Dak's Upcoming SRT Appointment

It has been a little bit since we have provided an update on Dak's adventure for treatment of his acromegaly, so here is how the last 21ish days have been since we posted last:

We found out that the private clinic is actually in Chattanooga, TN (not in Alabama) and called Veterinary Care and Specialty Group. They has the same SRT system as Auburn, which is the Varian Edge system. We had our IM specialist make a referral to Auburn at first, but after one or two phone calls with Auburn they refused to answer any questions we had about their experience with acromegaly cats, estimated cost for the treatment and scans, and how the treatment timeline would look like (besides letting us know that it could be 3+ weeks after the CT scan to when they could perform SRT for Dak).

As a result, we decided to have our IM specialist send a referral out to the Veterinary Care and Specialty Group in TN. Within 24 hours of the clinic receiving our referral, they called us and were happy to answer a majority of our questions before setting up a phone consultation with their Radiation Oncologist and onsite appointment for Dak's CT scan (and other tests). When they called, they actually had an acro cat scheduled for SRT a few days after that phone call. The Radiation Oncologist seemed very knowledgeable about acromegaly in dogs and cats, and had treated many cats at the clinic. He recommended to have a chest x-ray performed, on the day of our onsite appointment, before Dak had his CT scan to make sure his heart looked ok and was not enlarged due to acromegaly (he recommended this before we asked about it).

Fast forward to this week, we drove 4.5 hours to Chattanooga, TN for Dak's diagnostic appointment on 10/21/2024 and Dak got chest x-ray, blood panels, abdominal ultrasound (this was done based on his eosinophil value being elevated, to make sure everything looked ok), and CT scan performed in this appointment. Good news from all of this is that Dak's heart looked normal size, with no indications of enlargement, nothing major was discovered from the ultrasound (besides what we already know about his IBD) and they can easily see his tumor on his pituitary gland. The oncologist roughly guessed that the tumor may be about 1cm wide (we will get the official size once the radiologist accurately measures the size of the tumor), and he is confident that he can treat the tumor with a single SRT session. When talking about availability to get the SRT performed, the oncologist let us know that they had an opening this Thursday (10/24/2024) or on 11/4/2024 (the latest he felt comfortable before having to perform the CT scan again).

So we will be traveling back up to Chattanooga, TN tomorrow for Dak to receive his single round of SRT on Thursday. The treatment will be an out-patient procedure, so we will drop him off in the morning and then pick him up in the afternoon, after Dak has had time to wake up from the anesthesia.
 
Best of luck on your adventure. I like the sound of the staff you dealt with. I makes all the difference. CSU was great - did the free phone consult too, plus I got the email address of the IM vet and radiation oncologist for any follow on questions - even months later. They had the Varian too.

Great news on his heart and boring U/S!

It's awesome they think they can do it in one SRT session. That was just becoming a thing when Neko had her second SRT and what the vets recommended due to her heart issues. At CSU they usually do CT one day, SRT the next, or next 3 day if doing that. I hope that means Dak will be coming home with you that night, though the overnight at a hotel might be easiest for you rather than a long drive starting later in the day. The nice thing is that the SRT anaesthesia is much shorter than the one for CT scan, so should be easier on him too. I picked Neko up not long after lunch.

Keep us posted.:bighug:
 
Yeah, we definitely feel good about the staff. Yes, the plan will be for us to pick up Dak once he is awake from his SRT anesthesia, and we will take him back to the AirBnB (gives Dak some extra room to roam instead of a hotel room), so he can relax a little before driving back. We booked the AirBnB through Friday, in case we don't want to drive back Thursday night.

We will keep you all posted for sure!
 
Dak did really well at on his SRS (the itemized bill line item stated SRS instead of SRT) treatment day at Veterinary Care and Specialty Group (VCSG) in Chattanooga, TN! It was a pretty quick procedure and he seemed very energetic after the procedure. They told us that he had no complications during the procedure and had eaten well for them, once Dak woke up at the clinic. He was discharged the same day and we travelled back home, so that Dak can enjoy sleeping in his favorite spots at the house. The oncologist told us his single dose of radiation was 17 gray up to 22 gray, which was Level 4 on the Varian Edge system. The staff was very nice and sweet, and they even sent Dak home with a "I'M A RAD GRAD!" bandana!

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We read in another recent thread about setting a custom reduction point for the coming months, as the tumor starts reacting to the radiation it received the other day. Do you all think this would be a good idea, especially with Dak being on such a high dose of insulin right now? We do not plan on starting Cabergoline, due to getting SRS for him.
 
Great news!

Absolutely on the reductions. CSU suggested reducing under 70 and I was glad I did. Once I didn’t and she found the 20’s shortly after. :eek: Caution is key, at least in the beginning.
 
Good to know and oof to the 20's! We are definitely standing by on watching his BG, as who knows when his values may start dropping.

Yeah, the clinic also sent us some good discharge/post-treatment follow-ups to do with our primary vet. This includes monthly glucose curves (which we will do at the house and may do more frequently based on his BG values in the coming months), blood tests to check thyroid levels (can't remember the frequency for this off the top of my head), and then a CT scan in 6 or so months to see how the radiation treatment is progressing with taking care of the tumor.
 
I was told every 3 months for a year to check thyroid levels. I would personally skip the follow on CT. To much risk for too little value (and too much cost). Acro heart issues are far too common, and that means risk for anaesthesia. Plus the CT won’t tell you much more than current insulin dose will do. Also not sure why monthly curves if you are getting frequent daily test, which is actually more valuable. Neko’s dose needs could change a lot after SRT, even within a week!
 
It can take a while for SRT action to start, it only neuters the tumour cells so you have to wait for them to die off. Neko started dropping dose on the car ride home after SRT. :eek:. But I've seen some take a couple months. In the mean time, you can increase as you normally would. Over 20 units, increases can by by 2 units (think increase as 10-15% of total dose), especially if all you are seeing is over 300.
 
I was told every 3 months for a year to check thyroid levels. I would personally skip the follow on CT. To much risk for too little value (and too much cost). Acro heart issues are far too common, and that means risk for anaesthesia. Plus the CT won’t tell you much more than current insulin dose will do. Also not sure why monthly curves if you are getting frequent daily test, which is actually more valuable. Neko’s dose needs could change a lot after SRT, even within a week!

Yeah, looking through Dak's discharge notes from his treatment, the oncologist recommends checking the thyroid levels at 3 months post-treatment, 6 months post-treatment and then every 6 months after that. The oncologist probably recommended the monthly curves, as part of his general post-treatment check-ups for acro cats who are diabetic and he was not aware that we are checking Dak's BG multiple times a day (it did not come up in conversation with the oncologist about us testing Dak's BG daily). And with the CT scan, we are on the fence if we want to do it in 6 months, due to the higher risk like you mentioned and depending on how his BG is looking by that point in time.
 
I was curious about if once we got to the 20 units, if you can follow the same 10-15% rule of dose amount increases as when we got into the 10 unit range. Today was a bizarre day with Dak's numbers, where his BG stayed around the mid-300's but his blood ketones started out at 2.8. The ketones bounced around and landed at 1.7 during his night time snack.
 
Yes, keep on with the larger increases. Increase by 2 units now, especially with ketones still showing.
 
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