Possible acromegaly/lymphoma

pablo'smom

pablo'smom

Member
Hi everyone,

Not a great update for Pablo. He saw the specialist today and it has come down to either lymphoma or acromegaly. His kidneys, liver and spleen are all enlarged but his heart is all good. They are sending out labs to test for both and we will see what happens. The vet is leaning towards acromegaly since he isn’t having any of the symptoms of lymphoma but she said we have to rule it out with the enlarged organs just to be safe. We also switched to lantus as well. Any advice on navigating this? I’m heartbroken
 
pablo'smom said:
Hi everyone,

@pablo'smom
@pablo'smom
Not a great update for Pablo. He saw the specialist today and it has come down to either lymphoma or acromegaly. His kidneys, liver and spleen are all enlarged but his heart is all good. They are sending out labs to test for both and we will see what happens. The vet is leaning towards acromegaly since he isn’t having any of the symptoms of lymphoma but she said we have to rule it out with the enlarged organs just to be safe. We also switched to lantus as well. Any advice on navigating this? I’m heartbroken
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@pablo'smom

I'm sorry you and Pablo are going through this
I can tag a few members for you and also take a look at your spreadsheet about the dose you gave when you started with Lantus

If you switched to Lantus can you please add that and the date to your signature so members are aware of this.
Tap on your name up top then tap on signature and add that after you ended with Relion meter on your signature .

Also on your spreadsheet you need to add that up top after you have Prozinc add Lantus and the date

Can you put a blank line above the date you switched to Lantus and type Lantus and the date then highlight any color so it stands out, if you don't know how to put the blank line I can tag a member to do it for you just ask and I will tag Bhooma for you @Bandit's Mom

@pablo'smom
 
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pablo'smom said:
Hi everyone,

Not a great update for Pablo. He saw the specialist today and it has come down to either lymphoma or acromegaly. His kidneys, liver and spleen are all enlarged but his heart is all good. They are sending out labs to test for both and we will see what happens. The vet is leaning towards acromegaly since he isn’t having any of the symptoms of lymphoma but she said we have to rule it out with the enlarged organs just to be safe. We also switched to lantus as well. Any advice on navigating this? I’m heartbroken
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@Sienne and Gabby (GA)
@Wendy&Neko
@Suzanne & Darcy
 
They sent out the lab for IGF-1 to MSU and it comes back in about a week. If its elevated then they will do an MRI or CT scan I believe. For lymphoma, they took cell samples from his organs and sent it to the pathologist at UIC which takes about 2 days to come back. Prays it is acromegaly as that is much more manageable and treatable especially because they have a radiation oncologist at the specialist who is able to do radiate the mass. I'll update everything when I get home later today. Also, the vet is leaning towards acromegaly because he doesn't have any of the clinical signs of lymphoma which gives me hope but I am trying to be realistic and prepare for the worst.
 
Update: his IGF came back in the acromegaly range which we expected. He is schedule for his MRI/CT scan (they do a full brain CT then partial MRI) next Wednesday then 3 rounds of radiation the following week. The vet believes he will have a good prognosis as we caught it earlier on and he doesn’t have any heart or neuro issues. I don’t know what to expect moving forward and I’m very nervous for him. The vet told me life expectancy is a huge range depending on a ton of factors because unfortunately there isn’t a lot of data on it. I’m just hoping for any amount of time with him at this point even though he’s only 8. I hope we can prevent any further issues by treating it now and keep his heart and organ function safe.
 
I just updated his spreadsheet! Sorry it has been a LONG week between medical school and managing Pablo. I'm not sure which method I am using as his specialist wants me to up by larger doses at first because his is acro. I just put him at 7 units. Also, today a little leaked out after injection so I am thinking of splitting the dose into two separate syringes and giving 3 units and 4 units in two separate spots for his own comfort and to help him keep it in since he is so skinny from weight loss that it's hard finding good spots on him with enough skin. Also, on a positive note, his ketones have gone down a TON since starting glargine. He went from consistently sitting in the 4s-6s to 0s-1s all within days.
 
Can you add to your signature that he has had ketones and would be a good idea to put the ketones in the remarks section on your spreadsheet which I see you are doing

Definitely add acro to your signature it's important.
Hopefully the member I messaged will reply back to your post
@pablo'smom
 
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How many cats with acromegaly has your vet dealt with before? Just wondering the basis behind the recommendations for dosing. We have (unfortunately), quite a bit of experience over on the Lantus forum. I'd still hold each dose at least 6 cycles. If you can swing it (all wet food or raw), ideally the Tight Regulation protocol would be what you follow for dosing. At Pablo's size of dose, increases are by 0.5 units at a time. His dose is rather small for dose splitting, unless he's seeing some reaction to the shot - which some cats do with Lantus.

