Not sure if I should go through with radiation treatment for my senior cat -- any advice?

BananaBo

BananaBo

Member
Hi all,

I have a 17 year old cat, named Bo, who has just been diagnosed with acromegaly. He also suffers from stage 3 kidney disease. We currently have the option to treat the acromegaly with radiation (SRT). I'm told that doing this would likely get rid of his diabetes (and associated symptoms like neuropathy, which he has pretty bad) and in theory would improve his quality of life by a lot. Now, his currently quality of life isn't terrible, but it could be better -- the worst he deals with now is probably the fact that we have to clean him every time he pees (due to the neuropathy, he is unable to squat properly, so he pees all over his legs), which he doesn't enjoy, since he pees like 6 times a day (and always outside of the box). My conundrum is that I'm not super comfortable with him needing to be sedated 4 different times for this treatment. His internist says he should be fine and that it will be low-risk for him, but just a few months ago his previous vet said he was no longer eligible for sedated dental cleanings due to his age and condition -- so why is it now suddenly fine for him to be sedated 4 times? The inconsistency is irritating, but I'm also more inclined to believe the internist since she is more experienced. I also acknowledge the fact that his life expectancy is lowered anyway due to the stage 3 kidney disease. But then I think about how, if he got the radiation, the life he had left would probably be a lot more pleasant... and I am honestly just really torn on what to do. Has anyone faced something similar, or just have an opinion on what they would do? Thanks in advance for any advice you may have!

By the way, in case anyone is curious, he is currently on 7.5 units of Lantus insulin (but likely to increase if we don't go through with the radiation since the tumor will get worse), and he's also getting 100ml of subcutaneous fluids every day for his kidney disease.
 
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Hello, where do you live? There are some places that do SRT in just one dose of radiation, which would mean sedating just two times. However, in a cat with stage 3 kidney disease it is a question of whether that would still be safe. What does the vet say about him having anaesthesia? And by the way, SRT is not a guarantee of getting rid of diabeties. I've seen numbers between 30-50% of the cases is it curative. And it can still take up to two years to be completely effective. My Neko had SRT and got down to small doses, and then the tumour came back and she had radiation therapy a second time. It's not common for it to come back, but I have seen a few cases of it.

At the time we did SRT, it was the only treatment available. And with the lower dose and improvement of symptoms, Neko did have a much better quality of life. She had acromegaly for at least 5 years, diabetic most of that time, but passed just before turning 16.

There are other treatments available now, the drug cabergoline being one of the most recent ones, and the only cost effective one I know that does not require anaesthesia.

Have you had Bo's heart checked? Heart issues are all too common with acrocats. Neko was getting fluids but we had to stop it as it sent her into heart failure. She did recover from that, but couldn't get fluids after that. And needless to say, no more anaesthesia for her after that either.

As for neuropathy, are you giving Zobaline or methyl B12 to him? That plus getting his diabetes under control will help greatly.
 
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If he was my cat, I would skip the SRT. Generally, the process is expensive. And as Wendy said, he will likely still have diabetes afterwards.

My kitteh Leoberry had SRT. He went from 18.0 units/dose to 2.0 units/dose after 33 months (then he went to the Rainbow Bridge). The anesthesia will be harder on an older cat. The cabergoline option is inexpensive and could possibly help with the Acro.
 
Wendy&Neko said:
Hello, where do you live? There are some places that do SRT in just one dose of radiation, which would mean sedating just two times. However, in a cat with stage 3 kidney disease it is a question of whether that would still be safe. What does the vet say about him having anaesthesia? And by the way, SRT is not a guarantee of getting rid of diabeties. I've seen numbers between 30-50% of the cases is it curative. And it can still take up to two years to be completely effective. My Neko had SRT and got down to small doses, and then the tumour came back and she had radiation therapy a second time. It's not common for it to come back, but I have seen a few cases of it.

At the time we did SRT, it was the only treatment available. And with the lower dose and improvement of symptoms, Neko did have a much better quality of life. She had acromegaly for at least 5 years, diabetic most of that time, but passed just before turning 16.

There are other treatments available now, the drug cabergoline being one of the most recent ones, and the only cost effective one I know that does not require anaesthesia.

Have you had Bo's heart checked? Heart issues are all too common with acrocats. Neko was getting fluids but we had to stop it as it sent her into heart failure. She did recover from that, but couldn't get fluids after that. And needless to say, no more anaesthesia for her after that either.

