5/24 newly diagnosed

[Malcolm & Heidi]

Hi. My cat Malcolm was finally diagnosed with Acromelegy. I'm currently waiting on his cabergoline prescription. I'm just concerned it's too late. He seems to be confused and has mobility issues and possibly some vision loss. Is this something that happens with a acromelegy diagnosis?

 

[Wendy&Neko]

Sorry for the diagnosis, but glad that you are going to start him on cabergoline.

What side effects a kitty see varies a lot. Quite a few cats have hardly any symptoms, some more. Has he been checked for arthritis? That's quite common in acros and can impact mobility. Neko's was quite bad and I had to give her some things to help.

Given how recently he was diagnosed with diabetes, I'd be surprised to see vision loss already. In what ways does he seem confused?

 

[Malcolm & Heidi]

He had been checked and diagnosed with arthritis. He's had two shots so far of solensia. (Just had the most recent shot on Monday of this week)
He's just not himself. He got stuck behind my tv console the other day and today he got stuck in between the wall and the refrigerator. Unfortunately I wasn't home when that happened and I heard scratching coming from the kitchen when I got home and found him there. He was in distress and was panting when I got him out. He also peed right outside of the litter box today. Yesterday he was just standing in his litter box with his head resting up against the wall. I expressed his bladder for him. I took him to the vet yesterday because I was concerned about his vision and was worried his blood pressure was high (it was normal) The vet attributed his issues with his acromelgy since his results were >1200. I fear it's too late for the meds, but I'm still going to try them.

 

[Wendy&Neko]

The vet attributed his issues with his acromelgy since his results were >1200.

The IGF-1 number has no correlation to the size of the tumour. MSU has changed their reference range units lately, but back in Neko's day, positive was over 92. She tested at 440 for her IGF-1 number. A couple weeks before she went to CSU for radiation therapy, a couple other kitties from FDMB went to CSU. Both of them had IGF-1 in the 200's. On CT scan, their tumours were a lot larger than Neko's. I asked the acro experts there, and they said the IGF-1 number had no correlation to tumour size. It's the tumour getting large and pressing on the optic chiasm (near the pituitary) that can cause vision issues. But that's something that's been very rarely seen here.

Cabergoline was found in research to work best in cats with smaller tumours, but we've also seen cats on much larger doses than Malcolm see a lot of improvement. Without the expensive CT scan, you can't really say how large the tumour is. Not worth getting the scan done.

Good to hear his BP was normal - that can be a concern in some acros.

Some acros are thought to possibly get headaches - human acros do. You might want to see if pain relief would help him, buprenorphine or gabapentin.

 

[Malcolm & Heidi]

Good to know. I wasn't sure what that number meant. Both vets i went to seemed to think it was very high number, so I thought that meant his tumor was large. But as you said there's no way to know other than a CT scan. I will ask my vet about the pain medications.
I haven't received the cabergoline yet. The compounding pharmacy called today and they are preparing it. About how long does that take? And is there a typical starting dose? How long does it take before it has an effect?

 

[Malcolm & Heidi]

Also, what does it mean that his IGF-1 result was >1200 H?

 

[Wendy&Neko]

At MSU, above 916 is positive with the new reference ranges, but I don't know how high they measure. I guess he was above 1200. As I said, until this year, the maximum for normal was below 92, so the new reference ranges make it look much higher.

Cabergoline was to late for Neko. I don't know how long it takes to make and ship, and may depend on the compounding pharmacy. Some people might talk about it in this post:
Cabergoline as a possible treatment for acrocats: discussion
I believe the normal dose is 10 µg/Kg of cat per day or every other day.

How long does it take before it has an effect?

Very much ECID. I've seen a couple cats go into remisison with 7-10 days of starting cabergoline to some cats taking a few months before there was an impact on dose. One of the important effects of cabergoline seems to be reducing the acro side effects, one of which is insulin dose.

 

[JL and Chip]

He's had two shots so far of solensia. (Just had the most recent shot on Monday of this week)

I’ve heard of a number of cats who have weird symptoms after Solensia. My cat was one of them. It might be totally coincidental, but I’d at least keep it in mind. My cat returned to normal over a couple of weeks and never had another Solensia shot. The symptoms haven’t recurred.

