Acromegaly and resultant diabetes cured by pituitary removal

Discussion in 'Acromegaly / IAA / Cushings Cats' started by John Irene and TITAN, Aug 6, 2018.

  1. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    I am new here. I want to read posts about IAA but when I search, the search term is too short and I get no results. TITAN is currently on 8 units twice a day, and every time the dose is increased, the BG drops but only to about 24 and only for a day or two. Any suggestion about finding IAA posts would be welcomed

    EDIT this was our first post before we knew how things worked. We are extremely grateful for the welcome and responses we received. In the event it wasn't IAA we were dealing with.
     
    Last edited: Oct 19, 2018
    Reason for edit: Clarification with hindsight
  2. Amanda and a Loudogg

    Amanda and a Loudogg Well-Known Member

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    Jun 16, 2017
    Hello! My buddy Lou was diagnosed with IAA only on July 2, 2018. My thread with the diagnosis and some basic information is located HERE. Within that post, Wendy&Neko provided me with the names of other IAA only members so I could review their spreadsheets and also a post HERE with a lot of other links/information about IAA. It's a lot of information, but hopefully they'll help you! :)
     
  3. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    Have you had the blood tests done for insulin auto antibodies? Or for acromegaly? We recommend getting both the IAA and IGF-1 tests done when kitty gets over six units. It is possible for a cat to have both high dose conditions, as did my cat. She also exhibited the action to an increase where she would show initial better numbers, then go back to higher numbers. I called it the dose going stale. :rolleyes:

    Feel free to keep asking questions, we'll try to help.

    What insulin is Titan in, and what food is he eating?
     
    Last edited: Aug 6, 2018
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  4. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    Thanks both for response. We managed to get both IAA and IGF-1 done. The IGF-1 came back positive yesterday and IAA is still awaited.. We are trying to feed zero CHO, and using prozinc (after a couple weeks on caninsulin ). Going stale is surely the IAA response? We Also had a positive Flp1 two days ago
     
    Last edited: Oct 19, 2018
    Reason for edit: Correcting an error
  5. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    I thought the same blood sample delivered both IGF-1 and IAA. Anyhow, can you please tell us the numbers for your kitteh?

    Sorry to hear about the FIP1 positive diagnosis for Titan.
     
  6. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Sorry to hear about the positive test results. :bighug: Most of the people getting the MSU tests done lately are reporting that the IAA results is coming in after the IGF-1 result.

    For food, it doesn't have to be zero CHO, low carb under 10% carbs is good.

    The dose "going stale" can also result from the pituitary tumour ramping out it's growth hormone output. It's easier to tell which it is if you have a spreadsheet or other mechanims to show your blood test values.
     
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  7. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    We're going for zero CHO because TITAN is still a long way from reasonable numbers. We get average results around this morning's figure of 30 / 540 and would be happy just to get to 20 / 360 . We have kept a spreadsheet since diagnosis on 6 July, and have reentered all data onto Royal Vet. College's App. But would be happy to do it again in a different format if it helps to get advice from you guys. Can you tell me where you store your SSs? On the forum site or individual cloud services?
    How can you distinguish from a spreadsheet between extra growth hormone output, and extra antibody output?
    TITAN is starving hungry and went out in the rain last night to catch a mouse.
     
  8. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    Here is the information on the common spreadsheet format used here:

    FDMB Spreadsheet Instructions:
    • Please set up a Google Spreadsheet as soon as possible. Always keep spreadsheets up-to-date! Valuable time may be lost looking for information when a spreadsheet is not up to the minute.
    • If you have not been able to transition your kitty off of DRY food yet, please note it on your spreadsheet and in your signature. A dry food diet will often require higher doses of insulin to bring numbers down. Having this information plainly visible will help us help you.
    Understanding the Spreadsheet/Grid
     
  9. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    We have loaded up a spreadsheet, and included a link to the folder in my signature. Can anybody tell me if it works? Titans IGF-1 score was off the scale at over 2000 ng per litre. They have lost the sample for the IAA test. We have an appointment in mainland England on 23rd August at RVC for the surgery to remove the tumour. We live in the island of Jersey so we have to fly, and get a pilot from the aero club to give us a lift.
    Before that we have to fly to the nearby island of Guernsey to get a CT scan to confirm the tumour, probably Tuesday, trying to find a pilot as I write.
    Should we get another sample and get the IAA test done anyway?
    The BG tests are still over 30 / 540. The vets (thats another story) are frightened to tell us we can increase his dose although we would like to. What do YOU think?
     
