Acromegaly and resultant diabetes cured by pituitary removal

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

  1. sbluhrs

    sbluhrs Member

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    Jun 7, 2012
    Well, Titan was up to 10 to 11 units per dose and his numbers were much higher than Sophie's, so I figure that if RVC is able to get him OTJ after surgery, and AMC is using the same protocols, Sophie has a good chance, too. I am not going to stress about clearing out her depot, etc. as I will trust the vets to know what they are doing.
     
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  2. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    During the operation they had Titan on intravenous rapid acting human neutral insulin. I am sure you can trust the AMC to handle the depot and all other BG issues.
    To counter travel anxiety we put a product Zylkene on his food for a few days beforehand. It seemed to work as he coped with a noisy little airplane OK. It is made/distributed by a Company called Vetoquinol
    Titans BG today down to 3.3 mmol/l, say 60. Gave some dry food soaked in water, and emailed RVC for advice.
     
  3. John Irene and TITAN

    John Irene and TITAN Member

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    We had a difficult day yesterday with BG going low, as low as 2.8 mmol/l. However with advice from Camilla at RVC, we gave him some Glucogel (3 lots of 1 gram) fed him a lot of high carb dried food (softened with water for the sake of his palate) and he was around 4.8 by bed time. He was 5.2 this morning. For those interested in technical details his discharge report from RVC is here.
    Only 2 weeks to go for Sophie !!!!
    RVC told us they do one of these every couple of weeks, and have done about 80 in total.
     
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  4. JeffJ

    JeffJ Well-Known Member

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    I'm kinda surprised that Titan had that mini-hypo without extra insulin. I guess his body is still adjusting. He probably like the carb treat...maybe he did it on purpose. It sounds like he is recovering pretty well.

    That is a good track record the RVC is providing with all those surgeries.

    I also hope Sophie's surgery goes well. That will be 3 hypophysectomies on the FDMB forum within 2 months!
     
  5. sbluhrs

    sbluhrs Member

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    John, how is Titan doing today? Noticed that he is still doing great BG wise. Per Amanda's post of Facebook, poor Shmee is having some issues with pancreatitis, so I was wondering how your boy is doing.
     
  6. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    Hi
    Thank you for asking.
    He is doing fine. Still quiet, has been out for a couple of walks but is purring a bit when petted and eating well. Today is the last day of his antibiotics. He is still a bit weak and looks pathetically thin (especially alongside his sister, that he used to make look like a wraith) I think he is happy .
    Tomorrow we go to the vets to have his stitches out.
    The extra dose of hydrocortisone seems to be doing a good job of keeping his BG up at a satisfactory level .
    The time is flying by for us, maybe for you it's dragging a bit ,but the 25th will be upon us soon. How is Sophie doing? We all wish you the very best, you are in our thoughts.
     
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  7. sbluhrs

    sbluhrs Member

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    We are counting down the days until we leave for NYC. Our only issue right now is that Sophie is not a good traveler. I've been doing test drives with her and I've found a dosage level of Gabapentin that works well to calm her anxiety, but we still have to tackle the fact that she suffers from motion sickness. I think that was compounding the travel anxiety. Waiting for my local vet to get back to me with ideas on how to deal with this.

    I've been taking her on local drives to get her used to riding in the car. The last one yesterday was great, except for the fact that she had to excuse herself and retire to the backseat to puke. Other than that, she really seemed to enjoy our drive, sitting in my lap for a good part of it, looking out of the windows, not upset (except for her tummy) at all.
     
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  8. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    Thanks for posting the discharge report, very interesting reading.

    Interesting on the low BG. With the AT, we consider below 3.8 (68) to be the point where you add carbs to bring them up, if they are on insulin. But like the human meter, I suspect there is some point below that which is still a normal number for a cat not on insulin. Using the human meter, we don't want them below 2.8 (50) on insulin but normal cat range goes down to 2.2 (40). I suspect Titan's body is adjusting to the new normal with hormones.
     
