Frosty’s vet visit

The visit went relatively well. We are just waiting to check out now. Frosty is singing me the song of his people, and I am trying to block it out, lol.

Basically, the differential diagnoses are Cushing’s, Acromegaly, or paraneoplastic syndrome. She said she has seen skin tearing with Acromegaly as well, and it's also possible if he has some underlying cancer to have skin tearing due to altered metabolism and malnutrition. Suddenly, Cushing has become a more desirable diagnosis....

So far they have only did the abdominal ultrasound, and they could see one of the adrenals, which means they are likely enlarged. The liver also looked abnormal, more homogenous in quality, which she said is common in Cushing's. (Interesting, because in humans, that's a normal finding). But the concern was the pancreas - it had a lot of cysts. And Frosty wasn’t cooperating so the exam was limited. The vet said it could be due to the long-standing Diabetes, or some other metabolic disease, but it makes me concerned.

For those of you whose cat's abdomen was imaged, did they find abnormalities in the pancreas? I have read that the pancreas can be ENLARGED with Cushing's, but never about cysts. I really hope he does not have pancreatic cancer or something. But if the bloodwork comes back negative, then it could be a possibility.

The next step is the low dose dexamethasone suppression test. Since it is already late in the day, we are going to do it on Monday. Luckily for me, the Animal Hospital is close to my work and since they are open 24/7, I will drop Frosty off before work on Monday, and pick him up after. So that works out. They are going to do another blood test I think, she was worried about sticking him twice due to the fragile skin so she decided not to do it today.

She also told me to slow down or stop testing his sugars all together because she is concerned about his skin condition. I told her I was going to do a curve tomorrow and possibly increase his insulin, but she said to leave it alone at 2.5 units for now, since he went kind of low on 2.75 (72 on the Alphatrack2 meter). She said that since we are ruling out another metabolic disease, it is unlikely that we will get his sugars under control this week anyway. Obviously the other underlying disease would need to be treated first before we can get control of the diabetes. She said I can continue testing for ketones, because it's more important to prevent ketosis right now, and worry about the blood sugars once we have some sort of a diagnosis/treatment plan.

She seemed optimistic about treatment for both Cushing's and Acromegaly - it would be either the medication for Cushing's, or SRT for Acromegaly. They do SRT at this hospital too, and she said they have seen great success in cats. Obviously SRT will be more expensive, since it involves and MRI and the treatment itself and will be around $6,000 or so. The medication for Cushing's will cost about $50 a month or so, plus visits and blood work ($175 for visit and about $200 for the blood work). I figured I'll post prices for others who may need this information in the future. Who needs a savings account anyway, right?

She did say that skin tears are indicators of poorer prognosis regardless of what he has. Which sucks. His wound is OK, it's closed still but I wouldn't say it's definitely healing. He's still wearing his shirt. She also said any type of surgery is not a good option for him right now because he won't heal. She said if he does well in 6 months and is healing then maybe that could be something to consider if there is surgical treatment available for what he has.

So that's where we are at. I am really hoping it's not cancer and something that can be at least attempted to be treated. The vet was really nice and knowledgeable. I definitely felt like she knew a lot about all the conditions, and has seen all of them before, which is reassuring.

I'll let you know what the results are next week. I think I am going to indeed skip the curve tomorrow and just let Frosty relax until another stressful day on Monday. I'm gonna keep him on 2.5u lantus and just check for ketones. He's had no ketones yesterday or today. I REALLY hope this is not cancer, ugh.. that's actually what I thought about first before the possibility of Cushing's and all these others things came out . He just looked really odd to me. and I don't know enough about feline oncology, but a human with cancer would have a decreased appetite instead of increased... again, not sure if that's the same in animals.

On a less depressing note, his cat onesie came, and it looks like it's gonna be ADORABLE. Frosty tends to have bathroom accidents in the car though so for now I am going to keep him in his shirt, but I'll change him into it on Tuesday. He's gonna look so cute. I will have to take pictures.
Hope everyone has a wonderful CATURDAY and a good weekend

 

I too hope Frosty has something that can be treated.

There have been a few cases of cats that have both acromegaly and Cushings, hopefully Frosty's not in that elite club. Ditto the C. Whether a cat is hungry or not depends on the type of cancer. My civie with pancreatic cancer lost his appetite.

I found a paper on abdominal ultrasonographic findings in acromegalic cats. See the attachment here. Neko did have abdominal ultrasounds done. Her pancreas was mildly increased in volume, a non uncommon finding for acros.

A cheaper alternative for acromegaly that you can try if you end up there, is cabergoline. It's new and probably not front of mind at a clinic that does SRT. You don't need an MRI, Neko didn't have one for either SRT treatment, but they did do CT scans. The cost depends on how many days of radiation they do. Depending on the location, typically it's 1-3 days, though I've heard Redback does more.

Have you noticed any tearing at the site when you test Frosty? For kitties that are experiencing skin tearing, backing down in dose and testing less if definitely a good idea. 2.5 units as per your vet's suggestion sounds like a good plan. Though it looks like you've backed him down to 2.0 units.

 

My dear, huge hugs to you and Frosty. I'm sorry you are going through this, but certainly hoping for encouraging news as you go through the testing process. I would like to see Frosty in his new onsie. Sending a multitude of healing vines.

 

Can’t wait to see the new onesie pic! Prayers it is treatable.

 

Thankfully, he hasn’t had any skin tearing on his ears where I test, just bruising. His only spots that are prone to tearing are in his upper armpit/elbow area. But I definitely understand the vet’s concern. I skipped testing all together tonight, but I’ll probably check his morning sugar and ketones and go from there. I guess if I’m not gonna be changing his insulin dose this week there isn’t much use in checking anyway. I’ve done some more reading on fragile skin in cats tonight, and there’s reports of skin tearing just from the vet handling the cat (normally) which is kinda scary and sad.

I only gave him 2 units twice last week due to him throwing up and not eating as much, as well as our schedule being screwed up due to vet visits. We are back to 2.5 units since Wednesday. We’ll probably stay there this week, and depending on what the tests show, maybe I’ll do a curve next weekend and make some adjustments.

 

Hugs to you guys and Frosty. I hope you find out what is wrong.

With Acro it is usual to have more demand for insulin.

Some comments about Little Dude's injury - which was a skin tear
- The bite/tear was on his chest, between his front legs
- Another cat attacked him, and he came home. We didn't see or hear it (1am or so).
- 3 to 4 weeks for total healing
- he had a drain tube for the abcess
- the abcess required in-hospital stay, plus a watch on his stitches
- he pestered the shxt out of the staples and stitches, jeez! And had staples reapplied twice!

Theresa bought like 6 different shirts - way overkill. I know this is different than Frosty. But my point is that skin tears can take awhile to heal. We ensured the wound stayed clean. I will not post pics of the wound, but we have them - where it is torn all the way open and you can see his little muscles. Horrific.

His low point was at the cat hospital. He doesn't know how to use a litter box (yeah we have tried). He peed finally, then walked and laid in it. We did a surprise visit when they opened and he was covered in pee. We almost broke down. It was pathetic. Our poor baby. They did a great job cleaning him up and we picked him up the next day. It was not their fault.

That was a year ago. Now it is like nothing happened....well except that he became even sweeter, if that is even possible. Also his fur grew back.

 

"I skipped testing all together tonight"
I recommend you always test pre-shot. He could always go low on one cycle. You do not want to hypo him. This is especially important at 2.5 units.