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  10. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    Michigan State University in the US is the only one doing the IAA tests. I wouldn't bother getting it tested at this point. If the tumour is removed, the IAA may just resolve itself as hopefully you'll no longer need to inject insulin. Lucky you on having the option to go to RVC, even if it is rather complicated travel. Do let us know how it goes. We have one person here @Amanda & Shmee getting the surgery done in New York shortly. I am sure she'd love to hear the details, as would I. I live in Canada, we have no one here performing the surgery, :(

    I get an error message when I try to open the spreadsheet. It says "URL can't be shown".
     
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  11. Amanda & Shmee

    Amanda & Shmee Well-Known Member

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    Feb 18, 2018
    Welcome! You are in the right place, Wendy and many others have helped me tremendously.
    What is your name? I am so happy you are able to get the surgery done, it is not some common here as it will cast us anywhere from $16,000-$20,000. The only reason I am getting it done is because there is donor money available in NYC. I cannot open your SS either.
     
  12. Olive & Paula

    Olive & Paula Well-Known Member

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    Sep 6, 2015
    I don't think he's been on insulin long enough to run the IAA. He needs be on insulin 76 days I believe or its a false reading.

    My lady is on 8.5 units. Was on 9 and possible it will go back and even increase. They need what they need. Some kitties have been over 50 units.

    I can't open ss either. If your following either of the protocols posted on the forum, you would follow the guidelines for increasing or decreasing. It's funny my vet with my first cat said he couldn't have more than 5 units. With my current kitty since I home test the vet is comfortable with me increasing if she needs it. Now the internal medicine Dr was against her getting the 6 units when he saw her. Thank goodness he only sees her for ultrasound.
     
    Last edited: Aug 10, 2018
  13. Wendy&Neko

    Wendy&Neko Well-Known Member

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    I don't think you'll get a false reading for IAA. There has been a study by RVC that showed that 1/3 of the acro cats tested before 73 days would be false negative.

    8 units is not a particularly high dose of insulin for an acrocat. My girl got up to 8.75 units, but we've had some kitties need almost 100 units per shot. But that was on a longer lasting insulin like Lantus and Levemir. We don't see many high dose cats on Prozinc.
     
  14. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    We are John and Irene, and TITAN. the spreadsheet link has been re-attempted. please tell us if it works. We are so envious of everybody's purple, yellow etc results. we are concerned to keep TITAN going until (now rescheduled) 29 August 2018. Should we bump up his shots to 10 units twice daily, or how about some shorter acting insulin?
     
  15. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    The spreadsheet is now working. Yes, Titan is getting a lot of insulin. You are indeed lucky to have the hypophysectomy option for a good price in the UK.

    At this point, Titan is under-dosed. There is no quick solution. I would do 10% bumps and hold them for 6 doses. If you raise the dose too fast, then you could create a hypo.

    Leo was at 36 units/day when I got him treated with radiation SRT in Sept 2016. Now he is at 5 units/day, and some of that is to overcome the prednisolone effects.
     
  16. JeffJ

    JeffJ Well-Known Member

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    How interesting to live on Jersey Island. A little bit of UK and a little of France. Plus access to some nice beaches.
     
  17. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    Thanks for that, Jeff. Thanks also for all the excellent graphs and notes which I have studied. We have increased from 8 to 9 units. He is still over 30 / 540, and very quiet and unhappy looking. It's very tempting to increase more rapidly. I know hypos are to be avoided; I have been a type 1 diabetic myself for about 45 years, and have had a few extreme hypos in that time. I remember them as being very frightening, and wouldn't want to add that to Titans troubles.
     
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  18. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Good luck with the increase . I want to stress the importance of getting a test in each and every night cycle if you can, perhaps just before bed. Many cats go lower at night. My Neko went months going lower at night(and earning reductions), then bouncing up during the day. If I only had daytime tests, I would have though she needed more insulin, but in fact she needed less.
     
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  19. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    Yes, humans certainly need less insulin overnight than during the day, not only because of food, but also the background metabolism. We had TITAN on 6 units AM and 3 units PM for a while. But now i am wondering whether cats being more nocturnal than humans, might need to be dosed more evenly. Did you ever get NEKO under any kind of reasonable control before the SRT?
     
  20. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Neko earned her first reduction just days before we hit the road for the three day drive for SRT. So I finally hit a good dose, but her numbers were still all over the place. Best thing I did to get her more even was to switch to Levemir, but hopefully you are going to see more immediate results with the surgery.

