PINKY'S 'SRT' ADVENTURE---FLORIDA

Pinky’s SRT Adventure- Long, long story. (Thanks to all the people that have written about their SRT experiences. Their accounts were invaluable in helping us make our decision to treat Pinky. I hope Pinky's story will help others as well.)

Diagnosed with Diabetes Aug. 1, 2011
Diagnosed with Acromegaly : Insulin-like Growth Factor test (367) Jan. 14, 2012
IAA test results (68) relates to insulin resistance
SRT March 5, 2012 through March 9, 2012

BACKGROUND:

Pinky has never seemed well to us since diabetes diagnosis. Very lethargic, not her old self. Starving and drinking huge quantities of water. We were dedicated to the Rand method of diabetic control that involved home testing and dosing based on blood glucose numbers. However, we have never been able to regulate her even close to good numbers. Used free- style lite meter for months and months only to find it was reading too low. So yellow chart numbers are deceiving and inaccurate. We did a fructosamine test a while back and the results were ‘poor’ and nothing has changed.

We knew if Pinky ever tested positive for acromegaly we would like to take her to Colorado State for stereotactic radiation treatment (SRT) despite our dread of such a grueling trip (we are in South Florida). We estimated she would be in a small carrier with no food or litter box for 10 hours-- longer if there were delays. When she is out of her comfort zone she would be frightened senseless. If she escaped even we wouldn’t be able to catch her. She would be too petrified to eat and there would be no litter box as she couldn’t be taken out of carrier lest she try and break free.

We knew SRT is still relatively new with very few cats even undergoing the procedure as few places offer it and the costs are prohibit able. We also knew it helps some cats but not others. Several have died as well. Still we wanted to help Pinky and were told that while they don’t even know if it increases a cat’s lifespan it should bring about a better quality of life if it is successful.

While our beloved boy cat Roy was undergoing cancer treatment we got the word that Pinky did have acromegaly. We put Pinky on the back burner but Roy was PTS on Feb 8 and with broken hearts we started concentrating on Pinky who was now also depressed about Roy’s absence. They were inseparable. :cry:

I emailed Dr Lunn some questions (which I will post along with her answers) and she responded quickly but also let us know she was leaving CSU. I then contacted Dr. Timian. The cost was estimated to be $4500 to $5000.
(though I believe Julie only paid 3500 for Punkin + the cost of some preliminary tests.)

An appt was made for Feb 20, 2012. A week earlier I had the preliminary blood work done but I also decided to have a heart ultrasound and cardiac workup done to be sure she was a candidate plus an ultrasound of abdomen. Neither of these is required though.

The cardiologist gave the go ahead for the SRT procedure. And the internal medicine specialist (Dr. Morales) who did the abdomen said all her organs were ‘big’ just as you would expect from acromegalic cat and that she didn’t have cancer.

This internal medicine specialist was fantastic and very interested in Pinky’s case. She asked me why I wasn’t going to the Univ of Fl vet school in Gainesville , Fl.? I said I researched online and had asked CSU about centers in the South and came up blank. I didn’t think they did SRT there. She said she was sure they did and right then and there she called them and spoke to the Doctor in charge.

She came back and said he was going to call me the next day and the rest is history.
I immediately cancelled the Colorado appt. though at that point I didn’t know where I was going. I was still committed to going to the ‘best’ place. I emailed Dr. Timian who wasn’t familiar with their program. She understood completely my desire for the least stressful trip on Pinky. In order that I could compare she said they had done 20 cats using SRT and that their long term success rate was very good. 50% remission, 50% reduced insulin with few complications.

When I spoke to Dr Kow (pronounced ko –w is silent ) in Florida, he said he trained at Colorado State and was very familiar with the program. They had not had their SRT machine as long and had only done 7 cats so far. But they had used the people SRT machine at nearby hospital for several years prior. ( of the 7 done on their new machine 3 cats had died later on (causes unknown ???) and 3 were doing well on reduced insulin, I believe one did not stay in touch. ).

I expressly asked about the number of fractions (radiation treatments) they did as I was under the impression that one fraction was not as desirable. In Colorado they would do 3 so a total of 4 days was required. Dr. Kow explained that sometimes they did one but the number of fractions could not be determined until the MRI and CT was completed. (as it turned out Pinky had FOUR fractions and we were there 5 days)

We decided that though Univ of Fl College of Veterinary Medicine didn’t have their present SRT machine as long (they did have access to another at people hospital) and had only done 7 cats on new machine, it was important that people go there (if they can manage the expense) in order that they can gain the additional experience and knowledge to help acro cats that live in the South.

Unfortunately the cost of treatment in Gainesville was more—estimated to be $5500 to 6500 but in the end it was decided that a 5 and half hour drive would be so much easier on Pinky and me (I HATE flying and had already had a NIGHTMARISH experience taking a cat on a plane). We are just so fortunate that we had the resources to pay for Pinky’s care. The SRT treatment came to approx. $6000 ($5783.00). WOW, that is a lot to spend on a little feral kitten found near a dumpster 11 and half years earlier with several brothers and sisters. We trapped and fostered them all and ended up keeping Roy, Dumpy, Whitey, and Pinky.

