07/19 Shmee AMPS 59, +1 99, possible acro surgery discussed, & driving to Canada for insulin

Previous condo

Hi L&L,

@JeffJ @Wendy&Neko and @Chubba (GA) thank you for your input the other day, I appreciate it. I feel bad sometimes that I don't totally grasp everything... it is just overwhelming and so much to remember.

Possible acro surgery

I have had an eventful last few days. I have been researching different options for Shmees acro and I got a call back from the neurosurgeon (Dr. McCue) at AMC in NYC yesterday morning. I called AMC because I had heard from the acro Facebook group that they had a large donation to their neurosurgery department and had paid for a cats surgery. I took a chance and called to see if there was any more money. Dr. McCue confirmed that yes, if I bring Shmee to him, the normally $20,000 surgery would be covered. I about fell to the ground. I talked to him for about an hour, and I just got done sending him an email with another long list of questions. To my understanding, they would be removing the tumor, or the entire pituitary gland. They have done this procedure at this particular hospital to only five cats (I think the fifth or sixth may be the one from the Facebook group, she just got it done last week so I don't know if he counted her. Last I update from her the kitty was having "a bad weekend" after the surgery. I need to send her a message to see how she's doing). The doctor said there has been one fatality, but that cat was older and had a very large tumor that was also encroaching blood vessels (I think that is what he said), so it was a difficult and last resort situation. The other four cats had "regular" sized tumors and "have done great after surgery" (I asked him on the email to clarify, how exactly they are doing, how long their recovery time was, etc.).

This is all still largely up in the air. He has gone down to 5U from 7, so he is doing well insulin wise... which is a little confusing. I asked my vet about the Cabergoline and possible Octeotide today too. She said she would look into it, and I am also waiting on an email back from the RCV diabetic remission clinic; about five days ago I asked them all the latest info they have on Cabergoline. I would not have really considered travelling with him before, but a free $20,000 surgery has definitely made me consider it... and I am overwhelmed trying to figure out the right course of action. I am so scared he would have a heart attack or something..... he just gets so scared in the car and at the vet. And driving in NYC on top of that?! And this is definitely not all free, the largest costs would be both MRI's. To my understanding, they prefer an MRI here beforehand to make sure he is a candidate / see how large the tumor is, and another at AMC; I think because the tumor could have grown and they need to pinpoint where they would be going in for surgery. Since the doctor said cats with acromegaly often have heart problems, he wants me to have an echocardiogram too. I think this will be my first move, so I am going to call and schedule that with my vet tomorrow (I talked to her as well today and she confirmed they get someone to come in to do the eco). Although Dr. McCue said a heart condition would not rule him out, it would just be something they would need to be aware of. The cost estimate I came up with is about $5,500 (majority of that cost being the MRIs), so I would have to ask for a bank loan...

Insulin from Canada

Has anyone from the US drove to Canada for insulin? My cousin is going to Niagara Falls on the Canadian side, so she told me she can get some Lantus for me if I wanted. I just got this bottle like a month in a half ago and its already halfway gone... so I think I should take her up on this offer. I called a Pharmacy by the border and he confirmed a 10mL bottle would be $60 US dollars, and the pens (15mL) would be like $80 I think. I know the insulin is only good for six months, but that is only after its been opened... right? Should I stock up? I am thinking of having her buy two orders of the pens, and as long as I don't open them until I need them, they should be good, right?
Side note -- I am reading that bringing insulin back over the boarder is not exactly legal.... I guess its not highly enforced though and there's some loophole in the law that if you are using it personally (and not buying a lot to sell) they should have no problem crossing the border. Maybe this is a better reason to only buy one set of pens? I really wouldn't mind driving there myself eventually, or buying them online in the future. I am trying to figure out what is best for my cousin. I don't want to ask her to do this and her family gets stuck at the border!

Thoughts?

Many vines to those in need of them.
Thank you all for sticking with me, letting me vent, and giving your valuable advice. I hope everyone has a nice night / day.​

 

With the pens, each one holds 300 units.....once "opened", the 4-6 months starts but the rest of the pens that haven't been "pierced" will remain totally good until the expiration date on the box....usually at least 2 years.

With the dose Shmee is on, you won't have to worry about it going bad (unless the surgery is 100% successful and he goes OTJ!!)

I'd go with the pens....not only are they the better buy, if you drop one, it's a lot less likely to break!! There's nothing as heartbreaking as watching your insulin dribble onto the floor after you drop the vial!!

 

Ella used to cross border shop for insulin for Rusty and @Sean & Rufus did as well. People here reported getting 5-6 months out of a vial once opened. Personally I liked the convenience of cartridges better. I think people here have also ordered more than one vial or package of pens from Marks at once.