  9. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    Yesterday visited our local vet. Gemma took out stitches, and did the Schimeer (?) test for dry eyes. Titan was a bit dry, so now has other drops 3 times a day. Because they are gloopy they are not really compatible with the desmopressin drops for urine concentration, so we do them 10-15 minutes apart. So far, Titan is being tolerant.
    On BG levels 2.2 seems awfully low. But I'm not a cat. Can you show me where to read about "normal cat" BGs ? We did one comparison on the day of the "mini-hypo" and my human meter was within 0.1 mmol/l of the alphatrak. Obviously not a significant sample size, but it was done just to check for malfunction of the alphatrak.
    Shortly after diagnosis of Titan's diabetes we cross checked and concluded (very small sample) that there was around a 12% differential between accuchek and alphatrak, at those high levels. This sort of differential is of a similar size to the differences between various human meters found when I ran a comparison several years ago at the time of changing insulin pumps.
    Titan is still quiet, but we think he is feeling better. Food input and output is satisfactory. He is still thirsty and drinking a lot, but without any measurement, we imagine he may be drinking a bit less.
    In the car, we didn't dare have Titan loose in case he ran under the pedals. So we bought the largest collapsible cage we could fit in the car, and put a litter tray in the back of the cage and a water tray in the front. He used both quite happily. The base was a fairly firm plywood, so he just lay down. Maybe being able to lie down helps with motion sickness. Having suffered sea-sickness for much of my life I certainly found it helped to lie down and close my eyes if possible.
    What do you think Wendy?
     
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  10. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Nice progress report for Titan, it sounds like he is doing a very good recovery. In general, Titan's BG values are looking very good.

    The normal blood glucose level for cats is 80 to 120 mg/dL
    https://www.thedrakecenter.com/materials/diabetes-mellitus-cats

    Optimal glucose curves
    https://www.aaha.org/guidelines/diabetes_guidelines/interpreting_glucose_curves.aspx

    I have done a lot of testing at home, even 2 minutes apart with different test strips. It is common to get differences. We know that nearly all the home testing units can have a 20% variation. That variation will produce smaller differences at the lower numbers.
     
  11. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    Thanks Jeff. Have you heard anything from Amanda and Shmee?
     
  12. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Ana (Ana and Frosty) has heard from her. No problems were reported. Perhaps Amanda is overloaded right now. I also hope Shmee continues to recover.
     
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  13. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    Sorry for the delayed response, I was racing (rowing) yesterday and that kept me away then wiped out. For sea sickness, watch the horizon. I had a motion sick kitty who was fine as long as we stayed away from curvy roads and she could lie in the back window.

    For normal BG numbers, what does the lab reference ranges say? Mine said 4.0 (72) to 10.0 (180). Lots have people have compared the AT numbers to human meter, and unfortunately there don't seem to be consistent answers. They are much closer in lower numbers than in the higher numbers. Good to see Titan's numbers are stabilizing.

    Amanda posted an update on the Lantus forum today. Sounds like having to adjust the post surgery hormone supplements is common.
     
  14. John Irene and TITAN

    John Irene and TITAN Member

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  15. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    Progress report. TITAN is doing well. BG s are fine. He is still drinking water. We are building his strength by carrying him to the bottom of the garden two or three times a day and so he has to walk forty yards or so back. He walks about 5 yards at a time and sits down for a rest. His back legs are still a bit wobbly. His appetite is fine, he is off the antibiotics and soon we will give up the twice daily BG tests in favour of twice a week. He is a bit more alert.
     
  16. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    TITAN BACK TO THE VET today because of coughing . Examination of mouth showed a bit of a stitch still protruding. No signs of grass at back of throat. Injected antibiotics ?Convenia? And some vitamin b12 for neuropathy. T was a bit wheezy but chest sounded OK.
    Thinking of Sbluhrs operation at AMC iin NYC tomorrow. Good luck Sophie !
     
    Last edited: Sep 25, 2018
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  17. JeffJ

    JeffJ Well-Known Member

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    Nice to hear that Titan is doing pretty well during recovery.

    Good luck Sophie kitteh - we are thinking about you and the surgery tomorrow!
     
