I apologize now for the novel.. I don't even know where to start. I'm a little overwhelmed with this new diagnosis, and I also just found out that the vet we have been seeing the past 3 years and has been overseeing Shadow's care is leaving the office. I was offered a new vet at the clinic, but the vet tech was unsure of which vet would be taking over our care. I'm concerned because this will be a whole new relationship to start during our diabetes diagnosis, and now I feel like I'm just flying in the wind with the new acro diagnosis. His current vet referred us to an internal medicine specialist in OKC, but I am waiting on a phone call back to see if she will accept Shadow as a patient or is even able to accept him. I tried calling the vet teaching school at Oklahoma State University per another referral by his current vet. They called back to say they are not equipped to do anything for him other than an MRI. The school then referred me towards a place in Dallas or the teaching school at U of Missouri. I don't even know where to start here. What kinds of questions should I be preparing myself to ask? What treatment options have the best outcomes? Hell..how many options do we even really have? And realistically, what exactly does this new diagnosis mean for my baby boy and his life expectancy? He just turned 13 in Sept '20! He has so much more to experience with life.
So sorry for the diagnosis. I hope the new vet is a good fit for you. My cat was diagnosed acro 21 months ago, although I suspect it started a long before that and that it is what brought her out of her year long remission in 2017. One treatment is radiation (srt) treatment. I didn't do it because the cheapest quote I got was 8,000 not including the tests that come before that, so more like 8,500. Some give Cabergoline which if I am correct slows down the tumor's output. I haven't tried it. I chose to just treat with insulin... as much as she needs... and at the times when the dose was really high I just had to remind myself that she needs what she needs. I test frequently and I change my doses frequently as needed. AT her most she needed 12.5 u twice a day. Currently it is unbelievably down to 3-3.5 U twice a day. In the end it's the kidneys or the hyperthyroidism that's going to get my cat as she has issues with both.
Sorry about the diagnosis. Just remember that Shadow doesn't know he's any different with that diagnosis, still the same sweet cat. It is overwhelming at first, but I hope we can help you. Keep asking questions. The actual gold standard for treatment is hypophysectomy, or surgical removal of the pituitary gland. In the US, I think it's only done in New York City. Next option is stereotactic radiation therapy, which is more available, but still not available everywhere. Next option is medical treatment. There are two options. The gold plated (very expensive) one is pasireotide, the reasonable one is called cabergoline. It's a medication you give every day. More details here: Cabergoline as a possible treatment for acrocats: discussion My girl had SRT (radiation therapy) as that is all that was available at the time. She lived 5 years after her diagnosis, well 1 week short. Some cats do well just with appropriate insulin support, meaning getting them as regulated as possible. You will likely have some secondary conditions to watch for and take care of. An MRI at this point is a waste of money. Can you tell me what his IGF-1 number was? Was he also tested for IAA?
What was Shadow's IGF-1 test result? Did you also test for insulin autoantibodies? (IAA)? I am treating my Snuffles with Cabergoline. I only treated my first aero cat, MurrFee with only insulin. MurrFee was up to 50 units twice daily. My SNuffles is at 13 units twice daily. I use a combination of Levemir and N insulins since Levemir is so expensive and I can get a 10ml vial of N from Walmart for $27.
His IGF-1 came back with a # of 330. We did have him tested for IAA as well and that came back negative, so thankfully we don't have both working against us. I'm still waiting on a call back from an internal medicine vet in OKC to see if this is a case she would be willing to take on. Unfortunately in the posts I have been able to read through, it's looking like surgery and the radiation therapy are most likely just going to be too far out of my budget to even consider. I'll do some more research behind the Cabergoline and see if that might be the avenue for us or if I'll just have to continue trying to treat just the diabetes with insulin for now. Thank you all for your replies! It helps so much to know I'm not totally alone in this!
One thing I learned was that I couldn't hold a dose that wasn't working for too long. If a dose wasn't enough after a few days, I had to raise it or she would quickly build up a resistance to the dose and need even more. If have to reevaluate every few cycles what to give her.
SRT is about twice as expensive now as when I took Neko to have it done. Cabergoline is quite affordable. And most people do find it does help their cats, both in terms of needing less insulin, but also helping the acro symptoms. I totally agree with Janet about the dosing. You can't "sit" on a dose for long. With the amount of testing you are doing, you could follow TR for dosing and increase faster. Otherwise the resistance will get away from you. One other thing for you look consider is how Shadow is reacting to the Lantus. Many cats feel a sting with Lantus at higher doses due to it's acid base. For that reason, many people with higher dose cats switch to Levemir. It has the side benefit of flatter cycles for a lot of cats.
I've thought a lot about switching to TR and that may be what I end up doing, but I also don't have anyone else here that is willing to help do his tests, but my mother is comfortable helping make sure he gets his insulin on time when I am not here. On the days I do work (I've been in quarantine for 2 weeks because of a positive Covid test in our household..not me) I am sometimes able to get a preshot test before I leave, then mom will do his shot. I do have other shifts I work where timelines just won't add up to me being able to get a PS on time..it's closer to a +10.5 or +11. Also on those days, there will be zero mid cycle info. This weekend for instance, since I'm finally able to go back to work, his PS today will be at his +10.5 because that's the latest I can push it before I have to leave. I also have to work til 2am, then I'm turning around and going back in at 11am, so I am having to stay with someone closer to where I work (I drive 45 minutes each way to work), so there will be 0 tests between his +10.5 this afternoon and whatever his PM+ is when I get back home tomorrow night. That'll most likely be around his PM +7 Is missing mid cycle tests and PS tests 2-3 days a week too much to be able to run TR? I've asked my mom several times if she'd like to watch me test him and learn how to do it, but she has admitted she is very uncomfortable trying to do it with her eyesight and her issues with her hands (she's had multiple surgeries for carpal tunnel)
OK, you are right, SLGS is probably better for your situation. But you aren't wedded to it. If you have a time when you are home for a while, you can switch for a bit, then switch back. And definitely don't hold onto doses past 7 days if they aren't getting you good numbers.
I just recently gave him a dose increase from 9 to 9.5. I was going to do a full unit increase, but I realized I wouldn't be available to him this weekend like I can be during the week. Since I will not be home to do mid cycle tests with the 9.5, would you recommend a curve on Tuesday (earliest I can do it) and to increase again by .5 if necessary or are we at a high enough daily dose to where I should be doing full unit increases?
Change to 1 unit increases (if needed), after you get to 10 units total dose. A curve on Tuesday sounds good and you can increase after that, based on what you see.
He is at 116 at +10.5, I'm currently on my way to work. Should I advise to skip his PM shot or would I be better off having my mother give him a token dose to help combat the chance of ketones since I won't be home to check his urine either?
How long after PMPS will you be home? I presume no PMPS test tonight. Just wondering if a half dose would be OK.
She does know what to look for and she knows the steps to take in case of a low. My uncle who is staying with us has thankfully agreed to attempt getting a test when he gets back to the house (around +6-+7) but that is not a guarantee since it'll be his first time trying.
I'd still stick with the token dose for now. If you had gotten a test earlier in the cycle, we'd know if he was going up or down by the +10.5. Nice to have other family members on team Shadow.
I advised to give him 3U, keep a watchful eye to check symptoms of a hypo, and will wait to hear how he's doing and what his BG is around his +6 or +7 Thank you for helping calm down my nerves!
