DCIN might need help with a Cushings Cat

Discussion in 'Acromegaly / IAA / Cushings Cats' started by Venita, Apr 21, 2010.

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  1. Venita

    Venita Well-Known Member

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    Dec 28, 2009
    I got an email last night from the Maine Coon Rescue looking for someone to help a Cushings cat.

    This is all the info I have so far, except the owner's email address and the fact the cat is in PA.

    DCIN can help financially, but I doubt there is anyway we could rehome this cat. I don't yet know what help the owner is looking for, but given the MCR has done a courtesy post on the cat (I don't have a link yet), I assume she's looking to rehome.

    I am looking for someone with Cushings (or related) experience that can help me let the owner know her realistic options for Casey.

    Thank you!!!
     
  2. Andrea and Seymour

    Andrea and Seymour Member

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    Dec 28, 2009
    Hey Venita. I'm in NJ so if you need some help with transport or anything let me know. I don't have Cushings experience, but if this is an urgent situation I'd be willing to help however I can.
     
  3. tuckers mom

    tuckers mom Well-Known Member

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    Can you find out if this cat actually was tested for Cushings?
     
  4. Phoebe_TiggyGA_NortonGA

    Phoebe_TiggyGA_NortonGA Well-Known Member

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    Dec 29, 2009
    Cushings most notable characteristic is fragile skin (and high dose) and it is difficult to diagnose if fragile skin is not present.

    So I agree -- it would be good to find out how the Cushing's was diagnosed. If some vet made an assumption based on experience with dogs and seeing the high insulin dose -- the cat may have something more treatable than Cushings. (cushings is more common in dogs than cats)

    We have found Acromegaly to be much more common amongst the high-dose kitties, and a blood test is needed to confirm the dx.

    Cushings is a difficult condition - if the kitty needs to be restrained for treatment, the skin can tear during struggles -- so the kitty can end up with wounds all over. A couple of the Cushings kitties here had to wear baby T-shirts or ones-ies to help protect their fragile skin / keep the wounds clean while healing.


    Since 2004, FDMB has seen 69 ACROcats and 4 Cushings cats.

    CUSHINGS cats on FDMB:
    2008 - 2
    Linda and Bear
    Tammy and Mika

    2009 - 2
    Mari and Punk
    Lisa and Franklin
     
  5. Venita

    Venita Well-Known Member

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    Dec 28, 2009
    Is there a test for Cushings?
     
  6. Larry and Kitties

    Larry and Kitties Well-Known Member

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    Dec 28, 2009
  7. OptOut

    OptOut Well-Known Member

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    I agree with Phoebe - many vets will think of Cushings before acro and it is very hard to diagnose. If the cat has NOT had an acro test, I would do that before trusting the Cushings diagnosis. I think we had one owner here whose cat was "diagnosed" as Cushings and we convinced her to get the acro test (Barbara & Misha(GA) maybe?), which was positive.
     
  8. Phoebe_TiggyGA_NortonGA

    Phoebe_TiggyGA_NortonGA Well-Known Member

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    Dec 29, 2009
    The acro test (IGF-1) and IAA test cost about $44 and $14 at the lab (MSU) -- vet charges for appt / blood draw and cold-overnight shipping. So usually $100 total in the US.
     
  9. Venita

    Venita Well-Known Member

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    Dec 28, 2009
    Keep an eye out for Diana and Casey

    I spoke to Diana this afternoon.I am hoping she will hop on here soon and give you Casey's story and ask the questions I couldn't answer.

    Good news is Casey, a 10yo Maine Coon Mix, does not have thin skin. The Cushings was a speculation by the vet. There is alopecia. Casey has not had the Acro/IIA tests.

    Diana seems willing to keep Casey at home if she can get some money-saving tips and some financial help from DCIN.
     
  10. Diana & Casey

    Diana & Casey New Member

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    Apr 21, 2010
    Hi All,

    Thanks Venita for posting Casey's info. Casey was diagnosed with diabetes in July 2008. He was on Vetsulin for about 1 year. His BG readings were always in the 300s range so around last July 2009 my vet switched him to Lantus. His readings never changes .. always in the 300 range, right now he is taking 18 units twice a day. Last summer we had a ultrasound done of his abdomen and his fur never seemed to be growing back. Also, for several years, Casey's fur has been falling out in little clumps, but we just thought his (kitty) brother was biting him. Also, his paw pads are extremely hard, not smooth like most indoor cats. My vet never seemed too concerned about the fur loss. Casey always had an extremely large appetite and he is a big cat - at one point he weighed 30 lbs , he now weighs 17-18 lbs.

    I mentioned to my vet that I thought he might have Cushing's because his fur on his belly (which is enlarged) was never growing back after the ultrasound. She thought it was rare but decided to have the test done. We first did some skin biopses. Unfortunately, Casey did not heal well and he deveolped an infection and abscess and was hospitalized for 4 days. The biopses indicated that he may have Cushings, so we decided to test him for it.The first test came back negative (I think it was the ACH? ) but the second test came back positive. She conclued that he most likely had Cushing's disease, however she mentioned that he might have acromegly. We did not pursue having the test done, becasue she told me that the only option for him would be surgery. I did not want Casey to go through surgery given how poorly he did with just the skin biopses. My vet never mentioned radiation treatment to me.


    Can cats that have acromegly have Casey's skin/fur conditions? I thought he showed the signs of Cushing's with the fur loss, pot belly, enormous appetite... but can an acro cat also have these symptoms?

    I would appeciate anyone's thoughts. Thanks so much.
     