As for neuropathy, are you giving Zobaline or methyl B12 to him? That plus getting his diabetes under control will help greatly.
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Hi there! I am in Austin, TX. We asked about the single dose since I had heard about that, too, and they didn't recommend it for him due to it potentially causing some sort of ocular issues. The internist we saw thought that he would do fine with the anesthesia, but she also understood if we didn't want to do it. It's weird because his previous vet told us that he had a heart murmur on multiple occasions, and this internist specifically said that she did not detect one, so he would probably need to get an echocardiogram before we did anything. And that's good to know about the uncertainty with regard to the how curative it will be... it would be really unfortunate if he passed away before it started to work. I'll need to take a closer look at that medication -- thanks! And yes, we do give him Zobaline every day (we also give him Cosequin, Nordic Naturals fish oil, and FortiFlora).
 
JeffJ said:
If he was my cat, I would skip the SRT. Generally, the process is expensive. And as Wendy said, he will likely still have diabetes afterwards.

My kitteh Leoberry had SRT. He went from 18.0 units/dose to 2.0 units/dose after 33 months (then he went to the Rainbow Bridge). The anesthesia will be harder on an older cat. The cabergoline option is inexpensive and could possibly help with the Acro.
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Yeah, I keep reading that it may or may not get rid of the diabetes for good, and that it can take some time to take effect, which is definitely factoring into my decision in a big way now... thank you for sharing -- I'm sorry for your loss.
 
I chose to just treat my cat with insulin. She's had diabetes 4.5 years, and acro at least 3 years. She has stage 2 almost stage 3 CKD. It is not the diabetes that is going to get her, it's the CKD eventually. My cat was up to 12.5 u twice a day at her most, now around 4.5-5 which isn't bad. We've had cats here on 30+ units twice a day. The neuropathy will improve with better BG control and b 12 supplements. We can help with dosing if you want. Is your cat also getting Sub q fluids? At stage 3 it would help a lot.
 
Wendy&Neko said:
Interesting, I was never told anything about that at CSU when Neko had a single radiation the second time.
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Long-term side effects are possible, but quality of life is usually very good.
The treatment may cause injury to the surrounding brain tissue and the nerves associated with the eyes. Rarely, this could result in blindness or neurologic abnormalities such as seizures months-years after SRT.
It is also possible that your cat’s hair coat could change color (on the head only), and this could be permanent.

Above from:
https://cvm.ncsu.edu/nc-state-vet-h...y-feline-acromegaly-pituitary-tumors-in-cats/
 
@Larry and Kitties That article talks about SRT in general - My comment was specifically about the 1 dose vs. 3 dose SRT side effects cause is sounds like Bo's vets had a concern specifically about the single dose SRT vs three dose.

We have had a couple kitties here who got hypothyroid after SRT (3 dose SRT cases) - I think it's less uncommon than that article says, but none with eye issues or fur colour changes in my time here. SRT has less surrounding tissue damage than conventional radiation therapy, which is one of the reason SRT is preferred, along with the fewer sessions/less anaesthesia.
 
Wendy&Neko said:
Interesting, I was never told anything about that at CSU when Neko had a single radiation the second time.

I believe @Tillie and Valentino just had that treatment too.
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It's possible that the doctors I'm dealing with are not as experienced in the treatment... we also discussed the surgery option with them and were told that only 2 cats in the area had had the surgery so we passed on that... so maybe the single dose is also just something they haven't performed enough times to recommend?
 
JanetNJ said:
I chose to just treat my cat with insulin. She's had diabetes 4.5 years, and acro at least 3 years. She has stage 2 almost stage 3 CKD. It is not the diabetes that is going to get her, it's the CKD eventually. My cat was up to 12.5 u twice a day at her most, now around 4.5-5 which isn't bad. We've had cats here on 30+ units twice a day. The neuropathy will improve with better BG control and b 12 supplements. We can help with dosing if you want. Is your cat also getting Sub q fluids? At stage 3 it would help a lot.
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Good to know... And yeah, I agree that the CKD will likely be the biggest issue in terms of his life expectancy, unfortunately. We do currently give him 100ml of subq fluids per day, along with B12 (Zobaline). He is only on 7.5 units of insulin currently, but his blood sugar has only become unstable in the last couple of months (which is what initially prompted us to see the Internal Medicine doctor), so I'm slowly increasing his dose every week until he's more regulated...
 
