Yoshi update: Test result

Stressedcatmom

Stressedcatmom

Very Active Member
Hi everyone,

Happy New Year!

I have a bit of sad news to share. The vet emailed me; Yoshi tested positive for acro. I cried all night and haven’t slept. I was reading the acro forum and posted there, but I figured I’d get more eyes here. I feel like he’s going to get super sick and I am completely terrified.

The vet is back in the office on Saturday and I plan to talk to her in more detail. I will share her email with you guys as an attachment. I plan to talk to her about radiation but I really doubt that I’m going to be able to afford it. I’m curious as to how many other acro cats are on Lantus/Levimir and what they’ve done to treat it.

As I mentioned before, I was going to switch back to Prozinc, but I’m not sure I want to do that at this stage. I don’t know. I’m at a loss.
 

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Hi again :) I posted in your thread on the acro board too, but I just wanted to comment here on Prozinc, at least from my experience. Rocket was diagnosed diabetic in Feb of last year, and he started Prozinc. It didn't touch his numbers whatsoever; he was in high numbers constantly. Plus it seemed like it wasn't lasting long enough in his system (8-10 hrs max). Of course we didn't know until July that he had Acromegaly. He seems to do much better on Levemir, for what it's worth.
 
I too posted on the acro forum, must longer than I will post here. Back in the day of Neko's diagnosis, the treatment options were radiation therapy, SRT being the best form of radiation, or treating with insulin as needed. We chose SRT, it was much cheaper then, even though it involved driving for three days each way. She handled it like a champ that time. Before that, she'd complain on short car rides, I wasn't looking forward to the long trip. But we'd had two people here get SRT around the same time as Neko's diagnosis, so I knew what to expect with the treatment.

Since then, there have been new treatment options. Other than cabergoline, the medical (drug) choices are way too expensive. The only ones who have done it have done is part of a research study by Royal Veterinary Clinic, where the drug was donated by the drug company. There haven't been many people in the US do the surgery, and most of those did it back when AMC in New York had a sizable donation paid for the majority of the costs. But of course, that still meant getting to New York. There were two kitties that I know of that got surgery done at Washington State University several years ago. One had complications, the second treatment left part of the pituitary so it didn't work and that person had to subsequently do SRT. Haven't heard of any kitties having surgery at WSU since then. Years ago one was done in California but that vet doesn't do the surgery anymore. I have heard of vet surgeons volunteering to do the surgery. But as RVC (Royal Vet Clinic and the gold standard place for surgery) said, the rate of success is proportional to vet surgeon experience with that particular surgery. You don't want to be first.

If you cannot travel, your choices are radiation therapy (hopefully SRT), cabergoline, or just treating with insulin and managing the symptoms, which you would have to do anyway. SRT is also in limited locations, but it used to treat many other conditions, so growing in availability.

We do have other high dose cats here, whose people have not yet chosen to get diagnostics done. Actually, given that 1 in 4 diabetic cats have acromegaly and it doesn't always result in higher doses, there are problem a few acros people haven't even though of getting tested. Now that you know you are dealing with acromegaly, cabergoline is an option for you. And you can learn what side effects of the growth hormone to look for, and how to manage them.
 
Keskat&Rocket said:
Hi again :) I posted in your thread on the acro board too, but I just wanted to comment here on Prozinc, at least from my experience. Rocket was diagnosed diabetic in Feb of last year, and he started Prozinc. It didn't touch his numbers whatsoever; he was in high numbers constantly. Plus it seemed like it wasn't lasting long enough in his system (8-10 hrs max). Of course we didn't know until July that he had Acromegaly. He seems to do much better on Levemir, for what it's worth.
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Hi Karen, Thank you so much. Thank you for your kind words on the acro board as well. Once I talk to my vet on Saturday, I will have more questions. :bighug:
 
Wendy&Neko said:
I too posted on the acro forum, must longer than I will post here. Back in the day of Neko's diagnosis, the treatment options were radiation therapy, SRT being the best form of radiation, or treating with insulin as needed. We chose SRT, it was much cheaper then, even though it involved driving for three days each way. She handled it like a champ that time. Before that, she'd complain on short car rides, I wasn't looking forward to the long trip. But we'd had two people here get SRT around the same time as Neko's diagnosis, so I knew what to expect with the treatment.