  11. OptOut

    OptOut Well-Known Member

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    Dec 28, 2009
    Hi Diana,

    I'm glad you posted. I know almost nothing about Cushings, but I do have an acrocat. Some of what you've described does sound like acro - big, pot belly, insulin resistent, etc. I would really recommend that you get the test done - the results are pretty conclusive if positive (and it's a simple blood draw, sent to Michigan State University). Also, read the stickies above and see if some of the symptoms sound like your Casey.

    Boo did have the SRS (stereotactic radiation surgery). It's is so incredibly easy on them - the worst part is that they are put under 5 days in a row, but they return to your hotel room every night. Regular radiation is much harder on them because there are more treatments and it's not so finely focused. Thankfully, it actually "cured" Boo - she went off insulin 12 weeks after the treatment..

    Also, regular surgery is actually not an option for acro. Dr. Lunn, at CSU, says that it's just too difficult to do surgery on a cat's pituitary.
     
  12. Linda and Bear Man

    Linda and Bear Man Well-Known Member

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    Dec 28, 2009
    Hi Diana,
    Venita asked me to pop in and look at your post. My cat, Bear, has Iatrogenic Cushing's Disease. It was caused by long term high doses of steroids which he takes for IBD. Bear never had any bloodwork or biopsies, but he was diagnosed on the basis of his clinical symptoms, many of which you describe in Casey: no hair regrowth after shaving, hair loss and poor hair coat, pot belly, thin fragile skin, and hind end atrophy. He has not had problems yet with open wounds or tearing skin. We try to avoid injury by, for instance, refraining from giving sub Q fluids for his renal disease, for fear that they may cause his skin to tear. I don't know much about Acromegaly. There are several people on the Lantus support group with Acro cats who use Lantus or levemir, and who are getting some decent results with shooting high doses. I will leave it up to the Acro experts to add more on this. I'm afraid that I have not been of much help, but I did want to stop in, introduce myself, and express support for what you and Casey are going through.
    Linda
     
  13. Diana & Casey

    Diana & Casey New Member

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    Apr 21, 2010
    Hi Linda,

    Thanks for checking in. Casey does not appear to have the fragile skin issues yet. Casey was taking Vetoryl when he was first suspected with Cushings but he could not tolerate it, not even 10 mgs. Casey does vomit alot, but he is always hungry and eats too fast at times. How is Bearman's appetite? What do you feed him? Casey's fur condition is getting worse, I wish there was something I could do for him.

    Thanks for your help.

    Diana
     
  14. Diana & Casey

    Diana & Casey New Member

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    Apr 21, 2010
    Hi Boo,

    Thanks for the info. about the acro radiation. I live in Philadelphia. Do you know if Colorado the only place where the radition therapy is performed. Also, Casey is 10, I am concerned about him being put under for 5 days in a row at his age. Also, what is the approximate cost of these treatments?

    Thanks for your help.

    Diana
     
  15. Carolynn FletcherGA & RobbieGA

    Carolynn FletcherGA & RobbieGA Member

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    Dec 28, 2009
    Hi Diana! So glad you came here and want to help Casey. I have a Casey (a diet-controlled diabetic Norwegian Forest Cat that I adopted via this board), so your boy's name caught my attention!

    Anyway, what you're describing could be Cushing's... could be acromegaly. My Fletch was diagnosed over 3 years ago with acro. His fur takes forever to grow back after a shave-- he's still pretty bald from being hospitalized in December. It also is very spikey and little clumps fall out. I did have him tested for Cushing's back in January 2007, before the acro testing, and he was negative, but he's been on steroids for a couple years and is now at 10mg a day so that status may have changed.

    Some basic questions:
    Do you hometest?
    Any way to remove the dry from his diet? ***but you must test his bg levels while doing this as it can reduce his insulin needs***
    Any other health issues? pancreatitis? dental?

    I'm sure there's more, but my mind isn't working too well at the moment. Please ask whatever you need to and we'll do our best to help.

    Give Casey a gentle kiss from me (and my Casey too!)
     
  16. Linda and Bear Man

    Linda and Bear Man Well-Known Member

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    Dec 28, 2009
    Bear Man's appetite isn't good, but that's due to his bowel disease. I feed him whatever he will eat in order to maintain his weight, which sometimes (and I'm not recommending this - it causes his BG to be higher) is dry food. He also has renal disease, so I am trying to find foods that are lower in phosphorus.

    If you can get Casey onto a lower carb diet, it could help lower his insulin needs. Sometimes a little gentle combing or brushing (being cautious of skin tearing) will help the coat look and feel better.
     
  17. Venita

    Venita Well-Known Member

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    Dec 28, 2009
    Diana,

    How did Casey get to 18 units of insulin BID (twice a day). Do you recall his initial dose and how decisions about increases were made and how much the increases were? How often do you curve him (take BG readings every 2 to 3 hours)? I ask these questions because diabetic cats can end up in high flat blood glucose numbers if they are receiving too high an insulin dosage. This is called rebound, and you can read about it here.

    Has Casey ever had diabetic ketoacidosis (DKA) or hypoglycemia (low blood sugar)? If so, when, what was the treatment and the results?

    You told me Casey eats Purina DM dry and W/D wet. This is a chart of nutritional values of dry food, and this page links to two pages of nutritional values of wet food. Purina DM dry contains 13% carbs. W/D wet is 26% carbs.

    Around here, we recommend wet food with 10% or fewer carbs, unless there are other health conditions to consider. Many of us use commercial food. It depends on what the cat will eat. My cats won't eat the pricey stuff, like Wellness and Iams, but they will eat the mid-priced Fancy Feast. I use the "Classic" line, everything but the seafood flavors, and those are (to the best of my memory) under 5% carbs. Some folks use the more economical Friskies, 9-Lives, Sophisticat. You can save alot of money by moving from the prescription food to commercial food, and maybe even do better with Casey's condition. But as someone else mentioned, you need to be careful about lowering the carb level in Casey's food because his insulin needs likely will similarly lower.

