Chester - out of remission

I posted about Chester last year when he was initially diagnosed with acromegaly. The specialist we're currently seeing does not think he's an acrocat, as he shouldn't go into remission. Which he did - in December 2009. I can't even remember how high his lantus doses were at the time (at least 4 units 2xs a day). The vets insisted that I stop using fancy feast, as it's "like McDonald's food. Very low grade."

By July 2010 his weight was back up to 17 lbs (from 12.9 in December). I didn't think we were over-feeding him, but we do have other cats who like to nibble... Oh, and a toddler who leaves food around. I noticed his BG (which I was taking every 2-4 weeks) creeping up into the 100's where it had been between 60 and 90 consistently. He became less interested in food in early August - his BG was 350. I took him in, they wanted to start Lantus at 1unit 1x a day. Nothing happened. His lowest low was at +3 (309). Not very low. I was concerned - then it hit 450 at +9, with no more lantus scheduled until the next morning (he'd been on Lantus for a week already). I gave him another shot. At +3 he dropped to 377. By +5 he was up at 415. That was last Thursday. His lowest over the weekend was 410 at +3.

I am waiting for a call-back. AGAIN. Seriously annoyed. He's on Purina DM. He has just tested positive for hyperthyroid.

 

Insulin needs for acrocats change, even to the point of not needing insulin. Fletcher was a perfect example of this - he went into remission several times. Hopefully, Carolynn will stop by and provide some input for you (however, Fletcher just passed, so Carolynn is still devastated).

As far as the Fancy Feast...take a look at the ingredients in Fancy Feast vs the ingredients in the prescription diets. Then, show your vet - he might be surprised.

 

I read about Fletcher earlier. Made me so sad!

I wasn't entirely convinced about the lack of remission in acro-cats, but Chester also has no outward signs of acromegaly. He's also been diagnosed with hyperthyroid, mild dental disease, pancreatitis, and cushing's. Something is obviously messing with test results. My original vet thought it'd be "really interesting" to get an MRI done on Chester. I'm not into spending thousands MORE just for "really interesting," when it's unlikely that I could afford transporting him for treatment (he vomits and defecates when I take him a few miles in the car).

 

If you got the tests done at msu for acro and IAA, then your vet can't say squat to the results. How can your vet dispute the numbers? Do you recall what the result value was? The range for normal is 12-92, so anything about that is a positive. My Shadoe was 120, and Oliver was 325 or thereabouts.

I also have a vet who told me, even AFTER getting a positive result for acro for Shadoe, that she was still not acro. Why? Because she did not 'look' acro! They did not even want to send the tests and I had to get all the info for them and tell them where to send what and how. Quite maddening, but they have been put in their place now and do as I instruct them.
When I came in with a 2nd cat, Oliver, and asked for the tests to be sent out, they did not even bat an eye. Why? Because he 'looked' acro!

I believe that sweet Fletcher went OTJ 4 times! Just out of curiosity, how many diabetic cats does your vet treat and how many acro cats? It would be 'interesting' to know just how experienced your vet is, in this area of feline treatment. With acro, you have a functioning pancreas so if no GH output, then no need for insulin, no?

There is nothing wrong with the foods on Binky's list, so I would ask the vet to show me the foundation under the statement that ff is a bad food. Show me documentation. Let's line up the vet's rx food beside ff, ingredient for ingredient. Put your money where your mouth is, thanks in advance.

Are you testing Chester daily now?

Aside from the acro tests at msu, all I had done was an u/s for Shadoe to check her organs & heart, and then for Oliver, I got Xrays which did show his organs enlarged and also his heart, plus something they stated was asthma.
I don't think the mri is worth the cost right now, but is the vet willing to put up the money for it, if it's so interesting?

I can't comment on cushings or any thyroid issues, but pancreatitis I just gave bupe for the pain and also fluids at home.

You mentioned the dental - you may find that taking care of the dental issues will help alot with numbers. My Shadoe was up to 14u BID, but came down pretty quickly after having a dental with one extraction. She's back up now again to 9.5u but the dental made a huge difference for her, so it's worth it to take care of any major dental problems.

I sure hope that maybe Chester just needs a bit more insulin or maybe a dental cleanup and can get back to his days OTJ again. You never know.

 

There actually can be false positives - Yes the test was done at MSU, and it was discussed with them. They don't know all of what can cause false positives, but it does, in fact, happen. The only way to know for sure is to have an MRI done to be positive there is, in fact, a tumor. I read one vet study (can't find the link right now, but I found it on the old site somewhere last year) - of 18 cats who had the MRI, one was found to not have acromegaly, despite testing positive for it. I believe his numbers were more like Oliver's, but I need to go find my records (we moved and my files are in disarray... just had them the other day, too. grrr).

He tested positive for cushing's also, though, so ??? Also, because he's not near being regulated and has not had his vaccinations, I can't have his teeth cleaned. I suspect the false positives could have something to do with his hyperthyroid issue.

Still waiting for the vet to call back. it's been more than 2 hours.

 

UGH, what a dilemma for you and Chester.
I hope you can get to the bottom of it all.

