Update on Willow: life is good with cabergoline

[cabreu]

It's been a while since I've logged in, and also since I've stopped recording Willow's BG. It's so stable! Since returning to work, I've only been checking it before each shot, and it's always in the 100-130 range. I had slowly reduced to 2 units (down from around 8 at the start of cabergoline).

We had to go out of town and couldn't find a sitter who could do shots, so for 3 days, Willow only got cabergoline, but no insulin. I figured her BG would spike to at least >200. But when I got home it was 112! Checked again with a bigger drop of blood and got 127. That was last night, and I didn't give her insulin, and this morning she was at 130. Checked this evening, and she was at 115. I am going to see how far this goes, but I think we're past the depot stage, right?

Other than that, Willow seems good. Vet said she has a slightly enlarged heart, but I never did the echocardiogram. She hates going to the vet so much! But her teeth are in bad shape, and I am not sure whether to risk putting her under for a cleaning/extraction. Is the echocardiogram going to tell me anything useful? I assume they'll have to put her under for that too, and even if it's not as bad as the dental anesthetics, I don't want to put her through anything unnecessary. I'm a little worried that if we do the teeth cleaning, she won't wake up. Any advice appreciated, and thanks to everyone (especially Wendy) for getting Willow here!

 

[Wendy&Neko]

Awesome news on Willow's insulin needs, or lack thereof!! The depot lasts 4-6 cycles, so should be mostly gone. At the end of 14 days without insulin, she'd be officially in remission. Keep us posted how that goes.

Before any dental, you will need to get blood work done at a minimum. Neko had a "slightly enlarged heart" for a couple years before it became something more. But once it became worse, it was no longer safe for her to have anaesthesia. Cats don't have to go under anaesthesia for an echo, though depending on how fractious, may have to have mild sedation. A echo can give you a baseline on the heart, can let you know if there other heart changes, and more importantly, in Willow's case, whether it's safe to have anaesthesia. Sounds like you might want to engage a dental vet specialist. They generally do more monitoring under anaesthesia, and are used to doing dentals on complicated kitties.

 

[Suzanne & Darcy]

My cats have never needed sedation or general anesthesia for any kind of ultrasound, including an echocardiogram. However, they’ve been “cooperative” cats. Some of the cats who hate going to the vet are so scared that they actually just hold still … so that works too (poor babies.).

I would definitely pursue getting her heart checked out to see if it is safe for her to undergo general anesthesia- as well as bloodwork, of course (which I am sure would be required by the vet anyway before anesthesia.). The reason is that you want to get the teeth taken care of while it is still safe for her. Bad teeth can cause soooo many health problems for cats - for other organs, including the heart, and obviously can be very painful and cause them to stop eating. Many people get into the situation where their cats cannot safely be anesthetized and then not much can be done about the teeth. I have been in that situation myself where nothing could be done except to pulse antibiotics. But that wasn’t a diabetic cat where I had the added complication of dealing with increased BG resulting from a tooth infection.

Anyway, I am really happy to hear about how well Willow is doing on Cabergoline! That is just such great news.

 

[cabreu]

Thank you both for the replies! It is a good point about not letting her condition worsen before taking care of her teeth, and I appreciate being able to learn from your experience on that. I'm not looking forward to spending thousands on all of this, but I think it's the best thing to do. Are the dental vet specialists even more expensive than regular teeth cleaning/extractions?

Meanwhile though, Willow is doing great! Before we stopped the insulin, she had been throwing up more often, and it had gotten to ~3 times per week. Since I wrote that last post a month ago, she only threw up once a couple of weeks ago, and it wasn't very much! It seems that handling both insulin and cabergoline was difficult on her body. Now she is in the 120s usually when I check her BG, or at the most, the 140s. We are increasing the cabergoline dose, since she gained a pound from when she first started the prescription. But the biggest sign that she is feeling better is that she is back to her complaining, can-I-talk-to-the-manager self! Lots of meowing and running around!

