Debbie & Bryce - New Acro

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Hi there - I'm Debbie and have updated the spreadsheet. Bryce is a 7 year old Calico dx in Feb. 2009. Still TBD if she's an Acro or not. She was a feral cat we adopted from a restaurant in NJ (with her sister, Aspen). We've been in the Sarasota, FL area since 2005. She's currently on 10 U of Lantus BID. Her IGF-1 was 429 and IAA 8 (normal). She does have an enlarged heart (on heart med), but no other physical signs. Getting an abdominal ultrasound this week, and GH test done in early July, 2010. I'm very interested in tracking the information from others on this site.

Hi Debbie,

I wanted to re-post outside of the "Roll Call" so that people can stop by and say "hi". I'm glad you had the tests done, although I'm sorry about the diagnosis. However, at least you know what you are dealing with and can proceed aggressively. With your IGF-1 number and your high dose, your diagnosis really is positive; don't waste money on a CT or MRI. Have you or Dr. P talked to Dr. Lunn @ CSU yet? I'm not sure if you are interested in pursuing treatment (outside of insulin), but if you are, Dr. Lunn is the person to talk to.

 

[Debbie and Bryce]

Hi there - a bit tied up at the moment. Will respond either tonight or tomorrow. Thank you for posting this and look forward to responding.

Deb

 

[Debbie and Bryce]

I'm glad you had the tests done, although I'm sorry about the diagnosis. However, at least you know what you are dealing with and can proceed aggressively. With your IGF-1 number and your high dose, your diagnosis really is positive; don't waste money on a CT or MRI. Have you or Dr. P talked to Dr. Lunn @ CSU yet? I'm not sure if you are interested in pursuing treatment (outside of insulin), but if you are, Dr. Lunn is the person to talk to.

Thanks again for the greetings! No, neither Dr. P or I have talked to Dr. Lunn. Not planning to move in that direction at this time (if ever). Given the numerous vets we've been working with, and their comments regarding "Acro's", I'm wondering how anyone can be sure they have a cat truly dx with "acro" unless there are physical signs externally and confirmation via ultrasound internally? Does a single IGF-1 score alone confirm the dx? Playing devil's advocate here...

In regard to Bryce, she only has two "acro" signs (very high IGF score of 429 and enlarged heart). Her IAA was normal (8). She had an abdominal ultrasound on 6/10, and it was completely normal. We're not convinced that her unregulated diabetes isn't somehow related to the heart issue (+/or visa versa). I need to re-visit the notes I have from Dr. P and our Cardio vet on this. We are waiting for the GH result from MN, but have heard it doesn't mean anything unless it's really elevated. And, I believe IGF scores fluctuate based on how the cat is the day it's taken (?). Have you found that to be true?

What have others found in regard to the "early" stages of Acro? Are we just not seeing them yet? I am very interested in hearing more from others on this, so thank you again , Heather for posting here.

 

[Phoebe_TiggyGA_NortonGA]

Insulin resistance is a major sign of acromegaly - and the first sign that we observe here at FDMB.

Vets are not trained to link acromegaly and diabetes - they are trained to look for exaggerated features -- which is an extremely advanced state -- by the time exaggerated feature / organs are present - the tumor has been present for probably years.

Insulin needs exceeding 1 unit per lb per day are considered "High Dose"

The IGF-1 test is accurate and reliable regardless of your vet's opinion.

Since Bryce is up to 20 units of insulin per day, he is definitely "High Dose", and with an IGF-1 test result of over 400 -- definitely an Acrocat.

Norton had an IGF-1 test result of 331; he needed 15 units of insulin per day (at one point, he was up to 26 units per day on high carb dry food) and he definitely had a brain tumor that had grown to the point of causing him to walk in circles. His feet were larger than average and he was very muscular, like a wrestler -- other than that, he looked like a normal, if stocky, cat.

Acromegaly is caused by a tumor affecting the pituitary gland - usually but not always adjacent/attached to the pituitary gland in the brain.

An ultrasound of the abdomen really wouldn't have any impact on a diagnosis on acromegaly in my opinion. Not all acrocats have organ enlargement.