Since then, there have been new treatment options. Other than cabergoline, the medical (drug) choices are way too expensive. The only ones who have done it have done is part of a research study by Royal Veterinary Clinic, where the drug was donated by the drug company. There haven't been many people in the US do the surgery, and most of those did it back when AMC in New York had a sizable donation paid for the majority of the costs. But of course, that still meant getting to New York. There were two kitties that I know of that got surgery done at Washington State University several years ago. One had complications, the second treatment left part of the pituitary so it didn't work and that person had to subsequently do SRT. Haven't heard of any kitties having surgery at WSU since then. Years ago one was done in California but that vet doesn't do the surgery anymore. I have heard of vet surgeons volunteering to do the surgery. But as RVC (Royal Vet Clinic and the gold standard place for surgery) said, the rate of success is proportional to vet surgeon experience with that particular surgery. You don't want to be first.

If you cannot travel, your choices are radiation therapy (hopefully SRT), cabergoline, or just treating with insulin and managing the symptoms, which you would have to do anyway. SRT is also in limited locations, but it used to treat many other conditions, so growing in availability.

We do have other high dose cats here, whose people have not yet chosen to get diagnostics done. Actually, given that 1 in 4 diabetic cats have acromegaly and it doesn't always result in higher doses, there are problem a few acros people haven't even though of getting tested. Now that you know you are dealing with acromegaly, cabergoline is an option for you. And you can learn what side effects of the growth hormone to look for, and how to manage them.
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Thank you so much for your messages, Wendy. You are invaluable. Once I talk to my vet, I will update you and I am sure I will have more questions. I mentioned the medicine to here while he was getting tested, and she seemed unfamiliar. She seems kind enough in that she would look into it for me. She made mention that she would be open to exploring if he tested positive. I know she is very busy, so hopefully it wouldn’t require much research on her part.

Thank you thank you again :bighug:
 
The cabergoline post I linked in the acro forum has a link to a paper on a cabergoline study in South America. Printing that off may help her come up to speed.
 
One thing I just thought of -- have you considered switching to a human meter? I used to use the AlphaTrak also, but the strips are 5x (!!!) the cost of the human meter. I use the Relion Prime now (Walmart), and have found it to be very reliable. The "take action" numbers are a little different, but once you get used to it, it's fine. Your vet may not agree with using a human meter, but you can always do a curve once in a while on the AT for the vet. You can save soooooo much money this way!
 
@Stressedcatmom .

So sorry to hear the acro dx. You now know why the insulin isn't working.

I can't speak for any other person or cat, only me and Ollie in dealing with it.

When I found out about Ollie, I was actually relieved because it explain so much. My whole way of thinking about FD changed. It became a matter of keeping her comfortable, managing symptoms, and getting the glucoses under control (ongoing) which meant with Wendy's help, went a little faster than TR.

Tx options Wendy has already mentioned. For me and varying reasons, radiation was to costly. The one medication (I can't spell it) at the time cost $13k a month, definitely out of the question. I truly considered the removal. AMC in NY had a grant that paid for the surgery and hospitalization. Did not cover post MRI or the lifetime meds post op. I talked to surgeon a couple of times. Followed 2 who just went through it. I decided it was not in Ollie's best interest. So that left cabergoline or no treatment. I am not expecting remission of diabetes. My only goal is to keep the symptoms limited and Ollie comfortable.

Ollie's original vet would not try it. He was told by specialist not to waste my money because it won't work. It took 3 more vets and 4 months to find a new vet willing to try.

Ollie was miserable and had trouble breathing, walking (not neuropathy), pain everywhere. Found a vet willing to try cabergoline as it was basically her only option and side effects were negligible. I said I would give it one year, if it didn't help we would stop. We just past the 1 yr mark, and staying on it.