BananaBo said:
Good to know... And yeah, I agree that the CKD will likely be the biggest issue in terms of his life expectancy, unfortunately. We do currently give him 100ml of subq fluids per day, along with B12 (Zobaline). He is only on 7.5 units of insulin currently, but his blood sugar has only become unstable in the last couple of months (which is what initially prompted us to see the Internal Medicine doctor), so I'm slowly increasing his dose every week until he's more regulated...
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We have a great template here that we use to track numbers. You can see the links in our signatures. Makes it easy to share and ask advice. Here's the template if you are interested https://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
 
Hi @BananaBo

My cat Valentino literally just had SRT - one single high dose - on Tuesday here in Austin, Texas. We did a heart echocardiogram first which did show some mild heart disease, possibly caused by the acromegaly, but my Vet did not think that it would be a problem. We used VCA Capital Veterinary Specialists on Spicewood Springs Road, Dr. Treuil. The Dr. initially recommended 3 doses but I was very paranoid about the anesthesia, given the heart issue, and asked about a single dose, which he did say he could do but would need to see the initial CT Scan first to see if it is feasible. After he did, the pituitary was only mildly enlarged, and he didn't seem to have a concern about the optic nerve. He mentioned that this was the protocol North Carolina University typically uses.

So, he did one single high-dose radiation. It required 2 general anesthesias.... 1 for the Catscan and one for the Dose of radiation. Both times it was pretty quick. I expect it could take weeks to months to start showing any effect. It takes a while for the cells to respond. I don't think it would hurt the cat in any way and it would mainly depend on other health factors I would presume, whether anesthesia is a good idea. The Dr. was very tuned in to that and I think gave good advice based on his underlying heart disease. The biggest problem is probably the fact that it could take a while to show effect and it is expensive. Do you have a good Vet who could steer you? Cabergoline also seems like a very promising alternative for some cats, but it just depends on if they respond.

I'd be happy to talk more about my experiences if you want to PM me.
 
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Hi BananaBo - I'm in NW Austin (183 near Arboretum). You and Tillie are very fortunate to have SRT facilities in Austin in 2020. In 2016, there was no SRT in (Austin, College Station, or San Antone). Leo had his SRT in Fort Collins, Colorado. I drove him there and back.

Thanks for the condolences. He was the very best.
 
Tillie and Valentino said:
Hi @BananaBo

My cat Valentino literally just had SRT - one single high dose - on Tuesday here in Austin, Texas. We did a heart echocardiogram first which did show some mild heart disease, possibly caused by the acromegaly, but my Vet did not think that it would be a problem. We used VCA Capital Veterinary Specialists on Spicewood Springs Road, Dr. Treuil. The Dr. initially recommended 3 doses but I was very paranoid about the anesthesia, given the heart issue, and asked about a single dose, which he did say he could do but would need to see the initial CT Scan first to see if it is feasible. After he did, the pituitary was only mildly enlarged, and he didn't seem to have a concern about the optic nerve. He mentioned that this was the protocol North Carolina University typically uses.

So, he did one single high-dose radiation. It required 2 general anesthesias.... 1 for the Catscan and one for the Dose of radiation. Both times it was pretty quick. I expect it could take weeks to months to start showing any effect. It takes a while for the cells to respond. I don't think it would hurt the cat in any way and it would mainly depend on other health factors I would presume, whether anesthesia is a good idea. The Dr. was very tuned in to that and I think gave good advice based on his underlying heart disease. The biggest problem is probably the fact that it could take a while to show effect and it is expensive. Do you have a good Vet who could steer you? Cabergoline also seems like a very promising alternative for some cats, but it just depends on if they respond.

I'd be happy to talk more about my experiences if you want to PM me.
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Wow, what are the odds! How is he doing now that's it's been a few days? Thanks for sharing all of this -- I will definitely reach out if we decide to go through with it... much appreciated!
 
JeffJ said:
Hi BananaBo - I'm in NW Austin (183 near Arboretum). You and Tillie are very fortunate to have SRT facilities in Austin in 2020. In 2016, there was no SRT in (Austin, College Station, or San Antone). Leo had his SRT in Fort Collins, Colorado. I drove him there and back.

Thanks for the condolences. He was the very best.
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Oh my gosh, so many Austin folks! I'm very familiar with that area. I've been coming across so many stories like yours in my research, with people making the trip to Fort Collins from all around the country... very inspiring, and I'm so grateful there are options nearby nowadays. Also, how about this snow, huh???
 