 

[Malcolm & Heidi]

I’ve heard of a number of cats who have weird symptoms after Solensia. My cat was one of them. It might be totally coincidental, but I’d at least keep it in mind. My cat returned to normal over a couple of weeks and never had another Solensia shot. The symptoms haven’t recurred.

 

[Malcolm & Heidi]

I actually wondered about that about the solensia shot. I looked up side effects, but none were what he was experiencing. He didn't have any symptoms the first dose. But I did get it at a different vet, not sure if that matters though. He acted off and different than he has ever acted the next day after he had the shot, and everday since. I got it on Monday, today is saturday. He seem a bit better, but still off. What symptoms did your cat have?

 

[JL and Chip]

What symptoms did your cat have?

He was very unsettled, I’d almost say distressed, and more vocal than usual (in an upset sort of way). He also seemed like his mentation was altered, like he was confused or discombobulated and didn’t quite know where he was. It was so dramatic that it scared me…I actually wondered if he’d had a stroke or a seizure or was partly blind.

Since then, I’ve heard other anecdotal stories, including cats getting stuck in corners and circling and having seizure-like activity. Almost always when I hear these “mystery” events, my first question is “did the cat have Solensia?” So far the answer has always been yes. It doesn’t prove anything, but it does make me wonder. That seems awfully coincidental, but who knows.

Anyway, you have to dig a bit deep on the internet to find symptoms than what the manufacturer lists. One interesting read that talked about the history of the drug is:

https://vetspace.2ndchance.info/solensia-a-new-approaches-to-arthritis-pain-in-cats/?amp=1

and the corresponding Cat Owner Feedback page (the bottom-most post on the page is purportedly from a scientist from Arizona and is interesting food for thought):
https://vetspace.2ndchance.info/the-cat-owner-solensia-feedback-page/?amp=1

 

[Malcolm & Heidi]

He was very unsettled, I’d almost say distressed, and more vocal than usual (in an upset sort of way). He also seemed like his mentation was altered, like he was confused or discombobulated and didn’t quite know where he was. It was so dramatic that it scared me…I actually wondered if he’d had a stroke or a seizure or was partly blind.

Since then, I’ve heard other anecdotal stories, including cats getting stuck in corners and circling and having seizure-like activity. Almost always when I hear these “mystery” events, my first question is “did the cat have Solensia?” So far the answer has always been yes. It doesn’t prove anything, but it does make me wonder. That seems awfully coincidental, but who knows.

Anyway, you have to dig a bit deep on the internet to find symptoms than what the manufacturer lists. One interesting read that talked about the history of the drug is:

https://vetspace.2ndchance.info/solensia-a-new-approaches-to-arthritis-pain-in-cats/?amp=1

and the corresponding Cat Owner Feedback page (the bottom-most post on the page is purportedly from a scientist from Arizona and is interesting food for thought):
https://vetspace.2ndchance.info/the-cat-owner-solensia-feedback-page/?amp=1

Thank you for responding. My cat had similar effects the day after the shot. He seemed out of it and would just stand in one place and not move at all. Or he'd stand and stare at a wall. His pupils were very dilated and he seemed as though he was blind too. I was worried so I brought him back into the vet to have his blood pressure checked but it's came back normal. Another thing happened where I couldn't find him and he was stuck behind my tv console. Then, the next day, I went out for a few hours and came home to a scratching sound in the kitchen. He was stuck between the wall and the fridge and when I go him out, he was breathing heavily and panting. He was in distress. And now I'm wondering if he had a seizure. He has also peed right outside his litter box, something he has never done before. I went down a rabbit hole last night and read of similar experiences after the shot, and now your story as well. I was attributing all of his symptoms with his acromelagy, since the vet also told me it was likely due to his tumor. Now I truly believe it's because of the solensia. He seems better today, but I do worry he's going to have lasting effects. Did your cat have lasting effects? And how many shots did you give your cat? My cat has had two so far. But I will not give it to him again after this. Thank you for letting me know about your experience and directing me to more information on it. It seems to be scarily common.

