Help with Mars's acro treatment

[Rachel & Mars]

Hello everyone, I have been spending a lot of time reading through this forum and have already learned so much. Big thank you! I'm hoping to get some advice for my boy, Mars, who is turning 10 next month. Mars was finally diagnosed with acromegaly (IGF-1=1160) last month after six months of uncontrolled diabetes. He is also IAA positive. We are seeing the internal medicine team at AMC in New York right now, but I am trying to figure out the best long term plan for him.

Surgery Options:
I know that Washington State University and AMC are no longer performing the hypophysectomy surgery. I have found three places that currently do it: the University of Florida, the Veterinary Referral Center of Central Oregon (VRCCO), and Texas A&M University.
I know that Dr. Annie Chen-Allen at the Oregon facility used to be with Dr. Tina Owen at WSU for a long time, so she clearly has a lot of experience with this. However, I haven't really heard of any cases or seen reviews for the University of Florida or Texas A&M. Does anyone here have experience with any of these three places? I am willing to travel anywhere in the US, but I want to find the place that offers the best possible outcome. Where do you think is the best place for this surgery right now?

Surgery vs. SRT
My vet at AMC thinks surgery is a better option than SRT because SRT outcomes are so hard to predict. I want to give Mars the best quality of life since he is still relatively young and has no other health issues, but I’ve seen such mixed reviews. My vet mentioned a life expectancy of 5 to 6 years with surgery, but I’ve read other reports, like from RVC, that say it is closer to 2.3 years. What do you all think about surgery versus SRT for a cat in his situation?

Cabergoline
Mars has been on Cabergoline for three weeks now, but his blood glucose is all over the place. I’ve updated his spreadsheet so you can see the trend. At 6u of insulin, he occasionally drops fast from the 300s down to the 60s, then bounces right back up to the 300s. If I try to lower the dose to 5.5u or 5.75u, he just stays flat around 300. It feels like his numbers are anchored there no matter what I do. His neuropathy is getting worse and he is walking on his hocks all the time now. I’m giving him Zobaline twice a day, but I know it won't help much until his BG is lower. I have two questions for the group here:
* Should I increase the Cabergoline to every day? He currently takes it every other day and has no side effects. My vet said not to increase it because she doesn't think it will be more beneficial and might just cause nausea. Have any of you seen better results with daily dosing?
* Any suggestions on how to handle the insulin titration? I’m really worried about the 6 unit crashes, but 5.75 doesn't seem to do anything. With him being IAA positive and having bad neuropathy, I’m feeling pretty stuck on how to get him into a safer range.

I know I just asked a lot of questions. I really appreciate any insight or personal experiences you can share. This has been such an overwhelming journey and I’ve gained so much useful information from this forum already. Thanks for helping me and Mars.

 

[Jodey&Eddie&Blue]

Hello everyone, I have been spending a lot of time reading through this forum and have already learned so much. Big thank you! I'm hoping to get some advice for my boy, Mars, who is turning 10 next month. Mars was finally diagnosed with acromegaly (IGF-1=1160) last month after six months of uncontrolled diabetes. He is also IAA positive. We are seeing the internal medicine team at AMC in New York right now, but I am trying to figure out the best long term plan for him.

Surgery Options:
I know that Washington State University and AMC are no longer performing the hypophysectomy surgery. I have found three places that currently do it: the University of Florida, the Veterinary Referral Center of Central Oregon (VRCCO), and Texas A&M University.
I know that Dr. Annie Chen-Allen at the Oregon facility used to be with Dr. Tina Owen at WSU for a long time, so she clearly has a lot of experience with this. However, I haven't really heard of any cases or seen reviews for the University of Florida or Texas A&M. Does anyone here have experience with any of these three places? I am willing to travel anywhere in the US, but I want to find the place that offers the best possible outcome. Where do you think is the best place for this surgery right now?

Hello Rachel and Mars, I been a member of this board for ages and have lived with two acrokitties, Eddie and Blue (brothers) and we have travelled to and fro to U Washington where they had hypophysectomy with Tina Owen when Annie Chen Allen was part of the pituitary team. I did not know they were no longer doing hypophysectomy? I'd be surprised if that is true. Did they confirm that? Anyway, I can speak with the highest for Annie Chen Allen. She's brilliant, knowledgeable, approachable. Don't know anything about Texas A&M or Florida.

Surgery vs. SRT
My vet at AMC thinks surgery is a better option than SRT because SRT outcomes are so hard to predict. I want to give Mars the best quality of life since he is still relatively young and has no other health issues, but I’ve seen such mixed reviews. My vet mentioned a life expectancy of 5 to 6 years with surgery, but I’ve read other reports, like from RVC, that say it is closer to 2.3 years. What do you all think about surgery versus SRT for a cat in his situation?