    Lantus/Levemir is dosed differently than Prozinc. On the Lantus/Lev forum, the dosing methods we use recommend the same dose AM and PM to stabilize the depot.
     
  21. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Just looked at Titan's chart again. You are doing a great job keeping it updated, and dosing. I would keep up the 6-dose protocol and 10% increases until you see some results. The high numbers are unhealthy.

    New chart - Tab 3 "SRT Summary" shows the updated chart. With hypophysectomy, the RVC predicted better results than SRT though.

    Leo's summary:
    - 2016 approaching a bouncy regulation on Prozinc
    - late 2016 switched to Levemir and did not have regulation
    - Sept 2016 SRT
    - Note I work full time, and sometimes 50-60 hours. Better records and better regulation would have been easier if not working.

    If all goes well, you end up with this 2 years later.
    Little Dude and Leo - best buds 08-12-2018c.jpg
     
  22. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    We have had a further reply from Ruth at RVC in response to our questions about raising the dose. They seem to be against it. After yesterday's raise, today's results are pretty flat and high. We are going to maintain this dose for a few days. Lovely picture of Leo and Little Dude!
     
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  23. Wendy&Neko

    Wendy&Neko Well-Known Member

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    To me this reads that it would be OK to increase, but it may not be enough to get him into good numbers. Just so you know, we have seen some very well regulated untreated acrocats on higher doses, that were using either Lantus or a Levemir. RVC may not have seen that yet, it really depends on home testing which not all caregivers do. She may also be thinking that it's not that long until the surgery, and you are unlikely to get him regulated in that period of time. I think it's your call, more insulin won't hurt, might help a bit.
     
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  24. JeffJ

    JeffJ Well-Known Member

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    Titan will be admitted on Tuesday 8/28/2018. That is about 2 full weeks away. I agree with Wendy. Giving Titan more insulin will only help him. Those black numbers are real bad - glucose toxicity.

    Sure, you probably won't have him regulated in 2 weeks. But you might give his kidneys a little break from filtering out all the glucose.
     
  25. John Irene and TITAN

    John Irene and TITAN Member

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    Thanks to Wendy and Jeff for good advice. Cannot tell you how comforting it is to deal with people who know what they are talking about and say what they think. Maybe no increase today because it's supposed to be a CT scan day. The light aeroplane flight has just been cancelled because of poor visibility at both airports. So we're going by car on the fast ferry, departing in 3 hours, hopefully return tomorrow. Titan can stay at the vets overnight, . Results can be sent by email to RVC and the scan costs around GBP1000. RVC can make a decision about operability and see the location of the gland/tumour from the email. If it's anything like the optical CT scans that I send to my eye surgeon in London, it's like a few shortish videos of the slices through the tissue, which the reviewer can pause and study at will. Maybe Dr McCue in NYC could do that too.
     
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  26. JeffJ

    JeffJ Well-Known Member

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    No problem. I hope all goes well with the ferry ride, and the scan. The scan sounds pretty expensive.

    Leo has been an Acro-cat since 2016, but he got SRT, so most of the Acro is gone. And just this week after being 3 years diabetic, I have him as close to being regulated as a bouncy kiteh can be.
     
  27. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    The trip to Guernsey vets went well, titan was very good. We got the scan results but still no decision as to whether he can be operated upon , because our local vet did not pass on the scan results to the RVC until late Friday after we chased them
    upload_2018-8-18_14-21-55.png
    The pituitary gland is about dead centre of this view, which is a slice taken vertically, ear to ear. I shall post a video of the whole scan here. The gland / tumour can be seen about 6.5 seconds into the video. Titans BG just seconds ago was 34.3 !!! his dose is 10 twice a day. We will try to do a BG during the night tonight.
    We are starting to worry that loading him up with exogenous insulin might trigger Insulin Antibodies, and we are starting to research (google!) the difference between Insulin antibodies and Insulin auto antibodies. Thought the latter was resistance to the cat's own insulin. Can anyone explain this in simple terms?
     
  28. JeffJ

    JeffJ Well-Known Member

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    Thanks for posting the results. His BG is so high, that 34.3 - I thought that was a U.S. value. These black numbers indicate glucose toxicity. The upcoming surgery will be a good relief for that.
     
