Yum my acro cat

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MJW

MJW

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Yum was diagnosed with acromegaly yesterday.

She has been diabetic for a year.
She went through 4 stages.
In the first stage, she went OTJ in a week or two after diagnosis, with a diet change (no more kibble).
She relapsed after 2 months, perhaps due to an infection. It took a few months, but I got her regulated on 3 unit shots of Lantus, twice a day. She held steady for about 4 months.
In the third stage, her insulin requirement dropped to 0.5 unit shots twice a day. She almost went OTJ.
In the fourth stage, starting this past November, her BG shot up and I haven't had her regulated since. She is at 10 units twice a day of Lantus now, with added shots of Novolin R.

She was diagnosed with CKD and a heart murmur in the second stage (August). The cardiologist said the murmur was due to physiological changes associated with aging. I will ask him to review that conclusion in light of her acromegaly diagnosis. I thought her chin looked odd in August, but we decided maybe she had a slight infection. That will have to be reevaluated. She might now have some breathing sounds. She might now have a rounded tummy. She might now have enlarged paws. I will have my vet reexamine those features this week, since I am too emotionally involved when I look at her.

Hypophysectomy and SRT both require multiple anesthesias and long distance travel. Yum will turn 16 in just over a month. Her sister died on an operating table 5 years ago, almost certainly as an undiagnosed diabetic, possibly as an undiagnosed Acro cat or Cushing's cat. (She had polydipsia, polyphagia and a round bowling ball stomach, at least before she became obese all over.) I want to make sure Yum is healthy enough for anesthesia and travel, before I make up my mind on hypophysectomy or SRT.

In the meantime, and as I wait for a specialist appointment, I will try to get my vet to start her on cabergoline. Might as well, right?

[BTW, Yum's mother passed at age 15 a year and a half ago, from an extremely rare chemodectoma---a probably benign tumor on the heart. There might be a genetic problem here.]
 
Neko's original heart murmur was due to physiological changes due to aging. The cardiologist just had us to periodic echos, and I had echos done before major anethesia. Any dentals I had done with a board certified vet anestheologist, with extra monitoring. Now that you have a diagnosis, you know where to be cautious.

Sorry about the other members of Yum's family. :bighug: It is thought there is some genetic component to the disease, along with environmental.

If the vet is fine with it, cabergoline should be OK.
 
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At that age, I would also elect to go the Cabergoline route. The Ft Collins CSU vets told me the mean lifespan after SRT is 300 days. I suspect that number is tainted by some cats which were deep into Acro before they got treated.

Leo is 1.5 years after SRT now, and doing well. I posted a summary here.
 
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The CSU vets told me the average life span after SRT was two years, but they didn't have enough data yet to prove it. And these are older kitties too. Of the ones that went to CSU around the same time Neko did (who lived over 4 years past SRT), half passed from other conditions (such as cancer not related to acromegaly).
 
Wendy&Neko said:
The CSU vets told me the average life span after SRT was two years, but they didn't have enough data yet to prove it. And these are older kitties too. Of the ones that went to CSU around the same time Neko did (who lived over 4 years past SRT), half passed from other conditions (such as cancer not related to acromegaly).
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Neko was 11 when she had her first SRT?
 
Yes, she was 11 and in pretty good health. The heart murmur didn't show up until later. But I figure she'd had acromegaly over a year by then - looking back she had weepy eye 6 months before her FD diagnosis. Not long after we were there, they had an acrocat that was 4 in for SRT. :( Hits all ages.
 
I took Yum in to see my vet yesterday, for blood work and urinalysis, to get a better idea of her overall health.
I want to understand if I should subject her to anesthesia.

My vet did not think Yum showed any physical changes associated with acromegaly. My concerns about Yum’s lower jaw seem unfounded.
She felt Yum's very slight stomach rounding could be due to the muscle loss associated with CKD.
Yum's nondiabetic mother with CKD also displayed the stomach rounding at the same age.

My vet had been busy reading articles quoting Stijn Niessen at RVC from 2016 and 2017.
She said he says cabergoline doesn’t work, nor is he in favor of radiation therapy.
He promotes hypophysectomy. Of course, he is cofounder of the hypophysectomy center at RVC.
My vet is encouraging me to investigate the surgery.