That is a hard call because as you know from this forum ECID. I learned that over the years. So much depends on the location of the tumour and its proximity to other areas of the brain, for example, the optic nerve. Both Eddie and Blue had hypophysectomy. Blue was first in Feb 2018. A followup MRI six months later showed a small regrowth (I mean we are dealing with cells, so hard to ensure margins, I guess) and we went for fractionated radiothereapy in late 2018 at WSU because I didn't know if SRT was an option. That treatment took 21 days because it's low dose, and given every second day. We came home and he went into remission really. Then a couple years down the line same thing: regrowth so we went to VCA Calgary where he had one dose of SRT. Remission and he pretty much stayed in remission for a few years, although I would check his BG every now and again and then in 2024, he was back on insulin and we were hoping for one last SRT (he was deemed ok to do this, again, placement of tumour). But what happened was that the acromegaly had affected his heart and we all know about that. He went into cardiac arrest during the MRI and I had to let him go. But here's the thing: he lived a good life for 7 years as an acro-kitty. He was just amazing and I'd do all over again.

Eddie had a different story. I lost him 11 months after Blue when we went for an MRI to assess what was happening with his seeming inability to eat without gagging after a dental procedure. During the MRI it was determined that the tumour was pressing on his brain stem and causing neurological havoc. I had to let him go. He was diagnosed in 2020 and had surgery at WSU only they reported the tumour was quite advanced and they could remove only 60-65% of it, hence, travels for SRT.

There's sure no easy route so I hope you and Mars prevail.

Cabergoline
Mars has been on Cabergoline for three weeks now, but his blood glucose is all over the place. I’ve updated his spreadsheet so you can see the trend. At 6u of insulin, he occasionally drops fast from the 300s down to the 60s, then bounces right back up to the 300s. If I try to lower the dose to 5.5u or 5.75u, he just stays flat around 300. It feels like his numbers are anchored there no matter what I do. His neuropathy is getting worse and he is walking on his hocks all the time now. I’m giving him Zobaline twice a day, but I know it won't help much until his BG is lower. I have two questions for the group here:
* Should I increase the Cabergoline to every day? He currently takes it every other day and has no side effects. My vet said not to increase it because she doesn't think it will be more beneficial and might just cause nausea. Have any of you seen better results with daily dosing?
* Any suggestions on how to handle the insulin titration? I’m really worried about the 6 unit crashes, but 5.75 doesn't seem to do anything. With him being IAA positive and having bad neuropathy, I’m feeling pretty stuck on how to get him into a safer range.

I know I just asked a lot of questions. I really appreciate any insight or personal experiences you can share. This has been such an overwhelming journey and I’ve gained so much useful information from this forum already. Thanks for helping me and Mars.

Before his dental in June of 2025, Eddie had SRT in Victoria, BC, Canada. He had been on very high insulin dosage (I believe when we got there it was up around 28u BiD). A week after we left he's BG started dropping and it levelled off but I realized that they had to be careful with the SRT because of his optic never. We got down into 8-6iu Levemir and then went to Cabergoline. That was dramatic. After a few weeks, Eddie was even going into blues and greens and it was great to see. But then, he needed a dental because it was believe his teeth/gum health was contributing to problems. I think now, if I second gues myself on anything I've done with Eddie and Blue over the 7 years we had living with acromegaly, I would not have gone for the dental. Not that it would have saved him from the acromegaly but I think it might have been a slower decliine.

Again, I would do it all in a heartbeat. FDMB is such a wonderful community and you are in the right place with Mars, to be sure. Wishing you all good thoughts for the best possible outcome.

 

[Rachel & Mars]

Hello Rachel and Mars, I been a member of this board for ages and have lived with two acrokitties, Eddie and Blue (brothers) and we have travelled to and fro to U Washington where they had hypophysectomy with Tina Owen when Annie Chen Allen was part of the pituitary team. I did not know they were no longer doing hypophysectomy? I'd be surprised if that is true. Did they confirm that? Anyway, I can speak with the highest for Annie Chen Allen. She's brilliant, knowledgeable, approachable. Don't know anything about Texas A&M or Florida.

