Ramone Results In 06/07

[Jerica&ramone]

So its official, Ramone has Acromegaly & IAA

IGF-1 214 IAA 77%

I'm sad but also not surprised as I was suspecting this for a long time... Ramone is her first acro patient so this is new for my vet too. I was a bit overwhelmed at the vet yesterday as I was taking in my other boy Tony, who is not feeling good this week,first diarrhea to constipation issues now and I really need to get him to have a full solid bowel movement. This isn't the first time this has happened either so I know what to do.. just got to try and get his body to cooperate !

With Ramone - she was suggesting that an ultrasound be done to check on his organs etc? Make sure is heart is ok and some other things I can't remember...

What is recommended to do with Acro/IAA once diagnosed? Ramone seems so good right now and we've been managing his #s pretty darn good.

If I were to just keep carrying on the way I am - what can happen ? I'd love to hear any stories and recommendations. Finances do need to be considered as much as I'd love to spend whatever it would take I have to be conscientious of that. I'm in BC Canada so I'm not sure where/what my options are IF I were to do anything for Ramone.

Also are his test #'s, are they higher than usual or is that average ? I don't really understand what they mean... Can those change over time ?

Some pics below of my boys.

 

[JeffJ]

Some people just treat with insulin, as you are doing now. The insulin dose amounts at around 7.0 units are not horribly high.

Ramone's recent BG numbers look good, you are doing a good job of regulating the BG and testing. If the BG and regulation stay in those zones, and if it was me, I would probably stay the course.

 

[Wendy&Neko]

IGF-1 214 IAA 77%

The IGF-1 number above 92 means positive for acromegaly. There isn't a correlation between the IGF-1 number and the tumour size or anything. I don't think there's a meaningful "average". The IAA number however, is on the highish end, though I've seen higher. Over 20% is positive, Neko's was 52%. The IAA test numbers won't test much over time while he's on insulin. Here's is Black Kitty's IAA story. The IGF-1 numbers can change up and down over time, but that change isn't meaningful - don't bother retesting.

By the way, this is probably not your vet's first acro patient, just the first one she's known about. One in four diabetic cats has acromegaly, unless she's a new vet, she's seen others, just not known it. After talking to Neko's acupuncture vet, she realized one of her previous rescues that had adopted her was probably acro too.

The two options are to treat acromegaly just with insulin as needed, and manage symptoms/side effects as they show up, or do some sort of treatment. Treatment options are generally pretty expensive (think $8000 and up for surgical removal of the pituitary or radiation therapy), except the medicine called cabergoline which is a daily med, often compounded into a liquid. The research on cabergoline is minimal, two studies with 5-6 cats each and opposite results. We have more experience here. It does tend to reduce the growth hormone output, which can impact size of dose, but more important - some of the symptoms and side effects and thus improve quality of life. The reason I mention the research is that some people's vets have been reluctant to prescribe it because of limited published results. However, there really aren't any other options so I'd take an approach of - it's better than nothing. Post here with links to info. If you can afford surgery or radiation therapy, the options near you are Calgary (radiation) or possibly Washington State University which is near Spokane. Not sure of the latest status of WSU offering the options. I drove the three days each way to Colorado State University for radiation therapy for Neko.

As for ultrasound, not necessary at this time, other than to satisfy the vet's curiosity. There are two exceptions to this. If there is any sign of a heart murmur, I would suggest an echocardiogram (heart ultrasound). Ramone looks like he has some Maine Coon in him (as did Neko), and that breed, along with acrocats have a tendency to get HCM (hypertrophic cardiomyopathy) or enlarged heart. A little bit of enlargement is fine - Neko had that for a couple years, but if it gets too bad can lead to thrombosis, or strokes, so should be monitored. The second case for an ultrasound is if you are seeing any chronic GI issues (diarrhea, constipation, vomiting). A number of our kitties get inflammation of the bowels.

No need to treat IAA, it's something that is supposed to be self limiting, meaning it goes away over time. When it does, reductions can come rapidly. In the mean time, what looks like a good dose may do what I called "go stale". The antibodies get ahead of you and you need to raise the dose again. Link to one of my old posts with links to other posts on IAA.

As for next steps, first I'd recommend wrapping your head around what you are dealing with. Ramone's numbers are looking good, so you are doing a great job with dosing. Your goal should be to try to keep him in blues/greens or under renal threshold as much as possible. Acromegaly is hard on kidneys, so good numbers will east the burden on them. Acromegaly is not a fast moving disease, but over time you will see more symptoms. You have to decide if you want to pursue cabergoline, which can slow down the progression.