I started Yum on cabergoline yesterday.

My vet said that she had a bad experience with Texas A&M a few years ago when treating another cat with acromegaly: they didn’t even know about the IGF-1 conversion factor between nmol/L and ng/ml.

My vet suggested that some vets in the US believe IGF-1 just goes up with blood glucose. Has anyone else heard that? I will ask that question in the cabergoline discussion thread as well.
Maybe acromegaly isn’t well accepted as a cause of diabetes in the US.

My vet has referred me to an IM for another viewpoint. I am debating whether that will provide any value.

Her IAA test has not come back yet. MSU has had the sample for more than 7 days. Frustrating.
 
The radiation therapy that is available in the UK is not SRT. So there it involves many sessions of anethesia and a wider beam of radiation which can get surrounding tissue. If I lived in the UK, I think hyphophysectomy would be a consideration.

Did you give the vet the South American article on cabergoline?
MJW said:
My vet said that she had a bad experience with Texas A&M a few years ago when treating another cat with acromegaly: they didn’t even know about the IGF-1 conversion factor between nmol/L and ng/ml.
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Why would you bother converting? It's like the difference between World and US reading for blood glucose. Those that get the test done at MSU use the US versions of the number. Speaking of which, did you ever get that uncoverted number from your vet? Most of us are more familiar with it in that terms.
MJW said:
My vet suggested that some vets in the US believe IGF-1 just goes up with blood glucose. Has anyone else heard that? I will ask that question in the cabergoline discussion thread as well.
Maybe acromegaly isn’t well accepted as a cause of diabetes in the US.
Click to expand...
Haven't heard that about IGF-1. But I did talk to the IM vets at CSU who said they have found no correlation between IGF-1 and anything else. I think they might know more than a lot of vets over a certain age who were taught acromegaly was so rare they'll never see it. There isn't the same level of vet education going on about acromegaly in North America as there is in Europe. We still see a lot of caregivers here running into resistance from their vets to get the testing.
MJW said:
My vet has referred me to an IM for another viewpoint. I am debating whether that will provide any value.
Click to expand...
Your vet has some odd ideas. Might be worth finding out if the IM vet has treated other acros.
 
Wendy&Neko said:
Did you give the vet the South American article on cabergoline?
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I did. I also gave her positive responses from the forum. She immediately wrote me the prescription for cabergoline.

Wendy&Neko said:
Haven't heard that about IGF-1. But I did talk to the IM vets at CSU who said they have found no correlation between IGF-1 and anything else. I think they might know more than a lot of vets over a certain age who were taught acromegaly was so rare they'll never see it. There isn't the same level of vet education going on about acromegaly in North America as there is in Europe. We still see a lot of caregivers here running into resistance from their vets to get the testing.
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I did just find this on Yum's MSU results:
"The serum concentration of insulin-like growth factor 1 (IGF1) is increased and is a likely differential diagnosis. Are there physical changes that are consistent with acromegaly? 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 latter scenario"

I guess that validates my vet's saying that sometimes IGF-1 goes up with blood glucose.
 
I don't read it as saying that the IGF-1 is related to BG at all. There can be some IGF-1 reponses to starting insulin therapy, which is not the same thing. Did you get the IGF-1 number on those MSU results?
 
Wendy&Neko said:
I don't read it as saying that the IGF-1 is related to BG at all. There can be some IGF-1 reponses to starting insulin therapy, which is not the same thing. Did you get the IGF-1 number on those MSU results?
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Hmmm. I guess you are right. Wonder if my vet said diabetes and I remembered it as blood glucose.
Yum's IGF-1 is 417 nmol/L. Not the highest on the list but up there. My vet did the conversion correctly.
 
I responded on the other thread. Anyhow, I hope your kitteh Yum responds well to the Cabergoline. That is the goal.

Leo's IGF-1 was 305, when he was getting 14 units / dose. His pituitary gland was estimated to be 4-6x normal volume in the scans during the week of his SRT. And he had reached 18 units/dose at that point but his BG was usually 180-300. I sure don't miss those stressful days.

Today is ~16 months after SRT. He achieved a BG = 110 nadir today on 4.5 units of Levemir. Plus he gave a lot of leg lovin' as well. I'll take that anyday of the week!
 