I get it compounded. She started at 0.6 ml once a day. In 10 days it started to help. Insulin came down, symptoms subsided. But like anything it didn't go forward. It stalled out, symptoms came back.

Vet and I decided to try something not in any study. Slowly increase cabergoline dose. So when her stidor (indicator I use) came back and stay for one week dose was increased 0.05 ml. Did it over time and slowly. She has been holding steady at 0.84 ml for few months. There have been ups and downs, other problems but I think her acro for now is stable. She has recently (over xmas) had some reducies back to back. I am so glad I tried it. Ollie is a different cat. She is more like a cat and not just a blob rolling on the floor in discomfort. She has her moments of kittenish but mostly normal for that of an older cat.

You have a lot to think about, a lot to talk over with the vet. Don't be afraid to try it if you can. Good luck.I

ETA. Switch over to lev as soon as you can. Lantus will sting at the dose your on now. You will probably have to really convince the vet, and be told it's to strong. But you have an acro now and strong is needed. Tell them yes you know it is but it will be a lesser dose and leave it at that (they don't have to know otherwise). Their are plenty here who use it. As long as you are testing it will be fine.
 
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So sorry about the diagnosis, but glad you have answers. Some acro cats here were on very high doses but earned reductions too and are now on very low doses. Levemir sounds like a good option to start with :bighug:
 
Keskat&Rocket said:
One thing I just thought of -- have you considered switching to a human meter? I used to use the AlphaTrak also, but the strips are 5x (!!!) the cost of the human meter. I use the Relion Prime now (Walmart), and have found it to be very reliable. The "take action" numbers are a little different, but once you get used to it, it's fine. Your vet may not agree with using a human meter, but you can always do a curve once in a while on the AT for the vet. You can save soooooo much money this way!
Click to expand...
I have, but there is so much else going on, I’m not sure I can deal with it right now. Maybe when the dust settles
 
Olive & Paula said:
@Stressedcatmom .

So sorry to hear the acro dx. You now know why the insulin isn't working.

I can't speak for any other person or cat, only me and Ollie in dealing with it.

When I found out about Ollie, I was actually relieved because it explain so much. My whole way of thinking about FD changed. It became a matter of keeping her comfortable, managing symptoms, and getting the glucoses under control (ongoing) which meant with Wendy's help, went a little faster than TR.

Tx options Wendy has already mentioned. For me and varying reasons, radiation was to costly. The one medication (I can't spell it) at the time cost $13k a month, definitely out of the question. I truly considered the removal. AMC in NY had a grant that paid for the surgery and hospitalization. Did not cover post MRI or the lifetime meds post op. I talked to surgeon a couple of times. Followed 2 who just went through it. I decided it was not in Ollie's best interest. So that left cabergoline or no treatment. I am not expecting remission of diabetes. My only goal is to keep the symptoms limited and Ollie comfortable.

Ollie's original vet would not try it. He was told by specialist not to waste my money because it won't work. It took 3 more vets and 4 months to find a new vet willing to try.

Ollie was miserable and had trouble breathing, walking (not neuropathy), pain everywhere. Found a vet willing to try cabergoline as it was basically her only option and side effects were negligible. I said I would give it one year, if it didn't help we would stop. We just past the 1 yr mark, and staying on it.

I get it compounded. She started at 0.6 ml once a day. In 10 days it started to help. Insulin came down, symptoms subsided. But like anything it didn't go forward. It stalled out, symptoms came back.

Vet and I decided to try something not in any study. Slowly increase cabergoline dose. So when her stidor (indicator I use) came back and stay for one week dose was increased 0.05 ml. Did it over time and slowly. She has been holding steady at 0.84 ml for few months. There have been ups and downs, other problems but I think her acro for now is stable. She has recently (over xmas) had some reducies back to back. I am so glad I tried it. Ollie is a different cat. She is more like a cat and not just a blob rolling on the floor in discomfort. She has her moments of kittenish but mostly normal for that of an older cat.