  29. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Here is an explanation of Insuiln Auto Antibodies. Sorry, the link the What We Know Sticky is broken but this is what it used to point to. Basically IAA is like the body's defense system to foreign bodies, ie. injected insulin. All cats have a minor amount of this, but for most it's very low levels. Neko had 52% IAA - she had it from the start, increasing her insulin does did not make it worse. In fact, eventually you inject enough exogenous insulin and you will overcome the antibodies.

    Those blacks are really hard on the system. I would increase to 11 units tomorrow. If you can get at least 2 tests per cycle, ie. the preshot and one other, and you don't see anything below 200 (11.1), I would keep increasing every 6 cycles.

    I hope you hear from RVC soon.
     
  30. John Irene and TITAN

    John Irene and TITAN Member

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    RVC have confirmed they think TITAN is suitable for the surgery. We have been back for a second sample for a further IAA test, and a full set of bloods to see what damage these sky high BGs are doing. Only 27 / 486 this morning when he came in!
     
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  31. JeffJ

    JeffJ Well-Known Member

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    That is great news that Titan is now confirmed for surgery. Like Wendy said, those blacks are horrible for your kitteh. I hope you can get a breakthru soon. If not, then the surgery is coming up to resolve it.
     
  32. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Good to know you can now proceed with the surgery. That CT scan condirmation was a relief to me too.

    Any chance Titan is finding a bowl of dog or cat food left out be a neighbour? Wouldn't be the first diabetic cat to do so. Especially with the acro hunger.

    I think you are fine to go to 11 units now, provided it's not a neighbourhood buffet contributing to the numbers.
     
  33. John Irene and TITAN

    John Irene and TITAN Member

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    Thanks Wendy. I think it's unlikely that he is dining out unless it's on wild food. He did bring In a rabbit last week. Our only close neighbours have cats but leave no food out. Their cats would not allow ours in through their cat flap.
    You mentioned on 10 Aug a study by RVC about false negatives in early diagnosis of Acro; difficult to understand that wrt IGF-1, but possible with IAA. Anyway would like to read it, can you point us in the right direction?
    We are very happy with the speed of diagnosis of TITAN, thanks largely to FDMB.
    It might have been quicker if vets routinely encouraged home testing
     
    Last edited: Aug 23, 2018
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  34. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Not a paper, but a video on the RVC Diabetes Remission Clinic FB page. Here is the link. We do have at least one example here of a kitty whose IAA came in later. Doodles looked like a normal diabetic kitty, well regulated, when he started getting heart problems. His dose skyrocketed to double digits and he was diagnosed with IAA. Very little is known about IAA. There have only been a couple of research papers on IAA, on very small samples sizes of cats, and with contradictory results. There doesn't seem to be anyone actively studying it in felines now.

    Titan may or may not have IAA, it could just be his acro tumour growing causing the increasing needs for more insulin.
     
  35. John Irene and TITAN

    John Irene and TITAN Member

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    Thanks, watched the video. Difficult to follow as she spoke so fast, but will try to get the gist with a few repeats .
    Titans increased dose was going well. He was down to about 20 /360 at 0200 last night BUT this morning was the highest ever at 35.3/ 630 !! Surgery on Wednesday can't come too soon. We don't think it's a bounce but not sure. Maybe we should switch to 3 shots a day? There was about 14 hours between last nights pm shot and this mornings shot. Probably not going to switch insulin type at this point .
     
  36. Wendy&Neko

    Wendy&Neko Well-Known Member

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    It's possible for cats to bounce if they see low pinks or yellows, if they are used to higher numbers. Don't worry about being the highest number to date. Meters can by law vary as much as 20%, at least in North America, and at those higher numbers that's quite a range. My meter just said "Hi" after 600, so I didn't have to care about exact numbers. And you are probably correct that the time between shots was also a factor.

    I would stick with 2 shots a day for now. At this point you probably have enough on your mind getting things ready to travel for the surgery. There isn't much expertise around using 3 shots a day and Prozinc. It's been done, but quite a while ago. If things weren't going to change for the better soon (positive thinking), I would have some other ideas for you to consider.
     
  37. John Irene and TITAN

    John Irene and TITAN Member

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    This afternoon was a YELLOW , the first since day 1 taken by the vet, and the only one we have ever had with home testing.
     
  38. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Not only yellow, but lower yellow! Progress. :joyful:
     
  39. JeffJ

    JeffJ Well-Known Member

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    Yes, very good progress. Getting out of the blacks - I bet Titan feels a bit of relief.
     
