11/25 Butters AMPS 301/../PMPS 268/

Yesterday

Butters met with the new vet this morning. He checked her from "nose to tail" and said she looks to be in pretty good shape overall. She has mild dehydration and will need a dental at some point.

He listened to her heart for a long time. He did not hear the gallop rhythm, and his assessment of her heart murmur is that it is only a 1-2. Not sure what to make of this. She was very chilled out in his office and she had her pain meds, so he wondered if maybe the gallop was due to stress, which he has seen before.

He gave me pain meds. No big deal. He is special ordering in some bupe at the concentration I have been giving her, since they don't stock it.

He re-ran all of the labs and plans to consult with an IM Specialist on the results. @Tomlin I did a little reading on the IGF-1 while I waited and was starting to understand why it might be a good idea. He took extra blood for it & will be asking the IM Specialist their thoughts on running it. He is conscious about spending my money, which I appreciate.

@Olive & Paula I don't have a printer so for today I just ended up emailing a PDF of the entire spreadsheet.

He reiterated that her case is complicated and we need to take our time to review each piece of the puzzle and come up with a plan together. He knows TR & the Roomp/Rand article, and said that for Butters, like a lot of cats with DM, it just may not be as easy as following what the paper says. And not to pin my hopes on being able to achieve tight regulation (which I'm not), but we agreed if we can get her to be below renal threshold that might be a good goal.

The report from her u/s at the hospital is missing. They never sent it to me and he called twice to get it from them but they seemed like they couldn't find it. This annoys me, like, what did I pay all that money for?

A lot of info. I'm glad I have it down for my records at least.

Have a wonderful day, all.

 

I’m so happy to read this! They need to find that report at the other place or refund your money.

 

Happy to hear that the vet visit went well and you may have a better vet partner!

 

I usually email a link to my google doc SS to our vet every month or so, so our vet can take a look. It’s a bit easier than the PDF due to size of font.

 

Yay for a good vet visit. And meds! hurray!

I'm with Elise that the other place needs to give a refund if they can't find the u/s records - hope that all gets sorted out and I'm here for any needed backup

Hope you and Butters have a great day, Lyla

 

It looks like he's a keeper. So happy for you and Butters.

 

So happy to hear that things went well with the new vet! He seems very understanding and supportive. Hope it all goes well from here with Butters and that you get the records

 

That is such great news Lyla - he sounds like a really good vet and willing to be a partner with you and Butters! Makes me very happy for you both

 

so happy to read this great update

 

What an awesome vetty report! Both on the vet and the results.

Many older cats have mild murmurs. Neko did for a few years - her cardiologist said just to monitor level and location and only worry if it changed. But the echo will let you know for sure.

If you do decide to go for the IGF-1 test, I STRONGLY recommend getting the IAA (insulin auto antibodies) test done at the same time. The cost for the IGF-1 from Canada is pretty high. Costs include blood draw and shipping to Michigan State University as well as lab processing costs. IAA gets done at the same place, and is a really cheap add on test. So many people get just one done, then if it's negative, you always wonder about the other. FWIW - when I look at Butter's SS, my acro radar isn't pinging. It's possible the radar is off line.

 

I'm so glad the vet visit went well. Seems like you may have found a good one. One that cares about the comfort level of your cat much as anything else. I'd definately be looking for a refund of your ultrasound results can't be found. How do they get lost?
Anyway, hoping Butters is feeling good and all is well. Have a great day

 

Such awesome news Lyla ! I love to hear that she was calm. That’s really comforting!

There have been many years since this paper & protocol have been around & there are ways to achieve your goal other ways . I have never used the protocol & was fortunate to have some brilliant vets manage Ts case. As you know, T he is managed with Prednisolone (always have to shout out to TAMU/Lidbury who let us know it was necessary for Ts disease management & that he has had many cases actually have DM be better managed with Prednisolone than without it due to the inflammation at play if it’s discontinued). I am going to attach a photo of of Ts “curve” from last evenings cycle with the Prednisolone he gets—CGM. So, again, there are other ways to manage DM & achieve your goal . This curve was even with T having a newly diagnosed ear infection with some discomfort . He has sat in some higher numbers at times in the past during a flare or when other adjustments were being made. Patience, calculated dosing—time for the body to adjust & trust in my team. A different approach. This is a testament to the fact that being patient & doing things differently can work...& work really well .

Unfortunately, short of finding the magic scanner I so badly want for Christmas , catching many HST cases & catching them early is impossible without the testing. This is exactly what Niessen & the other top endos are trying to change.....waiting for obvious signs of a problem before testing. They now know that a high percentage of diabetic cats have underlying and missed HST & therefore, are advocating that all cats newly diagnosed with DM be tested. New standard of care. It is imperative to know not only for for treatment of an existing issue like DM but also in order to help prevent future medical issues, including the historical signs or symptoms that vets used to want to see before becoming suspicious of an issue or that made people think “acro”.