You have a lot to think about, a lot to talk over with the vet. Don't be afraid to try it if you can. Good luck.I

ETA. Switch over to lev as soon as you can. Lantus will sting at the dose your on now. You will probably have to really convince the vet, and be told it's to strong. But you have an acro now and strong is needed. Tell them yes you know it is but it will be a lesser dose and leave it at that (they don't have to know otherwise). Their are plenty here who use it. As long as you are testing it will be fine.
Click to expand...
Thank you so much for this. I’m going to ask for levimir, but I go Bk to wk on Monday, so I’m not sure if I should start it... or if I should stay with Lantus for a bit. He is bouncing today, or maybe had a fur shot last night. @Wendy&Neko (and anyone else) do you think I should start levimir when I am unable to monitor am cycles until fri-sun. Should I stick w Lantus and hold off for a while? I still have a new vial of prozinc... my Lantus pen is almost empty, so not sure if I should refill that or switch. The vet is supposed to call me later today

THANK YOU
 
I would not go back to prozinc. I would finish the lantus you have then start the lev. Depending on how fast or where you get the lev, you might have to purchase another lantus pen. As to when to start I really can't say.
 
You could always switch to Levemir on a Friday night. If kitty shows a marked reaction to the switch, it’ll be the first couple cycles. Did you get the IAA test done too? IAA kitties often have a marked reaction - new insulin seems to fool the antibodies at first.
 
Wendy&Neko said:
You could always switch to Levemir on a Friday night. If kitty shows a marked reaction to the switch, it’ll be the first couple cycles. Did you get the IAA test done too? IAA kitties often have a marked reaction - new insulin seems to fool the antibodies at first.
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No, I didn’t. I asked about it but she initially said it was really rare. Then when i called back to have it added, she told me they would need a fresh new sample. His blood had to be frozen for the acro test because of the holidays
 
Wendy&Neko said:
You could always switch to Levemir on a Friday night. If kitty shows a marked reaction to the switch, it’ll be the first couple cycles. Did you get the IAA test done too? IAA kitties often have a marked reaction - new insulin seems to fool the antibodies at first.
Click to expand...
Sounds good. I would be more comfortable. But I don’t have enough Lantus to get me to Friday. I suppose I can buy a new vial and start lev once the vial is done. I’m not sure I can sell it to apply closet since it would be used, so I’m assuming if I get a new vial I should finish it
 
Can you just buy one pen instead of vial?

When you get lev, ask for script and send to marks marine. The pens (5 to a box) are more economical. Total amount you get is 15 ml vs 10 ml in the vial. If you should drop one, it won't break. You will always have a fresh pen should something happen to one your using. With the dose your on, you will go through a pen quickly. So if at all possible I found it best to order 2 boxes the first time (but thats pricey) then when I open the 2nd box I place order for another box, so now I always have 2 in the fridge. One pen at 5.75 - 6 units per shot last 3 1/2 weeks. You don't need the needles that go with it. You will continue to use syringes just like you do with a vial.
 
Update: the vet said she follows/knows some person who said the medicine didn’t work. I think this person has done studies on feline diabetes/acro or serves on some board. I told her it worked for some cats on the here, and I wanted to try it anyway. She said she would ask around.

I was at a birthday dinner when she called, so I could barely hear her. She is going to get in touch with me after she researches
 
Olive & Paula said:
Can you just buy one pen instead of vial?

When you get lev, ask for script and send to marks marine. The pens (5 to a box) are more economical. Total amount you get is 15 ml vs 10 ml in the vial. If you should drop one, it won't break. You will always have a fresh pen should something happen to one your using. With the dose your on, you will go through a pen quickly. So if at all possible I found it best to order 2 boxes the first time (but thats pricey) then when I open the 2nd box I place order for another box, so now I always have 2 in the fridge. One pen at 5.75 - 6 units per shot last 3 1/2 weeks. You don't need the needles that go with it. You will continue to use syringes just like you do with a vial.
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I use the pens. I meant pen instead of vial. I found another pen that I might be able to stretch till Friday. I have to ask the vet for a script yet. I think she was annoyed with me for not wanting to use the prozinc I bought.
 