  40. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    Yes he was better. But we backed off last night. And lost some ground. Our flight is now tomorrow lunch time because of weather, and we just want to get him there safely. Pilot wants cash in hand on arrival ... I feel like a smuggler! Consult Tuesday and hopefully op. on Wednesday. Thinking of Amanda tonight.
     
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  41. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    LOL. That is such an odd transaction. I guess the pilot got burned in the past.

    This is exciting that two FDMB kittehs are getting acro surgery in the same week. I hope it goes well for both Titan and Shmee.
     
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  42. Amanda and a Loudogg

    Amanda and a Loudogg Well-Known Member

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    I will be thinking of you all this week as well! Sending you all some good energy for the trip, I hope it is uneventful!
     
  43. John Irene and TITAN

    John Irene and TITAN Member

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    We have checked TITAN in for the night at RVC. He was very good on the plane ,hiding at the back of the box at first because of the noise, but later sticking his nose out through the feeding holes.
    20180827_145910(1).jpg
     
  44. John Irene and TITAN

    John Irene and TITAN Member

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    Pre op assessment tomorrow. Reception at RVC ( by Dee) was very friendly and efficient, inspiring confidence. Hope he sleeps well.
     
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  45. Wendy&Neko

    Wendy&Neko Well-Known Member

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    All paws crossed here for a successful tomorrow!:bighug:

    That's quite the fancy carrier you have there.
     
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  46. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Sending positive thoughts, white light, and healing energy for successful treatment and a speedy recovery...

    :bighug:
     
  47. JeffJ

    JeffJ Well-Known Member

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    Titan is a good boy. Healing vines for Titan and you on his upcoming surgery. This will be the start of his newly renewed Acro-free life.:bighug::bighug::bighug:
     
  48. John Irene and TITAN

    John Irene and TITAN Member

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    Thanks to all. Wendy... the carrier was one we borrowed from Tiz, the great vet nurse at home, who also came in to feed our cats and inject TITAN when we had a trip away in the early days. We broke a bit off it in Guernsey , and were able to buy a replacement from Amazon. It's quite heavy but has the advantage that you can put in food and water without risking escape.
    Not looking forward to seeing his head shaved!!!
     
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  49. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    Went to RVC for pre op meeting with Daisy student vet and Camilla the vet. All OK . Didn't see TITAN, nor Joe the surgeon. Only upset was when they asked if we wanted him to be revived if his heart stopped. We said yes. Paid 50% deposit on fees now estimated at £7k.
     
    Last edited: Aug 29, 2018
  50. JeffJ

    JeffJ Well-Known Member

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    I wouldn't be upset about that question. That is common for all animal surgery. Sounds like good progress leading up to the big day for Titan!

    The fees sound pretty high. I really hope Titan does well in surgery.
     
  51. John Irene and TITAN

    John Irene and TITAN Member

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    Disappointment.. Camilla called last night to say that titans white cell count was low and to suggest a 2 day pause, a couple of scans, and a dose of antibiotics . We are devastated but agreed. Trying to get a meeting today before we fly home . Also I forgot to mention that at the previous meeting they expressed doubt whether TITAN could fly in an unpressurised plane after his op.
     
  52. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Oh no! I'm sorry there's been a delay in the procedure and hope Titan can recover soon. Do you have alternative ways home besides the small planes? Or maybe the plane can fly really low and take the scenic route. :smuggrin:
     
  53. John Irene and TITAN

    John Irene and TITAN Member

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    Yes fast ferry is a minimum 8 hours doortodoor but departure times and Rvc hours probably mean an overnight on the south coast. We would probably have to bring the car over a day or two early. Haven't yet discussed skimming the ground with pilot or the RVC. In fact we are still sitting in a pub in St Albans waiting for a call from them. Titan's team a bit demoralised; but good news from Amanda and Shmee in NYC !
     
    Last edited: Aug 31, 2018
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  54. JeffJ

    JeffJ Well-Known Member

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    The delay is unfortunate. With luck the operation will occur soon, and Titan will get into recovery mode. This delay is especially unfortunate because he has such high BG now. But he is in good hands with people who understand the disease in depth.
     