That is a hard call because as you know from this forum ECID. I learned that over the years. So much depends on the location of the tumour and its proximity to other areas of the brain, for example, the optic nerve. Both Eddie and Blue had hypophysectomy. Blue was first in Feb 2018. A followup MRI six months later showed a small regrowth (I mean we are dealing with cells, so hard to ensure margins, I guess) and we went for fractionated radiothereapy in late 2018 at WSU because I didn't know if SRT was an option. That treatment took 21 days because it's low dose, and given every second day. We came home and he went into remission really. Then a couple years down the line same thing: regrowth so we went to VCA Calgary where he had one dose of SRT. Remission and he pretty much stayed in remission for a few years, although I would check his BG every now and again and then in 2024, he was back on insulin and we were hoping for one last SRT (he was deemed ok to do this, again, placement of tumour). But what happened was that the acromegaly had affected his heart and we all know about that. He went into cardiac arrest during the MRI and I had to let him go. But here's the thing: he lived a good life for 7 years as an acro-kitty. He was just amazing and I'd do all over again.

Eddie had a different story. I lost him 11 months after Blue when we went for an MRI to assess what was happening with his seeming inability to eat without gagging after a dental procedure. During the MRI it was determined that the tumour was pressing on his brain stem and causing neurological havoc. I had to let him go. He was diagnosed in 2020 and had surgery at WSU only they reported the tumour was quite advanced and they could remove only 60-65% of it, hence, travels for SRT.

There's sure no easy route so I hope you and Mars prevail.

Before his dental in June of 2025, Eddie had SRT in Victoria, BC, Canada. He had been on very high insulin dosage (I believe when we got there it was up around 28u BiD). A week after we left he's BG started dropping and it levelled off but I realized that they had to be careful with the SRT because of his optic never. We got down into 8-6iu Levemir and then went to Cabergoline. That was dramatic. After a few weeks, Eddie was even going into blues and greens and it was great to see. But then, he needed a dental because it was believe his teeth/gum health was contributing to problems. I think now, if I second gues myself on anything I've done with Eddie and Blue over the 7 years we had living with acromegaly, I would not have gone for the dental. Not that it would have saved him from the acromegaly but I think it might have been a slower decliine.

Again, I would do it all in a heartbeat. FDMB is such a wonderful community and you are in the right place with Mars, to be sure. Wishing you all good thoughts for the best possible outcome.

Hi Jodey - Thank you so much for sharing such a detailed look into your journey with Eddie and Blue. I was really moved by your story. It is honestly so inspiring to see the level of care and love you gave them both, and they were very lucky to have you. Hearing that Blue had seven good years after his surgery gives me so much hope for Mars. About WSU - I did call them twice to confirm, and they told me Dr. Tina Owen is no longer performing the surgeries there. They actually referred me to Dr. Annie Chen-Allen’s new location in Oregon and the University of Florida. My vet is in the process of reaching out to them, so I’m hoping to have a consultation scheduled very soon. I know the post-op medication schedule can be intense, but what did that life actually look like for you? Did managing the daily pills feel more manageable than this constant stress of chasing the glucose numbers?

I was really surprised to hear how the dental procedure impacted Eddie. Mars has one tooth with resorption right now. It isn't too bad yet, but I've been worried that the inflammation might be part of why his glucose stays so high. I've been debating whether to fix it now or wait, but my vet suggested holding off until we address the acromegaly. After hearing what happened with Eddie, I feel more confident in that decision to wait.

 

[Rachel & Mars]

We are really struggling with his numbers right now. Mars has been very high and flat this past week, and it feels like he isn't responding to the Cabergoline at all yet. I’m stuck in this loop where I increase his insulin, he looks better for a day or two, and then the resistance just catches up. It feels like a never-ending tug-of-war. How do you all usually manage the insulin in this group when they are this flat for cats with acro? Do you just keep increasing the dose to keep the glucose in a lower range, even if it feels like you're just chasing a moving target? I'd love to know what the typical approach is for cats who aren't responding to Cabergoline yet. He's been on Cabergoline every other day for three weeks. My vet basically said since Mars is "only" on 6u, there's lots of room to increase.

Since his neuropathy is making it hard for him to walk, I'm trying to figure out how to keep him stable until we can get to the surgery.

 

[Jodey&Eddie&Blue]

Hi Jodey - Thank you so much for sharing such a detailed look into your journey with Eddie and Blue. I was really moved by your story. It is honestly so inspiring to see the level of care and love you gave them both, and they were very lucky to have you. Hearing that Blue had seven good years after his surgery gives me so much hope for Mars. About WSU - I did call them twice to confirm, and they told me Dr. Tina Owen is no longer performing the surgeries there. They actually referred me to Dr. Annie Chen-Allen’s new location in Oregon and the University of Florida. My vet is in the process of reaching out to them, so I’m hoping to have a consultation scheduled very soon. I know the post-op medication schedule can be intense, but what did that life actually look like for you? Did managing the daily pills feel more manageable than this constant stress of chasing the glucose numbers?