    Dr. Lisa Pierson is our resident feline nutritionist and her website is at http://catinfo.org/. From reading that, you will see that the dry food is not appropriate not only because of carbohydrates, but also because of the type of protein and lack of water. Her site has a section on transition cats from one type of food to another.

    You mentioned you use the Alpha-Trak meter to test Casey's blood glucose levels. Congratulations on having taken the first best step to treat a cat with diabetes. However, most of us use a human glucometer. Two reliable meters with relatively inexpensive strips are Walmart's Reli-on and
    the Maxima ASTfrom Hocks.com. I use the Maxima because I need the strips to come in vials, and the Reli-on strips are individually wrapped, which I cannot open. However, whenever Diabetic Cats in Need (DCIN) buys a system for someone, it is the Reli-on because the strips are inexpensive and easily obtained just about anywhere. I have both strips for both meters on EBay at maybe 80% of what I pay through Walmart or Hocks.

    Hocks is also a great place to buy inexpensive syringes. I use these.

    You and I didn't talk about whether you buy Lantus in the 10ml vials or instead the 3ml pens/cartridges. At the rate you are going through insulin, the 10ml vials probably work out fine for you, but should yu be able to get Casey's insulin needs down, most find the 3ml pens/cartridges more economical (although a larger up-front cost).

    You might want to check out Frugal Feline Diabetes.

    DCIN wants very much to help you keep Casey in your home and is willing to help you financially to do that. Please do think about the things I and the others have said, and take some time looking around the Board, including the stickies on this forum and on the Lantus forum.

    I would like to know what others might think about doing a rebound test on Casey, and whether it should be done with a dose of R or by a large reduction in Lantus dosage? Or do you think it is better to do an acro/IIA test on him first?
     
  18. Venita

    Venita Well-Known Member

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    Dec 28, 2009
    Donation for Acro/IIA test

    A very generous member has donated $100 so that Casey can get the Acro/IIA test. I don't know whether that's going to be enough to cover the vet visit, shipping, and test, but DCIN will make up any difference.

    From the sticky above:

    Can someone provide some more information about which Acro test should be done on Casey (and why) and explain the proper procedure that the vet must follow to get the blood safely and soundly to the place it needs to go. Maybe this is in a sticky and I just don't see it.
     
  19. Blue

    Blue Well-Known Member

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    Dec 28, 2009
    My vet office contacted the lab directly to confirm/obtain all info regarding extraction, handling and shipping as well as the date the draw should arrive at the lab for testing as the tests are done only on Wed I think. I did fast Shadoe from the nite before for her blood draw, done on Sunday to be sure the sample was shipped in time to arrive at the msu lab in time for testing on Wed. We did not want to take a chance of arrival too late, coming from Canada, so the sample was picked up in time to arrive for the following Wed test. We wanted the sample to get there on Tuesday just in case the tests were done first thing Wed morn.
    The shipping is to be done by Fedex.
    Everything the vet will need is on the sheets for the two links:
    http://www.animalhealth.msu.edu/Bin/Cat ... st&Id=1401
    http://www.animalhealth.msu.edu/Bin/Cat ... st&Id=1494

    Edit to add:
    The above two links will provide most of the info you want, including the purpose of the tests, the date tests performed, general shipping instructions, prep for sample taking, etc.
    Note: the reason I fasted Shadoe was for the IAA test as she has issues with lipemia on most of her bloodwork.
     
  20. Nina and KB

    Nina and KB Well-Known Member

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    Dec 28, 2009
    Hi Diana. Just wanted to welcome you to this board.

    You've gotten some great feedback for things you can do today to help Casey, regardless of how quickly you find out about the Acro factor. My KB was diagnosed with Acromegaly in Feb. of 2009 and you basically treat the diabetes as you would a normal cat - you don't necessarily need to aim for remission, but for blood sugars that keep his systems safe, so in that regard the daily monitoring may have slightly different goals.

    I would highly recommend you visit the tech forum on this web site - there are some step by step instructions for setting up a spreadsheet where you can very easily track Casey's blood sugars (and anything else noteworthy in his health, appetite, feeding, etc.), and you can link that information for others to view so they can help you if you need it. Take a closer look at some of the posts in this thread and you'll see "clickable" links to other kitties' spreadsheets, there's a lot of information in there. For instance, if you open KB's Numbers you'll see that we occasionally change his dose based on the information we collect.

    Good luck with your precious kitty.

    P.S. I grew up in Malvern... :)
     
  21. OptOut

    OptOut Well-Known Member

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    Dec 28, 2009
    Casey is the same age as Boo (10). Even though they go under 5 days in a row, they are only out for 10-15 minutes for 4 of those days. Boo was "woozy" until about 8 pm each evening, but she did fine.

    CSU is the only place doing the SRS. It is expensive - $4000-$5000. I justified it by the amount it would cost to treat the diabetes. I figured diabetic supplies could cost up to $100 per month (especially at higher doses)...if the treatment worked and she went off insulin, the break-even point would be about 4 years. Considering that she's relatively young, I thought she had a good chance of living 4 more years.

    Many people can't afford the treatment. If it is acro, the tumor is slow-growing and the kitties do quite well with insulin.

    I think they actually do SRS with Cushings cats too. Aren't some types of Cushings caused by a tumor?

    Regarding the tests...just have your vet look at the two links Gayle provided. Basically, they need to draw and spin the blood, and then send it out to MSU.
     
  22. Larry and Kitties

    Larry and Kitties Well-Known Member

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    Dec 28, 2009
    This January 2010 article says:
    http://www.ncbi.nlm.nih.gov/pubmed/20123483
    "There is no single diagnostic test for feline acromegaly - a confident diagnosis relies on a combination of clinical signs, feline growth hormone and insulin-like growth factor 1 levels, and intracranial imaging."