The excess growth hormone is just rushing through the blood stream and can literally be used anywhere in the body. Some kittys have organ enlargement, some have large feet, some are muscular, some have larger upper or lower jaw / teeth are spread/ don't fit together well -- some have a broader face/forehead than average. Many have breathing issues / snoring from excess tissue growth in the throat.

 

[Debbie and Bryce]

Re: Debbie & Bryce - New Acro Debate

Insulin resistance is a major sign of acromegaly - and the first sign that we observe here at FDMB.

Insulin needs exceeding 1 unit per lb per day are considered "High Dose". The IGF-1 test is accurate and reliable regardless of your vet's opinion. Since Bryce is up to 20 units of insulin per day, she is definitely "High Dose", and with an IGF-1 test result of over 400 -- definitely an Acrocat.

An ultrasound of the abdomen really wouldn't have any impact on a diagnosis on acromegaly in my opinion. Not all acrocats have organ enlargement. The excess growth hormone is just rushing through the blood stream and can literally be used anywhere in the body. Some kittys have organ enlargement, some have large feet, some are muscular, some have larger upper or lower jaw / teeth are spread/ don't fit together well -- some have a broader face/forehead than average. Many have breathing issues / snoring from excess tissue growth in the throat.

Thank you for the time you spent replying..much appreciated. By the way..LOVE Michigan. Have a family house in Beulah. Ok, so yes, insulin resistance...Acro sign #3 for Bryce which I should have mentioned. We plan to have another IGF-1 test done when we see the Cardio Specialist in Sept. to get another number (if nothing else). It was the Internist who was a bit skeptical on the IGF-1...I'm sure there are debates about this on an ongoing basis.

The other comments we've heard are .....well, so what if she is an Acro? There's nothing you can do about it except treat the diabetes. That comment also from the Internist who a) doesn't believe the radiation option is where it needs to be (yet), and b) wouldn't radiate her kitty's (period). I'm sure Dr. Nunn would have words to the contrary.

For now, we are working with Dr. P to treat the diabetes, and try to manage Bryce's weight as best we can. Thanks again for your information.

 

[Phoebe_TiggyGA_NortonGA]

The stereotactic radiation done by Dr. Lunn at Colorado State is very tightly focused -- they make a custom fixture to hold the kitty's head in an exact position and do very precise computer-controlled radiation based on a CT scan showing the tiny tumor.

CSU is the ONLY place in the US with a stereotactic radiation machine for veterinary use.

It is expensive, but has had good results.

Norton was already at an advanced stage (brain tumor big enough to cause circling) and developed an inoperable intestinal cancer, so it was not an option for us.

The value of believing the diagnosis (personally I feel that you already have adequate proof) is:
1) treat with insulin aggressively -- increase insulin dose faster than with a traditional diabetic. (every six doses instead of waiting a week)
2) be prepared for fluctuations in the tumor's output -- insulin needs / blood sugar can change over time. Acrocat Fletcher has been OFF insulin several times in the three years since he has been diagnosed. Acrocat Girlcat is currently in a downswing -- she was up to 62 units of insulin BID at one point, and now she is getting 17.5 units BID.
3) watch for other developing symptoms of acro and be ready to treat - headaches are the most common. (easy to miss if you're not looking for this - kitty will sit in "meatloaf" position with head down - eyes may be squinted a bit, depressed/lethargic) Treatment with either an anti-inflammatory (Norton got prednosolone) or other pain med like Buprenex can help.
4) many acrocats get a long-lasting insulin and also get a "bolus" of a fast-acting insulin like "R" to help get high bgs down before the long-lasting insulin kicks in.

Since acrocats have a functioning pancreas, treatment for HYPO is a bit different too --

 

[Debbie and Bryce]

The value of believing the diagnosis (personally I feel that you already have adequate proof) is:
1) treat with insulin aggressively -- increase insulin dose faster than with a traditional diabetic. (every six doses instead of waiting a week)
2) be prepared for fluctuations in the tumor's output -- insulin needs / blood sugar can change over time. Acrocat Fletcher has been OFF insulin several times in the three years since he has been diagnosed. Acrocat Girlcat is currently in a downswing -- she was up to 62 units of insulin BID at one point, and now she is getting 17.5 units BID.
3) watch for other developing symptoms of acro and be ready to treat - headaches are the most common. (easy to miss if you're not looking for this - kitty will sit in "meatloaf" position with head down - eyes may be squinted a bit, depressed/lethargic) Treatment with either an anti-inflammatory (Norton got prednosolone) or other pain med like Buprenex can help.
4) many acrocats get a long-lasting insulin and also get a "bolus" of a fast-acting insulin like "R" to help get high bgs down before the long-lasting insulin kicks in.