Hi Rachel, I guess because Annie C-A has left UW the team been broken up. I hope Tina O continues working as a surgeon, tho. I have to say that WSU, in particular, Tina O and Annie C-A, were so generous. For all of those years (7 of them), I could email, phone or Zoom with them, no charge. When I was having some issues with Eddie in Victoria for the SRT, she talked me through and helped me made a decision. She also was there on the phone with me when i had to go to the clinic to let Eddie go. And, many was the time, I met with her and Annie C-A on Zoom or conference call to work through some clinical acromegaly anomaly. The same with Linda Gail Martin, who is the critical care vet at WSU. She was part of the team and I've spoken with her late in the evening when she called me from her home. They are awesome women and I'm forever grateful to them. But, I digress. if you can work with Annie Chen-Allen, do so. Please give her my best wishes if you do. She knew both Eddie and Blue.

Again, I digress: managing the daily medication regime just became part of daily life. I kept a log with comments and changes and effects and affects, which really comes in handy when you need to provide information. The post-op medication schedule really was pretty simple and continued that way and it was just Desmopressin (DDAVP), Levothryoxine (later Cabergoline and other various medications over periods of days/weeks). They got to the point of coming to sit on the little rug by the cupboard and I'd give them their medicaitons, take a glucose reading, feed them and while they are eating, give them insulin. It really felt like it was all part of my DNA and after awhile, I could feel if I was out anywhere that it was time to leave for the evening routine without even looking at my watch.

I was really surprised to hear how the dental procedure impacted Eddie. Mars has one tooth with resorption right now. It isn't too bad yet, but I've been worried that the inflammation might be part of why his glucose stays so high. I've been debating whether to fix it now or wait, but my vet suggested holding off until we address the acromegaly. After hearing what happened with Eddie, I feel more confident in that decision to wait.

If Mars has resorption and inflammation, most likely, they might recommend an antibiotic to get things under control before any other procedures. However, it's good to keep in mind that Eddie's tumour had only been 60-65% removed by surgery and even with SRT (2x), it was still really unmanageable. It was pressing on his brainstem, so Eddie dental issues--which were more than one resorption00 were not the cause of his weird response after the procedures. It was the tumour and with the dental, we had the perfect storm. In any case, you and Mars are in good hands. All good thoughts.

 

[Wendy&Neko]

Hello and welcome. Thanks for the updated information on where the surgery is being performed now. Been a few years since a member here has had that done.

My Neko had both IAA and acromegaly too. She had SRT, twice. The tumour came back 3 years after SRT. She lived 5 years after diagnosis with those treatments, most of the time on smaller doses. I knew the tumour was coming back when her dosing needs increased sharply. It's like you are chasing after a speeding train!

I am popping in from Victoria where another kitty of mine is getting her first dose of SRT today. Not acromegaly, but SRT is good for other types of tumours as well.

What Jodey mentions about surgery and the vets doing it is what you have to consider. You only want to go to a surgeon who has plenty of experience with hypophysectomy. It's tricky surgery. I've heard of people from Europe flying over to England to go to the RVC for it. Do you know who the surgeons are at U of Florida or Texas A&M? Make sure your vet asks about their experience and number of surgeries performed.

Trading off type of treatment is a hard decision. Life spans after treatment are tricky to judge, mostly because we are dealing with older cats. Of the three cats here who got SRT treatment before Neko that I followed, two got cancer and one lasted a little longer but kidneys were his downfall. None of those lasted 5 years but it wasn't due to acromegaly. I've also seen a couple cats get no treatment and live 5 years, including one that went off of insulin after a few years. That is very rare. Of the few cats here who's people posted about their surgery, Jodey's are the only ones that lived 5+ years. We've also seen a few kitties on cabergoline do well and survive several years. Note, it can take several months before you see results with cabergoline and doing it every other day can increase that time frame.

And my last words are about dentals, Neko had a few dentals, at least one of them was critical. At one point, a bony growth started growing on her jaw. It was starting to interfere with her eating ability. I could feel it was growing quickly but thankfully the dental specialist managed to fit her in. The majority of bony growths on the jaw are cancerous, but in this case Neko was "lucky" to have acromegaly and it was only acro bony growth which was removed and didn't come back. She did have another dental surgery where soft tissue growth in her gums was causing a canine tooth to rub on her gums. The dental vet recognized the redness on her gums was not dental disease. Her canine tooth was shaved and the tooth below with the redness was saved. After Neko's second SRT, her heart condition worsened and she was no longer able to undergo anesthesia. She has some soft tissue back again making it hard to eat, but there was nothing we could do but purree her food. I can't stress enough encouraging you to get an echocardiogram at some point if you haven't done it already. Hidden heart conditions are far to common with acros. If you select surgery or SRT, they will probably require an echo first.