  55. John Irene and TITAN

    John Irene and TITAN Member

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    Good news! Went back to see Camilla at 1500. They have rerun the bloods, the figures are acceptable, and it's all go for tomorrow. We decided not to visit him (which was hard), and we flew home this evening. Camilla confirmed they dont think he should fly soon after surgery. But they might arrange an early morning departure so we could catch the ferry. All those details can wait.. tomorrow is the big day...wish us luck!
    P.S. the pituitary gland and tumour together are about 7mm across, (just a tad over one quarter of an inch)
     
  56. JeffJ

    JeffJ Well-Known Member

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    That is really good news. Isn't it amazing how such a small gland can control so much in a kitteh! I really hope the surgery goes as well as it did for Amanda and Shmee.:bighug:
     
  57. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Paws, fingers, toes, tails all crossed here for good results tomorrow.
     
  58. Olive & Paula

    Olive & Paula Well-Known Member

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    Hugs and prayers all goes as scheduled.
     
  59. John Irene and TITAN

    John Irene and TITAN Member

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    Just heard from Joe the surgeon. The pituitary removal was a success and Titan is in recovery. His bleeding was more than average, but has stopped and he will get a transfusion if necessary. His labs showed low-ish platelet levels which slows the clotting. Still not out of the woods completely, but things sound hopeful.
     
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  60. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Thanks for the update John. Bleeding is one if the risks of the surgery but I am glad to hear it stopped. Paws crossed for a quick recovery. Is he in the hospital for a week?
     
  61. Olive & Paula

    Olive & Paula Well-Known Member

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    Sep 6, 2015
    To Titan. Good news John. Speedy recovery vines on their way.
     
  62. John Irene and TITAN

    John Irene and TITAN Member

    Joined:
    Aug 6, 2018
    Further call from Camilla. It is really good that they keep us informed like this. Titan coming round, eating (which is what he does best!) and BGs around 20 which is better. Currently on intravenous insulin, will be switched to sub-cutaneous tomorrow.
     
    Last edited: Aug 31, 2018
    Amanda & Shmee likes this.
  63. John Irene and TITAN

    John Irene and TITAN Member

    Joined:
    Aug 6, 2018
  64. John Irene and TITAN

    John Irene and TITAN Member

    Joined:
    Aug 6, 2018
    He looks so much better than expected! Such a good cat!
     
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  65. Amanda and a Loudogg

    Amanda and a Loudogg Well-Known Member

    Joined:
    Jun 16, 2017
    He looks great considering he just had surgery! Sending you many healing vines for Titan! :bighug::bighug::bighug:
     
  66. sbluhrs

    sbluhrs Member

    Joined:
    Jun 7, 2012
    Wow, he really looks good, despite just having surgery. Heal fast, sweet Titan. [​IMG] Set a good example for Sophie and her surgery in 26 days...
     
  67. Olive & Paula

    Olive & Paula Well-Known Member

    Joined:
    Sep 6, 2015
    Looks good. Keep healing Titan.
     
  68. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    He really does look very good after surgery. They did a great job. I am really happy for you guys and Titan.

    Healing vines for Titan's continued recovery.:bighug::bighug:
     
  69. John Irene and TITAN

    John Irene and TITAN Member

    Joined:
    Aug 6, 2018
    Yes we think so. Going back to mainland overnight Tuesday, hoping to pick up Friday early am and dash for the ferry. But of course it all depends on how he does......
     
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  70. John Irene and TITAN

    John Irene and TITAN Member

    Joined:
    Aug 6, 2018
    Call from Camilla at 1100 as promised. TITAN doing well BG has been as high as 37/666 !!! And as low as 7/126. Eating well.
    Finally got the IAA result. It is described as just th IA, Insulin antibodies, or INAB result. Stated result is 1%, well under the top of normal 20%. Wendy I was expecting a result in nmol/l or something similar??
    Guess this means we are no longer searching for IAA. Will change title of the thread in a day or two.
     
    Last edited: Aug 31, 2018
    Reason for edit: typo
    JeffJ likes this.
  71. sbluhrs

    sbluhrs Member

    Joined:
    Jun 7, 2012
    The incisions by the ears are interesting. So, they didn't go in through the roof of the mouth or are those incisions for other/additional things?
     
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  72. John Irene and TITAN

    John Irene and TITAN Member

    Joined:
    Aug 6, 2018
    Yes we are 99% sure that those are for the skull supports to ensure there is no movement during the operation. They certainly went in through the roof of the mouth to get the pituitary.
    Call from Camilla at 2000 as promised. Titan will remain in ICU for about 2 days more. he is off his fluid drips because he is eating and drinking of his own volition. The hormone replacement therapy started yesterday. Electrolytes are being checked every six hours. Potassium particularly, as shortage can cause oedema in the brain. latest BG down to 7.6 / 137. Titan is happy, wanting head butts constantly. Titan's team is very happy, and beginning to hope for the best. !
     
