07/20 Shmee AMPS 64, +1 96, +3 76, dosing question & more talk about possible surgery

Previous condo

Hi everyone and happy Friday.

Side note / dosing question = @Wendy&Neko (or if anyone else wants to comment) Shmee got down to 52 at +7 tonight, although I fell asleep and fed him his +3 meal late (at +4) so that might have had something to do with it, maybe not. I know regularly if we do not see under 50 we do not decrease, but that it could be a little different for acros. Do you think I should reduce in the morning to 4.75U?

I keep telling myself the tumor is still in play, even though he is getting reductions in insulin. Most likely from it "pulsing" like Jeff said. His reductions in insulin / the possibility of him going into remission on his own is hard to ignore... although I know getting the tumor out would still help with any future issues that could be caused by the tumor, and even if he did go into remission he could always go back on the juice.

Thank you for the thundershirt suggestion, I have it on my list that I would want to buy him some sort of harness if I decide to go that route so I will look into that.
I did not read her story before, that is wonderful. I am still a little worried since that story was in the UK and we don't have quite as much experience here in the US, but regardless it is nice to hear different stories of kitties that have gone through this.
And as for the MRI costs, at AMC it's $2100, and if I got it done here in Cleveland as well, they quoted me anywhere from $2,000 - $3,000. I just read the reply from all my follow up questions from Dr. McCue. I had asked for clarification on what he needed before we came, as I was under the impression they needed an MRI beforehand as well as when he gets there. He said "The purpose of the MRI is to evaluate the size and characteristics of any pituitary mass. It would be unusual to find a mass that is excessively large or complex that would prevent us from doing surgery. It is certainly possible but very unlikely. MRI (or CT scan) requires anesthesia to be performed properly because, as you said, he will not hold still for such a test. To limit the number of anesthesia’s and because he will require a pre-operative imaging study as part of surgical planning the MRI could be performed once he is at the hospital in New York City." I also asked him about the echo and his response was "An echocardiogram is helpful to stage any level of heart disease. This is something we would look at here before surgery. It is something that we can perform here as part of his overall treatment plan. Certainly knowing his degree of heart disease before coming to New York would be helpful but that is also something that we can figure out once he gets here. As I mentioned in our conversation on the phone heart disease can complicate the surgical recovery. But is not necessarily a cause of surgery related death. Also if the cardiac disease is related to his acromegaly treating the acromegaly will help his heart disease."

I just made an appointment for an EKG here, it is $369, so I thought might as well get that done now, one less thing for them to do there.

Since this is about a 9 hour drive it makes me nervous to NOT have an MRI beforehand, but since he said its uncommon for the mass to be very large, I feel like just getting the one in NYC is definitely an option on my radar, and would save me thousands of dollars.

I also asked for more specifics on the five cats that have already had the surgery, and this was his response; "Regarding the cats we have treated to date, there have been five overall. Two of those cats had acromegaly, one had Cushing’s disease and the other two had non-functioning pituitary tumors. Of the two cats with acromegaly one had resolution of their diabetes and is still in remission and normal six months later. The other kitty cat had improvement in diabetic control with a 50% reduction in need of insulin. He is clinically normal for the past 10 months. The kitty with Cushing’s disease only finished their surgery last week but we have also seen a 50% reduction in insulin requirements and she is recovering very well.
Of the two cats with non-functional pituitary tumors, both tumors were very large and causing significant neurologic abnormalities. In one kitty we were able to remove the tumor completely. His neurologic symptoms resolved and his owners were quite happy with his outcome. Unfortunately he had a very sick heart. His heart disease was not related to pituitary disease but was genetic because he was a Maine coon cat. He died of heart disease six months after surgery. A postmortem examination showed that he was cured of his brain tumor.
The only cat who has died with us had a very large pituitary tumor with severe neurologic symptoms. He did not fully recover from anesthesia unfortunately. His was the largest and most complex tumor that we’ve had to deal with. His was also a non-functional tumor that was invading the brain so his case is unique and not the same as the cats that we see with endocrine diseases like acromegaly and Cushing’s disease.
All of the surviving kitties have required supplementation of their thyroid and cortisol. The ADH requirements have not been permanent in the two cats that have been out of surgery for many months. Our most recent case is still in the initial 2 to 4 weeks postoperative period where ADH is still needed."