Since acrocats have a functioning pancreas, treatment for HYPO is a bit different too --

We've been working with Dr. Lisa since March...do NOT know what we'd do without her. She was the one who pointed out Bryce's enlarged heart on the x-rays we sent her (and now have Bryce on a heart med). Our [old] vet didn't see it, and was NOT with the program re: diabetic care/regulation. In case you're wondering, we now have a new vet. And, we KNOW that Dr. Lisa is there to continue to handle Bryce's diabetic and nutrition needs. She's very good at what she does...

Very interesting regarding the "fluctuations". We've been getting some very good numbers lately (compared to just a few weeks ago). Have seen other's SS that have "R" noted, but did not know what that meant. Will ask Dr. Lisa about it. And did not know how you can tell if a cat has a "headache"...thank you for the details on that.

Treatment for Hypo different? We've got the "kit" handy, but have only needed to feed a small amount of HC FF on two occ. Is there something else we need?

GREAT information....THANK YOU!

 

[Blue]

It's funny how different both of mine are and both tested positive for acro.
Shadoe doesn't look the part, has only the belly and the high dose. Her IGF-1 was only 120 so maybe all was quiet on the tumor front. I would have to say that her dose fluctuation could be considered acro related : up to 14u with some R, free fall down to 2.75u and no R, a spell of all fine, then up the dosing we went, stopping at 6.75 for a bit and then we were on the move again at 8.5u now and numbers not looking great.

Oliver is LARGE and people literally take a step backwards when they see him in person. Even at the vet office, the vet knew what the results would be by just looking at his face. He is a gentle giant and looks the part. He's got the big broad head, large paws, paunchy belly, and snores and grunts instead of purring. His IGF-1 was 325, and his IAA was also positive with 60% which is way over that 20% line. His dose also is quite high 20+ and frequent doses or R were also needed. Recently, he suddenly started to go green and very low, so either we have found his good dose or he is revving down, or the IAA has been squished and we are now dealing with just the acro. It was quite worrisome one time when he was low and full cans of HC were not bringing his numbers up AT ALL. So if you are talking about getting stuck in greens and trying to bring the numbers up, forget all about a couple tsp of HC, dump the WHOLE CAN in the bowl. If the pancreas is functioning, all that food does is bring down the numbers! Hence the reason people will say, Acro aims for blues and reg FD plus IAA aim for green. Again yesterday at the vet for Xrays, Oliver hit his lowest and stayed low for hours! Again, foods did nothing. I was worried. You then get into skipped shots of 20+u and then some 1/2 dose shots - it is quite the roller coaster ride.

 

[Phoebe_TiggyGA_NortonGA]

I didn't have to deal with HYPO with Norton, so that is why I didn't include details -- Gayle covers it nicely.

Another thing - don't use syrup unless the kitty is not able to eat food. (applies to any diabetic really - food will last longer and stabilize the blood sugar better)

And yes - the goal is blues or 100 to 150 rather than greens (50 to 100)

it is important to remember to look at the whole cat and not just focus on numbers.

When Norton was having headaches and walking in circles - we started him on Pred, even though steroids are not recommended for diabetics. It really helped him a lot - he seemed brighter and happier (tail up in the air) and circled less. We watched his blood sugar, and were lucky -- he did NOT need any additional insulin because of the steroids.

 

[Debbie and Bryce]

This is all so helpful. Thank you....I plan to print this entire thread and keep it on-hand.....staying up with more green #'s tonight. 74 at +4 and 63 at +4.5....lowest yet at this time.

p.s. Today's correspondence has brought my head out of the sand...denial is a wonderful thing, isn't it....thank you!