  73. Amanda and a Loudogg

    Amanda and a Loudogg Well-Known Member

    Joined:
    Jun 16, 2017
    Whooo!! What a fantastic report! So exciting! Here's to continued healing and progress! :bighug::bighug:
     
  74. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Love the BG report! :cool: Isn't that numbers on the AT? If so, bye bye insulin. :woot: Plus the head butts, Titan must be feeling great compared to before.

    IAA is just a percentage, so one less thing to worry about. :)
     
    Last edited: Aug 31, 2018
  75. Phoebes

    Phoebes Well-Known Member

    Joined:
    Jan 16, 2017
    Awesome Titan!! He looks so cute! What a good boy! Head bumps are our favorite!
     
  76. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    That is a great status report. Thanks for keeping us updated. How interesting they made those skull supports during the operation. I'm also glad to hear that Titan's BG went down so fast. That is really great!
     
  77. Olive & Paula

    Olive & Paula Well-Known Member

    Joined:
    Sep 6, 2015
    Sounds like he is doing wonderful.
     
  78. Amanda & Shmee

    Amanda & Shmee Well-Known Member

    Joined:
    Feb 18, 2018
    Wow, you all have gone through so much! :bighug: I am sorry I am playing catch up. I am so happy he is doing well now!!

    Yes I wonder why Shmee and Sofie have to have their whiskers and whole faces shaved.
     
  79. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    It will be interesting to see BG and insulin numbers over the next few months for the hypophysectomy patients (Shmee, Titan, and Sue's kitty). Exciting and very happy times on this forum!
     
  80. John Irene and TITAN

    John Irene and TITAN Member

    Joined:
    Aug 6, 2018
    Call today from Camilla at RVC. Titan is out of ICU. Yesterday am shot down to 5 units AMPS c. 7 mmol/l / 126. Yesterday PM shot down to 1 unit and resultant BG up to 27/486. Todays am dose is 5 IU and this pm will be 2.5. It is possible that by end of next week he MIGHT be OTJ !!! That doesn't matter so much, he is responding to the insulin, his doses are falling, and that is a fantastic step forward. He is described as happy and cuddly and head-butty. Thanks to FDMB and to RVC !!!:joyful:
     
  81. Olive & Paula

    Olive & Paula Well-Known Member

    Joined:
    Sep 6, 2015
    Very good news.
     
  82. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    That is great to hear his BG numbers and insulin demand is dropping so fast. Also great to hear that Titan is out of ICU and into the normal care unit. Exactly what you and all of us were hoping for.

    It takes such dedication to commit to this surgery and for Titan - to get him to the distant clinic. I am glad that it is working out so well.
     
  83. Bellasmom

    Bellasmom Well-Known Member

    Joined:
    Feb 12, 2018
    Sending healing vines and hope for a quick recovery :bighug::bighug:
     
  84. John Irene and TITAN

    John Irene and TITAN Member

    Joined:
    Aug 6, 2018
    Yesterday's call from Camilla said Titan was constipated and had Been given 3 warm water enemas. He had been good but was now a bit grumpy!! Wonder why ?
    We leave home tonight on the slow ferry to England. Car in for a service this morning to prepare for unaccustomed motorway driving.
     
    JeffJ likes this.
  85. John Irene and TITAN

    John Irene and TITAN Member

    Joined:
    Aug 6, 2018
    Tcall from Daisy this am. TITAN happy. AMPS BG was 11 / 198 so the dose was just half a unit of insulin. We are feeling optimistic and packing our stuff.
     
  86. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    That is a great update. It sounds like Titan is doing very good. His BG seems a bit high, but I suppose there is no guarantee that all his diabetes is Acro-caused. Some could be pancreatic diabetes. Still, that is a low insulin dose so no worries there.
     
  87. John Irene and TITAN

    John Irene and TITAN Member

    Joined:
    Aug 6, 2018
    We went out for a meal last night and received this email from Camilla
    QUOTE
    Titan has been doing well today – he no longer feels constipated on abdominal palpation and is eating normally with no further vomiting. He did not require insulin this morning as his blood glucose was 5.2 mmol/l, and it has stayed between 5.2-9.5 mmol/l since then. It will be interesting to see what his blood glucose is this evening, when he would potentially next be due insulin.
    Due to his reducing insulin requirement, I do think it would be beneficial to give him one more day in hospital, in case he is on the cusp of no longer requiring insulin (it would be useful to know this before discharging him). Therefore, if it is ok with you, it would be ideal if we could have our “discharge talk” on Friday afternoon/evening, with the aim for him to go home on Saturday morning. Please let me know if this will be difficult for you. UNQUOTE

    This is good news although we think we could handle him going off the juice. We just want to get him home. But we will continue to trust their judgement and are trying to rebook the ferry and get an extra night's accommodation.
     