Stressedcatmom said:
Update: the vet said she follows/knows some person who said the medicine didn’t work. I think this person has done studies on feline diabetes/acro or serves on some board. I told her it worked for some cats on the here, and I wanted to try it anyway. She said she would ask around.
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I am curious to know where this person she follows/knows works. There aren't very many places in North America that I know of that are doing studies on acromegaly. Always looking to find more. The Royal Veterinary Clinic in London didn't have great success with their trial, though honestly, their trial had less cats than have tried it here. The RVC pushes pasireotide instead, but as I mentioned before, no one can afford. Get your vet to look up the costs of Novartis Signifor LAR (brand name), that ought to convince her it's not a viable option. People can actually afford cabergoline. The South American study on cabergoline had better results. FYI - a human study using treatment of cabergoline for acromegaly.
 
pasireotide that's the one that cost 13k a month in the states.

I went through the same thing with vets trying to get it (cabergoline). If you want to try it. I think you need to strongly but nicely tell them you want to try. I told Ollie's vet it was Ollie's only option at this point. I warned her ahead of time I can be overbearing and demanding in what I want unless she can give a good argument otherwise. She said she could be the same way and let me know when I reach that point. After 4 vet refusals, I don't think I was to tactful but not nasty. I do not expect remission, I just want to hopefully have the symptoms subsided so she is more comfortable. That we have nothing to lose, but everything to gain. If it didn't help then we stop and let things be.

Ask your vet what she expects from it. The tumor will always be there (unless removed). Cabergoline will not kill it, remove it or stop it. It will help it secrete less over time. But there will always be times it can be active (Wendy calls it pulsing). I think of it as; It's not a cure, it's a medicine to help control it.

The practice had me sign some waivers which I gladly did. It was to release them of liability in using the cabergoline. They also wanted fructosmine levels regularly as it was the vets only way to measure effectiveness (they only did the initial one). Vet decided my testing was enough. She also knows I don't follow their every word and instruction, yet knows I will call to ask or tell them when I have a concern or question (except on insulin dose) on anything.

When we started it, my vet was willing to talk to others about it (I think there were 2 others here thinking about it but their vets were giving a hard time). I'm sure she would still talk with others.

The only reported side effect is GI upset that lasts about 3 days and resolved on its own. Ollie did not have any. However, I did start probiotic while waiting for it to arrive.

Pamela & Amethyst have been on it longer than Ollie. Their strength (it comes in different strengths) is also stronger than Ollie's is.

There is another here (can't remember who, I really need to write this stuff down) who recently started it. They have seen a decrease in symptoms I think after 3 weeks.

I'm all for it. I wish I would have started it earlier and not be complacent and drag my feet.

I get it from Wedgwood, in almond oil based. It costs $127.50 and that includes shipping. My vet calls in higher dose, so we have room to increase and lasts me 30-33 days.

If you want to try it, all I can say is fight your hardest to find someone willing to try with you. Like I said Yoshi has everything to gain.
 
Thank you for this. I was going to follow up with her via email today. I found some Lantus in my fridge that will get me to Friday. I'm going to ask that she write a script for Levimir that I can start on Friday. When I talked to her last, I told her I needed a new Lantus pen and I didn't want to start on Levimir during the week. That has changed now that I found some. ***I just realized this makes no sense. Anyway, I am going to start Levimir when I can monitor this weekend. I'm scared to switch to be honest.

@Wendy&Neko -- I am going to ask who she is getting her advice from.

I feel scared to contact her, she seemed slightly annoyed with me. I will anyway. Yoshi seems fine. The only symptom I see is his breathing. It's not labored, he kinda just sounds like a piegon when he purrs. He's had that for a while though. I really hope he stays with me for a while. I couldn't bear to lose him with all that is going on in my life right now. I am tearing up as I write this. I love him SO MUCH.

I will keep you posted on what she says. I am also scared to try something that the vet doesn't advocate, but if it has helped other cats, I want to help my Yosh.
 
