Post pituitary surgery discussion of medication and other issues

Discussion in 'Acromegaly / IAA / Cushings Cats' started by sbluhrs, Nov 26, 2018.

  1. sbluhrs

    sbluhrs Member

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    Jun 7, 2012
    @John Irene and TITAN , @Amanda & Shmee and I have all had our kitties undergo surgery to remove their pituitary gland within a one month period. If you want to ready about some of the issues we have had with the meds they are now on, and a number of other things we have encountered, please go here:

    http://www.felinediabetes.com/FDMB/...r-and-go-otj-with-sophie.205746/#post-2295111

    One thing you need to know about this surgery is that it doesn't fix things immediately and there is also a learning curve with regards to providing your kitty with the proper care afterwards. But, if you have negotiated the waters and have learned the Sugar Dance, you will have no problems learning this new one, as its merely a variation on the same theme.
     
  2. Amanda & Shmee

    Amanda & Shmee Well-Known Member

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    Feb 18, 2018
    This ^ is the thinking that helped me decide to have the surgery. But, I still don’t know if it was worth it for Shmee. At this time I honestly think it wasn’t, but I’m trying my best to hold out hope it will be at some point. Shmee became OTJ, but he’s not my cat anymore. He’s depressed, lays around all day, hardly meows (very different than his old self), and when he does it’s not the same. Literally a different sound. He’s easily annoyed, developed pancreatitis from the trauma and stress of the hospital, always extremely hungry and no one knows why (my vet says “fat cats are hungry”...... but he was never like this before) and will most likely be on the extremely expensive (way more than insulin) Desmopressin for the rest of his life (something that is “very rare”...). If he was younger, and a different personality, this may have gone better. He is very sensitive and I should’ve known him better, that he couldn’t handle the stress. He was so happy before this. Now we are all suffering and I miss him every minute of the day and second of the night, as he used to lay with me almost all his life... right next to me. Now nothing. His eyes are also constantly dilated. Just my two cents... I hope sometime in the future I can update this and say he’s better.

    PS Susan have you tried the refractometer yet? I haven’t. I don’t understand it and Dr. McCue hasn’t called or emailed in quite a while.... I tried to get some pee but Shmee got very mad at me. So I don’t even know if I’ll be able to get a sample like I used to but I have to try again soon.
     
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  3. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    This is a very good info thread.

    Amanda, I also hope Shmee eventually turns around and becomes a friendlier kitteh. None of us really expected him to become so radically transformed. .....I was just in NYC for the last 3 days and was remembering the nice lunch we had together there...when Shmee was having his operation.
     
  4. sbluhrs

    sbluhrs Member

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    Jun 7, 2012
    I finally got a sample for the refractometer and got a 1.020 reading. When you first use it, you have to zero it - take a drop of water and focus the lens, then adjust it per instructions to set it at zero. The SG readings are the ones on the left.

    Sophie mostly uses pee pads in litter boxes, though occasionally she is starting to relent and use a regular litter box at times. I just happened to be in the basement where everything is set up and she was peeing in her favorite box on a pad. I grabbed one of the clean cans from our recycling and scooped up some pee before it could sink into the pad. Plenty to create a sample to use on the refractometer.

    I really wonder what the deal is with other kitties who have had the same operation, whether it be at RVC, AMC or in Washington. No one discusses moods, etc in anything that I had read prior to deciding on Sophie's surgery. This is very important information when deciding on a life changing operation like the one our guys went through. I just hold onto the hope that 6 months or so from now, all of our cats - Shmee, Sophie & Titan from the UK - will be in a better place mood wise and back to their normal selves.

    Sophie is still on desmo, too. I use injectable from Wedgewood Pharmacy out of NJ. It costs $86 for the vial including shipping ($56 for the meds, $30 for shipping, shipped overnight), less than the place that AMC got it at in NYC. She is just on a very small amount, so that vial will last me a long time.
     
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  5. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    I am really sad to read Amanda's post. We think titan is still improving slowly, learning all the things that he seemed to have forgotten and regaining confidence in himself and us. But it's a slow process and made more difficult by his deafness which mysteriously arose at the time of the operation. He may get back to his former self, or we may just get used to his new self, but at the moment he is definitely a changed cat.
    It would be a good project for a student vet at RVC to do a study of character changes in cats that have been treated.
    Nothing has changed in Titan's medication. He is still on desmopressin, and we judge that he still needs it by the amount he drinks and pees. We have never taken a urine sample; only at the vet who takes it with a needle.
    He is developing a habit of spitting out his cortisone pills and we may have to start crushing them....so far we use a pill pocket when he does that.
     
