60 units dose down to about 12.

Overall I think you are doing a great job managing multiple conditions. A number of acros do well with gabapentin and I hope it works out for Cricket. Neko did better on buprenorphine, but ECID.
 
Adding to Wendy's info. WSU offered SRT until at least June 2018. They should still have it. We had two forum members go there last year. In addition to Sarah's kitteh Pig, Deena's kitteh Malby also had SRT there. Deena didn't not post much publicly, and sent me a few private emails.

Pig's SRT 5/8/2018 - 5/10/2018, doing well thru 8/31/2018, then no news - Sarah has removed the youtube vlog
Malby's SRT 6/1/2018, doing well 2 weeks later, then no news

Even 2 years after SRT, Leo's glucose levels fluctuate. It seems to come in cycles. But still challenging. As an example, if you see his chart, sometimes he hypos for pretty much no reason. If I do a 0.25 dose increase, that can trigger a hypo.

For Cricket, I would also be concerned about anesthesia because of the cardio issue. However, I bet WSU still has SRT, even though I couldn't find it on their website. Their radiation therapy page is here - it almost looks like a description of linear radiation, which requires more sessions http://vth.vetmed.wsu.edu/specialties/oncology/information-for-owners/radiation-therapy
 
@Wendy&Neko thanks for that info. I am trying his advice for a little while because I had my own feeling that she was doing okay at 5.25. So far, no change. I'm fully prepared to bring her back up, esp if she starts drinking more water, etc.

I asked him for clarification on tests in regards to intestinal issues, especially to give me a list of "most important first".
I think the full body radiograph was to also see how her heart is and the tumor? It does seem like a lot.
I am happy with her diet right now-- it is looking like she could simply have an allergy to turkey and fish because cutting those out has had her in normal stools for a while now. Plus I am giving her S. boulardii.

I asked him and he says he has treated a few acrocats, but I don't think he's seen spreadsheets like these. In fact, from looking at the SS, he asked if I worked in a medical profession bc it looked like someone treating diabetes from a human perspective.

I emailed WSU for clarification on SRT.

The vet also knows a radiation oncologist I might be able to speak with to discuss risks. Mainly I want to know if ANYONE has even done radiation therapy on a cat post CHF.

@JeffJ I am leaning toward not taking a big risk with radiation because of the stress anesthesia and travel could put on her heart and lungs. I know I can't control when she crosses the gate 100%, but I am not about to lose her that way!
I am trying to convince him to come around on cabergoline because it seems like the best bet to cut back on the growth hormone and take stress off her heart and other organs.

There's not much else I can do about the neuro stuff w/o killing the tumor though, unfortunately. It's hard watching her slip and fall.
 
We are fortunate to live in an age where these medical treatments are at least options for us to consider. I agree with you, that big risks on an unhealthy kitteh can go wrong. There are many considerations, and in the end you will be the one with the decision. The cabergoline option is fairly inexpensive and could potentially help a lot.
 
I just talked to the IM today on the phone to clarify a few things.
His concern with the insulin is to have her steady and be able to check the fructosamine levels and focus more on her water intake, urination and appetite.
He wants to see a solid baseline.
He's not worried about her being in the 300's.
I think that's weird, but I am going to attempt to follow his advice for a bit.
The one thing I thought was weird is that when I mentioned that I notice a difference in her energy level, he felt that it was likely other things and that she shouldn't be able to notice that difference.

Ultimately, he doesn't want her to become resistant to insulin (in the traditional sense, not the acromegaly sense).
My plan is to go with his methodology for a while to see if I have improvements. He seems to think she might level off.

I know Wendy likely disagrees here and I am just trying to not discount his expertise and experience in IM. But really, I'm just overwhelmed.

He is putting me in touch with a radiation oncologist who I might be able to ask Q's about CHF and anesthesia.
He is also now open to trying cabergoline :bighug: So THAT is at least a plus.

