Valentino Update & Questions

Hi all,

I am really thinking about SRT for Valentino and pretty much made up my mind before his echocardiogram showed "mild thickening" of left ventricle in his heart. My vet said that it shouldn't disqualify him from treatment and that with successful treatment for acromegaly it might actually reverse.

The SRT would be a catscan and then three consecutive days the following week. Is this dangerous or risky now? Seems like 4 anesthesia episodes could be bad. What have your experiences been?

Tillie

 

@JeffJ what do you think?

 

Was the echocardiogram viewed by a cardiology vet? Neko also had mild thickening of her left ventricle (mild HCM) when she went for SRT. The thickening did not reverse after SRT. The most common SRT is 4 days of anaesthesia, though some places are doing just two. Which was what Neko had for her second SRT. Her tumour started growing back after 3 years. It isn't common. She was the first cat to have a repeat SRT.

 

hi Wendy,

Yes it was sent to a cardiologist at Texas A & M who mentioned that about it possibly resolving. I guess he is still cleared for the treatment but I am nervous about that with his age and this underlying heart problem. Somehow the 2 sessions seems so much better to me but not sure if they are offering that around here.

I was also wondering about doing a quick trial (3-4 weeks) of cabergoline first to see if that would help...as that would be the least invasive treatment it would seem.Of course there's probably only a small chance of it helping. Do you think waiting til after the holidays is too long to wait for the SRT? And try the cabergoline in the meantime?

 

It is reassuring to hear that your Neko had a similar condition and that the treatment went so well though!

 

The second SRT treatment, went not so well. During her anaesthesia for the CT scan, she had a heart block. They managed to get her to recover with help of a cardiologist vet. And she ended up only having 1 session of radiation after that. That was her last anaesthesia, ever.

Not sure of the value of doing a short term trial of cabergoline. Some cats take a couple months to respond to it, though some as soon as 10 days after starting it. Unless you were thinking of seeing how it went then deciding to cancel the SRT if cabergoline worked well.

 

Thank you for sharing her experience. Yes, on the off chance he might be a responder I thought I could see if he was and it worked relatively quickly. Seems like doing it too close to the holidays could be bad anyway, because vets might be off if I need to speak to them.

 

Waiting a month to do SRT would be fine. Just not sure that's enough time for a proper cabergoline trial. Here is Moe's SS, he started cabergoline mid June and it took just under 2 months to see the impact. If you did a month trial and didn't see a reaction, you won't know if it's because you didn't wait long enough.

 

Leo did not have any heart issues before (or after) SRT. So I don't have experience there. If your cardiologist vet cleared Valentino, they probably have a lot of experience in that area.

Wendy is right on cabergoline. A 2 month trial would be more measurable. You could try the cabergoline now, and then evaluate in 2 months. It sounds like A&M (College Station) now has SRT, unless there is some facility in Austin now. I sure wish that was the case in 2016 - either location would have been better than driving 2 days each direction to Colorado.

 

Thanks so much for that insight. I wasn't sure how long it would take to see a difference. I don't want to delay his treatment in any way for a more sucessful SRT and less overall complications but it might be nice to evaluate that first.

 

Thanks Jeff. I think that might be a reasonable path to take, as long as that delay doesn't worsen his prognosis. I will have more talks with his Vet and also with the Radiation specialists. There is one place in Austin that is now doing the SRT with 3 doses plus a catscan. It is VCA Capital Area Veterinary Specialists. The Dr. Treuil had some training at Colorado State and has been doing this for about 15 years since then it looks like. I want to look into whether a single SRT would work in his case and if so, where that might be offered. I think A & M does offer it.

 

Other questions... what are y'all's experience on types of Insulin? He is on Prozinc and his Vet said based on his curves it looks good for now. Also, what about mid-day feeding and does that impact the blood glucose? I am only feeding more of the low carb midday because he cries for it. His hunger seems to be about the worst sympom he has.

 

I am BIG TIME jealous. That location is on Shoal Creek in Austin, and is only a few miles from my house. Versus driving Leo to Colorado (in 2016). Just the driving and the whole car setup was very stressful on Leo. You are so lucky to have this option in Austin. I looked up the VCA (Austin) website =
https://vcahospitals.com/capital-area/departments/radiation-oncology

The SRT of catscan + 3 doses is pretty common. That is an estimate. It could be 2 - 3 doses depending on the treatment regime, such as tumor size.

 

Thanks, Jeff. I'm sorry that this wasn't an option during Leo's treatment! I guess that SRT treatment for all kinds of tumors is becoming more widespread. I am very lucky to have it so close. I wouldn't hesitate if he hadn't shown signs of cardiac hypertrophy already..now I just want to really research all my options before the treatment.

 

When Neko had just the one day of SRT, it was because of her heart. The folks at CSU reached out to University of North Carolina folks who had been doing the 1 day and learned from them what to do. She had a larger dose of radiation just the one time.