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Wendy&Neko said:
Yoshi is counting on you to fight for what is best for him. I know you will do a good job at it. :bighug: My mantra was "it's all about the cat", not vet egos. Have you ever asked the vet how many acros she's treated?
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Thanks Wendy :bighug: I haven't asked her. That is a good question. She is a new vet, so I've only met her once and had that weird phone call. I will ask once I talk to her.
 
Hi Jennifer, I can imagine how stressful this diagnosis is for you. But consider how much excellent help and experience you have available right here on the board. Don't be concerned about switching to Lev. It is an excellent insulin and has the advantage of "kicking in" later in the cycle than Lantus. This gives you extra time to see what is happening and to plan your days.

Sending you lots of :bighug::bighug::bighug:s and Yoshi lots of scritches.
 
Hi everyone,

I am so sorry I have been absent. It is the first week of school and I have been incessantly busy. And I hadn't heard from the vet. She emailed me tonight, and yes @Carol & Murphy, she is reasonable and kind (a HUGE difference from my previous vet). The practice is also super busy. I totally get it.

The long and short is that she is part of a veterinary consulting group. Her contact is the leading researcher of feline acro at RVC. He helped found the clinic and is the author of the papers into cab use in acro cats. His studies indicated that it doesn't help. She went as so far as to contact him to see if any current studies were being conducted; he has a PhD student that is doing a study on acro and cab use in cats and they haven't seen improvement in the patients. I'm not sure if they are deeming these results based on the tumor shrinking (I know that won't happen) or the lessening of the symptoms. I will ask.

**Yoshi is running around the house currently and you wouldn't bet your paycheck that he was sick. 200 pms (I will update spreadsheet soon) which for him is pretty awesome. He's been largely in yellows in I'm guessing some blues at nadar. Am is always red or pink. My guess is he's constantly bouncing. He clears them mostly in the same day now... Anyway...

She is open to trying cab, as it helps cats here and there (which probably include those on this board since I mentioned it to her).

She is writing me a script for Levimir, and to be honest I am so scared to start. She said to start low and re-regulate. I feel like Yoshi is pretty regulated on Lantus (below renal threshold, I think, mostly) and I am scared to make a bad situation worse. I need advice on how much to start with. We have been holding steady on 7.5 of lantus. And I've finally figured out his (late) nadar and bounce habits and I'm scared new insulin will throw us for a loop. He IS FOR SURE getting surly with his shots, which he never used to. I think sometimes it burns, and sometimes it doesn't, but its like Pavlov once I put the needle in, he meows and fusses.

I think an insulin switch is first, and I will likely try cab, but I am also scared because I'm not home during the day. I'm literally gone 11 hours and I'm scared if I start the cab this semester I will have unwanted surprises. I'm off for the summer come April, I wonder if I should wait until then?

@Wendy&Neko @Olive & Paula @Keskat&Rocket I meant to tag you since I promised I'd follow up.
THANK YOU
 
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:bighug::bighug::bighug::bighug:

I wouldn't start low again on Levemir. It's usually recommended to start a little lower at 70% of the current Lantus dose (which is what I did) but I had to go back up anyway. I think we were at the same amount of insulin as Yoshi before I switched to Lev.

But you can pretty much go 1:1 when switching insulins if you can monitor and are prepared.

Now we're at 5 units of Lev today!

The acro experts will be along soon to give you better advice and support!!
 
Crista & Ming said:
:bighug::bighug::bighug::bighug:

I wouldn't start low again on Levemir. It's usually recommended to start a little lower at 70% of the current Lantus dose (which is what I did) but I had to go back up anyway. I think we were at the same amount of insulin as Yoshi before I switched to Lev.

But you can pretty much go 1:1 when switching insulins if you can monitor and are prepared.

Now we're at 5 units of Lev today!

The acro experts will be along soon to give you better advice and support!!
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Congrats on the lower dose!!
 
You do start lev at a lower dose. Ollie was on 8 units and we started lev at 5.25 units. She was pretty much 300-400s. Started seeing the blues when we hit 6 units.

A lot of kitties will reach the same dose your on and go higher. Ollie went up to 9 units. If stayed on lantus her dose would have been even higher.