Oh, and the full body x-ray and abdominal ultrasound are basically to do a full cancer check, to make sure there isn't another one somewhere.... this is especially if she is approved for radiation--- which again, I highly doubt.
 
Reading through your thread there is a lot advice given.

I can't advise on SRT. Olive has hcm, chf when I first got her and ascites , and has an abdominal mass. She had the stridor breathing, walked extremely cautious like she was afraid, sat with her face pressed in the furniture, could only take a few steps before needing to rest an hour, really lethargic. She was just a big blob.

She started cabergoline (didn't know what to expect really) in October and it cut her dose in half. It was 8.75 units. Her acro symptoms lessened. But then glucose started going back up, symptoms returned and we couldn't figure out why. Insulin dose was going back up. Turns out it was pancreatitis. She is just getting over it. Her dose of insulin is almost back to where it was when cabergoline started. HOWEVER, her acro symptoms are gone.

She walks the length of the house now. Trots into kitchen for her meals, you don't hear her breathing from another room over the sound of the TV. She even plays occasionally now. Her tail is up not hanging down all the time. Face is alert, she sits now not always laying like a log.

I might be a bit disappointed caber hasn't reduced her dose, maybe it will yet, but I'm thrilled her symptoms are gone and she is more comfortable and acting more like a cat now. She is still recovering from p'titis yet. I'm thrilled we started it.

I just saw your post. Although I know you are following your vets advice, I think it's misguided. 300's are not okay. It puts a lot of strain on the kidneys which will cause damage. The longer the glucoses are high, the longer and more insulin it will take it get the diabetes under control. I know, I've been there, done that with previous kitty, he just got sicker and more miserable. Vets don't live this 24/7/365. They see a diabetic rarely unless they specialize in it. Most never see an acro.

I hope your kitty feels better soon whatever you decide.
 
Olive & Paula said:
Reading through your thread there is a lot advice given.

I can't advise on SRT. Olive has hcm, chf when I first got her and ascites , and has an abdominal mass. She had the stridor breathing, walked extremely cautious like she was afraid, sat with her face pressed in the furniture, could only take a few steps before needing to rest an hour, really lethargic. She was just a big blob.

She started cabergoline (didn't know what to expect really) in October and it cut her dose in half. It was 8.75 units. Her acro symptoms lessened. But then glucose started going back up, symptoms returned and we couldn't figure out why. Insulin dose was going back up. Turns out it was pancreatitis. She is just getting over it. Her dose of insulin is almost back to where it was when cabergoline started. HOWEVER, her acro symptoms are gone.

She walks the length of the house now. Trots into kitchen for her meals, you don't hear her breathing from another room over the sound of the TV. She even plays occasionally now. Her tail is up not hanging down all the time. Face is alert, she sits now not always laying like a log.

I might be a bit disappointed caber hasn't reduced her dose, maybe it will yet, but I'm thrilled her symptoms are gone and she is more comfortable and acting more like a cat now. She is still recovering from p'titis yet. I'm thrilled we started it.

I just saw your post. Although I know you are following your vets advice, I think it's misguided. 300's are not okay. It puts a lot of strain on the kidneys which will cause damage. The longer the glucoses are high, the longer and more insulin it will take it get the diabetes under control. I know, I've been there, done that with previous kitty, he just got sicker and more miserable. Vets don't live this 24/7/365. They see a diabetic rarely unless they specialize in it. Most never see an acro.

I hope your kitty feels better soon whatever you decide.
Click to expand...

Your info gives me a lot of hope for Cricket and the cabergoline!
Sad about the pancreatitis, but Wow! on the acro symptoms!

The vet is an Internal Medicine Specialist, so my assumption is that he does see a lot of diabetic cats and he said he has treated a few acrocats.

I am skeptical because I know she feels better under 300, its obvious. His main point is that it is not just about the numbers, that he wants to consider everything as a whole (urination, appetite, water intake, etc).
 