Great news that you might get a free surgery. It is more expensive than I had previously heard. An echo is a good idea, I had one done for Neko before her last SRT. The MRI price sounds really high, much more than I was quoted at CSU, if we had needed one. I must admit that I didn't consider hypophsectomy (pituitary removal) cause of the risk, sounds like they are getting more experience now.

 

Yes he said the price was anywhere from $16,000 - $20,000 normally.
And I am hoping that the $2100 is the steep NYC pricing, I am curious what it will be here when I call in the next few days.
I would have never considered it either, it is risky and makes me super nervous... I think I might call WSU and whoever else does the surgery too, to see how their cats have been doing with this surgery recently and maybe get some better statistics then just the five cats at AMC.

Thanks I was leaning towards the pens too, might as well since you get more.

 

I'm so torn on whether or not this would be worth it. Since I know he would be incredibly stressed (although I could give him meds and hope for the best), its still expensive, its risky and I would have to ask my work to give me a lot of time off... so much to think about...

 

Woke up late and shot 20 minutes late - AMPS 59, gave him the shot. I hope I did the right thing.
He was low pretty much all night so he should be on his way up. Testing again at +1.

 

+1 99, whew

 

Don’t feel bad. It is so much information and you are right it is overwhelming. We all ask questions and learn as we go.

I’m glad Shmee is coming up some for you. Hopefully he doesn’t go to high, but instead just hangs out in the lagoon today.

 

Well that is exciting and slightly terrifying news! That would be utterly fantastic getting the surgery for free, but WHEW! the price of those MRIs is insane! I know someone else drives over to get insulin from Canada, but I can't remember quite who it is this morning.

 

@Sean & Rufus drove across the border for a 5 pack of pens I believe.

Very exciting news and terrifying. Knowing you, you will get all the data and then consider your options.

There are things you can do to help calm him for the ride. Pheromone spray, medications and I wonder if it is a trip with longer days if he wouldn't get more used to the ride vs. a short ride to the vet.

 

Right!! Haha my thoughts exactly.

I was actually going to ask about this - he has Gabapetin, and I saw that @Wendy&Neko gave her Neko "Rescue Remedy". I had not heard of that before, the reviews for this on Amazon are great. Seems like just a more natural version of Gabapetin. I was thinking maybe I can buy it and just "try it out" on a random day and see how he does with it. I have never used Feliway spray either, but have heard great things.

Thanks it looks like that's what he is doing, at least for now :)

 

Oops ^ no clue how I did that.

 

I use the feliway spray and infusers. With 4 cats - some days are not so harmonious. I can tell when they are out.

 

Feliway spray was a game changer for Gizmo, but I have heard it didn’t work at all for others. It’s worth a shot in my opinion.

 

Make sure you get the Rescue Remedy for Pets (no alcohol, save that one for you ). I also sprayed the inside of the carrier with Feliway. I now always use the Rescue Rememdy/Feliway combo for vet visits. You can try that out on the trip for the echo. Another thing that might help is something like a Thundershirt. When I took Neko on the plane , I had a close fitting harness that acted a bit like a Thundershirt, and helped keep her calm. It was a kitty holster.

Did you ever read Rebecca's happy story on the surgery her kitty Louie had at RVC a couple years ago?

FYI - Anesthesia plus MRI was under $1000 at CSU a couple years ago. Echo should be well under $1000, depending on whether they have to do an EKG.

 

The possible surgery sounds interesting. For Leo, we postponed the MRI to onsite at CSU. That was because Leo was at 18 units/dose and it was clear he had a tumor. The tumor resolved to 5x the normal pituitary size.

It is possible that Shmee's tumor is fluctuating. That would explain the insulin dose change. For the surgery, it is always good to have options. In the past year someone in the UK was able to get the hyphysectomy for basically free. It resolved the issue and at least a month later there were no issues. Now I can't remember who it was. (It was Rebecca, as Wendy has just posted).

 

Hi! So sorry I haven't been on in a while! I did drive to Canada back in February. Honestly, I wasn't too worried about keeping it cold. I just drove back home with it on the front seat of the car. Took about 5 hours to get home. I received different advice about storing it. Some said it needed to be kept cold at all times, and others said not to worry too much as it was unopened. I did store it in the fridge when I got home. Such a huge savings by buying it across the border. I hope it all works out for you and Shmee!

 

Yes, I crossed the border at Messina NY to Cornwall ON to buy insulin and shopped at Shoppers' Drug Mart, one of the big Canadian chains. They will provide an ice pack; just ask. I always brought along a small cooler bag (and put the insulin in it, under my lunch). I agree with Wendy that the cartridges (not available in the US) are the easiest. I paid in Canadian cash. No prescription is needed for insulin in Canada, but I don't think it would hurt to have your vet write one for you, just to have in case they look through your car at the border . Good luck with the surgery and all of the prelims.