    Michigan State performs the insulin growth factor test and their site provides the information on collecting and shipping. I could not find on the MSU site any tests for the feline growth hormone. While cranial imaging would be desirable it may not be necessary. I would expect the vet visit and the necessary blood test to be greater than $100 though.

    I think the article I referenced above together with other articles and info in the this HIgh does forum provide justification for the required tests. I good vet needs to be found to take ownership of the diagnosis. We should not be specifically defining what test should be done. But we should question what the vet recommends.
     
  23. Venita

    Venita Well-Known Member

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    Dec 28, 2009
    OK, it looks like the Colorado test is the one for the growth hormone.

    But you are right, Larry, in a perfect world where money isn't an issue, Diana should find a vet (if she doesn't already have one) that will take ownership of the diagnosis and suggests the proper tests.

    There is a good Veterinary Referral Center in Malvern PA. I used them to firm up the diagnosis of my Max's pancreatic-origin cancer, and Kris and Jane used them to treat Janie's colon/anal cancer. I don't see an endocrinologist on staff, so would it then fall to the internal medicine vet?

    Taking this approach, yes, is going to be way more than $100 because the specialist will want to do a full evaluation, including of past tests, and maybe repeat some of the Cushings tests. Is that what Diana wants, if the treatment outcome won't change?

    Maybe I'm pushing too much here for the acro/IIA tests. When we have a high dose cat come onto the Board, the first thought many of us have is chronic rebound. The Cushings test, I've read, are highly unreliable. If Casey were my cat, I would want to understand why he was on such a high dose, and I thought an acro/IIA test requested of the vet by the client, would be an inexpensive way of putting that question to rest.

    I'm basically where Nina is:

    It's just reassurance/understanding of the need for a high dose; not just a matter of having worked to a high dose through chronic rebound. That's why I asked Diana my question about how it was Casey got to his dose.
     
  24. Nina and KB

    Nina and KB Well-Known Member

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    Dec 28, 2009
    Just want to add something about diet - if you check out the charts mentioned earlier you'll see that there are quite a few acceptable foods for a diabetic cat, there are alternatives to the pricey stuff from the vet clinic. Also, take a look in the Supply Closet forum for coupons and such.

    I want to forward a link to Carolyn's hints on low-budget care but I'm at work right now and can't hunt for it, I'll check for it later this evening.
     
  25. OptOut

    OptOut Well-Known Member

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    Dec 28, 2009
    Venita, I think the safest thing to do would be to get the acro/IIA test. If the IGF-1 is positive, we treat him as an acro here; if it's negative, we assume the Cushings diagnosis was correct.

    From what I understand, you cannot do a rebound test with Lantus (probably because of the cumulative effect of the insulin). Jojo did describe a "reverse" rebound test using R, and while she thinks it would work, it was theoretical, designed for a Canadian for whom the shipping to MSU is prohibitive. Honestly, considering that Casey is alive and well on 18 u of anything, he must have something causing resistence.

    Just my opinion...
     
  26. Phoebe_TiggyGA_NortonGA

    Phoebe_TiggyGA_NortonGA Well-Known Member

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    Dec 29, 2009
    Vets are taught that to have Acromegaly, a cat must look like a freak of nature.

    So -- no vet immediately jumps to a diagnosis of Acromegaly for insulin resistance in a fairly normal looking cat.

    Since we are approaching the problem from the insulin resistance perspective, we need to lead our vets to run the d%^#@ test --

    My vet did not believe Norton had Acromegaly until after the positive IGF-1 test.

    I had to ask repeatedly for this test -- even after he had a brain tumor confirmed by a neurologist and was high dose for over a year of FD treatment.

    Agree -- if the original vet will PLEASE just take the blood and send it to MSU -- better than spending for a new vet/specialist work-up
     
  27. Venita

    Venita Well-Known Member

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    Dec 28, 2009
    I found this in the petdiabetes wiki, in the rebound article.
    So if a traditional rebound test "cannot" be done with Lantus, would this simple test with R be reasonable?
     
  28. Blue

    Blue Well-Known Member

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    Dec 28, 2009
    I also had a horrible time with my vet office to get the tests done. Being in Canada did not make it easy at all. My vet office knowledge on the condition? They had heard of it. :D

    I had to do all the legwork, rather gathering the info and taking them printouts of the two information sheets from those two links. I had to keep after them again and again and again, to get on the phone, and find out what we had to do. I had to tell them they must use fedex and also that I would bring Shadoe on a Sunday so we could get the draws to msu in time.

    Shadoe is the 2nd FD kitty at my vet office and the very first acro that they have experienced. The vet offices in most cases honestly don't know what needs doing, so they have to be informed by us.

    The tests are very simple to get done, and the results will clearly tell you if the kitty is positive or negative. There are ranges, for each of the tests, and if you get a result that is out of the range, you likely have a positive. The upper side of the IGF-1 range is 72 I think and Shadoe was 120. I can't recall the normal range for IAA, but someone else may be able to provide them.

    You would save much expense by just having the 2 tests done, as opposed to seeing a new vet and have specialists run tests; I should say that most of my expense was for the transport from Canada to MSU.

    The suggestion to try with R sounds like a good idea, but what do you expect to see?
    I use R for both Shadoe and Oliver, and right now, there are times Oliver is not responding to R.
    R is very powerful, so great caution is needed to use it. There are several cats that get R shots to complement and bring down high numbers to safer levels, so reacting to R may not tell you much.
     
  29. Venita

    Venita Well-Known Member

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    Picture....

    [​IMG]
     
  30. Linda and Bear Man

    Linda and Bear Man Well-Known Member

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    What a beautiful boy!
     