He is right that's it's not just about the numbers. But high glucoses creates increased excessive thrist which increases huge urine output putting strain on kidneys. Appetite is ravenous because diabetic kitties can not process food probably, hence the weight loss. They are literally starving. Acros tend to gain weight. Research feline diabetes these are classic symptoms even for humans. The ONLY way to get them under control is to treat with insulin. Cricket will not get better by not getting what he needs. A wait til they are more stable does nothing but make him sicker and harder to treat.

Are you testing for ketones daily! Very important with glucose that high. You need to prevent ketone acidosis, it can be fatal complication of diabetes. Are you home testing?

The IM Olive saw for her ultra sound didn't believe cats should get more than 3 units of insulin. THANK GOD I DIDN'T LISTEN TO HIM. She would be dead now if I did. A cat needs as much as they need.
 
I am aware of the classic sx of diabetes, have done lots of research, and am, and have been monitoring her urine output and thirst-- both of which are already elevated because she is on diuretics.
At this point, she urinates 4-5 X per day. I keep a record. Soon I'll switch my recording of that over to the ss, so its all in one place.

Exact amount of water is hard to say (bc I have 2 water dishes/giver her water in a syringe w/pilling and I freeze her sncks w/water), but it has stabilized a lot since the first month.

I am aware of the dangers of ketones, she is not currently showing signs leading to ketoacidosis.
The issue here is that her numbers were better at 5.25 and i still raised it with the goal of getting her nadir closer to normal and since I raised it, her bgl went back up. This is all in my SS.

Other things shifted at that moment, including a new-to-me vial of lantus.
It is also possible that the lantus has a little less potency.
The point, I believe, is to see if 5.25 will bring her back down, in case she was going through a very low number in the nadir and bouncing back.This is also a theory I have seen around the fdmb.

So he wants to see what it looks like at a consistent dose for at least 10 days, hoping that leads to better numbers. It is not that he wants to keep her in the 300s.

Honestly, I just want to get the cabergoline Rx.
 
High blood sugar causes glucose toxicity. The most obvious external symptom is neuropathy. Short periods of high numbers are mostly fine. Prolonged numbers with no lower nadirs will cause damage that may be challenging to reverse.

Leo had bad neuropathy from the initial runup of his Acro. After SRT we concentrated on good numbers and a balance. Plus we gave B12. We were lucky, and almost all of his neuropathy is gone.
 
I should also add-to be clear-- that I am fully prepared to bring her dose back up if her numbers don't get better and she starts having other issues before the 10 days.
 
I can understand doing things your vet’s way until you get the cabergoline started. Sometimes you just have to compromise for a while. :bighug:

As a reference point, even when Neko was diagnosed with kidney disease, she wasn’t peeing more than a couple times a day, until her kidneys got a lot worse. The difference was that I didn’t like seeing numbers above 300, heck, not even above mid 200’s. She too felt better and was more active in lower numbers.

Glad to see you got a spot check tonight. Nice blues. :cool: You might have seen some on higher doses too with more mid cycle testing. When you start cabergoline, you really will have to step up the testing. Insulin requirements can change suddenly.
 
Hi everyone! Here is a Cricket update:

Cricket is okayish. We went back to the IM vet yesterday after following his tx plan of keeping her insulin the same. I get his rationale: that it should stay stable because her urination/water intake/weight and hunger are all stabilized currently.
I still want her lower and am hovering her dose just under 5.5 but leaving it 5.25 on my ss because he sees it and gave me **** the last time I raised it. (I'm recording it on paper)

He's more concerned about her neurological symptoms. He felt her pupil was more dilated than last time we were in and that her right side weakness is worse (both looked the same to me). He is also convinced she likely can't see out of her right eye because she has a much lower flinch reaction. I'm close to agreeing because she does appear to not see things on the right side.

His biggest concern is that she will eventually start having seizures because of the tumor. This is scary to me.

