1/19 Darcy PMPS 315, +2 333, +3 359, +4 370 KETONES 0.6!

Gave 17 L this morning with 1 unit R. The R didn't look like it pulled him down too much, but maybe it kept him from going up with his breakfast. It took about 4-5 hours before I got much downward movement on him. I'm giving him a break now for a few hours from testing. It looks like he really could take more R and/or possibly go up with his Lantus :-(

yesterday's post:
https://felinediabetes.com/FDMB/threads/2-18-darcy-pmps-352-2-5-331-3-5-338.243332/

 

I guess I'm going to reply to my own thread here since I don't know how to add anything to it once I've posted it.

I am feeling super depressed today about the Acromegaly. @Wendy&Neko your Neko had the SRT done twice, and you she still was suffering from the effects of Acro when she passed away, right? I feel so hopeless. Even if I can convince my husband to do the SRT, it seems like it may not help. Then, I am determined to start the Cabergoline (even though my vet STILL hasn't called me back about what she found out). But, am I really kidding myself... is it really going to do any good. @Howiesmom , you recently started the cabergoline, I saw on the Acro forum. I know it's only been 10 days, but do you think it has made any difference yet?

 

Nothing to add, but sending big hugs and good healing thoughts that whatever you do is effective.

 

Thank you!!

 

Next time you try R, try 1.5 units, provided he's above 300. The 17 unit depot still has to build, you may be seeing some NDW which should be over by end of day.

Acromegaly treatments and how a cat reacts really varies by cat. ECID again. Neko was one of the rare cats who've had SRT that had the tumour come back. But it took 3 years after her first SRT before it did. She was the first to have SRT a second time, though I've heard of one other since then. Neko had acromegaly for more than 5 years, I later recognized a symptom from before her diabetes diagnosis. SRT the first time gave her a lot of relief. Her quality of life was much improved. Her main symptom was arthritis. She did get early stage CKD a few years in, but the worst of the symptoms didn't show up until 4.5 years after her diabetes diagnosis. So quite a few years of a fairly good life.

At the time of Neko's diagnosis, the choices of treatment were SRT or just treat with insulin. There are a couple other acros around here who have had SRT recently, Rocket and Valentino. It's nice to have more options now. The gold standard treatment is hypophysectomy (pituitary removal) and I only know of one experienced surgeon doing it - in New York. I'm also not sure what the current cost is as people here who had it done, got it done when someone had given a large donation to make the surgeries very low cost. Pretty sure that money has run out and people would need to pay full cost now. Cabergoline is another thing where reactions vary by cat. Apparently it has something to do with the type/location of the actual tumour, which you wouldn't know with out a CT scan. It's much cheaper just to try the cabergoline. The first cat here to try it went OTJ, and two others have since then. Almost all have some reduction in dose, and more importantly, relief of the acro symptoms. I encourage you to look at the spreadsheets of other acros here. Besides Howie, there is Amethyst and Pamela posts regularly. If you look at the acro forum in the cabergoline threads, you'll see others.

 

As always, many thanks!! Okay, so tonight I will give 17 L and 1.5 R as long as he’s above 300. Got it!

 

Wendy, what would you think of getting a cardiac ultrasound or at least do the ProBNP on Darcy? I’m so terrified of him having organ damage that I will be unaware of until it’s already progressed quite a bit. Oh, and he’s already had a few abdominal ultrasounds last year and probably we will schedule more later to keep an eye on things (like his liver). I guess it wouldn’t cost much more to add on a heart echo.

 

Absolutely a great idea to get an echocardiogram or at least a ProBNP. I see way too many acros with heart problems where the caregiver had no hint something was amiss. Of course one is too many but I've seen more than that. Personally, I had a Maine Coon cross throw a clot 3 days before a scheduled echo. Getting a baseline is a good idea, even if no damage. I'm not sure I've seen acros with liver damage that made a difference, mostly kidneys, heart and bowels.