  31. Nina and KB

    Nina and KB Well-Known Member

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    Dec 28, 2009
    If we (you) can get his blood sugar lower and regulated, he won't feel as hungry all the time and his skin and fur condition will also improve. Right now he's not properly using all the nutrition he's taking in. Giving him insulin is likely making a huge, positive difference, so I'm very glad you're treating him.

    I hope you don't feel like we're drowning you with information. It's obvious you care very much for Casey and want him to get better and we want to help.
     
  32. Diana & Casey

    Diana & Casey New Member

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    Apr 21, 2010
    Thank you so much for all of the information and the support and help with Casey's testing. I just want to make sure I understand what acro tests should be performed. Should we have both the IGF-1 and IAA test performed? I spoke to my vet today about having him tested for acro and she said it would cost about $200. She did mention that there are various testing centers? From the info. posted, it seems that MSU is the only place that does the testing?? Am I correct? Venita mentioned the Colorado test- should I have this test done as well?

    Venita - I am familiar with the clinic in Malvern. I take Casey to Hickory Vet Hospital in Plymouth Meeting, PA. He has been going there his entire life and they are good (but pricey). My vet mentioned that she would like him to see the internist. I am fine with that but I think Casey should have the acro test first. Also, she mentioned that if he is acro (which she doubts becasue it is so rare), University of Penn does radiation therapy. We did not go into the details at this point. I will be speaking to her tomorrow aboout how we should proceed. Any advice would be greatly appreciated.

    Boo - you mentioned that CSU does SRS. Do you know how this may differ from the radiation treatments that U of PA may offer?

    Thanks so much for your continued input! Casey and I thank you so much.
     
  33. Larry and Kitties

    Larry and Kitties Well-Known Member

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  34. Diana & Casey

    Diana & Casey New Member

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    Apr 21, 2010
    Venita - I apologize for not answering you post about how Casey got to 18units of Lantus twice a day.

    As I mentioned, we switched to Lantus from Vetsulin last July 2009. My vet started Casey at 1 unit twice per day and then increased him by 1 unit twice per day every 2-3 weeks in general based on his BGS.

    I did not start doing home testing until last Nov. I have done about 3 curves and they have all been fine.

    Casey's reading are high- always in the 300's with an occasional reading in the 200s or 100s. I test him about 3 times a week.

    I keep asking my vet why are we increasing his dosages if his BGs never seem to respond to the increase? She never really give me a good answer other than to stay we can go up tp 30 units/ twice day. I do not want to get to that level.
     
  35. Venita

    Venita Well-Known Member

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    Dec 28, 2009
    Diana,

    It might help you to understand my concern about Casey getting to 18U BID if you read this Lantus forum sticky about protocol. It takes a methodical, measured approach to find a cat's perfect dose, and I am concerned that Casey's dose may have seriously "missed the mark."

    That seriously scares me.

    At least according to the cats we see here, Cushings is much more rare than acro, so I am a little surprised at your vet's response. I don't know if there are other places that do the acro test, but the MSU tests for acro/IIA are what are recommended here. So that is what I would ask for. The folks here on the High Dose board have been doing this for some time, and have developed relationships with MSU and Colorado.

    Larry is the one who brought up the test for the growth hormone, which is the one that is done at Colorado. I understand that Colorado requires that test if you are going to have Casey treated at Colorado, which I don't know is in the plans right now. Larry, is there another reason to have the growth hormone test?

    Also, I have received another $50 donation for Casey's acro/IIA tests. So it seems to me, Diana, that you can go ahead and start planning for these tests.

    Venita
     
  36. Larry and Kitties

    Larry and Kitties Well-Known Member

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    Dec 28, 2009
    I only mentioned the growth hormone since that was in the 2010 article I cited. I leave it up to the vet with what is required (and based on costs).
     
  37. OptOut

    OptOut Well-Known Member

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    Dec 28, 2009
    Michigan State University is the only lab in the country that runs IGF-1 and IAA. IGF-1 tests for acromegaly; IAA for insulin auto-antibodies. IAA is fairly rare, but it's a very cheap add-on.

    Minnesota State University runs a GH (growth hormone test). They have a relationship with Colorado State University, working with Dr. Lunn, who did the research study on SRS and will be starting a new, drug study soon. The GH test is newer and not run as often. However, Dr. Lunn runs both IGF-1 and GH tests on a regular basis, on all the acros under her care.

    Last I heard, CSU is the only vet school in the country that does SRS on pituitary tumors. It's an incredibly expensive machine. Other places do standard radiation therapy. SRS is much quicker and easier on the cats. The therapies are very similar in cost.

    If, by chance, Casey tests positive for acro, Dr. Lunn is very accessible. She would talk to Diana or Casey's vet to explain the various options.

    Acro tests are run Thursdays; results are available Friday if you bug them or Monday if you are polite. I would get the blood drawn and shipped on Monday and we'll have an answer at the end of next week.
     
  38. Phoebe_TiggyGA_NortonGA

    Phoebe_TiggyGA_NortonGA Well-Known Member

    Joined:
    Dec 29, 2009
    Mich State Univ is the ONLY lab in North America that does the IGF-1 test.

    Any OTHER lab that claims to provide the service is really only taking your blood sample and shipping it to Michigan State University and charging you a middle-man fee.

    Have your vet contact MSU directly (info on the link) and the price should be more reasonable.


    SRS is Stereotactic radiation -- it is very precise so there is less brain damage to the cat. The pituitary tumor is a pretty tiny target in a cat's head. The people here that have gone to Colorado for this treatment have had pretty good results -- and their cat's health has improved - not degraded.
     
  39. Nancy and Cody

    Nancy and Cody Well-Known Member

    Joined:
    Jan 1, 2010
    Welcome!