 

[Wendy&Neko]

I found a dental specialist a bit more cost, but not a lot more. But they also had a dedicated person there monitoring Neko's vitals during the procedure. Which made me feel better because of her heart and kidney issues at the time. A dental specialist also saved Neko's tooth. She had some red on a gum line, regular vet thought the tooth needed extraction, but I asked for a referral to the dental vet for it. Turns out the red was due to soft tissue growth on the gum below the tooth above rubbing it and some tooth shaving was all she needed. Not all vets do full xrays before dentals, and that's an extra cost item, but well worth it.

 

[Suzanne & Darcy]

Are the dental vet specialists even more expensive than regular teeth cleaning/extractions?

Yes. I am afraid they are usually more expensive, but you can perhaps get an estimate. I've seen a great deal of variation in the prices that people here have quoted for the dental specialists.

 

[Suzanne & Darcy]

What great news about how Willow seems to be feeling much better! And weight gain is excellent! A very good sign (unless she was overweight, of course!) Thanks for the update! Keep us posted on your sweet Willow!

 

[Elisha and Charlie]

Charlie had the same problem with teeth. We are brushing them every morning and night (well my daughter is) at first it was just water and a tooth brush, my vet gave me some solution to use as he had early signs of gingivitis. She didn't want to put him under to clean with everything he has. She is so impressed with how they are looking. We also have strips of meat, where possible, rather than mince.

 

[Suzanne & Darcy]

This product has very good results You cut open the capsule and put the contents on their gums. I have used it with very good results and I have a friend who has used it with very good results Of course, the cat I am using it on lets me do this with no fighting

 

[MollyG]

Can I ask what dose of cabergoline you're using? I have been using it since last year and it slowed Allie's lantus dose increase, but hasn't lowered it by much (22-18 units). My vet told me today that her cab dose was too low (25mcg/kg) and she doubled it.

 

[Suzanne & Darcy]

Can I ask what dose of cabergoline you're using? I have been using it since last year and it slowed Allie's lantus dose increase, but hasn't lowered it by much (22-18 units). My vet told me today that her cab dose was too low (25mcg/kg) and she doubled it.

Are you saying your new dose will be 50 mcg per kg?

 

[MollyG]

Just saw the vet today, haven’t rec’d the script yet so not really sure. Her weight changed and her dose changed when we changed the concentration of Cabergoline so I don’t know the exact dose she was getting. Let you know when I know.

 

[cabreu]

An update on Willow: she is still doing great. We had the echo and they said the side of the heart that is most important wasn't much affected, so they went ahead with the anesthesia for the dental procedure and extracted a couple of teeth that needed it. Willow is being Willow! The only downside was how much they charged us for the extractions- felt like gouging, and next time we'll go somewhere else. But anyway, thanks again for the advice and help for Willow!

Photo of Willow here: https://imgur.com/a/lDVR1Sq

 

[Suzanne & Darcy]

An update on Willow: she is still doing great. We had the echo and they said the side of the heart that is most important wasn't much affected, so they went ahead with the anesthesia for the dental procedure and extracted a couple of teeth that needed it. Willow is being Willow! The only downside was how much they charged us for the extractions- felt like gouging, and next time we'll go somewhere else. But anyway, thanks again for the advice and help for Willow!

Photo of Willow here: https://imgur.com/a/lDVR1Sq

This is great to hear! I’m happy that her dental went well …. despite the damage to your wallet

 

[MollyG]

Glad to hear Willow is doing so well. I also haven't posted in a while, and I thought I should since Allie is doing so well on cabergoline and toujeo. We had brought her cabergoline up to the highest dose around the same time we switched to toujeo, and she has become her old self again. No settling on her BGs tho, she's continually up and down, but not too high so we're just dose adjusting constantly. The toujeo is great since she's getting 7.5 u (using a 100u syringe on 300u, which means if she was still on lantus she'd be getting 22.5u)
https://docs.google.com/spreadsheet...CYUfUDXD-yY7iDwQLXoq0eLZGU/edit#gid=394692367

 

[Jodey&Eddie&Blue]

