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Cushings cat who had radiation therapy is not eating much

Discussion in 'Acromegaly / IAA / Cushings Cats' started by Babs and Chloe, Aug 14, 2019.

  1. Babs and Chloe

    Babs and Chloe New Member

    Joined:
    Jul 11, 2016
    Hello. I have a 12-year-old kitty who was diagnosed with Cushing's disease a couple of years ago. We have been maintaining her cortisol and glucose levels well with insulin and trilostane. However, the tumor continued to grow and she started to act "dull". So we came to a fork in the road and chose to have the tumor irradiated. Side effects were supposed to be minimal. She did well for a month or so, and then just did not want to eat, and appeared groggy and dull. The vet school here at UGA seems to think that she has some demylination in the nerve cells of the brain - an acute but reversible side effect. So they have put her on fairly large doses of prednisolone, Cerenia, and Entyce appetite stimulant. Her glucose has been up and down and all over the place - from 50 to 300 sometimes in one day (due to the tumor shrinking and the prednisone interfering and who knows what). They told us we just had to get her through this. the last 4 days or so she has seemed to feel better and seems much brighter and more herself - but still not eating well. Now, the last day or two she has started vomiting, and since she eats so little this is really bad. They have her on 0.66 ml of Prednisolone, and we have continued the Cerenia for more than the recommended 6 days. Does anyone have any idea if this could be a side effect from the medicine, or what is going on? I fear if we can't get her feeling better quickly this will be the end of the road for us. I might take her to the vet school for fluids and see if we can figure out the vomiting issue.
     
  2. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    What type of radiation therapy did kitty (name?) have? My girl had stereotactic radiation therapy twice for her pituitary tumour (acromegaly) and I did not see the symptoms you describe.

    Have you tried ondansetron for nausea? It targets different nausea receptors from Cerenia and in some cases works better. Or kitty could need both like my Neko did at one point. Or the Cerenia dose could be low, some vets underdose. What is the pred and Cerenia dose being given in mg? The ml dose doesn’t mean anything without knowing the concentration in liquid. There is no time limit on how long Cerenia can be given, that is old school so I suspect that vet might be out of date on dosing. I have never given Entyce, but have seen one cat not here react not well to it, made it more nauseous.
     
  3. Babs and Chloe

    Babs and Chloe New Member

    Joined:
    Jul 11, 2016
    Thanks for the reply. I am feeling rather desperate at this point. I am not sure the exact radiation - I will have to rummage through papers to find it. She stayed at the vet hospital for five days and had a treatment every day. She had/has a large adenoma on the pituitary, which is (or was) actively producing chemicals (I think it pretends to be a pituitary gland). She was on prednisolone for the radiation itself, which was tapered off. She was doing well and then just quit eating, so they thought it was the "acute early" side effects, which are supposed to be transient. I have found one or two papers on this that talk about these - they are rare. The vet school then started prednisolone. The dosage is 0.66 ml and the concentration is 3mg/ml. So she is getting 1.98 or approximately 2 mg of prednisolone every 24 hours. She weighed about 10 pounds but has been losing weight I am sure. We started out with a transdermal mitirzipine but for some reason they stopped that and prescribed this Entyce. She is supposed to get 0.4ml of 3 mg/ml so that is 1.2 mg every 24 hours. I did not give that last night. We have been giving Cerenia tablets, 8 mg every 24 hours for about 2 weeks. They warned us that it is usually only used for 5 days and this could cause side effects. Do you have any idea what is causing her to not eat well and to vomit? Prior she has always had a good appetite. She is just wasting away at this point. I am thinking hospitalization for fluids (she cannot have a "bubble" due to her thin Cushing's skin"). I contacted the vet school but they have to have a meeting between internal medicine and radiation to give advice.
     
  4. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Traditional radiation has more brain side effects than SRT, though short term (first week) brain swelling for which pred is given is possible with SRT. Not this long out though. The tumour causing acromegaly sends out growth hormone, instead of cortisol for Cushings. The tumours look different too, but still treated with radiation on the pituitary. The radiation treatment is not common for Cushings, in my time here, I haven’t seen it. which is why I am comparing to acromegaly treatment.

    The prednisolone dose is not high. I have a smaller cat getting twice as much, 1 mg per kg. Maybe go back to transdermal mirtazapine?
     
  5. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    And, the Cerenia dose is fine. M6 girl was on Cerenia for half a year with no side effects. I would also try ondansetron. It’s a human anti nausea med, but the vet has to write a prescription.
     
  6. Babs and Chloe

    Babs and Chloe New Member

    Joined:
    Jul 11, 2016
    Thank you for the advice. Apparently nothing is commonplace about Cushings and cats. I found a paper where they irradiated 8 cats but 2 had carcinoma and several had acromegaly. So we are working with data points of maybe 10 total of the papers I have seen. I did speak to the vet school and they did not think any of the meds would likely be causing this vomiting. I have made arrangements to get her into the vet school hospital tomorrow for fluids and to see if we can figure out if something else is going on along with the rest of this. Her blood sugar has been like 300 for several days, pretty flat, and then this evening it decided to go down. It is really just crazy how nothing will stabilize. But the main issue right now is getting her to eat. I will keep you posted as I think this could eventually be helpful to others at any rate.
     
  7. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Best of luck, keep us posted. :bighug: There have been a lot more cats radiated for acromegaly. In 2012, the vet school I went to had done about three dozen with SRT. Add in other schools, and countries, and years going by and you have lots. Got one kitty here doing it this week for acro.
     

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