Foster Tinkerbell diagnosed Acromegaly

Tinkerbell has been in foster with us for about a year now. She's had a lot of different diagnoses in play, but has gotten pretty healthy except for BGs that never want to come down and an appetite that is always in high gear. I've suspected acro for a while and finally got the testing done to confirm it. I didn't get the number, but the vet said it was "very high".

Unfortunately, a small shelter that takes in quite a few harder to adopt animals, SRT may be hard to swing financially. We are just starting to explore options for Tink. She is the sweetest kitty and I can't imagine not doing whatever we can for her. I recently had a friend donate 6 boxes of Lev pens, so we have her switched to Lev with a good supply of that thankfully.
Any recommendations will be greatly appreciated.

 

Hi Melanie - your extra sweet girl sure looks pretty. I'd be interested in the IGF-1 number if you can get it. Did you test for IAA (antibodies)? You might want to consider cabergoline, it's a fairly recent med that has worked quite well for some. Way cheaper and no travel. The long term effects are not known. We've had a couple cats go OTJ, but more important, most have gone to lower doses. There are some posts on this forum about it.

 

One more thing, when we switch from Lantus to Lev, we don't go back to 1 unit but rather to 70% of the Lantus dose.

 

Thanks Wendy. I agree, but this was vet directed. I also don't usually move by 1U, but it makes things a bit more difficult when it is not your cat. I at least have a vet now that I trust (it is mine of 20+ years) she is one of the more educated in diabetes, one of the few that prescribe Lev, and she isn't one that is stuck on a max dose - had one that told me we were at max dose of Lantus at 4.5U , and she listens to me and respects my knowledge of the cats and experience with the disease. Its been a struggle with Tink, we have been through a lot of vets, she's got a lot of different issues (she gets very ill from the pancreatitis/IBD flair ups), so there have been compromises I haven't exactly agreed with.

I do not know if the IAA was done. I have been asking for MONTHS - every time there is blood drawn - to get the tests done as I suspected she was Acro by her facial features and big feet. Dr S had said she was going to wait on them and only do the Cushings tests this time. I was surprised when she called and said they did the testing for Acro. She told the shelter manager that all the other tests done looked really normal, so if it was done it was normal.

I was at the vet again today with one of my own and couldn't remember the name of cabergoline. Dr S said that all of her research shows that the med alternatives are not proving effective. I said that the experience on the board seemed mixed, but that some cats seemed to have reduced doses and some into remission. That is seems to be an option to slow down the side effects if we can't treat the acro. She was going to do some more looking. We again run into the issue that she is not my cat, its not my pocket book, and I don't get to make the final decisions. The shelter is fabulous about doing things I recommend and they trust me on the diabetics, and we also donate a buttload of money, but Tink already costs over $200 a month in meds and food alone and with this diagnosis, it is unlikely we find an adopter capable of caring for her. It wouldn't be the first cat we adopted to take over the care of, but our house isn't Tink's ideal home. She likes to beat up other cats and we are at 11 with ours + fosters right now. She needs to be separated most of the time and she craves attention so much. My heart is totally broken for this girl.

 

Hi Melanie

Tinkerbell is such a pretty kitteh, with nice bright eyes and white paws. What a cutey.

While you are considering Acro treatments, I recommend trying to get Tinkerbell more regulated. At least with some nadirs in the 120-150 region. Those high BG values mean glucose toxicity. I know how hard it can be to regulate an Acro-cat. Leo just bounces around all the time, even after SRT.

 

I agree with Jeff. Even if treatment is not an option, getting her to a dose where she spends the majority of her time under renal threshold is best. Do not hold doses overly long. You need to combat the resistance. You could increase by 0.5 units now.

 

Regulation into normal numbers certainly is our plan. We have been going up by 1U for the last month to try to get ahead of her resistance. Now that we are seeing the blues poke through it may be dropped back to 0.5U, we will see how the dose settles. The vet doesn't want to go up sooner than 7 days, and when jumping her by 1U and us not being able to test as often we are needing to wait until we could get some numbers on the weekend to see if she is starting to dip or not.

We sat at 8U of Lantus for so long with crappy numbers waiting while I tried to get progress on her case. I had one vet telling the shelter she'd maxed her dose on Lantus when she was at 4.5U, another saying I was moving the dose too fast, the one good one I had was an out-of-town vet and sooo busy, I had been asking for months that she get IAA/Acro testing... I finally had a friend donate the Lev so that I was able to move to that and when she ended up with my vet for a dental recheck was able to talk to her about moving forward with getting Tink some better regulation and figuring out what is causing her insulin resistance. No one here has apparently had a cat diagnosed with Acro. Not that they haven't probably seen it, but they haven't had people like me insisting on the tests getting run I guess.

 

Just took Leo to our cat-only vet again today. She is a great vet. She has only had 2 Acro patients in the past 20 years. Of course, most people don't get the Acro test done, so it is hard to tell if there were others. My point is that Acro is often not diagnosed or pursued as a root cause. I think many vets and people just don't know about it.

 

Aww, what a beautiful baby!! My baby was a foster too... I adopted him before the scary diagnosis. Not sure if they would have paid for his work-up since I was having trouble getting them to pay ANY of his bills. I got frustrated for having to deal with/argue with the rescue owner, so I just adopted him because I knew I couldn't give him back.

Are you seeing a regular vet or an internal medicine vet? I was lucky there is a really good hospital nearby, and our IM vet was very knowledgeable and experienced with Acro and Cushing's. Either way, I hope you guys come up with a good treatment!

 

We have foster failed our way to 9 of our own

Tink is seeing a regular vet. To see an internal medical specialist, we would need to go 4hrs away and its can be hit-n-miss with some of them. At the UofMN I walked out of a internal medicine consult with one of our own because the vet's knowledge of diabetes was so bad. The other specialty hospital has a good IM vet I go to with another foster, but I think this shelter would use the U. The vet I have her with now has been in practice for 20yrs and her interest is in internal medicine so she has focused a lot of her continuing ed in that area.