Eddie: News about our journey

Hello Everyone,

I'm writing at this moment to let you know that tomorrow, October 23, Eddie and I are travelling to VCA Victoria to meet with Dr. Genevieve Hammond, the radiation oncologist who designed Eddie's SRT plan back in February 2021 when it was delivered at VCA Calgary, Alberta.

I know not everyone agrees with seeking further treatment for acromegaly after hypophysectomy, which Eddie had in 2020 but which removed only 60% of the tumour. That was followed by SRT in 2021 to support the hypophysectomy. As for the DM, Eddie never went into remission, as did his brother, Blue.

I have spent a lot of time reflecting, even agonizing about this decision but have taken it for a number of reasons:

• Eddie's insulin requirements have for the most part been increasing. He's currently on 27u Levemir BiD and even though he's relatively stable at that dose, that stability is provisional based on the tumour secreting GH.
• Eddie's last IGF-1 was 156 and that was in February 2022.
• Eddie had a CT scan in March 2022 and it showed an area that could have been scar tissue but is probably tumour material, even though it was smaller than before his SRT.
• I do not want to see Eddie deteriorate while that tumour takes up space and causes all kinds of trouble. He is relatively stable right now and I'm grateful for that.

I spent 1.5 hours on a Zoom call on October 20th with Tina Owen, the surgeon of the Pituitary Team at Washington State University Veterinary Teaching Hospital and she supports this decision and this course of action. She has arranged for the scan to be done at VCA Victoria to be uploaded to their server so that the team can consult on Eddie's plan.

Tina Owen said there are two ways to look at SRT:
Year 1_ 9-12 months post SRT: effect on the actual tumour
Year 3. Possible SRT effects on Endocrine system

I may find that Eddie is not a candidate for SRT. Perhaps it's already too late, I don't yet know. If they determine he is not, I will return home and we will carefully and purposefully looking into Cabergoline.

Tina Owen pointed out one issue that needs be taken into account and that is Eddie's insulin dose: 27u Levemir. If his is a candidate for SRT and receives it, that high a dose is of concern if he goes into "remission". She has impressed upon me that he needs be closely monitored while he's receiving any treatment and I'm taking it upon myself to ensure that happens.

Dr. Hammond is aware of Eddie's issues with 3 different types of sedation and they have assured me they will not administer them either for the scan or for any sessions he may have., which might, if he's a candidate, be anywhere from 1 - 3.

I am both hopeful and afraid. I am doing what I think is best for Eddie and I'm doing my best. I really appreciate all the support he gets on the DM/Insulin side of FDMB and here in the Acro forum and I hope you all will keep us in your thoughts and prayers.

@Wendy&Neko

 

I’m not as well-versed on IAA as acro, but I’ve seen cats go to pretty high doses based on IAA alone. Have they ruled that out as a potential cause of the higher insulin needs?

Tubby never went OTJ after SRT; as you know, most cats don’t. His dose reduced for awhile but then started back up the scale when his kidneys started to tank. His BG spikes and dosing needs didn’t seem to be related to tumor regrowth but rather concurrent medical issues.

Best wishes for a safe and productive trip and some answers. Please post updates. I’ll be thinking of you and hoping for the best.

 

Hi JL, thanks so much. I'm pretty confident in saying that Eddie's high doses can be traced to GH but we'll see what comes next. I'm just wanting to do the best I can. I will post updates. In fact, I'll know quite a lot by Monday. Thanks, again!

 

The minority of acro cats go OTJ with SRT. You were lucky with Blue. He beat the odds. Don’t expect remission. Good control, fewer symptoms and good QOL are better and more realistic goals.

I have read and been told by CSU that it can take a couple years for full SRT effects to occur. But I seem to remember you went to Calgary for it first time? I have never seen anyone else here go there, so cannot comment on what they do.

Most importantly, are you going to see a cardiologist with him before any possible SRT or scans? I am really concerned about his previous history of anaesthesia without a cardio vet weighing in. Multiple anaesthesia is also hard on kidneys, which in acros are an area of risk.

As JL said, we have seen cats with IAA and other conditions (especially heart) drive the need for higher doses.

Just make sure what you are doing you are doing for Eddie, not you, and is as risk free as possible for him. Been there with regrets, don’t want you to have the same.

 

Hi Wendy, I think what CSU told you was what Tina Owen was referring to which is that SRT affects the tumour at the cellular level (in 9-12 months) whereas the endocrine results can take a couple of years. So I think they are on the same page. We're not going to Calgary although we are seeing the same radiation oncologist who developed the SRT plan. This is the first time I will meet her in person.

His cardiology requirements will be met and I am striving to make this as risk free as possible. I do not want to have those kind of regrets nor do I want to have the kind of regret I might have if I do not follow what I feel is the best way to go. It's not easy but that what it is.

Wendy, as I mentioned, I have thought long and hard about this situation. I even asked myself if it was for me. And, what I think is that it is for both of us. I haven't been explicit about this plan because I have long been living with it. I told myself I can cancel anytime and I have arrived at the threshold of my decision. All I want is to do the best I can and I honestly am trying to do that.

 

@Wendy&Neko I should mention one more thing. I've considered all of this as a process and that means there are unknowns and variables. What this means now is that I am allowing for the decision to take Eddie to Victoria but I can promise that if we get there and I don't think it's right, I will decline the rest and we'll come back home. Just thought you'd like to know.

 

Gather as much information as you can. Make sure you are making the decision, not the vets or us. You know Eddie best.

 

I hope you can give us an update soon on how it went yesterday.

BTW, I was a little slow responding, as I was in Victoria for the weekend myself.