12/05 WENDY = PMPS 284/ AMPS 282/ +4@305 IGF-1 & IAA Results

[Wendy and Eva]

Wendy's vet finally received the results for Acromegaly & IAA. I don't have the report on-hand but will pick it up tomorrow and upload on the SS.

IAA = 68
IGF-1 = 255

The vet admitted that he has never treated a feline with this condition but spent hours reading up on it. He recommended treating her with Cabergoline. I advised him that I was going to consult with the FD board and research. Furthermore, he will do whatever is recommended on this board.

Before getting the results he had advised to keep her on 7 units. Ondansetron (4mg 1/2 tab) has been ordered and will be administered as soon as they arrive.

Wendy has been doing well for the most part. She's eating, moving around and drinking water without any issues. We started letting her out in the patio to catch the sun for an hour in the mornings and that seems to also help her. She's very alert!

I haven't posted on the board due to personal matters. I'm beyond stressed and I know it's my responsibility to post daily but I've been in the hospital attending to my sister. I can't seem to catch a break. I will do everything humanly possible to save her life.

Experts:

• What's the next step?
• Do I keep her on the same insulin? If so, do I continue with the increases?
  
• Do we get her started on the Cabergoline?
• Do I have to change her diet (Fancy Feast pate)?
• I haven't been giving her any sub-q fluids. Should I start once again?
• Any other tests I should request?

https://www.felinediabetes.com/FDMB...414-2-311-amps-353-2-382.270901/#post-3017496

(GA) @Wendy&Neko @Chris & China (GA) @Marje and Gracie @Sienne and Gabby (GA)

 

[Wendy&Neko]

Sorry to hear the results of the diagnosis. But at least now you know why she needs the dose she does. And you can look for treatment plans. Most important thing one person told me when I got similar results, Wendy doesn't know the diagnosis, she's the same cat she was before.

Do we get her started on the Cabergoline?

To the questions. First, it's awesome that your vet has been researching. A big yes to cabergoline! It's something you can do at home, is relatively inexpensive compared to other treatments, and some people have had amazing results. Most get at least some reduction in dose, with the odd one even going OTJ. Most important, a lot of the acro side effects seem to be reduced.

Do I keep her on the same insulin? If so, do I continue with the increases?

Is Wendy reacting to the Lantus? Some higher doses Lantus kitties feel a sting from Lantus's acid base, and do better on Levemir. Many caregivers just prefer the Levemir action too. I found Neko was walking away from shot time and I ended up doing more fur shots. She purred through the Lev shots. Only you can say if Lantus is bothering her.

As for increases, I strongly recommend that follow TR as written, but that means you really do have to start getting a second night time test, each and every night. You can only increase more quickly if you know it's safe to do so. Increases should be every 6 cycles/3days if she's seeing nothing under 200. Today she is bouncing from however low she went last night. With that yellow PMPS last night, she could have easily hit the 100's.

If she starts cabergoline, we have some kitties see a very strong reaction to it. At the extreme end, two went OTJ within a couple weeks. That mean a really increased amount of monitoring to keep her safe and reduce the dose as needed. I recommend you read some of the cabergoline posts in the acro forum.

Do I have to change her diet (Fancy Feast pate)?

How are her kidney numbers? FF is OK, but rather high in phosphorus. Acrokitties often have kidney issues, so I'd recommend keeping up twice a year blood work and switching food to something lower phosphorus if her kidney numbers go up.

I haven't been giving her any sub-q fluids. Should I start once again?

Why were you giving subq before? I see no reason to start them if no kidney issues, and even have a caution against giving them. Another one of those common acro things is heart conditions. Subq can be contraindicated in this case. Neko got congestive heart failure twice from fluids. At some point, and especially of Wendy gets a heart murmur, and echocardiogram from a vet cardiologist may be a good idea.

As an aside, my vet had never treated an acrocat before either. I got a lot of help from here. Of course, my vet learned too and also figure out she had another acro in her practice as a result of that knowledge.

 

[Wendy and Eva]

Thank you so much for replying to my post!

I did notice Wendy puffing and growling once we hit 6 units but she never bites or scratches. If I switch the insulin to Levemir, what dose do you recommend I start? In the meantime, do I continue to increase even if I see it's stinging her?

I was giving her sub-q during the time she had a flareup. I appreciate you sharing that information and will not administer any fluids.

What food did you feed Neko? Any recommendations?

I will make arrangements to be present when we start her on cabergoline. What dose do you recommend? She's weighing 9.4lbs.

My vet is like yours and makes it hard to go elsewhere. He's willing to learn and get advise from the experts. Most importantly, he's willing to go through this journey with me to save Wendy's life!

 

[Wendy&Neko]

If I switch the insulin to Levemir, what dose do you recommend I start? In the meantime, do I continue to increase even if I see it's stinging her?

She needs more insulin, I would increase. When people switch to Levemir, we suggest starting at about 70% of their Lantus dose. Some cats have a strong reaction to the switch, so the reduction is for safety. Eventually the doses of the two will be similar.

I fed Neko raw food, some home made with a premix, some premanufactured. Her buddy got an idiopathic cystitis diagnosis a week after her diabetes diagnosis, and his vet suggested raw as a food both could eat. Turns out any low carb low phosphorus wet food would have done.

As for cabergoline dose, what most do is 10mcg per kg of cat. That would be 4.3 kg of cat you have, so about 43 mcg. Some give every day, some every other day to start. Most people get it compounded in a liquid. More details in this thread.
Cabergoline as a possible treatment for acrocats: discussion

 

[Sienne and Gabby (GA)]

I'm glad Wendy replied. She's our most knowledgeable member when it comes to acro and IAA. You're in great hands.