    Be sure not to send it USPS, so that it avoids sitting in the university mail room waiting to be delivered. Fed Ex or UPS should deliver directly to the lab.

    We had the blood draw on a Monday (in Atlanta), sent it Fed Ex overnight, and it made it on time for the Wed test.
     
  40. Diana & Casey

    Diana & Casey New Member

    Joined:
    Apr 21, 2010

    Thanks so much for everyone's support. I did talk to my vet today and she did mention running the IGF-1 test on Casey but wasn't aware of the IAA test. She did call back with some info. on this but We have not connected yet. Does everyone agree that we should have both tests - the IGF-1 and the IAA done ?

    Also, I asked my vet about conclusiveness of the results. She doesn't think the tests are that conclusive. What is everyone else's opinion?

    I know that Cushings tests are not conclusive and Casey has had both.
     
  41. OptOut

    OptOut Well-Known Member

    Joined:
    Dec 28, 2009
    I think the IGF-1 test + history of insulin resistance is fairly conclusive. That was enough for Dr. Lunn to treat cats; yes, she requested the GH and she wanted to see a tumor after the CT scan, but we would have proceded even if the CT didn't find a tumor. The most conclusive way is the list Larry provided, however, the CT scan is overkill. 1) Not all acro cats have a visible tumor; 2) CT scan costs about $1000 (or more); and 3) If you are going to treat w/ SRS, the scan must be done at CSU because it feeds into the radiation machine...just not worth getting it done. Also, as Phoebe mentioned, not all cats show physical symptoms.

    The addition of the IAA is very minimal, so you might as well get that one.

    Diana - a girl posted on the Health forum about Cushings. Her vet thinks her cat might have it. If you get a chance, can you look at this post?
    viewtopic.php?f=29&t=12747
     
  42. Phoebe_TiggyGA_NortonGA

    Phoebe_TiggyGA_NortonGA Well-Known Member

    Joined:
    Dec 29, 2009
    The biggest cost for these tests is shipping -- so for $14 extra, it is a good value to get the test done.

    In the years that we have been keeping records here at FDMB, there have been 69 acromegaly cats, 5 IAA cats (2 also tested + for acro), and 4 Cushings cats. (since 2004).

    If the acromegaly comes back negative, then you will want to get the IAA test -- so might as well get the test done at the same time.

    Both IGF-1 and IAA tests have good confidence rates -- the results are pretty definitive. (unlike Cushings)
     
  43. Nina and KB

    Nina and KB Well-Known Member

    Joined:
    Dec 28, 2009
  44. Diana & Casey

    Diana & Casey New Member

    Joined:
    Apr 21, 2010
    I talked with with my vet this morning. We are going to have both the IGF-1 and IAA test done on Casey next Tuesday. Let's pray for the best!

    Casey and I thank you for all of your continued support and guidance.
     
  45. Nancy and Cody

    Nancy and Cody Well-Known Member

    Joined:
    Jan 1, 2010
    Any chance of drawing on Monday so you don't miss the once a week testing on Wed? If you test on Tues and ANYthing disrupts the overnight delivery, the blood is a week old when they test.

    Or if they set up the test at 8-9AM Wed , and the blood arrives at via UPS at 10:30AM Wed, and it doesn't get opened immediately, it missed the weekly Wednesday test.
     
  46. Blue

    Blue Well-Known Member

    Joined:
    Dec 28, 2009
    I had Shadoe's draw done on Sunday and the sample was shipped via FEDEX not UPS.
    You want the blood draw to arrive by Tuesday so that you don't miss the testing done sometime on Wednesday.

    Contact your vet to arrange to have the draw done on Monday, and have FEDEX pick it up that day, for next day delivery to the LAB, not the mail room. You don't want your draw lost or spoiling in some mail room.
     
  47. Venita

    Venita Well-Known Member

    Joined:
    Dec 28, 2009
    A week's wait, to draw next Monday, would be a much better idea than this Tuesday.
     
  48. Venita

    Venita Well-Known Member

    Joined:
    Dec 28, 2009
    Financing for tests

    DCIN has received donations/pledges for Casey's tests totaling $175.
     
  49. Diana & Casey

    Diana & Casey New Member

    Joined:
    Apr 21, 2010

    My vet doesn't work on Monday, that is why I have the appt. on Tuesday. She does work on Sat. If I get the blood drawn on Sat. ..Fed Ex would pick it up on Mon and it should get there in time for the Wed. test. Would this work or should have the blood drawn on Mon? I would appreciate your thought? Thanks!
     
  50. Diana & Casey

    Diana & Casey New Member

    Joined:
    Apr 21, 2010
    Re: Financing for tests


    Thanks so much to everyone! I can't believe how generous and helpful everyone has been. We are so fortunate to have found such a wonderful and supportive group.

    Special thanks to Venita.
     
  51. Blue

    Blue Well-Known Member

    Joined:
    Dec 28, 2009
    So long as the draw is prepared properly for shipping, your vet can call the lab and find out the exact shipping requirements as that's what my vet did. That way, the draw on Sat could arrive at the lab in plenty of time for the testing on Wednesday.
    It would be horrible if they run the tests at 7am and your draw arrives at 8am, then it has to sit for a week and wait. And who knows how the wait would affect the results, but sitting for a day has to be preferable to sitting for a week.

    I had a question though; how come Fedex can't pick up the draw on Saturday, the day of the draw? Fedex must work 7days/week because the offer next day delivery.

    Is there no other person at your vet's office that can do the draw? I am just wondering as I go to a vet clinic with a few vets and techs, so I don't know how your situation compares.
     