This sounds like a success story and I'm glad to hear Willow and Allie are doing so well on Cabergoline and have dentals that worked. I live with two acromegaly kitties (Eddie and Blue, who are brothers). Eddie is getting booked for an echocardiogram to see if he is ok for any further treatment requiring sedation and his brother, Blue, is currently booked with a specialist for dental treatment (along with an anesthesiologist). I'm currently research Cabergoline because my IM vet, who has not experience or knowledge of cab, is slowly coming round to it. Eddie is currently on 16u Lantus BiD and it's been creeping up slowly for the past while.
My question is: how is the cabergoline dosage determined if one's vet doesn't know how to do anything with it other than order a prescription?

 

[MollyG]

I got the information my vet needed to write Allie's script right from this list. Someone suggested the bacon/marshmallow flavor and a 300 mcg/ml suspension, she is 12 pounds and gets .2 ml a day. Wedgewood Pharmacy is the only place I found to fill the script. My vet told me that was the highest she could get, he has done some research on it now.

 

[Jodey&Eddie&Blue]

I got the information my vet needed to write Allie's script right from this list. Someone suggested the bacon/marshmallow flavor and a 300 mcg/ml suspension, she is 12 pounds and gets .2 ml a day. Wedgewood Pharmacy is the only place I found to fill the script. My vet told me that was the highest she could get, he has done some research on it now.

Thank you for this information. I have found a compounding pharmacy, which is great. Do you know how the .2 ml/pound/day was determined; that is, is there an equation that you learned here?

 

[Larry and Kitties]

Thank you for this information. I have found a compounding pharmacy, which is great. Do you know how the .2 ml/pound/day was determined; that is, is there an equation that you learned here?

The standard dose is 10mcg/kg
12 lbs is 5.44 kg
so @10mcg/kg is 54.4mcg.
@300mcg/ml that would be .18ml.

 

[FrostD]

Thank you for this information. I have found a compounding pharmacy, which is great. Do you know how the .2 ml/pound/day was determined; that is, is there an equation that you learned here?

The papers (linked somewhere in this forum lol but I know you're aware of them) used 10mcg/kg q48h as the dose, which is why most of us start there. They did use it daily in some cases, so also why some of us give it about 6 weeks and then go to daily dosing if not getting results. (Just remember Mr Kitty had a bit of a unique reaction to the cab and that is why I am not currently following the dosing in those papers).

The volume you give depends on how they compound it (i.e. concentration), and each pharmacy tends to have different options for that. Larry gave an example above, another is my vet:

8*0.5mg (total 4mg) cabergoline pills compounded in 16mL of solution (4mg = 4000mcg that's just standard metric unit conversion)

4000mcg/16mL = 250mcg/mL concentration

Mr Kitty is 5.5kg, so his dose per the articles should be 5.5kg * 10mcg/kg = 55mcg.

55mcg / (250mcg/mL) = 0.22mL -> this is final dose drawn up in oral syringe

They *should* do the math properly for you, but I've been burned before and always like to double check everything. We can help!

 

[Jodey&Eddie&Blue]

The papers (linked somewhere in this forum lol but I know you're aware of them) used 10mcg/kg q48h as the dose, which is why most of us start there. They did use it daily in some cases, so also why some of us give it about 6 weeks and then go to daily dosing if not getting results. (Just remember Mr Kitty had a bit of a unique reaction to the cab and that is why I am not currently following the dosing in those papers).

The volume you give depends on how they compound it (i.e. concentration), and each pharmacy tends to have different options for that. Larry gave an example above, another is my vet:

8*0.5mg (total 4mg) cabergoline pills compounded in 16mL of solution (4mg = 4000mcg that's just standard metric unit conversion)

4000mcg/16mL = 250mcg/mL concentration

Mr Kitty is 5.5kg, so his dose per the articles should be 5.5kg * 10mcg/kg = 55mcg.

55mcg / (250mcg/mL) = 0.22mL -> this is final dose drawn up in oral syringe

They *should* do the math properly for you, but I've been burned before and always like to double check everything. We can help!

Thank you! I'm taking notes!