When you switch, you will still see the high numbers as the lantus depletes and the lev depot builds.

You will be fine.
 
Could you start a new post next time? This is getting a little long and I almost didn't take a look here. For some reason didn't get the tag.

Yoshi is less than half the time below renal threshold, you want him mid yellows and lower most of the time.

Starting Lev dose at 70% would be 5.25 units. Without knowing if he is IAA or not (sigh!), best to start there and work your way up. Chances are he will need a similar Lev dose to Lantus or at least closer. But if there is IAA there is often a "dramatic" response as the antibodies get initially confused by the new insulin, but best be safe with the lower dose to start.

I (and a couple others from here) was in discussion with Chris Scutter of RVC in 2016, the PhD student then and now graduated, about cabergoline. He was just starting the trial then. He knows we had a cat here go OTJ and he used that information in one of his presentations on cabergoline. Dr. Niessen, the lead acro researcher, sadly no longer at RVC, did not participate in the South American cabergoline study, a paper that was published before their results.

From what I heard from Chris, the goal of the study was to see if cabergoline reduced the output of IGF-1. It did not, hence considered a fail. However, it did seem to reduce GH output as the symptoms were reduced and dose went down in some cats. Also note, the RVC trial only tested IGF-1 after 1 month. From experience here, it takes 10-14 days for any effects to show in the cat. Only one of six of the RVC cats showed improvement in that month. The South American study went on much longer and had better results. And it is true that not all cats see improvement on cabergoline, though it seems like the majority do. Worth a trial anyway. Been doing some reading lately, still trying to digest it all, but it may be that cats with smaller pituitary tumours do better with the medical solutions. Note, there is no correlation between IGF-1 number and size of tumour - that takes a CT scan or MRI to measure.
 
Wendy&Neko said:
Could you start a new post next time? This is getting a little long and I almost didn't take a look here. For some reason didn't get the tag.

Yoshi is less than half the time below renal threshold, you want him mid yellows and lower most of the time.

Starting Lev dose at 70% would be 5.25 units. Without knowing if he is IAA or not (sigh!), best to start there and work your way up. Chances are he will need a similar Lev dose to Lantus or at least closer. But if there is IAA there is often a "dramatic" response as the antibodies get initially confused by the new insulin, but best be safe with the lower dose to start.

I (and a couple others from here) was in discussion with Chris Scutter of RVC in 2016, the PhD student then and now graduated, about cabergoline. He was just starting the trial then. He knows we had a cat here go OTJ and he used that information in one of his presentations on cabergoline. Dr. Niessen, the lead acro researcher, sadly no longer at RVC, did not participate in the South American cabergoline study, a paper that was published before their results.

From what I heard from Chris, the goal of the study was to see if cabergoline reduced the output of IGF-1. It did not, hence considered a fail. However, it did seem to reduce GH output as the symptoms were reduced and dose went down in some cats. Also note, the RVC trial only tested IGF-1 after 1 month. From experience here, it takes 10-14 days for any effects to show in the cat. Only one of six of the RVC cats showed improvement in that month. The South American study went on much longer and had better results. And it is true that not all cats see improvement on cabergoline, though it seems like the majority do. Worth a trial anyway. Been doing some reading lately, still trying to digest it all, but it may be that cats with smaller pituitary tumours do better with the medical solutions. Note, there is no correlation between IGF-1 number and size of tumour - that takes a CT scan or MRI to measure.
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Sorry @Wendy&Neko I didn't see your response here. I'm not getting many notifications. I just posted asking for dose help. I will try and delete it.
 
You are getting a lot of good advice. Some of us have been through the more expensive options. I think you have some good options to explore. And other noted, that many people just treat with insulin.

I would suggest looking at inexpensive suppliers. As the insulin usage goes up, you will be spending more. I used to get levemir from Alan in the Supply Closet subforum. Very reliable. Others have used the Canadian supplier.

Hugs to you and your sweet kitteh. Acro can be challenging. You are doing the best you can for Yoshi.:bighug::bighug::bighug:
 
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