  52. Larry and Kitties

    Larry and Kitties Well-Known Member

    Joined:
    Dec 28, 2009
    I would call MSU up and ask if Saturday draw and mailing is OK. For the IGF the MSU site says:
    "May be shipped via regular mail. Recommend shipping samples with an ice pack in an insulated container second-day or better delivery in summer months."

    For the insulin antibody test MSU states:
    "Refrigerate or freeze prior to shipment. Ship serum samples in a leakproof tube with an ice pack."

    This implies that you shouldn't freeze the IGF sample and drawing an Saturday and running test on Wednesday might not be the best. When i sent sample to TAMU I uses UPS next day shipment with ice pac.
     
  53. Diana & Casey

    Diana & Casey New Member

    Joined:
    Apr 21, 2010

    Thanks for all of the advice. Is there a phone number of the MSU webiste that I can contact?
     
  54. Larry and Kitties

    Larry and Kitties Well-Known Member

    Joined:
    Dec 28, 2009
  55. OptOut

    OptOut Well-Known Member

    Joined:
    Dec 28, 2009
    It's perfectly acceptable to freeze the IGF-1 sample (in fact, I would it keep it cold longer). Dr. Lunn had one of mine frozen for almost 3 months before shipping to MSU.
     
  56. Phoebe_TiggyGA_NortonGA

    Phoebe_TiggyGA_NortonGA Well-Known Member

    Joined:
    Dec 29, 2009
    Agree - Saturday blood draw is fine -- Norton's blood was drawn on Saturday for the IGF-1 test.

    ALSO -- MSU used to only run the test twice per month (every other Wednesday). They increased the testing frequency to every week in just the past couple of years as the demand has increased.
     
  57. Larry and Kitties

    Larry and Kitties Well-Known Member

    Joined:
    Dec 28, 2009
    I knew if it could be frozen then Saturday would be fine I just wondered why the DCPAH's site didn't mention freezing for the IGF but did for the antibody test.
     
  58. Diana & Casey

    Diana & Casey New Member

    Joined:
    Apr 21, 2010
    Hi All -

    I just thought I would let you know that Casey is having his blood work done this Sunday, so there should be no problem with the blood getting there in time for the Wednesday test.

    Thanks so much for all of your generous support!

    Diana & Casey
     
  59. Blue

    Blue Well-Known Member

    Joined:
    Dec 28, 2009
    Great news, Diana,
    There's nothing like knowing what is and is not going on.

    I wanted to mention that I had been told the tests done on Wednesday would give me results by Friday. I waited too long to harass my vets office, so by the time I got them to call to see if the results were available, the lab was closed and I had to wait till the start of next week.

    While I don't know what time they run the tests, I made my vet office call to confirm the draw arrived there in time to be included in the Wednesday's tests, so that's why i had expected to hear results Friday. I guess that's why it mentions a turnaround of 2 to 9 days on the info sheet :lol:

    One last thing - fasting. Shadoe has issues with lipemia on most of her blood draws and it's mentioned on one of the sheets, so I did fast her to lessen that factor interfering her draw. I did not want anything to mess up her results.
     
  60. Diana & Casey

    Diana & Casey New Member

    Joined:
    Apr 21, 2010

    Hi Gayle,

    How long should I have Casey fast? My vet said 4 hours. Do you think that is enough time? Four hours will be tough, Casey is always hungry!
     
  61. Blue

    Blue Well-Known Member

    Joined:
    Dec 28, 2009
    Diana,
    On the sheet for the IAA test, it mentions "avoid hemolysis or lipemia" - well, lipemia is always mentioned in the comments for Shadoe's results. I fasted Shadoe from midnite and the draw was before noon. She may have been hungry, but that was too bad because I did not want to mess up the results. I did bring a small container of some yummy foods she liked so that she could eat as soon as they had taken their draw.
    I did give her foods at 5min to midnite :lol: - just like if you have to fast for some testing.

    Check on your copies of Casey's past blood work results and look in the comments sections someplace near the end of the results. Look around for any mention of lipemia and if there are none, then maybe you could go with a shorter fast time, but if you can get the draw done early in the day, just ignore Casey or even better, go OUT and come home just before it's time to head to the vet - yes, I did that. I may have gone to the gym I believe.

    Overnite is the best because it's a big chunk of time.
     
  62. Phoebe_TiggyGA_NortonGA

    Phoebe_TiggyGA_NortonGA Well-Known Member

    Joined:
    Dec 29, 2009
    Definitely check on past results.

    Norton did not have a history of lipemia, and he did not have to fast before the blood was drawn.

    However, he did not have the IAA test done - just IGF-1 (because 1. we already knew he had a brain tumor, 2. didn't think about the IAA test and 3. he already had inoperable intestinal cancer - very short life expectancy)
     
  63. Diana & Casey

    Diana & Casey New Member

    Joined:
    Apr 21, 2010
    Hi All -

    I just wanted to let everyone know that Casey's IGF-1 test results came back today. His reading is 68. My vet said that is does not have acromegaly. Does everyone agree? She did mention that a reading of 70-100 is inconclusive and over 100 is positive. Isn't 68 close to 70, so is it possible he could have acromegaly? She firmly believes that he has Cushings disease.

    The results for IAA are not in yet. We should have those in by Monday.

    Thanks so much to everyone for your generosity and support! We are so grateful.
     
  64. OptOut

    OptOut Well-Known Member

    Joined:
    Dec 28, 2009
    I think that number rules out acro and leans towards Cushings...you might have to become our resident Cushings expert. I'm not sure any of us know much about it. I'm not even sure if Cushings is better or worse than acro, but at least this makes the other diagnosis more reliable. Thank you for updating us.
     
  65. Blue

    Blue Well-Known Member

    Joined:
    Dec 28, 2009
    For the IAA results, anything under 20 is considered as normal.
    The ref range on IGF-1 results, 12-92, so I would think that the 68 is pretty much a negative. It could be that the upper range of 70-100 is looked on as suspect only, with over that 100 mark as positive.
     