Really, I did not know that about dental ... Shadoe had no vacc and was not what you could call regulated, but we had her dental done. Are there any teeth that are very bad?

I would love to see that study; I really need to read more stuff.

I am not sure Oliver's numbers could be disputed ... I would want a darn good reason for 23u BID of insulin if he's not acro!
Shadoe, well, who knows? There has to be a reason for needing 9u BID, so maybe we should look more for something additional as a problem. I can't ask my vets; they don't know much at all.

 

You are correct in that there can be false positives; an MRI or CT scan that actually shows the tumor is the only way to be absolutely certain. However, high amounts of insulin w/ little response along with the IGF-1 results is fairly positive.

Is it worth $1200 to be absolutely certain? In my opinion, no...if you ever decide to treat Chester w/ SRT, you would have to get a CT scan done at CSU because it feeds into the radiation machine. If you're not doing the SRT, $1200 is a lot to spend on something that doesn't change his treatment (i.e. insulin & pain meds as needed). By the way - SRT is also used to treat Cushings.

 

https://spreadsheets.google.com/ccc...Ux3aXNGWUk4eldKUXFIc0E&hl=en&authkey=CLCXk40O

Yep, 23 seems high! I'm just concerned right now that my 2 units 2x's a day isn't doing much, and how quickly can we get this cat below 400? He's been ketoacidotic before, and I'm not interested in going back there.

Many docs won't do the general anesthesia without all the vaccinations - but some obviously will. No vet has said anything specifically about his dental issues, although he had some major calculus that popped off a few years ago.

Just wish there were some way to know if the Lantus is bad, or if we're just not high enough to see a result yet!

Hi there mr. vet - would really like to get some info. know you're busy, but STILL....

i have soooo much to do today. (and i hate worrying about my giant sweetheart) You would all love Chester if you met him. He loves people.

 

You can get Chester down into safer numbers if you use Humulin R (especially if you are worried about ketones). However, you would need someone to help you use it safely...the only person that is willing to help people use R at this point is Carolyn/Spot, but she hangs out on Facebook. Maybe Gayle would ask her to come check on you?

Have you seen the Lantus protocol we follow? Knowing that you have a high-dose cat (whether it's from Cushings or Acro), you can be very aggressive on the increases until you get into nicer numbers. Are you increasing on your own or trying to wait on the vet? I don't post very often anymore, but Gayle is great about checking on people and can probably help you or get the right people to help you.

 

How old's the lantus, and are you following the protocol in the stickys in the Lantus/Levemir section? I am not at home, so I can't flood you with links (it's your lucky day!) but I think the best way is to go slow and move up the dosing scale, I think it's 4 cycles then up you go to the next level, but the others know more about what else can be done out of norm.
Heather's right about using Humulin R; you can get some and while it's short lasting, it could give Chester a pull down in numbers and then the Lantus will kick in and take over.
The shelf life for Humulin R is forever and a day, so no worrying about it going bad.
I used it in addition to Lantus and Lev for both mine when their numbers were going very high and before we got to 'their good doses'.
I got some good directions from a couple people that know tons more than I'll ever know, so I can ask them to check and see what you could do.

If Chester's acro, why not just switch over to Levemir? I think most acros are on Lev. I think Lantus is guaranteed to 28days, and Lev, to 45days, but lots use the insulin for longer times.
When did you open this container? You have a vial or using pens/cartridges?
The best way to know if the insulin is bad is to try a new container. With smaller doses, you are better to go with cartridges or pens because you don't end up paying more but the insulin lasts longer and no waste. I get a 5-pack of 3ml cartridges. I can't get the vials of Lev in Canada or else I would because of Oliver's dose, but you would be good with the pens for sure.

I can relate to a gentle giant, to be sure. Oliver coincidentally weighs 23lb and is on 23u BID LOL! I just got a new kitten from a rescue on the weekend. She is 20weeks and weighs 2kg .... Oliver is scared of her!

Sometimes, you have to be pushy to get results.

What about if you posted over in the Lantus forum as many over there can answer alot of info too. There is not alot of traffic over here in the high dose forum.
For ketoacidotic type problems, they for sure would have some things to say and suggest.

For his teeth, I was wondering if they can do Xrays on any teeth that look like some work is needed. Can you have that done? I think Shadoe had 4 teeth that were questionable and were Xrayed. Then they cleaned the teeth and found only one needed to be extracted. Maybe Xrays could be a compromise to rule out any crazy bad teeth under the gums for Chester.

 

The vet has now forbidden me to take anymore BG's! Hah!

Ok, anyhow - the vet doesn't think he's acro, so he doesn't want me to increase the Lantus yet. He wants to do the glucose curve at the office. I'm not sure how long it will take to build up in his system, but it has only been 4 full days since the increase to 2 units. They are worried that I'll push it up too fast and have the rebound thing happen.

The Lantus is a vial, I just opened it two weeks ago (although I bought it in December, expiration is July 2011).

 

Just found my old post from December - he was on 7 units of Lantus 2xs a day. Good to know!