Is it time for celebratory wine and ice cream yet ? I am a big believer in celebrating the small & big wins along these journeys !!

 

26% percent I think was the number of HST cases in all diabetic cats. That paper is now 5 years old. It would be a lot easier to test all diabetic cats if it wasn't so darned expensive, even more so in Canada.

I'm not talking clinical signs. I think the Niessen research said something like only 35% of acros have clinical signs at diagnosis, meaning the majority don't. However, spreadsheets often have their own way of talking. I've seen a few. At least of those people willing to share their spreadsheets.

That sad thing, even if HST (acromegaly) is caught early on, is that not much would be changed in terms of care and treatment of most such cats. @Tomlin the endos may call it new standard of care, but until the most effective treatments costs a lot less than $10,000, the diagnosis is not going to change how most cats are treated. There is cabergoline which provides some relief for many acros and is cost effective, but it also gets dismissed by most endos. There is definitely some value to testing regardless of treatment being done other than "as much insulin as they need". Knowing to look for potential issues with organs, soft tissue and bony growths can help the cat. But telling someone to spend several hundred dollars to find out their cat should have a treatment they can't afford is not an easy sell.

Lyla, don't give up on regulation yet. I think it's still possible for Butters.

 

Sounds like everything went well today with the vet. So happy for you and Butters have a great day Lyla

 

YAY!!! for a good vet visit soo important

 

so very happy to hear you have found a vet that seems to understand Miss Butters' needs. I will have glass of wine to celebrate too!

 

I am not sure why a paper keeps being brought up. I am referencing actual recent conversations with endos in the field to be clear. But to be precise—the prevalence estimate of HST/acro is 12-32%. Dismissing screening for the diagnosis based on percentage doesn’t make sense. UTIs in diabetic cats is about 12% but we don’t ignore those (Niessens point, not mine).

While it may be your opinion Re: testing being too expensive and not necessary as it wouldn’t change much with care, the experts on the subject clearly disagree & I quote:

“Given the tremendous implications on optimal treatment method, potential for diabetic remission, and prognosis, each new diabetic cat should be assessed for this underlying condition.”

Chapter 2 Feline Endocrinology written by Dr Stim J.M. Niessen, DVM, PhD, DECVIM, PGCertVedEd, MRCVS and Christopher J Scudder, BVSc, PhD, DACVIM, MRCVS

I have also spoken with a few other endos who confirmed this is standard now. I can also share that local IMs in the US at ERs are following this standard & it has been game changing.

It is ok to have your opinion about the standards but it is very important for people to know about them & to discuss the reasons why the change has been made & the implications for their cat with their vet. The idea that the diagnosis is meaningless, a waste of money, has no implications because they cannot do much about it anyway is simply untrue.

I highly recommend people please discuss such testing with your vets & if necessary, request they do a consult with an IM, subspecialized in endo to get the latest information & guidance regarding testing and follow up as well as how to proceed if the test is indicative of HST !

[I will post more as I get more info as I am currently in process of potentially working with a cat with probable HST & what is going to be a new, advanced research & treatment center for HST/Acromegaly.]

 

I'm so so glad the vet went well. He seems to really know what he's talking about. Also SO good that he is giving you the pain meds Butters needs with no hassle. That must be such a weight off your shoulders to know you've got a good vet now.

Carry on doing what you're doing, Lyla. You're an amazing kitty mama <3

 

I'm so glad the appointment went well and you found a good vet.

 

Yeah, not crying in my car after a vet visit was a refreshing change of pace. That alone calls for a wine and ice cream celebration! Or a sleep celebration if I'm really lucky.

It is hard to imagine still having a chance at regulation and what that might look like, but I'm keeping myself open to any and all possibilities.

 

I'm so happy that you've found a good vet. You're doing an amazing job with Butters. (FWIW, I agree with Wendy about getting the IAA test done, so long as you're testing. I'm definitely glad I did.)

 

I agree with everything Wendy said above. I also don’t think all cats with pancreatitis need prednisolone. Max definitely didn’t.

 

Oh Lyla! I'm so glad that I found your post from yesterday and was finally able to catch up on Butters! And a reasonably good report too! I'm so happy to read that you've finally found a good vet who listens to you and is cooperative and understanding!

I'm sorry that I haven't been around much lately ... I feel like I've been on a runaway train lately...I sure hope things slow down soon...I'm too old for all this frantic pace!

Take care and enjoy your day with your beautiful Butters! Sending hugs your way!!

 

Just to be clear, I never messages that “every” cat with pancreatitis needs Prednisolone. However, there are some cats that do despite what is often posted in response to it on this board . Again, it is very important for there to be an understanding of current practices with respect to certain cases. Some cats will do amazing with just some supportive care & then, if lucky, will even avoid future flares. That is my hope for Butters—!! One and done.....prayers for this!!

 

I'm so happy the vet visit went well Lyla. It definitely appears you have found a good
vet. ♥