  6. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    I am sorry to hear of Titan's issues, including his new deafness. When we first encountered Little Dude as a wild kitteh in the neighborhood, he was fearful of everything. Fast forward 3 months - we had tamed and treated his issues. He was 99% deaf from ear mites, and that was causing the extreme fear because he was "feral" at the time. We killed off the ear mites, and within ~3 more months he regained most of his hearing. His behavior changed significantly after this, and now he is a lovebug.

    I think the major loss of a sense (hearing) could be quite disturbing. I hope the best for all the kittehs here, and I hope Titan gets his hearing back.
     
  7. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    Maybe the common factor is memory loss. Shmee reverting back to his pre-rescue character and Titan finding everything unfamiliar.? Titan has been loved and spoiled every second of his life, with only his weaning onto solids causing him a problem. So loss of memory wouldn't cause him as much stress as Shmee.
    How about Sophie?
     
  8. sbluhrs

    sbluhrs Member

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    Jun 7, 2012
    If Sophie has any memory loss, I really don't have a baseline for which to determine how she acts now. I adopted her in February of 2017. I don't know her pre-diabetes, etc., so I don't know what her personality was back then. She is basically the same cat that I adopted. My biggest problem is getting her to eat less. She has gained a lot of weight since surgery and is now a little porker. I am now watering down her meals and giving her less food and not letting her get away with eating any of my other cat's meals. Admittedly, we spoiled her a bit during the Holidays with letting her lick plates, but that has stopped.

    My gut is telling her that I won't see who she will be for another 3-6 months down the road, perhaps a year. Her vet thinks that part of it is that her body is still adapting to her new hormone levels and it is just a matter of time. I'll just be happy when spring rolls around and I can take her out for walks on the harness and, hopefully that exercise will make a difference. The runs up the basement stairs help a bit, but she needs more.
     
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  9. Amanda & Shmee

    Amanda & Shmee Well-Known Member

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    Feb 18, 2018
    Shmee wasn’t a rescue, I’ve had him since he was a baby. Memory loss was never discussed with me either. I feel extremely let down by this whole ordeal. Let down isn’t even the right phrase, but I won’t say how I really feel.

    I’m sorry I haven’t been around, I hope everyone had a nice Christmas. Thank you for being so supportive.
     
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  10. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    Sorry Amanda. I don't know why I thought he was a rescue... must have confused him with another. Signature is clear enough!
     
  11. sbluhrs

    sbluhrs Member

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    Jun 7, 2012
    Behavior issues are definitely something that NO ONE ever mentions regarding the pituitary surgery. Seriously, this is an issue that needs to be addressed and people need to be informed BEFORE they have their cat undergo the procedure.
     
  12. sbluhrs

    sbluhrs Member

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    Jun 7, 2012
    Did a trial of no desmo this AM with Sophie. This is what I noticed - HUGE behavior change - not sleeping the whole day, engaged in life, did a few things that she hasn't been doing in MONTHS - including kneading. Not quite as hungry as usual, but, unfortunately, drinking a lot and peeing more than is good. So, back to her needle juice of desmo this PM.

    But, I also decided to research the affect of Desmo on feline behavior. Some side effects of it can include mood changes (irritability), and tiredness. Usually, this is seen in high dosages, but, since our cats are not the typical, they might be more sensitive to the drug. That might be why they are more sluggish and crabby. I'm going to ask Dr. McCue, along with our Maine vet about this.

    So, all the behavior issues might be related just to this. Wow!
     
  13. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    Very interesting! Titan's still on 3 x 1 eyedrops a day. Still slowly improving, has started resuming play fighting with his sister (led by her) early morning. Think his deafness may be improving. Still peeing and drinking. Still coughing. He is certainly rather sluggish but not at all crabby.
     
  14. sbluhrs

    sbluhrs Member

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    Emailed Dr. McCue today and, amazingly, he got back to me this evening.

    He is amazed that needle juice of desmo makes a difference for her, that such a small amount will keep her regulated regarding her water consumption and peeing. She's a little off today regarding this, but I am chalking it up to not getting 1 shot yesterday, and getting the second very late, but she should be back to her pattern of peeing no more than twice a day soon.

    He didn't have anything to say regarding possible side effects of the desmo re: moods & energy level, but he wants me to continue giving him info regarding our observations.
     