 

[Rachel & Mars]

If Mars has resorption and inflammation, most likely, they might recommend an antibiotic to get things under control before any other procedures. However, it's good to keep in mind that Eddie's tumour had only been 60-65% removed by surgery and even with SRT (2x), it was still really unmanageable. It was pressing on his brainstem, so Eddie dental issues--which were more than one resorption00 were not the cause of his weird response after the procedures. It was the tumour and with the dental, we had the perfect storm. In any case, you and Mars are in good hands. All good thoughts.

That's an interesting point about the antibiotics for the resorption. I'll ask my vet if that might help settle his inflammation while we wait for a surgery date. If we do end up in Oregon, I will absolutely give Dr. C-A your best wishes and tell her Eddie&Blue sent me. Thanks again for all the good thoughts. It means the world to us.

 

[Rachel & Mars]

Hello and welcome. Thanks for the updated information on where the surgery is being performed now. Been a few years since a member here has had that done.

My Neko had both IAA and acromegaly too. She had SRT, twice. The tumour came back 3 years after SRT. She lived 5 years after diagnosis with those treatments, most of the time on smaller doses. I knew the tumour was coming back when her dosing needs increased sharply. It's like you are chasing after a speeding train!

I am popping in from Victoria where another kitty of mine is getting her first dose of SRT today. Not acromegaly, but SRT is good for other types of tumours as well.

What Jodey mentions about surgery and the vets doing it is what you have to consider. You only want to go to a surgeon who has plenty of experience with hypophysectomy. It's tricky surgery. I've heard of people from Europe flying over to England to go to the RVC for it. Do you know who the surgeons are at U of Florida or Texas A&M? Make sure your vet asks about their experience and number of surgeries performed.

Trading off type of treatment is a hard decision. Life spans after treatment are tricky to judge, mostly because we are dealing with older cats. Of the three cats here who got SRT treatment before Neko that I followed, two got cancer and one lasted a little longer but kidneys were his downfall. None of those lasted 5 years but it wasn't due to acromegaly. I've also seen a couple cats get no treatment and live 5 years, including one that went off of insulin after a few years. That is very rare. Of the few cats here who's people posted about their surgery, Jodey's are the only ones that lived 5+ years. We've also seen a few kitties on cabergoline do well and survive several years. Note, it can take several months before you see results with cabergoline and doing it every other day can increase that time frame.

And my last words are about dentals, Neko had a few dentals, at least one of them was critical. At one point, a bony growth started growing on her jaw. It was starting to interfere with her eating ability. I could feel it was growing quickly but thankfully the dental specialist managed to fit her in. The majority of bony growths on the jaw are cancerous, but in this case Neko was "lucky" to have acromegaly and it was only acro bony growth which was removed and didn't come back. She did have another dental surgery where soft tissue growth in her gums was causing a canine tooth to rub on her gums. The dental vet recognized the redness on her gums was not dental disease. Her canine tooth was shaved and the tooth below with the redness was saved. After Neko's second SRT, her heart condition worsened and she was no longer able to undergo anesthesia. She has some soft tissue back again making it hard to eat, but there was nothing we could do but purree her food. I can't stress enough encouraging you to get an echocardiogram at some point if you haven't done it already. Hidden heart conditions are far to common with acros. If you select surgery or SRT, they will probably require an echo first.

Hi Wendy, thank you so much for sharing your experience and knowledge with me. It’s very helpful to hear about Neko’s journey, and knowing she lived for five years with both IAA and acromegaly gives me a lot of comfort. To answer your question about the surgeons, at Texas A&M, the lead neurosurgeon is Dr. Ito. He has performed over a dozen of these surgeries, though most were on dogs. However, he did one for a diabetic cat who actually went into remission within a month, which sounds promising. As for the University of Florida, I'm still waiting for more details. My vet is currently in the process of talking to them to get more information on their team and their specific experience levels.

It was also really helpful to hear that Cabergoline can take much longer to work than I thought. Mars’s numbers are still quite elevated and it doesn't feel like the medication is doing much yet, but my vet wants to keep him on the every other day schedule for now. He's currently on week 4 with the medicine. Mars actually had an echocardiogram about six months ago and his results were normal. We also did a proBNP blood test recently which came back normal too, so that is a relief. I’ll make sure to check with the surgeon if they want to repeat the heart scan before we move forward, just to be safe.

Best wishes to your kitty who is getting SRT! I hope everything goes smoothly and that she starts feeling much better very soon.