 

[Jerica&ramone]

The IGF-1 number above 92 means positive for acromegaly. There isn't a correlation between the IGF-1 number and the tumour size or anything. I don't think there's a meaningful "average". The IAA number however, is on the highish end, though I've seen higher. Over 20% is positive, Neko's was 52%. The IAA test numbers won't test much over time while he's on insulin. Here's is Black Kitty's IAA story. The IGF-1 numbers can change up and down over time, but that change isn't meaningful - don't bother retesting.

By the way, this is probably not your vet's first acro patient, just the first one she's known about. One in four diabetic cats has acromegaly, unless she's a new vet, she's seen others, just not known it. After talking to Neko's acupuncture vet, she realized one of her previous rescues that had adopted her was probably acro too.

The two options are to treat acromegaly just with insulin as needed, and manage symptoms/side effects as they show up, or do some sort of treatment. Treatment options are generally pretty expensive (think $8000 and up for surgical removal of the pituitary or radiation therapy), except the medicine called cabergoline which is a daily med, often compounded into a liquid. The research on cabergoline is minimal, two studies with 5-6 cats each and opposite results. We have more experience here. It does tend to reduce the growth hormone output, which can impact size of dose, but more important - some of the symptoms and side effects and thus improve quality of life. The reason I mention the research is that some people's vets have been reluctant to prescribe it because of limited published results. However, there really aren't any other options so I'd take an approach of - it's better than nothing. Post here with links to info. If you can afford surgery or radiation therapy, the options near you are Calgary (radiation) or possibly Washington State University which is near Spokane. Not sure of the latest status of WSU offering the options. I drove the three days each way to Colorado State University for radiation therapy for Neko.

As for ultrasound, not necessary at this time, other than to satisfy the vet's curiosity. There are two exceptions to this. If there is any sign of a heart murmur, I would suggest an echocardiogram (heart ultrasound). Ramone looks like he has some Maine Coon in him (as did Neko), and that breed, along with acrocats have a tendency to get HCM (hypertrophic cardiomyopathy) or enlarged heart. A little bit of enlargement is fine - Neko had that for a couple years, but if it gets too bad can lead to thrombosis, or strokes, so should be monitored. The second case for an ultrasound is if you are seeing any chronic GI issues (diarrhea, constipation, vomiting). A number of our kitties get inflammation of the bowels.

No need to treat IAA, it's something that is supposed to be self limiting, meaning it goes away over time. When it does, reductions can come rapidly. In the mean time, what looks like a good dose may do what I called "go stale". The antibodies get ahead of you and you need to raise the dose again. Link to one of my old posts with links to other posts on IAA.

As for next steps, first I'd recommend wrapping your head around what you are dealing with. Ramone's numbers are looking good, so you are doing a great job with dosing. Your goal should be to try to keep him in blues/greens or under renal threshold as much as possible. Acromegaly is hard on kidneys, so good numbers will east the burden on them. Acromegaly is not a fast moving disease, but over time you will see more symptoms. You have to decide if you want to pursue cabergoline, which can slow down the progression.

Thank you for all this info.

I'm willing to get him on the Cabergoline if it can/will help slow down the progression of the pituitary tumor. Unfortunately radiation/surgery are not options for me at this time.

Is there any negative side effects of the drug that anyone has experienced that you know of? I just don't want to mess with things too much as he's been doing and acting really well these days.

As for the ultrasound, that is what my vet was talking about regarding his heart to see how it is and then monitor it from there. I do see him breath quickly sometimes when he's just laying down, but its not very often. My Vet said ultrasound isn't overly urgent right now but will help give more information whats going on inside his body. Luckily, so far Ramone doesn't seem to have any GI issues. ( thats my other boy ) He does throw up hair balls though but you can clearly see its a hair ball, the odd time he has thrown up but I usually think its from him eating to fast.

 

[JanetNJ]

Sorry for the diagnosis. My cat was diagnosed with it a year ago in May. We are just treating with insulin.

 

[Wendy&Neko]

In the early days of cabegoline, some cats, not the majority, have some GI issues. It doesn't last. The only ultrasound I got done early on was the echo, the rest came years later.

 

[Cleocatra]

Cleo has no side effects on the cabergoline. Just don't let her bite it open right after eating a big meal otherwise she'll vomit. I don't think the caber is doing much to thwart the hunger effect from the high IGF #, but I won't know for sure unless I take her in for blood test.
Vet has us up to 13U 2xday on the Prozinc. Her BG#'s are down in the 300's to 400's- a little better than a few weeks ago but I'm still hoping for 250.