  88. John Irene and TITAN

    John Irene and TITAN Member

    Joined:
    Aug 6, 2018
    Yesterday's pic of TITAN showing funny shaped head caused by shaving over the head and beside the eyes. Also his pupils look small and round instead of vertical slits? But he looks brighter. IMG-20180905-WA0000.jpg
     
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  89. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    That is a great progress report. Glad to hear Titan will be coming home soon. I hope he can go OTJ too.
     
  90. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Woohoo! Coming home and probably off insulin. Best report ever!:woot:
     
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  91. John Irene and TITAN

    John Irene and TITAN Member

    Joined:
    Aug 6, 2018
    IMG_0538(1).JPG
    On our way home. Picked up the boy at 0500. Drove to Poole in very light traffic with sunrise behind us. Here is TITAN queuing for the ferry. He is now alone in the car on the car deck. We have permission to visit in one hour. Nerve wracking times.
     
  92. Amanda and a Loudogg

    Amanda and a Loudogg Well-Known Member

    Joined:
    Jun 16, 2017
    So exciting!! I am so glad you are all on your way home! Safe travels!
     
  93. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    He is looking alert and ready to come home. I hope you enjoy the ferry ride, I always liked being on a ferry. Good news for Titan!
     
  94. John Irene and TITAN

    John Irene and TITAN Member

    Joined:
    Aug 6, 2018
    Yes all is well[​IMG] Titan is home and on watch. The kind people at RVC gave us a printout of all their BG readings and insulin doses. We have entered it all up on Titan's spreadsheet as far as possible. You can see what a brilliant job they did on adjusting his dose against a declining insulin requirement. We are very grateful. and tired. and off to bed.
     
  95. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Titan's BG shows an immediate sea of blue with no dose. What a remarkable procedure and nice results. Expensive, but very nice.

    I hope Titan does not have followup issues, like Amanda is seeing with Shmee. The loss of appetite seems to be the biggest problem there.
     
  96. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Welcome home! That spreadsheet is a great example of dosing after surgery and the huge changes you can see. Looking forward to hearing how he settles in. Those RVC folks are great.

    Ferry system here just changed the rules so you can't be in your car on the lower decks. :mad: Annoying if you have a kitty as the "pet" area is barky. Neko was a frequent ferry rider with us. I even did test/feed/shoot once on a ferry.
     
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  97. John Irene and TITAN

    John Irene and TITAN Member

    Joined:
    Aug 6, 2018
    TITAN allowed a rare treat of sleeping on our bed last night, so we could keep an eye on him. Woke at 0230 with six snorty sneezes. None since then. He went outside for a few minutes around 0500. This morning's home BG test was 3.7 / 67 ! Just realised that the notes inserted on the mmol/l spreadsheet don't show on the translated American one. Shame as many timings are explained more clearly in the notes .
     
  98. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    That is just amazing. Titan went from
    11.0 units/dose
    to no dose

    and now his BG is regulated. Pretty soon, the spreadsheet will barely be used (I hope). Sounds like Titan is getting some cuddly attention at home to help with healing. Glad to hear all continues to go well with his recovery.
     
  99. sbluhrs

    sbluhrs Member

    Joined:
    Jun 7, 2012
    Yeah, seeing Titan's progress has made me really optimistic concerning Sophie's result. She's up to 17 units of Levemir twice a day. My biggest concern at this point was, in addition to dealing with her travel anxiety, is whether or not I needed to start bringing her dosage level down prior to surgery like Amanda did with Shmee, but it seems that, since AMC will be monitoring her BG levels in a manner similar to what the RVC have done with Titan, I can just keep her where she is and not stress. So great to read all the information that both Shmee's and Titan's message threads have included.
     
    JeffJ likes this.
  100. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    I hope it goes well for Sophie too. 17 units/dose is a lot, and Sophie is not even regulated at that level. Leo was at 18 units/dose when he got the SRT - 2 years ago. Now he gets 5 units/day. So not a complete cure like the surgery route.
     

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