    Last edited: Sep 24, 2018
  18. John Irene and TITAN

    John Irene and TITAN Member

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    We are worrying a bit about Titans character. He is less affectionate, in fact he is less enthusiastic about everything and slower to react to any stimulus . We wonder if it might be thyroid related but we are waiting til next Friday for a T4 test. Gemma our local vet talked to Camilla the RVC vet, about character changes. Camilla said it can take a long time to normalise, maybe up to a year for an older cat. Hope it doesn't take that long!
    Still coughing a bit, maybe something to do with the way we hold him under the chin when we do his eye drops.
    But he is doing OK; yesterday's BG was 4.8mmol/l. And he continues to eat everything he is offered . He weighs about 5.1 kilos. (11 pounds)
     
  19. Olive & Paula

    Olive & Paula Well-Known Member

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    Doesn't Amanda say the same thing about Shmee? He isn't cuddly not clingy the way he use to be. Maybe it is a side effect of the surgery. Didn't know if could take a year though.
     
  20. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    Today TITAN came and voluntarily sat on irenes lap for the first time since he became seriously ill with diabetes. It was a great occasion and feels like a big step forward. His BG was 4.4
     
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  21. sbluhrs

    sbluhrs Member

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    Has he lost weight since his surgery? Sophie has.
     
  22. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Diabetes and Acro takes so much out of our kittehs. I am glad to hear that Titan is feeling better and evolving back to love bug status.
     
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  23. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Love that Titan is feeling better again and wanting laps. :)
     
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  24. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    He certainly lost weight whilst in uncontrolled diabetes. He lost a little more during the week or more at RVC for surgery. He has gained 0.1 kilos and is at 5.2 kg which is 11.5 lbs I guess.
     
  25. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    Had Bloods drawn last Friday 5th October, including IGF1 for the RVC to complete their data. Today our vet Gemma called to say that urea and creatinine were raised, would we go in to get a little more blood to do a SDMA test and a urine sample. All to check up on the kidney function. went in and urine OK. Gemma is trying to talk to Camilla at RVC about the kidney concerns, and also to get images of scans taken at RVC, in case Titan's cough becomes an issue. Titan is very relaxed. RVC have asked if they can use Titan's case as an example in their December fund-raising effort.
    Thyroid T4 is 24 normal.
     
  26. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    SDMA kidney test was slightly raised. Creatinine too. So we will try dropping the cortisone dose to protect the kidneys. Because the dose was originally raised to counter low BG readings, we are back to BG tests. 3 times a day. Until we know how we stand.
     
  27. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Sorry to hear about the possible kidney issues. I hope the BG's remain in the normal range. The hormone system sure is a tricky one. Seems like a real balancing act. How is Titan feeling these days?
     
  28. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    He's still quiet. Coughing occasionally say twice a day. Eating well. Slow to react especially to calls, I'm beginning to wonder if he's a bit deaf. He purrs when fussed. Think he's improving but at glacial speed so it's hard to tell.
    It's tricky to fine tune the hydrocortisone when it's either one tablet a day, or two!
     
  29. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Can you get it compounded to an in between dose? I get mine compounded into a chicken flavour chew treat.
     
  30. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    This is an interesting idea. I am not sure but imagine that compounding pharmacies are somewhat rarer in the UK than in Canada. However the University of Edinburgh list a few. I have had one rejection so far, but have now tried contact the University Vet college direct. Will see what comes of it.
    On a separate issue, do you think it matters what time of day a levothyroxine dose is given?
     
  31. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    The compounding pharmacy I use is across the street from the public hospital. They do people and pet meds. On line compounding pharmacies are less common here.

    I belonged to a cat thyroid group for a while, and I didn't see anything about time of day for the levothyroxine.
     
  32. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    Got this reply


    Dear John and Irene,


    We are unfortunately not compounding such palatable treats and at the moment, I am not aware of any other laboratories that would compound the medicines your cat is on. I wish you all the best with finding an appropriate product,


    Kind regards,


    Pharmacist at HfSA




    SO no help there ! I wonder if a Canadian vet would accept a UK script and post the meds over to us
     
  33. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    Today we phoned the vets and chased the IGF-1 results. They forwarded us an email dated 3 days ago....
    Grrrrrr!! Anyway the results were good at 32. This is in the dwarfism range, but we guess it's not a problem at Titan's age.
    SO that counts as a cure, fingers crossed. Will change the title of the thread.
     
  34. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    I haven't had the test done yet but I'm in the same boat. My cat is currently on 8 units of ProZinc as well.
     

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