I'm on the fence about this vet, he seems a bit cavalier and had tons of pushback against me wanting her BS lower. It was frustrating.

He doesn't believe she could feel better when her BS is in the 200s instead of 300s...says she shouldn't notice/feel it. I disagree because I know what I see.

There was a weird thing where in the exam yesterday, there was what looked like a hair on her right eye (it wasn't there earlier in the day). He immediately insisted it was a tear in her cornea and that it happened because she isn't properly closing her eye all the way to blink (that has NOT been my observation and I said so).
He went straight to worst case scenario, said we needed to check her with a dye, I needed to giver her anti-inflammatorys and antibiotics or it could get severely infected blah blah blah optometrist.
Handed me a bill for $200, which meant I couldn't afford the fructosamine test that he originally wanted to do (and had neglected to tell me cost $$165).

They took her in the back, I paid, went in the bathroom and cried, then came back out and "Oh, turns out it was just a hair!"
Sigh.
Then he insisted I still buy the eye lubricant and apply it twice a day.
Which I did cause I was overwhelmed (Also, I have a foot injury-so that didn't help).

When I got home I started to feel like he just wanted to be right. I'm watching her blinking and she always does it fully.

On the positive side, he is willing to give me a Rx for cabergoline.
He talked to someone at RVC and they told him they stopped the trials because they found it unsuccessful. They recommend surgery to their patients. Their viewpoint is that it likely won't do anything, but is also not harmful.
So, I have that decision to make.

Needless to say, I want a second opinion for an IM, so I am going to a different one in March, when I'll have more money (I'm getting a promotion and raise! Yay!)
The other place I want to go is a part of the ER and the same place Cricket goes for cardiology... makes way more sense to do it all in one place. I originally just chose this first guy because he is super close.

Overall, Cricket is lower energy, she barely talks- whereas she was always the chattiest cat in the world who would scream at the door for me and announce herself to every room she walked in--she's now mostly silent w/ occassional meows and purring.
Her digestion has been great now that I removed turkey, but she actually pooped in the carrier on the way to the vet yesterday! That has NEVER happened before and really freaked me out.

Today when I got home from work, she was a little twitchy, like a couple mini-shivers. I'm watching for repeats.

After looking into it and asking questions, I declined to seek out SRT. I don't think she'd even be a candidate with her heart condition being a year past CHF. Plus, I feel even the travel would be bad for her respiration and heart.

Note: WSU at Pulman told me and my vet they do not do SRT. So if they have in the past, they no longer do it.


Anyway,
I'm going to think on the cabergoline... at least get the Rx. I can't really afford it until March anyway.
 
@Teresa & Cricket , I do understand the frustration. It took months and changing vets to get cabergoline. Yes, there is no guarantee it will work, but then there is no guarantee anything for anything will work.

My goal using it, is to hopefully interrupt the secretions of the tumor to slow down the bone and soft tissue overgrowth so Olive doesn't have the pain it causes. Hopefully lower insulin dose. I never thought of remission with it, although I believe there are a couple that were lucky enough.

I must say her insulin dose did go down by half but then pancreatitis caused us back up to the starting point again. It is now starting to come back down very slowly. Her symptoms have subsided. She doesn't have the stridor, her walk has improved, and no noticeable headaches. Her HCM will not improve though.

The only side affect is GI upset for a few days and resolves on its own. Olive never had any upset. She is certainly more comfortable overall.

I just saw another study that was published 2017. Again it's a small study only 3 cats, it does state cabergoline can be effective and should be considered an option. Of course it recommends a larger study and longer follow up should be done. However, it's the only one I have read that was positive. I don't remember seeing this one when I was researching. I can post it tomorrow if you want. @Wendy&Neko I don't know if you have this study. I don't remember this one.

I figured I would try cabergoline a year, we have nothing to lose and everything to gain. It is expensive though and with the higher insulin on top of it as well as her other meds for HCM and p'titis, Olive is now high maintenance.