Any chance you could put your blood test data into a spreadsheet like we use here? I can't comment on insulin without it. I know that for most acro cats, they do better on Levemir than they do on Prozinc. It seems to be a bit longer lasting. As far as mid day feedings, it's always better if most of the food is before the insulin nadir. After than, the insulin effects are fading and carbs will put the brakes on even faster. I fed Neko several meals per cycle - it seemed to help the hunger. She got about three meals before nadir and one low/no carb after nadir.

 

Thanks, Wendy. His insulin was recently upped to 4 units BID Prozinc and the spreadsheet starts there, monitored with human numbers Freestyle Libre. I had read here that Levemir might be better but my vet said she thougth the Prozinc curves were looking good although not yet at the right dose. The last couple of days his daily numbers haven't been dropping during the curve very much even though I"m 99 percent sure the shot went in properly. He does eat a couple of small amounts in the morning of the same very low carb food, and I wondered if that could be influencing things.
https://docs.google.com/spreadsheet...1Hla2zkDwFYuOuNZu8v9qF60A/edit#gid=1182885903

 

The spreadsheet permissions need to be changed so that those with the link can see it.

 

Oh, sorry! I believe I fixed it.

 

I see it now, thanks. How long have you had the Libre on?

He seems to be getting not bad duration from Prozinc, though it'll become easier to tell as he gets closer to a better dose. Does the vet have an ideal range for the nadirs? My suggested goal for acros is for them to spend as much time as possible under renal threshold. Acromegaly is hard on kidneys by itself so best not to tax them more with higher numbers where the kidneys have to work harder to flush out the sugars.

I rather suspect Valentino isn't used to blues yet, and is doing what we call bouncing:
Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

 

Oh Interesting! He's had it on for almost 2 weeks...the first one didn't work the whole time so had to put a second one on... so this one has about 6 more days. I have an alpha trak I already bought but might get the Relion too. I think that could be what is happening. Does that start to lessen once they get used to a dose? Oh, I see that it might clear after 3 days, let's hope!

 

I mainly use Levemir since my firts aero cat, MurrFee came to me already being on Levemir. I get a flatter curve than Lantus. I tried ProZinc on my Badger and that was worse than Lantus and Levemir.

Based on the BG you got today I say you need an increase. With my current aero cat, Snuffles, (and MurrFee too) frequent dose increases are required.

 

Thanks so much for your input on this, everyone. This board is amazing and it's so helpful to read all of your posts to see what type of issues you have had to address with acromegalic cats.

 

With Prozinc, we typically wait 3 days/6 cycles before increasing. If you don't see better numbers tonight, you'd go to 4.25 units tomorrow.

Tagging @JanetNJ Who has stayed on Prozinc with her kitty. You can look to see what her kitty's spreadsheet looks like. I can show you some for people on Levemir too if interested. Not all Levemer kitties go flatter, but the majority do. There is some advantage to Prozinc if you are getting a cat treated and if that treated will make a sudden change in insulin needs. And that is the depot. The depot helps can have flatter cycles, but also stays around for several shots after a reduction. The change from SRT is not what I'd call a sudden change in insulin needs.

The "link" in your signature is not a working link.

It's starts reducing when they get more used to normal numbers. It's not related to the dose. Though a good dose will bring more normal numbers.

 

Oh, I will fix that! thank you for responding with so much great information. It seems his numbers are a bit better at night overall so far. Fingers crossed!!

 

Hi.... My cat is acro on ProZinc.

 

Interesting! I'm noticing his numbers are much better at night so far, and it could be because he's not eating at all over night. I am going to try just giving him pure boiled chicken today and see if that changes the numbers at all.

 

It looks like you are ready for an increase. Id try 4.25

 

Thanks, Janet... I am curious to see if his daytime numbers are any better today. I already gave him his 4 units this morning.

 

Hi @JanetNJ - Just watched your video on testing. That was unbelievably helpful! Loved it.

I'm learning to test Valentino as the Freestyle ran out and it is so expensive if the vet puts it on. We upped his dose to 4.5 from 4 and he had a very low blood sugar event and then now my vet prefers he stay at 4. I'm hoping to do SRT soon, so I'd like to keep him on Prozinc for now rather than switching. I think we should have done what you said and do 4.25 instead of 4.5. My vet seemed to think that even 4.25 was a little low for him. What do you think ?

 

I would try 4.25, but until you have the hang of testing is not a bad idea to do 4 until you do. I'm glad you found the video helpful.

 

Thanks, Janet, that's a really good point. I know I have not done as much testing to truly get a handle on it yet.

 

Any reason why some days Valentino gets a good drop in BGs and other days he BG drops little?
I wouod consider changing insulins. I have best luck (flatter curves) with Levemir. Also, it is supposed to sting less at high dose.

 

HI @Larry and Kitties,
Thank you for weighing in! I was wondering that myself! At first I thought it had to do with midday feedings but I've seen that pattern at night too. Just discussed switching with my vet, but since we are really hoping to do SRT very soon (just waiting on some tests), we thought we would hold off on that as it seems a bit of project to figure out new dosing, get used to different syringes, see how he responds, etc. I decided to keep it for now, knowing we can switch at some point when we know what the SRT does.