He's doing just fine! He seemed a bit tired yesterday but overall pretty much as he was, which is pretty low energy these days. Don't know how long it will take to see any changes. I'm hoping his ravenous appetite will improve, and that he'll just seem overall more comfortable, and of course, that it will improve his diabetes management if not reduce or remission. It's been quite a roller coaster learning about feline diabetes and also acromegaly all within the last 4 months. We have a great vet at South Austin Cat Hospital, Dr. Breitreiter, who has been most helpful as she has experience with acromegalic cats. I hope you're sweet Bo is doing okay! Even if it's just managing the diabetes I think that helps a lot.
 
BananaBo said:
Oh my gosh, so many Austin folks! I'm very familiar with that area. I've been coming across so many stories like yours in my research, with people making the trip to Fort Collins from all around the country... very inspiring, and I'm so grateful there are options nearby nowadays. Also, how about this snow, huh???
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Can't believe it's really snowing!
 
Tillie and Valentino said:
He's doing just fine! He seemed a bit tired yesterday but overall pretty much as he was, which is pretty low energy these days. Don't know how long it will take to see any changes. I'm hoping his ravenous appetite will improve, and that he'll just seem overall more comfortable, and of course, that it will improve his diabetes management if not reduce or remission. It's been quite a roller coaster learning about feline diabetes and also acromegaly all within the last 4 months. We have a great vet at South Austin Cat Hospital, Dr. Breitreiter, who has been most helpful as she has experience with acromegalic cats. I hope you're sweet Bo is doing okay! Even if it's just managing the diabetes I think that helps a lot.
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Aw, that's good to hear! I hope he starts feeling even better soon. How old is he? And I know what you mean... Bo got diagnosed with diabetes, acromegaly, and CKD all in the last year -- just par for the course in 2020, I suppose!
 
Thank you, @BananaBo! I didn't realized Bo was just diagnosed with all of that this past year, too. It is a lot to take in and manage. I did a lot of internet research on Cabergoline and SRT and since Valentino was in otherwise very good health and we think we may have caught it a few months early perhaps, I decided to give the SRT a go. The anxiety leading up to it all was much worse than it actually was. He turned 11 this year and has had absolutely no prior issues. When it rains it pours!
 
Tillie and Valentino said:
Thank you, @BananaBo! I didn't realized Bo was just diagnosed with all of that this past year, too. It is a lot to take in and manage. I did a lot of internet research on Cabergoline and SRT and since Valentino was in otherwise very good health and we think we may have caught it a few months early perhaps, I decided to give the SRT a go. The anxiety leading up to it all was much worse than it actually was. He turned 11 this year and has had absolutely no prior issues. When it rains it pours!
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Yup! That's awesome -- everything I read seems to indicate that treating it early is important, so hopefully he'll be back to his old self soon!

Was your doctor familiar with cabergoline use for cats? I just asked the internist about prescribing it and she was not on board with it, so it sounds like I'll need to ask around...
 
BananaBo said:
Was your doctor familiar with cabergoline use for cats? I just asked the internist about prescribing it and she was not on board with it, so it sounds like I'll need to ask around...
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I got my hands a new paper recently, which I'm attaching here. It talks about treatment methods for acromegaly, and includes cabergoline. I always liked giving research papers to vets to back up what we've learned here. :) The article is a mix of topics, but start reading page 1092 and see page 1095 for the mention of cabergoline. This is quite new, so not surprising if an internist has not heard of it. Note that one of the authors is at Royal Veterinary College in London, where they do hypophysectomy, so of course it'll be their preferred choice. It probably is the gold standard, but only done in less than a handful of places world wide and quite costly. Tillie also contacted one of the South American authors of a research study into cabergoline, and I think it was something like 50 cats who've had it there. Hopefully they'll do a paper soon too.
 

Attachments

Interesting article. It includes saying that Toujeo (300U/ml Glargine/Lantus) "seems to provide a more flat, constant activity profile than other
long-acting insulins and could be particularly effective in cats with glycemic variability." It also says never to use a syringe to draw out the Toujeo from a pen. I can understand that since a caretaker could get confused as to drawing out since there are no U300 syringes. Using a pen is OK since at high doses 1 unit increments are fine. I di a calculation of cost of the Toujeo vs Levemir using SIngleCare coupons. The Levemir was 28 cent /unit while the Toujeo was 22 cents per unit.
 
Interesting information on the Toujeo, thanks. Valentino is on Prozinc but am considering a switch at some point. My doctor was not familiar with cabergoline and I did give her research papers, but she ultimately was a bit wary of giving it I think and thought that the SRT had a greater probability of success in his case.
 
I've only seen one spreadsheet of a cat on Toujeo, it wasn't remarkable. I think it was more an experiment in cost savings at higher doses.
 
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