. Pinky would travel in our SUV in a large dog cage with a bed and litter box. She has never traveled well in the car –even on a 5 minute trip to the vet. But we thought once on the road she would settle down and as it turned out she did. She didn’t enjoy the trip but she wasn’t overly agitated either. She never budged from the bed, never used the litter box, nor did she eat.

GAINESVILLE:

We stayed at Homewood Suites –about a 7 minutes drive from hospital. The hotel was great. They are used to animals staying there. They had a complimentary breakfast and a complimentary dinner which I never heard of a hotel offering. The dinner was available M thru Thurs and was actually pretty good on a couple nights. We also microwaved frozen meals etc. We really couldn’t be away once Pinky was picked up as we needed to be with her in such a strange place. We kept saying over and over how fun it was to have a cat in our hotel room and wished we had one on future vacations. Pinky said to count her out next time—she had enough adventure already.

We found the hospital Sunday night so we wouldn’t be late. It was a very impressive place.
Inside the lobby is stunning. Soaring ceiling with tons of glass about 3 stories high.

On Monday, March 5 we met Dr. Kow who was very conscientious, caring, and knowledgeable.
He explained everything to us. Pinky was to have MRI and CT that day and dental plate made so that she could be set up in identical position every day. She would also have a stint or port put in her leg.

We were called to come and get her at 5:00. He explained that it was a very large mass encroaching on optic nerve chiasm. One of the largest he had every seen. He drew on a chalk board, explaining how the radiation would be delivered. He also thought it was a possibility that she would have gone blind in a couple months. We had noticed she was bobbing her head around and putting nose in air when we approached her with food as if she was not seeing as well but we weren’t sure.

It was explained that when the mass is not close to optic nerve you can do 1 or 2 fractions without fear of damaging optic nerve. This means that a large amount of radiation can be used during fewer sessions. But if damage to optic nerve is a possibility you do the same amount of radiation but divide it up into more fractions. He said there is a tradeoff in deciding how many fractions to do. If you do more that means more anesthesia and more stress and discomfort but in Pinky’s case it was decided 4 would be better. A ‘people’ radiation Dr. who does this procedure on people would also come from nearby hospital every morning and work with vets. They have had such an arrangement with the hospital for 10 years.

The only really difficult part of the whole thing was that first night. Pinky had ports in a front leg and back leg that had to be flushed with a tiny amount of water every 3 hours to prevent the tubing from getting blocked. We also had to prevent her from chewing on the tiny tubing so I got some self stick bandage wrap and covered it , on subsequent nights we used baby socks which were easier to get off. They had given us one of those collar thingies but those things are impossible for cats to wear without going berserk.

That first night Pinky looked like she had 2 broken legs and she flopped from side to side ALL NIGHT LONG and she didn’t think she could walk. I didn’t sleep one wink nor did Pinky. I honestly didn’t know how we would get through 3 more nights but after that first night she realized she could hobble about and she also slept. The last 2 nights we also were told flushing every 4 hours would be OK. It only took about 5 minutes—DH got very quick at it and was back to sleep in 2 seconds. (I barely slept the whole week.) On the very last night (Thurs) they had removed the port in the front leg so we only had one to do.

We arrived at hospital at 8:30 every day and she was finished around 1 or 2.
She was fairly relaxed and comfortable once we got back to the hotel. She stayed glued to our sides as we watched TV in the bed. Once when we did have to go out we put her in the bathroom otherwise she would crawl into a small crevice behind bed to hide if we left her alone and it was hard to get her out as she would wedge herself in and wasn’t mobile with all the bandaging.

Even though with an acromegalic cat the diabetes is actually the result of excess growth hormones originating from pituitary gland I am assuming that the uncontrolled diabetes and high blood sugar damages the organs (including the pancreas) just as it would the regular diabetic. So control of diabetes is of paramount importance. We were told an acromegalic cat can have cardiac, kidney, and infection problems due to this disease.

I hope Pinky’s case will provide additional knowledge into the treatment of acromegaly with radiation. We are very pleased with our decision to go to the Univ of Fl College of Vet. Medicine and thought Dr. Kow and staff were wonderful.

Elaine and Pinky

 

Re: PINKY'S 'SRT' ADVENTURE

Great information! Thanks for the post and good luck to Pinky for reducing insulin dependence.

 

Re: PINKY'S 'SRT' ADVENTURE

Great write-up, and I'm glad you did try another place, just to that people in the future have more options. Please let us know how Pinky does.

 

Re: PINKY'S 'SRT' ADVENTURE

glad to hear you went on with it and it all went well, elaine! i hope you'll update in the months ahead and let us all know how pinky does.

i haven't been sorry - it is expensive, but so is treating the diabetes.