  66. Diana & Casey

    Diana & Casey New Member

    Joined:
    Apr 21, 2010
    Hello All -

    I just swithed from using the Alphtrak to the ReliON meter this morning. I am very concerned because I took two readings on Casey and I got 50 and 58. Casey's reading are always in the 300's with the Alphatrak. I must be doing something incorrectly? I am also concerned becasue Casey has not been feeling well. He vomited three times during the night. I would appreciate any advice. Thanks.
     
  67. OptOut

    OptOut Well-Known Member

    Joined:
    Dec 28, 2009
    Is it the ReliOn Micro, which does not need "calibration" or is it one that you have to use a calibration stip each time you open a box of strips?

    Do you still have a stip for the AlphaTrac that you can use? That way, you can compare (you should see some difference, but obviously not 250 pts!). You could also test yourself with the ReliOn.
     
  68. Monique & Spooky

    Monique & Spooky Well-Known Member

    Joined:
    Dec 29, 2009
    Well I don't know much about Cushing's in cats but I know alot about it in humans (I'm a pathologist). A test for Cushing's is not that difficult generally it requires measuring the blood cortisone levels and then giving an injection of dexamethasone (which is a version of cortisone) suppresses the adrenal gland from producing cortisol in normal dogs, but not those with Cushing's. It achieves this suppression by interfering with the negative feedback mechanism. The dexamethasone is monitored by the brain as an excess of cortisone in the bloodstream, so less ACTH is secreted, and therefore less cortisol is secreted by the adrenal gland. This test is always positive if Cushings is present, but being positive doesn't mean Cushing's is the reason (Since cats are prone to stress related cortisone release I think this may give many false positives) Cushings does have a number of symptoms (diabetes being one of them) and some other findings (blood tests such as elevated alkaline phosphatase or high cholesterol. Cushing's can be caused by several differnt things mostly tumors of the adrenal glands (which produce cortisol) or the pituitary which produces ACTH the hormone that stimulates the adrenals to release cortisol. An Ultrasound of the adrenals could potentially show such a tumor. In addition the finding of slightly enlarged adrenal glands (hypertrophic) indicates that they are working overtime which means Cushings could be the cause. A urine test can also be used to measure the level of excreted cortisol and is simple to obtain. I suspect this might be a better test for cats because the sample could be obtained at home and brought to the lab so there would be less stressed related cortisone release.

    As for how it can be treated in cats i really don't know, in humans it is usually cureable. Then again so is acro in humans but in cats the procedure is reletively new so..... Removal of the adrenal glands will cease the over production of cortisol, of course then you have the opposite problem (called Addison's disease) and the person needs to take a cortisone suppliment life long, but supplimentation is easier to mange than a chronic over production, if only one gland is removed treatment may only be nessisary short term until the remaining gland can produce enough on it's own. Simularly pituitary tumors that causing to much ACTH can be removed. Several medications which can supress cortisone or ACTH production are availble as well. Of course until everything is resolved (if it can be) the symptoms such as the diabetes need to be treated as well.

    For anyone that thinks they don't have a clue about Cushing's.... Cushing's can also be caused by giving cortisone drugs which are to treat another condition (allergies, arthritis etc.) and the symptoms are the same (drug induced Cushing's syndrome) so cats that have become diabetic while on steriod therapy actually are dealing with Cushing's syndrome and anyone who has dealt with this situation knows that it makes treating the diabetes a bit more challenging espcially if the cat needs to continue on the steriods. Insulin dosages are often higher and regulation is more challenging.
     
  69. Diana & Casey

    Diana & Casey New Member

    Joined:
    Apr 21, 2010

    Unfortunately Casey's readings are correct. He is in the hospital now. I'll keep you updated.
     
  70. Phoebe_TiggyGA_NortonGA

    Phoebe_TiggyGA_NortonGA Well-Known Member

    Joined:
    Dec 29, 2009
    So sorry that Casey is in the hospital.

    Next time you get low-ish numbers and question the meter -- Test Yourself -- should be around 100. (or use control solution)

    Hope Casey is feeling better soon
    phoebe
     
  71. Diana & Casey

    Diana & Casey New Member

    Joined:
    Apr 21, 2010
    I visited Casey today and he is doing much better. He BGs got as low as the 20-30 range yesterday. They put him on a dextrose IV and his numbers are finally going back up and he is starting to eat. Casey has a large mass in his panacreas and the vet believes this may be causing some havoc with his insulin production. We are doing a recheck on his March ultrasound tomorrow to see what is going on with the mass and to check for any more abnormalities. Let's keep our fingers crossed!
     
  72. Blue

    Blue Well-Known Member

    Joined:
    Dec 28, 2009
    What a huge relief he's doing better now, and how fortunate that he was with professionals who were able to deal with his low numbers. On the mass, what was said that can be done or will you hear more about that later once he looks at the rest of data? Let's hope for good news tomorrow for you and Casey.
     
  73. OptOut

    OptOut Well-Known Member

    Joined:
    Dec 28, 2009
    Poor baby boy!

    Diana, do you keep some high-carb food in the house? Fancy Feast Grilled varieties are good. Whenever you get "uncomfortable" numbers, the high-carb can bring them up nicely (although it sounds like he really did need the vet). Please keep us updated - we want to hear good news on Casey.
     
  74. Venita

    Venita Well-Known Member

    Joined:
    Dec 28, 2009
    Casey is at peace. I posted separately.

    Just to let you know, his acro and IAA tests were negative for those conditions.
     
  75. OptOut

    OptOut Well-Known Member

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    Dec 28, 2009
    Venita, thank you for all that you did to help Casey!
     
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