Sounds like you are all set for stereotactic radiation therapy. That's great! Can you tell me which clinic you are going to? We have a few cats here who have had it done, including Neko and twice. We had one member post on the acro forum with a post you might want to read:
Dose increase & SRT consult prep
 
Wendy&Neko said:
How many cats with acromegaly has your vet dealt with before? Just wondering the basis behind the recommendations for dosing. We have (unfortunately), quite a bit of experience over on the Lantus forum. I'd still hold each dose at least 6 cycles. If you can swing it (all wet food or raw), ideally the Tight Regulation protocol would be what you follow for dosing. At Pablo's size of dose, increases are by 0.5 units at a time. His dose is rather small for dose splitting, unless he's seeing some reaction to the shot - which some cats do with Lantus.

Sounds like you are all set for stereotactic radiation therapy. That's great! Can you tell me which clinic you are going to? We have a few cats here who have had it done, including Neko and twice. We had one member post on the acro forum with a post you might want to read:
Dose increase & SRT consult prep
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Both the internist and radiation oncologist have seen this before and have done the treatments. I'll hold the doses for 6 cycles and see how he does. He seems a little uncomfortable to the injections but still lets me give them without a struggle. I just can tell he notices when I give them now.

For the SRT I'm going to MedVet in Chicago. The radiation oncologist has done this treatment before which makes me feel better. The price is insane but thankfully pet insurance will cover most. I'm just very nervous for him to be going under 3 days in a row and I don't know what to expect for his quality of life/expectancy but I'm trying to cherish everyday I get with him in the meantime. I am grateful this is somewhat treatable at the very least.
 
When I went to CSU for SRT, they'd done over 30 of them at that point, as well as two people from here just a few weeks before hand. Neko did anaesthesia 4 days in a row first time. The CT scan session is longer, but the following sessions are quite short. Good to know they've got experience. I snooped their website, and looks like the radiation oncologist specializes in SRT and brain cancers, so all good. Cost for SRT skyrocketed from the first time Neko went. First time was less than $3000. Plus I had to pay for hotels, etc. We did have one member get it covered by pet insurance, but then the insurance company lowered what they pay for afterwards. :rolleyes:

In the post I linked above, I posted a paper on SRT by some folks at CSU, and it gives a summary of the procedure and what you might see afterwards. Neko got 4+ more years after. Some cats got less but died of completely unrelated conditions, so hard to say much about outcomes. They range all over. But I was glad I did it, her QOL was so much better for the time she had, as a result of SRT.
 
I’m sorry to read this update on Pablo. Just yesterday I was scanning my list of people I hadn’t heard from in a while and you were top of my list to contact. Then I saw this post over here.
I am very relieved that the samples were negative for lymphoma! He has a much better prognosis with the SRT. You are on the right track. Just keep up with the dose increases if necessary, per Wendy’s recommendations. Please keep us posted! Tag me so I will hopefully see. If you post on the Acro forum, I will see it. On this forum I may not, but if you tag me, I may.
 
Hi everyone, he is doing okay. His levels have been really crazy and I’m not sure why. I’m just monitoring him when I can but he’s acting normal and looks less skinny or at least I think so.
 
Can someone take a look at Pablo’s sheet and let me know what they recommend? His levels are not the best lately and I’m not sure why. He goes for his scans in 2 days then gets SRT in a week from today! I hope everything goes well as I’m so so so stressed about all of this. He is still acting normal. Crazy appetite. Running around.
 
Hold the dose for 6 cycles. If no blue by the end of that time, increase to 8.0 units. With Lantus, it can take a few cycles before you see what the dose can do. I presume he'll have to have a reduced dose the morning of his CT scan, but you should be able to get the full six cycles in before then.
 
Wendy&Neko said:
Hold the dose for 6 cycles. If no blue by the end of that time, increase to 8.0 units. With Lantus, it can take a few cycles before you see what the dose can do. I presume he'll have to have a reduced dose the morning of his CT scan, but you should be able to get the full six cycles in before then.
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Thank you! I will keep you guys updated as much as I can as having an acrokitty is SOOOO stressful. I have a lot with school this week, but I'm dropping him off in the morning on Wednesday then picking him up after class. I'm just happy knowing this hospital is very knowledgeable and has every specialist there just in case. It has already made a huge difference in care and getting answers taking him there. His regular vet is really good and sweet, but they just truly didn't know any of this and I appreciate them for referring me out.
 
Update: I’ll update his sheet tomorrow when I have the chance. It’s been one chaotic day. Pablo had his first day of SRT and it went well other than his sugar was upper 400s post anesthesia so they gave him some insulin (I don’t know the details to be honest as it was so busy with me trying to study/go to class and back and forth to the vet etc). Once he was in the 300s he came home and then he was mid 300s prePM shot. The scary part is he dropped to 130 within 5 hours and I ended up giving him a snack because he hasn’t been this low in a long time. He can’t have any more food now since he has to fast for the morning. He is acting a little weird. We came home and he was starving trying to eat everything. He calmed down after his dinner but then I noticed he kept trying to chew/eat? these little puff ball toys he has. He has never been a cat to do this and this is also when his levels dropped to 130 so I’m not sure what was going on. Also his eyes are a little watery but that could just be from the anesthesia etc. He is also the opposite of drowsy/sedated and has spent the entire day running around looking for food and yelling (this is usual for him). Hopefully tomorrow goes better with his levels.
 
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