? IGF-1 = 97....is this considered Acromegaly?

[MISSY + Simone&MICIO (GA)]

I took my Missy to the IM on July 7th for a check up, especially since after the 2 episodes of bloody nose discharge after sneezing. Also, because of the increased snoring, breathing noise and her BGs not being really effected by the insulin increases, I went ahead and add the IGF-1/ IAA tests done as well aong with some blood work
Results on the mini chem showed an improved Creatinine @ 1.5 with an increased BUN wich could indicate some GI upset or Panc flare so we went ahead and add some famotodine for about 10 days.
While IAA results still pending, IGF-1 is at 97 and, although a bit elevated, the IM doesn't think is high enough to consider Missy acromegalic ...not yet. IM suggested to either a CT scan of her head to see if there is a mass or rechecking her IGF-1 levels in 1-3 months to see if they're trending up.
IM doctor agrees with me on Missy's diet but as far as the insullin amount she totally disagreed! She went on and on a few times scolding me about the dosage Missy's on the saying that the "Tight Regulation protocol is extremely tight which does put her at risk for hypoglycemia and, if anything, we should decrease the dose".
I just let her express her opinion but I believe in what I'm dong and will continue with same protocol.
I have been keeping a steady 4.75u for several weeks now as I wasn't quite sure what to do (I did post a new thread on Lantus forum a bit ago, ( https://felinediabetes.com/FDMB/thr...-resume-dose-increasing-or-stay-4-75u.279219/ ) looking for advices but no answers so I am here to try again...

Missy is doing "ok", eats ok and pretty calm and relaxed . Big hairballs here and there (she has long hair and doesn't like being brushed at all) so I add some insoluble fibers along to other supplements to push the hair down easily. She still taking Azithromycin every other day now, apparently is being helping with her sinus issues. Also giving her small doses of Gaba every other day for her arthritis.
She doesn't do any activities at all besided laying down, sleep, drink and being fed; since the day Micio passed in January, she secluded herself in the bedroom.
Overall, her BGs are still very flat but sometimes may go higher for a bit and then come down again.

Is there anything I should start doing to help Missy? What are your thoughts on this?
TIA

@Wendy&Neko, @Suzanne & Darcy , @Bron and Sheba (GA) , @FrostD

 

[Wendy&Neko]

The MSU scale says 92 and above is positive. But I don't know the margin of error that close to the line. I agree with the IM vet strategy of waiting a couple months and retesting again. A CT scan is both expensive and requires anaesthesia. Maybe if still up but barely, then a CT scan after the second test might be appropriate.

As far as dose goes, you probably do have room for a little increase to 5 units if you wanted. But that depends on your goals for her Her numbers are looking pretty good.

As for other things to do, is she getting any probiotics? Visbiome is a good one for IBD. Along with psyllium husk powder, if that's what you are giving now.

 

[Suzanne & Darcy]

Hello, Simone! How are you doing? I was just thinking about you this morning and happened to look at Missy’s spreadsheet. I was amazed at how much progress you have made with her since you began. You are doing a great job. She’s in such good green numbers for the most part. Is your goal to get her into lower greens? About the acromegaly, if she’s not over 100 then she’s not considered an acrocat, as you are aware I am sure. To me she also doesn’t look like the other IAA cats that I have seen, but I am not an expert.

 

[Suzanne & Darcy]

Okay it looks like I stand corrected. I was going by what it says on our acro info page, I thought. It said over 100 was positive for acro. It’s very close. If Missy were my cat, I would retest in a few months too, for peace of mind.

 

[Suzanne & Darcy]

I second the recommendation for Visbiome. I have been giving Visbiome Vet to my IBD boy for the last couple of months, and it’s been a really positive improvement. I was very skeptical because I have tried a lot of probiotics, but I’ve never been able to lower his Prednisolone dose to every other day before because every time I tried, he would get diarrhea or vomiting. After the first two jars of Visbiome, I was able to reduce his dose of pred to every other day and he’s doing great.

 

[MISSY + Simone&MICIO (GA)]

The MSU scale says 92 and above is positive. But I don't know the margin of error that close to the line. I agree with the IM vet strategy of waiting a couple months and retesting again. A CT scan is both expensive and requires anaesthesia. Maybe if still up but barely, then a CT scan after the second test might be appropriate.