I'm glad I'm giving it a try, I think it is helping her. It's worth keeping it an option.
 
Acro is such a challenging disease. Perhaps the cabergoline will be helpful.

Cricket will probably feel even better with nadirs between 100-200. It will give her kidneys a break - from filtering out the glucose in her bloodstream.

Acro is not the same in all cats. Some have slow growing tumors. Some are fast. With Leo in 2016, we saw a dramatic fast increase in insulin requirement. His tumor was either growing fast, or at least producing more. Then we got the SRT for him and it was successful in reducing most symptoms.
 
I do hope you can start the cabergoline. Most kitties here on it (larger number of kitties than the study at RVC), show that most have at least some improvement, even if it's easing some of the acro symptoms. There is only upside to trying it, glad the vet agrees with that at least.

Bummer that Pulman no longer does SRT, they were by far the low cost option.
 
That truly is unfortunate that WSU no longer offers SRT. That is a recent change for them, and it was so affordable.

Kudos on warming up the spreadsheet. I would still urge you to dose enough insulin to get into the blue range.
 
Thanks everyone for the replies, somehow I wasn't getting email notifications for this.
I had to wait on the cabergoline because of finances, but am trying to get it now.
I am also increasing her insulin, but more slowly and recording it on paper at home.
I left the chart at 5.25 because I wasn't sure if this vet would be an a-hole and refuse to give me the Rx if I didn't follow his advice.
I'm also going in for a consult with a different specialist later in the month, she is at the ER and that is also where I see Cricket's cardiologist. Their specialist prices are actually about $25 less than the norm-possibly because they are a non-profit.

She continues to be very sensitive in her GI tract, having a horrible reaction if I change her food too suddenly. I had to do an entire load of towels and pillow cases and a rug on Sanitize! Mostly, if she has soft stools, she winds up falling in it and there goes the mess... Also she misses alot more, so I invested in some puppy pads.

I'm working on figuring out a lower litterbox solution. Going by a garden supply store to look at starter trays and have been looking at plastic storage bins. She needs it to be big as well as low,I'm thinking about 3-4" should be best. Any thoughts?
 
Some people use plastic storage boxes and cut out an opening. Puppy pads are great. They also help on the out side of litter boxes to catch any fly overs.

Once we get to 5 units, we usually increase by 0.5 units to try to get over the resistance, especially if you are at most seeing mid blues. You would want more under renal threshold time than is on the spreadsheet. It will also help with less pee volume. Good luck with the new specialist.
 
Sorry to hear about the messes. I'm sure Cricket doesn't like them either.

Like Wendy said, I also heard some people just get a big litter tray or storage tray - then they cut out the front as low as they need it. If it was me doing the cutting, I'd be wearing leather gloves and using a box cutter. Be careful!

I hope the new specialist works out for you.:bighug:
 
I just tried to cut an opening into the litter box we have with a box cutter and the plastic is too thick! The plastic storage tubs are a thinner plastic, so I might try cutting one of those since the lowest I could find in still 6" high.
I might try a run to Home depot to look at other sizes as well.

My big issue right now is that she has a ton of dingleberries from her gross poop over the last week. Bathing got us nowhere this time and so today I managed to CAREFULLY snip some off and comb a little before she freaked out. Noticed her skin looks irritated. This is the first time it has gotten bad enough for her to have irritated skin. I think getting back there to groom is getting harder for her, esp on the right side.
Going to try some coconut oil tonight to loosen it up and soothe the skin. Might invest in blunt-tipped scissors and trim her butt floof or look into groomer prices.
 
Dingleberries are the worst. Our cats sometimes get small ones and they are impossible to get off.

For the cutting you might try a serrated steak knife. I have a dedicated serrated knife in the garage. It makes a messy cut, but the sawing action allows me to cut some stuff that the box cutter struggles with.

Or if you have tin snips....those work too.
 
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