Happy Thanksgiving! This is my first post in this sub-forum. I posted a bit of background here a few weeks ago: https://felinediabetes.com/FDMB/thr...perthyroidism-any-advice.254911/#post-2872038 She had her follow-up blood work to see how her T4 levels were responding to treatment and she was down to 3.4 (4.0 was the high threshold). But, there have been no positive effects on her BG levels. So, I managed to get my vet to send blood for IAA and IGF-1 testing. IAA was normal (3 vs. <20 for the reference range), but IGF-1 was very high (>521H vs. 12-92 nmol/L for the reference range). The MSU report says "The serum concentration of insulin-like growth factor 1 (IGF1) is increased and acromegaly is a likely differential diagnosis. It is recognized that increases in this hormone may occur as a metabolic response to diabetes mellitus in some cats, but this result is clearly higher than what would be expected in that case." So, my vet is unwilling to try medication and says that the only options if we want to pursue treatment is surgery or surgery + radiation. She wants us to go to some internal medicine specialists. Based on our reading here and in journal articles, we'd really like to try medication - Cabergoline - before considering a pretty invasive surgery. Since we are interested in trying a treatment which isn't exactly standard, and we'd like to get started quickly (she's currently getting 11.25 units of Lantus BID and not all that well regulated), we aren't looking forward to trying vet after vet until one is willing to try medication instead of jumping right to surgery. My question is, does anyone know a vet who would be willing to prescribe Cabergoline remotely? I have all of her medical records in electronic format, including recent full blood work-ups, etc. Thanks again for a great forum!