As far as dose goes, you probably do have room for a little increase to 5 units if you wanted. But that depends on your goals for her Her numbers are looking pretty good.

As for other things to do, is she getting any probiotics? Visbiome is a good one for IBD. Along with psyllium husk powder, if that's what you are giving now.

Only thing I can consider right now is another IGF-1 test in a few months or so, unless something else happens and she gets worse. For some reason, both the IM and I, suspect some sort of growth/mass and wanted to rule out a possible URI before jumping into the CT scan, rhinoscopy w/anesthesia. Azithromycin seems to have help with stuffy synus so far so we'll wait and see.
Have been giving Missy pro/prebiorics and fiber for many years but definitely going to get Visbiome next, also very well recommended on the "Raw feeding for IBD Cats" group I'm in for long time.... thanks for the reminder though.

 

[MISSY + Simone&MICIO (GA)]

I second the recommendation for Visbiome. I have been giving Visbiome Vet to my IBD boy for the last couple of months, and it’s been a really positive improvement. I was very skeptical because I have tried a lot of probiotics, but I’ve never been able to lower his Prednisolone dose to every other day before because every time I tried, he would get diarrhea or vomiting. After the first two jars of Visbiome, I was able to reduce his dose of pred to every other day and he’s doing great.

Hello Suzanne! Yes, going to order Visbiome soon as I'm finishing up with the other probiotics. May I ask were you usually get it from?
Have been giving Missy Denamarin per IM suggestion since March as it was suppose to help with liver and pancreatitis but the values actually seemed worsened in the last blood work....if is not helping I don't see why continue with it. Wonder if stopping Budesonide completely back in April may have been good or bad?!

 

[Suzanne & Darcy]

Hello Suzanne! Yes, going to order Visbiome soon as I'm finishing up with the other probiotics. May I ask were you usually get it from?
Have been giving Missy Denamarin per IM suggestion since March as it was suppose to help with liver and pancreatitis but the values actually seemed worsened in the last blood work....if is not helping I don't see why continue with it. Wonder if stopping Budesonide completely back in April may have been good or bad?!

What changes have you seen since stopping Budesonide? Maybe the GI upset that you have started the Famotidine for? And you definitely ruled out a URI? Or pancreatitis? Dental problems?

 

[Suzanne & Darcy]

Hello Suzanne! Yes, going to order Visbiome soon as I'm finishing up with the other probiotics. May I ask were you usually get it from?
Have been giving Missy Denamarin per IM suggestion since March as it was suppose to help with liver and pancreatitis but the values actually seemed worsened in the last blood work....if is not helping I don't see why continue with it. Wonder if stopping Budesonide completely back in April may have been good or bad?!

Oh, sorry I didn’t reply to your specific question: but I have just been ordering my Visbiome Vet directly from Visbiomevet.com. Let me know if you find a better place to order from. Some people just buy the human version.

 

[MISSY + Simone&MICIO (GA)]

What changes have you seen since stopping Budesonide? Maybe the GI upset that you have started the Famotidine for? And you definitely ruled out a URI? Or pancreatitis? Dental problems?

I thought she's been doing fine since slowly stopping Budesonide, will have occasional softer stools if she gets hairballs stuck sometimes or if taking antibiotics like recently (that's why we're now giving Azythromycin only twice a week now) but it only takes a couple caps of S. Boulardii probiotic to fix that.
IM noticed some values were higher in this last blood work and prompter to think Missy may be having some panc flare up so she wanted me to give her Famotodine for 10 days.
Missy never got a URI before and I don't know if she was having one at this time, she did not have any discharge from her nose or eyes but twice she sneezed harder and had a couple drops of blood and her synus sounded stuffed...it was so weird and scary. If she'll have more episodes like that then we'll have to think of the more invasive procedure.
I will let you know where I'll get Visbiome.

 

[Wendy&Neko]

Okay it looks like I stand corrected. I was going by what it says on our acro info page, I thought. It said over 100 was positive for acro.