I am going to read about paseriotide today and try to figure out the shelf life etc to determine exactly how much it costs.
I probably will go see the IM for a second opinion on Yum's health and possible treatments.
I just feel she is too old for surgery or radiation and long trips. But, my mind and emotions are still spinning.
It's also tough to get enough sleep with all the ear pokes and shots and worries!
Yum is old and she won't live forever, but I want to make the best possible choices for her. Choices are hard.

She has mild diarrhea today, possibly from 3 doses of cabergoline.
 
From RVC, the dose of the long acting pasireotide (Signifor LAR by Novartis) they used is 8 mg/kg by subq injection, once monthly. In Canada, I didn't investigate the long acting version, just the short acting one that was to be given daily, because my vet couldn't find a source for the long acting one. That was two years ago. At that time, the short acting one was $5000 every 3 months for a Neko sized dose. I had heard it was $2000 per month in the US. On the up side, at RVC they did have one cat that I heard went OTJ after just one month on the long acting version.
 
Wendy&Neko said:
At that time, the short acting one was $5000 every 3 months for a Neko sized dose. I had heard it was $2000 per month in the US. On the up side, at RVC they did have one cat that I heard went OTJ after just one month on the long acting version.
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It looks like both the long acting and short acting versions would be around $2000 a month in the US for a 10 lb cat. That's assuming the medicine can be divided up into cat doses without contamination or deterioration. Specialty pharmacies won't quote prices without a prescription, so I'm basing that on the ~$13k a month price drugs.com and GoodRx.com show for a 1 month human prescription. I will post links and comments this weekend. I don't think human insurance companies cover it.
 
Right now it looks like cabergoline has worked a miracle for Yum.
She has gone from 11 unit shots of Lantus, up to 16.75 unit shots, and now down to under 3 unit shots in just 30 days.
I will retest her IGF-1 in a few weeks for further validation.

She started a daily dose of 10mcg/kg (45mcg for her) on 1/30/2018.
At the time she was on 11 units of Lantus twice a day, with unregulated BG numbers ranging from the upper 300’s to 600’s.
She had some mild pudding poo off and on through her first 10 days on the drug. I responded by increasing her prebiotic Saccharomyces Boulardii & MOS from 2.5 billion CFU twice a day to 5 billion CFU twice a day. She also had a few episodes of gag vomiting, which were probably unrelated CKD events.

She reached her maximum Lantus dose of 16.75 units of Lantus on 2/18/2018, the 20th day of her cabergoline treatment.
After that her blood sugar started plunging dramatically.
She seemed to be more lethargic, and at one point I thought her respiratory rate was elevated (high 40’s to 50 breaths per minute). I don’t have a good pre-cabergoline respiratory rate for her.
It might have been in the low 30’s. Since then it has ranged from 26 to mid 40's, mostly mid 30's.
Because I was worried about side effects, I cut her cabergoline doses back from every day to every other day on 2/18/2018 (following the abstract from Argentina).
She is still lethargic. It could be due to the cabergoline. It could also be due to her body having to adjust to suddenly much lower blood sugar levels. Also, since she is no longer ravenous, she does not get as excited about food. She checked out normally at the vet with an X-ray and exam on 2/19/2018.

From 2/18/2018 to 2/27/2018, her Lantus dose has dropped from 16.75 units of Lantus to 2 units or less. I have had to treat her for repeated hypoglycemic events. This has been a dangerous time for her. Fortunately, I was able to make her my top priority. We have messed up her healthy low phosphorus low carbohydrate plus supplements diet with too many high carbohydrate interventions. She has started refusing the healthy food. I also gave her some favored food that caused liquid poo. If your cat responds to cabergoline, you will need to be on your toes. Perhaps I should have reduced her insulin dose more aggressively, without waiting for the hypoglycemic events.

Yum is still lethargic and I am still working on stimulating her appetite, but the improvement in her diabetes has been miraculous.
 
What a remarkable drop in BG over such a short period. The cabergoline seems to be a miracle drug for acros. I wish it was around 2.5 years ago.

Yum's numbers look great. I hope you can avoid future hypos, we all know how bad they are. Yum is lucky you were able to devote so much time to monitoring and treatment during this drastic set of changes. I'm happy for you guys:bighug:
 
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