 

[Renee2602]

Hi Malcolm and Heidi. I thought I'd reply, not with advice but just to say you aren't alone and it would be great to communicate our experiences as we go through this. We are looking into cabergoline, I'm not sure how quickly I can get in as I'm in Melbourne Australia. Oscar has a pituitary adenoma that is really big and we are doing palliative care. Unfortunately he has similar symptoms to what Malcolm has - which is Oscar shows ataxia - basically slowed movements, poor balance and coordination, personality and behaviour changes, cognitive issues, and vision loss. We only picked up the tumour on a CT scan after these changes became apparent, he had no diabetes. Once the pituitary tumour keeps growing and gets large enough, the brain starts to become inflamed and there's only so much space for it due to the skull. So this results in the frontal lobe functions also being impacted which is where learned behaviours, mentation, personality, balance etc occur. The actual tumour position impacts things as well - the pituitary gland is close to the cerebellum which controls motor coordination and balance, and it is also close to the optic chiasm, so once it grows big enough unfortunately it impacts functioning of those areas. Oscar is on 12.5mg prednisolone daily to decrease the brain inflammation but this has caused diabetes and neuropathy. But it is meant to help the pain, headaches, possible seizures that may come. From my understanding though, it can decrease the inflammation but not the tumour itself, so I think that is why while we have seen a reduction in Oscar showing head pain, his vision and slowed movements, has still gone downhill. I truly hope and pray that you aren't in a similar position and that the tumour is not as big yet, but I thought I would prepare you by sharing my story. Oscar was diagnosed in February and given 2-3 months to live by one vet and 3-6months by another, based on research, but of course we always hope and pray it could be years... there is very limited evidence out there on these tumours. We are now at month 3. Please keep me updated on your cabergoline journey, what you are doing for dosage, flavouring?

 

[Suzanne & Darcy]

I’ve heard of a number of cats who have weird symptoms after Solensia. My cat was one of them. It might be totally coincidental, but I’d at least keep it in mind. My cat returned to normal over a couple of weeks and never had another Solensia shot. The symptoms haven’t recurred.

Thank you for responding. My cat had similar effects the day after the shot. He seemed out of it and would just stand in one place and not move at all. Or he'd stand and stare at a wall. His pupils were very dilated and he seemed as though he was blind too. I was worried so I brought him back into the vet to have his blood pressure checked but it's came back normal. Another thing happened where I couldn't find him and he was stuck behind my tv console. Then, the next day, I went out for a few hours and came home to a scratching sound in the kitchen. He was stuck between the wall and the fridge and when I go him out, he was breathing heavily and panting. He was in distress. And now I'm wondering if he had a seizure. He has also peed right outside his litter box, something he has never done before. I went down a rabbit hole last night and read of similar experiences after the shot, and now your story as well. I was attributing all of his symptoms with his acromelagy, since the vet also told me it was likely due to his tumor. Now I truly believe it's because of the solensia. He seems better today, but I do worry he's going to have lasting effects. Did your cat have lasting effects? And how many shots did you give your cat? My cat has had two so far. But I will not give it to him again after this. Thank you for letting me know about your experience and directing me to more information on it. It seems to be scarily common.

My cat had a few Solensia injections, but after due consideration and talking with @JL and Chip and having had a friend’s acromegaly cat on this Board who had very serious problems after (I say after, we can’t prove the cause) receiving Solensia injections— I decided to stop Solensia and just to use Adequan. We have had good results with Adequan for her arthritis. Having said that, my cat Sheba who is now receiving Adequan injections (but formerly was receiving Solensia injections) is not an Acrocat.

 

[SmallestSparrow]

All of the symptoms you mention are listed as potential side effects under prescribing information on solensia. That said they’re sort of common symptoms so I can’t say for sure it’s solensia since your kitty has other issues, but I’d still be suspicious.
I’m not a veterinarian, the species I treat walks upright on two legs, but I’m actually sort of surprised neurologic/behavioral factors aren’t found more frequently. Solensia is an immunobiologic, a monoclonal antibody that binds to NGF (nerve growth factor) to block NGF effects. It’s used because of the high levels of NGF in cat osteoarthritic joints. Which is good. Here is where you need to recall I treat man not beast: in the species I treat NGF is sort of important —plays a role in cholinergic pathways in the brain and is being researched as a treatment for Alzheimer’s
but I don’t treat cats nor do I know their neuroanatomy and physiology. Perhaps it’s not the same in cats.