 

Unfortunately, most vets know little about successfully managing diabetes and almost nothing about managing acro. For whatever reason, they don't utilize the more current (yet successful) protocols. The fact he doesn't want you to test clearly shows he's "old school" (glad you said "hah!!!").

If you decide you want dosing help or help with R, please ask. If you just want friendly ears or general questions, you might want to mention that (otherwise, you'll get lots of advice that you many not actually want. :smile: )

 

Any other vets near you? Forbid??? Are you kidding me? I would have some things to say to my vet that I would not ever be able to post in here! Your vet is a comedian! hahaha I laugh.

Excuse me, but who is the customer here? I think that would be YOU and Chester.
Ask your vet how many humans give themselves insulin and don't check their BG BEFORE EACH SHOT??

You can easily do like many others here do .... smile and nod, say OK. Then go home and do the RIGHT things.
A curve at the vets? Why? Seriously, KaCHING $$$ Is the curve going to be free?
And did you not say that Chester gets upset with travel?? Nope, no curve at the vets because Chester can give you REAL numbers in the comfort of his own home.

Your insulin if unopened and kept nicely in the frig is good till that expiry date. Once you pierce it for the first draw, start counting down. I keep track of the life of my cartridges in a column on their spreadsheets. I just remembered that the 28days is for nicely handled and not in the frig, I think. But, my pharmacy takes it from a frig to sell to me, so that's where I keep mine. If the vial is only 14days old, you are likely OK but cracking open a new one will prove only that it's still good. I did that early on. what a waste.

Give your vet a printout of the protocol that is followed by many here, and maybe you can tell him about the hundreds of felines who are now OTJ by following that same protocol.

I think it calls for holding a dose for 5-7 days initially, but looking at your numbers, and being acro and the past dose of 7u BID, I am betting that 4 cycles/shots on 2.5u is plenty to be able to raise to 3u BID.

As for 'the rebound thing', it's not a thing that happens with Lantus/Lev, I don't think, if you are following the protocol.

Wow, you are forbidden! I seriously can't get over that statement.
I am not worried because I am sure you will do what is best for Chester and if that differs from the vet, well so be it. Chester is important.

 

Hello and I'm sorry to say... welcome back.

I have to agree with what everyone has said thus far. Just a couple thoughts I wanted to add.

Have you had a chance to look over the Sticky above - What we know about acro....

A few interesting things we've now gathered over time....

You say that Chester has no outward signs of acromegaly - just a little FYI - gaining weight - and especially staying at 17 lbs (what with having hyper T) - that itself is a sign of acro. There are many subtle signs of it. Not just the big head, feet, etc that are so often assumed of these cats.

altho the ct/mri may be the gold standard of diagnosis - the igf1 has proved quite conclusive in all the cats here on this board and the catacro board. Again - if you look at the Sticky - you can see the numbers that have been increasingly been diagnosed over the last few years. Many of us have not had a ct/mri. AND in another study - yes it has been shown that some do NOT have a tumor in the brain - it has been found elsewhere.

It's interesting that Chester tests + for both acro and cushings. What was the test they did for cushings? It's not hard and fast but statistics show that the majority of acrocats are male - the majority of cushings are female. Does Chester have very thin fragile skin? That is a classic sign of cushings.

I don't know that any of this will help you at all - just hoping maybe it can give some ideas/hints to help muddle thru some of the things going on. I'm so sorry that Chester and YOU have to be back on insulin again.

One thing I'm wondering about is how often they are wanting you to get Chester vaccinated? And please forgive me as I can't remember how old Chester is? and if he is mostly or totally an indoor kitty? Really if he is an indoors and an older guy - does he really need any vaccines? I wonder if that is some of what is playing havoc with all these results. I thought the new rule was that only every 3 years were vaccines being pushed and that in older kitties (at least where I live) - they aren't even necessarily being given. But I do know different parts of the country are different too.

I hope to hear more and i hope soon Chester is feeling better soon!
xx
patti

 

wanted to add - just saw your post on health too - you mentioned his voice is hoarse - THAT is another sign of acromegaly - voice changes in our kitties! This is one many of us notice in our cats. :sad:

 

Oh, yes, I've read the acro stuff. Chester does not have fragile skin as far as we can tell, although he did get some nasty burn/cut last year from who knows what. His fur is in excellent condition as well. He always loses weight during these episodes - last year he dropped from 17 lbs to 13 lbs in about a month or two. This last month he dropped 1 lb, despite continued eating (although this time we were trying to get him to lose weight by strictly regulating his food intake - other cats and small child make this difficult!).

Also, I am not sure how being hyperthyroid can affect other numbers - so I'm not sure if the tests are valid given that we are now positive he is hyperthyroid. He has a node on his thyroid, breathes rapidly, has a systolic heart murmur. He's on methimazole and we're hoping it helps. I doubt radioiodine would be considered until we get his diabetes under better control.

Oh, and he's probably 11 or so.

 

Sarah, I went looking in the old board to see if you had posted the acro results.
I found the below I think you mentioned around 260, and that value for the IGF1 test is pretty positive to me.
http://www.felinediabetes.com/phorum5/r ... 7,report=1

 

Yes, I just found that, too. I remembered it was quite high.