That page was written ages ago, thanks for reminding me to correct that. I just checked the results from Neko, and it said reference range up to 92. The Sticky on acrocat IGF-1 levels has several other people also saying 12-92 is normal. Someone else with high 90's reporting waiting a few months to retest. Simone, the results from MSU should say the reference range. I'd be interested to see if that has changed lately. For what it's worth, the 1000 nmol/L system in the UK seems to have moved down too.

 

[MISSY + Simone&MICIO (GA)]

That page was written ages ago, thanks for reminding me to correct that. I just checked the results from Neko, and it said reference range up to 92. The Sticky on acrocat IGF-1 levels has several other people also saying 12-92 is normal. Someone else with high 90's reporting waiting a few months to retest. Simone, the results from MSU should say the reference range. I'd be interested to see if that has changed lately. For what it's worth, the 1000 nmol/L system in the UK seems to have moved down too.

Here's a copy of Missy's results, not sure when I'll get the IAA results back, looks like they only run that once at month.
I was also reading through the sticky on acromegaly people's comment and saw someone saying her cat was on low 100's and repeated the test a few months later and numbers triplicated...that's crazy.

 

[Suzanne & Darcy]

That page was written ages ago, thanks for reminding me to correct that. I just checked the results from Neko, and it said reference range up to 92. The Sticky on acrocat IGF-1 levels has several other people also saying 12-92 is normal. Someone else with high 90's reporting waiting a few months to retest. Simone, the results from MSU should say the reference range. I'd be interested to see if that has changed lately. For what it's worth, the 1000 nmol/L system in the UK seems to have moved down too.

Thanks. I could tell it was old, but it was interesting to see a little more about who the pioneers were with Acro kitties on the Board.

 

[Suzanne & Darcy]

Here's a copy of Missy's results, not sure when I'll get the IAA results back, looks like they only run that once at month.
I was also reading through the sticky on acromegaly people's comment and saw someone saying her cat was on low 100's and repeated the test a few months later and numbers triplicated...that's crazy.

View attachment 67259

Wendy is right that the range goes up to 92. I was just thinking this morning that… what are the odds that you should have 2 acrocats? Two cats not related to each other (they weren’t related, right?) It seems so improbable. I guess the odds are 1 in 3 or 1 in 4?

 

[Jackie55 & Bootsie]

My vet was at the AVMA conference in Denver last week. She attended a presentation about diabetic cats and acromegaly - so maybe vets are becoming more aware of the condition. Fingers crossed.

 

[Wendy&Neko]

what are the odds that you should have 2 acrocats? Two cats not related to each other (they weren’t related, right?) It seems so improbable.

It is thought that there is an environmental component to acromegaly. For myself personally, what are the odds that I'd have three cats in a row with small cell lymphoma. Completely different disease but chance can play funny games.

 

[Suzanne & Darcy]

It is thought that there is an environmental component to acromegaly. For myself personally, what are the odds that I'd have three cats in a row with small cell lymphoma. Completely different disease but chance can play funny games.

Uh oh. This has me scared. I still have Darcy’s biological sisters still (he was the only boy) and sometimes worry that one of them will get acromegaly. So far they’re still very healthy at age 12. I do think about this. I wonder if he was born with the pituitary tumor in him already (very tiny?). I suppose it’s not like that, but that there are defective genes in there somewhere that may express themselves at some point (due to age and environmental stimulus?)

 

[Suzanne & Darcy]

It is thought that there is an environmental component to acromegaly. For myself personally, what are the odds that I'd have three cats in a row with small cell lymphoma. Completely different disease but chance can play funny games.

And that is kind of amazing about you having 3 cats in a row with SCL. I’ve had two, but they were separated by some years.

 

[Jackie55 & Bootsie]

I guess I am just happy Vets are talking about it more and perhaps checking for it. I know my vet was shocked to learn that 1 of 4 cats with diabetes have acromegaly and she said she will discuss with owners and test as needed.
For Bootsie I do wonder what set it off. She has/had been a very healthy cat and very normal cat. It is over 2 years since she was diagnosed and over the last 2 months I have seen a very slight decline in her attitude but otherwise she is about the same as when she was diagnosed. She has developed 2 more mast cell tumors, one on her side and another very small one on her face.