And as for getting him ready for the surgery; "Even though the surgery is performed through the mouth we still need to shave some of the hair around his head and face. We shave the head so that we can attach a temporary marker that allows us to control where our instruments go during surgery. This is removed immediately after surgery. The facial hair is clipped to keep the whiskers and other longhair is out of the surgery site so that we don’t have infection."

Clipping his whiskers makes me nervous and sad on top of everything else! For some reason I thought whiskers were necessary for cats..... maybe this is why I have read some prior cases where they were having balance issues. This seems so silly to worry about after speaking of brain surgery...

 

AMPS 64, I decided to reduce to 4.75U to be safe. Plus we are (hopefully) going out later to celebrate our five year anniversary, so I think this was the best option overall.

 

Amanda --

Did you happen to check with OSU to see if they do the procedure here? The vet program is one of the top 5 in the country and it's a much shorter drive to Columbus than NYC. (And I have a spare bedroom and the vet school is about 10 min from where I live!)

 

They did tell me to check OSU, that is on my to do list. The big draw to NYC is because the surgery would be covered by the donor money, but I will call today to get my options. Thanks so much, that is such a kind offer.

 

@Sean & Rufus how did you store your insulin when you drove to Canada to get it? My cousin is going to Niagara Falls on the Canada side and I am going to have her pick me up Lantus. I don't really know what to tell my her about storing it. I was just thinking she can put it in a small insulated lunch box with a freezer pack, but by the time they get the insulin I don't know if the freezer pack would stay cold, since I do not think they will have a fridge in their hotel room. Maybe I should tell her to get the insulin on her way back here, and then not worry about keeping it cold? Since it won't be opened yet so it should be fine in the car for about 6 hours?

 

Just called OSU and she wasn't sure if they offer SRT or the pituitary gland removal surgery. She is looking into it and calling me back. If they don't know that kind of puts me off right away but I will stay open minded and wait for the return phone call.

 

Thanks for typing in all the info they gave to you about the potential surgery. I would also worry about shaving the whiskers - that is a major mechanism that cats use to detect stuff as they walk.

The cats that had neurological symptoms - that is always the scary part about Acro. If one waits too long to resolve the Acro, that impingement into the brain can occur. I got lucky with Leo. Even though his pituitary was drastically large, it was not yet to that point.

 

Post back with what you find out. Doesn’t sound likely, but I live in Columbus too. It’s possible that your cat could get off insulin with Cabergoline. Are you getting anywhere with that with your Vet?

 

Happy Anniversary!

 

You generally follow TR with acros, but also keep in mind the potentially larger depot. There were times I took a "temporary" decrease when Neko was dancing the 50's at night, only to have the reduction hold. I also found that I could keep doing 0.5 unit reductions until I got a little lower in dose. This is part of the experiment you have to do, to find out what works for Shmee. As for the tumour, you can see all sorts of variations in action. Phoebe was up to over 20 units, and just earned a reduction down to 0.5 units.

Thank you for posting the answers to your questions on kitties who have had hypophysectomy in New York. Could I ask you to post a summary at some point in the high dose forum, for those beans whose kitties may not be on Lantus/Levemir, or might not think to look here for that information.

I took a risk on a 27 hour journey to Fort Collins. Must admit I was relieved, though not happy, when the CT scan at CSU found a tumour.

I would vote for an echo before an EKG. Neko's cardiologist didn't usually do an EKG unless the echo indicated he should.

I'm not Sean, but when I drove to CSU, I had the insulin in a tupperware, wrapped in a facecloth or bubble wrap to keep it still, then in a cooler with gel packs inside. The tupperware kept the cartridges away from direct contact with the gel packs. We were on the road for 9-10 hours a day with that solution, a lot of it in ridiculously warm weather.

As for whiskers, have you looked at pictures of kitties who have had hypophysectomy? Look at first picture there.

 

Check these out. https://www.adwdiabetes.com/category/diabetic-wallets?msclkid=31f03add9c2d1c378690618f1354050e&utm_source=bing&utm_medium=cpc&utm_campaign=CATEGORY | Insulin Coolers CPA 7&utm_term=frio insulin cooler&utm_content=FRIO Wallets ####
You need to be careful that insulin doesn't freeze. I bought these in the event my power went out. They keep insulin stable for about 24hours. I sent mine to Puerto Rico for my hairdresser's father who lost power and was diabetic after the hurricane knocked them out of power. I need to order another one. They really work well.

 

I used the Frio wallet when I flew with Neko. Worked well then and took up less space. It just requires buying something else.