  15. sbluhrs

    sbluhrs Member

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    OH, and I forgot to mention, Sophie saw her Maine vet last Friday (1/4) and her ears were a little dirty and had a bit more yeast in them than is good. Not enough to need an antifungal, but we didn't want them to get worse. Well, the doctor put her on prescription ear drops that have some steroid. Wouldn't you know, those stupid drops threw her out of diabetic remission - look at her numbers on 1/8 & 1/9 - called the clinic on 1/9 (Wednesday). So Sophie is no longer on those drops and I will just clean her ears twice a week instead. Already she is doing much better. Just seems that she will need an AM shot for a few days.

    I'm thinking that the stupid drops were the same reason why the trial to stop desmo didn't work.

    Some cats don't seem to be affected much by the drops, others are like Sophie and get a significant jump in BG. AMPS on Wednesday was 384, and she was down to 56 at +8. Just NJ today, and she dropped from 219 to 47 - so really, she doesn't need insulin. Just spot checking this evening and tomorrow AM and she should definitely be definitively OTJ, baring any other stupidity with steroids other than the orals she gets.
     
  16. sbluhrs

    sbluhrs Member

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    Jun 7, 2012
    Gee, Sophie definitely is a mystery wrapped up in an enigma. She sure is the poster child for ECID. Got results back from Michigan for her IGF-1. It was 0!!! You read that right - 0. Michigan has never had that happen before. Dr. McCue doesn't seem concerned - he just thinks that it shows that there is no problem with recurrence - that, obviously, since the tumor was encapsulated, and the whole thing was removed, along with the pituitary gland, that all is good. One of the vets here in Maine was concerned that this might be a reason to increase the amount of Sophie's steroid dosage, but I guess that is not the case.

    And, on the desmo front, just giving her nj once a day - 7 pm. It definitely affects her personality. She is much more active during the day now as she doesn't get her big nj shot (being sarcastic here) at 7 am. Yes, by 7 pm she is drinking more, but with even just nj twice a day, she only pees once a day, twice at the very most, and it is very concentrated. So the plan is to continue weaning her off of it, encouraging those brain cells that have taken over making the kidney regulating hormone to do just a bit more.

    Oh, and she is off of insulin again. Only needed 3 shots to get her over the hump of the increase caused by the ear drops.
     
  17. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Those are good results for Sophie. Pretty amazing to have absolute zero on IGF-1. And great to have her off of insulin again. That part should be enjoyable, no more worries about hypos.
     
  18. sbluhrs

    sbluhrs Member

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    At this point, we are now working on weaning Sophie from Desmo. She is getting 1 shot per day, only needle juice, at 7pm, with her evening meal. Usually she doesn't pee from that time until around 10-11 am the next day. Seriously. Yes, she will pee quite a bit at that time, but, then she pees about once or twice more the rest of the day. Pee amounts are still rather larger than a normal amount, but she is a big girl. She starts to drink more water than usual starting in late afternoon, but that resolves within an hour of getting her desmo shot at 7. The idea is that this will make her brain, which has already started the conversion of some portions to creating the hormones to regulate her kidneys, accelerate that process so that she will be off the Desmo in the near future. Hey, even if it takes another few months, it would be wonderful.

    Some of her bloat seems to be coming off, too. Desmo isn't supposed to cause water retention, except for cases when large amounts are used, but no one ever does studies on cats post pituitary surgery when it comes to this. And, then, ECID.

    Dr. McCue is amazed that such a small amount makes such a difference for her - again - ECID.
     
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  19. sbluhrs

    sbluhrs Member

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    Jun 7, 2012
    Got the ok from Dr. McCue to go down to 1.25 mg once a day of the Prednisolone. Hoping that helps with her appetite - still wants to eat more than a normal cat still peeing a bit more than a normal cat, but the frequency is going down. I'm going to wait a couple of weeks after the steroid dosage change and then do another trial with no desmo - her specific gravities have been doing well - I just seem to have been able to get some good samples lately, and she doesn't appear to be drinking significantly more than our other kitty, although both are drinking more than normal due to the dryness in the house.

    Oh, and her pee, all around, must be more concentrated as, on the odd occasion when she pees in a box with litter instead of on a pad, it actually clumps now instead of being a sticky, gooey mess. (we use clumping litter).

    She is still a little tubbo - up to 13.5 lbs, hoping that, between the steroid dosage decrease, and the fact that I am making her portions even smaller and cutting out her snacks, the weight will come off and that she will be back to a svelte 12 lbs.
     
    Last edited: Feb 4, 2019
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