I finally got the MSU test results back and we have answers!!! Finally!! She does indeed have Acromegaly! I see the vet on Friday. I'm going in and sitting down with him to go over her bloodwork and the IGF1 results so we can come up with a treatment plan. Hopefully they can work with me since the vet was not convinced she had Acromegaly. Reference range is [12-92] nmol/L and her results came back at 477. I also had MSU run the IAA Insulin Autoantibody which came back as a 3. Reference range for that test is [<=20]. I haven't posted in a while with the cats, life and me catching up on my doctors the months have just flown by.
Sorry about the results, but knowledge power and now you can move forward. The "good" news is no IAA, which just adds a complication. Any questions we can help you with? A lot of people here are treating with cabergoline, as it's the easiest/cheapest option. Other options require travel (depending where you live) and are more costly. We have links to papers you can share with your vet if you need to. How is Allie feeling/acting these days?
@Wendy&Neko She is one strong cat! I don't want to jinx it but she is doing good. All habits are normal Just wish the vets would have listened to me sooner. They seem to focus on the outward physical looks. I will more than likely do the cabergoline. The less I have to stress her out the better. They had to give her some gas to do the bloodwork. She just doesn't like to be poked and prodded by strangers (can't blame her). They gave her a complete exam and took picture of her teeth too. She needs a cleaning but nothing rotten/broken (thank goodness). I'll try and work on her spreadsheet tonight it has her recent labs in there but not her current numbers. She is currently at 22 units 2 x's a day no doubt maybe a bump up in a few days. She does like to bounce.
Great Allie report. Our acros are definitely tough cats. Neko had no physical signs either, until a few years after diagnosis. And she had "attitude" at her vet's office too. Did like her acupuncture vet though. From what I did see in her spreadsheet, you can use larger size increases. Over 10 units total dose, you can increase by 1 unit, over 20 by 2. Unless they are seeing green and you just want to tweak the dose a bit.
If I have learned anything, when cats know something makes them feel better, most will except the treatment. Allie has gotten to purring while I'm poking her ear or gives me rubs while I'm filling her syringe. Yeah she throws those 90 out here and there but not as often as I'd like. Any questions you can think that I should ask the vet, Wendy?
I’m sorry about the acromegaly diagnosis, but you now know what is going on. Cabergoline did help my boy to get into better BG numbers on a much lower dose. He was over 40 units at one point.
I'd ask if the vet feels comfortable keeping Allie as a patient. My first tried "firing" me to an internal medicine vet at first as we were her first acro, but I stuck with her until Neko got more complicated. I had been seeing the vet for over 20 years by that point. I knew she was willing to learn and I liked our relationship. Things to keep on top of are her kidney numbers, and if the vet hears any heart murmurs I think an echocardiogram would be a good idea. Not saying you'll have to deal with those, but they can sneak up on you quickly with acros and are fairly common. Arthritis can also be a common symptom, so maybe ask the vet how they'd treat that if it happens. Several years after diagnosis, Neko had to go on full time buprenorphine. Some vets seem reluctant to give meds for pain relief but even human acros say it can be a painful condition with the excess growth hormone. It sounds like Allie is still doing well with the Lantus? Some cats detect a sting with the acid base of Lantus, so need to switch to Levemir.
Thanks for that! At least we know what is going on since the vets can't prescribe 22 units 2 x's a day without knowing a cause. How long was your boy on Cabergoline? Any side effects? I guess it is like starting at square one since adjustments to the insulin will be needed.
Well if he isn't he should tell me before I pay for an office visit! I'll give them a call. Better yet I'm email him. Sure do miss my vet of 30 years but he is retiring and it is a two hour drive each way. Hopefully on her exam while they had her there they listened to her heart but I will note that for Friday. I know her SDMA is elevated 17.8 should not be <15. She also had elevated Urea Nitrogen normal is 14-36 and hers was 48. Her Thyroid was 4.5 high side is 4 She did have a full breakfast that morning at 8am and her visit was at 10:30 so not sure if that could affect readings. Her A/G ratio was good as was her AST and ALT Her hock walking has resolved and she ran the other day and jumped on the bed. I'd like to see her run and play more but as far as pain think she is OK but will mention it. Gabapentin raises her sugar!!! She gets the B12 instead. There are some of the readings that concerns me. Thanks Wendy!
My SNuffles has been on cabergoline for 3 years. I was able to get lower BG with a a decrease in dose. I cought it early based on my experience with my previous aero cat MurrFee. He was only on insulin and got up to 50 units twice daily. My vet can't do much with Snuffles and Snuffles set me to the ER once.
I am hoping to go the Cabergoline route. That gives me hope, thank you. What is a typical dose to start? Common side effects? I have seen it can be compounded but I'd rather put it in her food. She does not do treats and any liquid medication she hates it. What sent Snuffles to the ER? Allie should have been tested earlier, but it is what it is.