 

And may I ask an off topic question, please. I have a friend who is really struggling with her diabetic cat. She is in Canada — in Calgary. She’s struggling with her diabetic cat. She finally took him to a “cat only specialist” and they charged her $95 for the visit, $414.88 for an IDEXX complete GI panel, $50 to add on a urinalysis, $68.05 for blood and urine collection, and $35 for an in clinic urine culture! Are these typical charges for that area? It’s very expensive.
Also the cat is on Levemir and the vet says that she “doesn’t know about Lantus or Levemir.” Tbis kitty just switched from Lantus to Levemir on January 25. This vet wants her to switch to ProZinc and wanted her to raise the dose by one unit and to stop testing so much and to only test once per day because the kitty is probably sick of being poked.
But really I wanted to know about the charges. I have no idea why they ran the GI panel but I have certainly never paid that much for one (have had the one where they send it to Texas A&M before— a few times. This seems excessive and obviously not a good cat vet.

 

We just check Darcy's liver because when he went DKA and hepatic lipidosis last year he had hyperechoic spots on his liver that we did FNA on... the largest one could not be reached but the other smaller spots that appeared to be the same on the echo were sampled. I'm a little overly cautious, so I had her repeat the u/s in about two months... no changes. Good news is that other things like kidneys, spleen, pancreas, all looked okay at the time. I think I will look into scheduling something for him. She's very good with heart echos (that's how we met years ago).

 

Your friend got robbed on the Idexx GI panel. The rest of the charges aren't horribly off. Though I'm in BC, not Alberta. Not totally fond of cat only specialists here. The clinic owner where Neko went (not cat only) was a certified feline specialist and she got put on Caninsulin. It took a locum vet before she got onto Lantus. Had another friend take his diabetic to a cat only and they pushed dry "prescription" food.

Get your friend to post here. Levemir is a great insulin for cats. The fact her vet doesn't want her to test and to increase by 1 unit means they aren't so knowledgeable.

 

Yes. When I look at his (the cat's) spreadsheet, he never goes down no matter what she does and I'm concerned. I'm going to recommend that she join and post her spreadsheet. So awful they charged her that much. She's a young person who has been out of work from COVID and now is, I think, working infrequently. And her boyfriend/partner worked in the oil and gas industry and recently (January 20!) lost his job because of the cancellation of the Keystone Pipeline. So I feel awful for her. She's spent so much money on him so far. This was like her last shot... but I'll try to get her to post over here.

 

I don't even know where to post this. For the first time since October 2020, not long after he'd been in the ER for a week and on IV fluids. I hooted and hollered when I checked his ketones. I did a happy dance... Darcy and my kids looked at me like I was nuts. I can't even believe it. With his PMPS of 315, and the ketones down; I feel like we must be getting close to something. I am so frustrated when I read that email from the UGA vet (the one I transcribed in a separate post this evening)... so I'm already planning to go see every vet in the universe until I get one to prescribe me Cabergoline to try until I hopefully can get the funds to do the SRT.... but then this lovely thing happens.... I check ketones and I see a 0.6.... HAPPY HAPPY HAPPY! This is huge. HUGE!!!

 

Yay for the ketones. Yeah I went through 3 vets and numerous calls to others for cabergoline. Had multiple emails with Dr McCue in NY regarding the surgery. Even got my levemir on the "black market" if you will cuz original vet wouldn't script it. With my 1st diabetic I had to do the same thing for Lantus and prove to him it worked better than vetsulin. He wanted me to switch to N since vetsulin wasn't working. Now Lantus is his preferred insulin for cats.

 

Wow, Paula, I may be in for a fight... I hope not, but I will fight.

 

Okay... that's a wrap for the night! What do you recommend for tomorrow morning, Wendy? It looks like we may be trending downward a tiny bit. Stay the course for tomorrow morning or make changes?

 

19 L, no R in the AM. Continuing the fast track of L. Tomorrow night back with 1.5U R if over 300.

 

Hi Suzanne, sorry I didn’t respond to your post until now. As Wendy says, ECID. I’m not sure I’ve seen the effects of the cabergoline yet as I’m having to do some increases in his Levemir. Some cats have taken a couple months for the effects to be seen (from what I’ve read). He went screaming down the dosing scale when we broke his glucose toxicity which was around the same time he started on cabergoline. I would definitely try it when you find a vet. There is nothing to lose. Howie is just a complicated cat. I am so blessed with Howie’s vet...he lets me try whatever I suggest and let’s me be in the drivers seat. He also sees how vigilant I am in testing, etc. which helps him help me.