He was on Cabergoline for about 4 months. He was doing great with blood glucose, but kidney disease came on hard and fast and killed him. I would advise you to always check a urinalysis for kidney function and not just bloodwork. The urinalysis will give you the USG and that’s how you really will be able to tell how well her kidneys are concentrating urine. You already have some elevated numbers it sounds like, so best to stay on top of that. Excess growth hormone can make kidney function appear better than it actually is (in bloodwork) by increasing the kidneys GFR. Actually, growth hormone has a profound influence on the kidney’s functioning and it’s quite complicated. I do advise checking the Urine Specific Gravity.
Lots of discussion here: Cabergoline as a possible treatment for acrocats: discussion Paper attached to this thread is a good one to give to vets. New paper on: Cabergoline treatment in cats with diabetes mellitus and hypersomatotropism
I am so very sorry to hear that. Dang kidney disease. That is what I'm afraid of with Allie her kidneys. We did a UA and her Specific Gravity was 1.028 normal range is 1.015 - 1.06 so she was within limits. I can't get the link to her bloodwork to post here, trying Google Drive. https://drive.google.com/file/d/1NteZU3FdzuJK7RTXLGJ0J9BbD9CRd67a/view?usp=sharing That should work and also her pancreas number is 1 over I need to do something ASAP. Precision PSL normal range 0-26 ---- At diagnosis it was 19 This bloodwork it was 27 Her thyroid is up also.
I have been reading and reading...my brain is scrambled. Thanks Wendy! Hope the link works to her bloodwork, wasn't sure how to post it.
There is a Labs tab on the spreadsheet. Some people keep the data there. I did that cause it made it easy to track changes over time.
Yes, I can see the labs. Thanks for that. Definitely looks like more investigation needs to be done with her thyroid. Which could also be impacting or masking her kidney numbers. Creatinine is fine, I wouldn't worry about the BUN yet. However, the phosphorus is too high, and you should work to get it lower. Look at foods with are lower phosphorus. In other words, less Fancy Feast to start More information here: https://felinecrf.org/phosphorus.htm If you haven't been to that site yet, it's a good one to browse. A lot of info there.
Yeah her thyroid jumped since January. I was worried about the red blood cells in the urine too. Now that bloodwork was not fasting she had a full can of FF chicken at 8am and the blood was pulled about 10:30am. Not sure that makes a difference? I have bought food on that list months ago because I suspected Acromegaly and was wanting to get a jump on things. The Humane Society here LOVE me! At least it was down since January, it needs to be under 6? Maybe a binder? I thought about that a while back too. She should have food below 0.5% on a DMA basis I'm seeing. I have this site but most of those foods are not low enough. https://www.bizave.com/foodlists/CKD Diabetes Food List.pdf I just sat down for the night I ate dinner standing in the kitchen and now have clothes in the laundry. Birthday is on Saturday but no big deal going out to eat early that's it.
Neko never fasted for her blood work, unless there was particular thing that required it. I tended to get b/w done later afternoon, longest stretch in between food for her. The list you linked was what I was going to suggest. I ended up making most of Neko's with the FoodFurLife premix (EXComplete) and one other premix from Canada that is for CKD kitties, they both made pretty low P food. The vet probably has some thoughts on whether binder or not, and when. Curious to hear what the vet says about next steps for the thyroid. Having hyperthyroidism can also contribute to insulin resistance. She wouldn't be the first acro here needing to be treated for that. One other I remember, had his insulin needs drop after treatment started.
Just throw it all at once at us! I had a cat years ago my girl Thai. The thyroid medication almost killed her. We took her off of it and she lived another 10 years she passed at 21 yo. I'd hate to throw the kitchen sink at Allie all at one time. Adding meds on top of meds seems overwhelming for me and her system. What do you think I should do first?
If your vet doesn't have suggestions, see if you can get a referral to an internal medicine vet. Neko already had CKD and got a small cell lymphoma and congestive heart failure diagnosis one day after the other. Both required meds. The internal medicine vet kept me sane by prioritizing what conditions were most important (heart) and which meds. She started two meds for the SCL and two for the heart at almost the same time.
Sorry to hear that Wendy, that is a lot to deal with all at once. Neko sure was lucky to have such a dedicated Mom. I know some people think I am crazy for doing what I'm doing for Allie...How can you not? As long as she is willing and does well I'll continue the fight with her. I talk to the vet tomorrow. Have all my questions and copies of the blood work printed out, have everything of concern highlighted. He may refer me out we will see but if I have to wait where can I find a list of pharmacies that compound the Cabergoline? I'm sure they thyroid medication won't be a problem. Maybe I could get them both from the same place?
Read through the discussion thread I linked in post 14 for where people are getting it compounded. I know one person in Canada is just getting it done at her local compounding pharmacy. Your vet may have a favourite compounder, mine does.
Is the link in this thread? Just asking on my way out to pick up neighbor had a heart cath this morning she is 89! She is tough. Mom and her friend will be here soon. Never enough time. Ugh.
Thanks Wendy. I called Wedgewood and I spoke to the pharmacist. They are awesome! If the vet has any questions about dosing he can call them. I think this is a learning curve for him and I'm going to be straight up with him about that fact. I have searched for vets in the area and without stress to Allie I'm willing to work with him. If at any time he is over his head he will have to tell me. Maybe this will also help other patients in the future. I will always do what is best for her.
