Pablo's IGF-1 is 397. Where do we go from here?

Hello all!

At the suggestion of some peeps in Lantus, I'm venturing over here to talk about the possibility of Pablo having acromegaly. We've worked our way up to 5 units of Lantus BID and are rarely seeing even yellows anymore. A couple of months ago we saw blues and greens a few times on smaller doses, but now I can't get a blue to save my life.

Can the more experienced members take a look at my SS and Pablo's profile and give me some feedback? I have the msu link with the IGF test information, but what is IAA? Something else to test for? I work at an animal hospital, and though we've never tested for acro, I can draw the blood and send out for any tests I need at nothing more than the cost of the test for me.

My question is...what is advised at this point, if anything?

 

Re: Should I consider testing Pablo? 5u Lantus and increasing

Well, read the sticky posts here and post any questions.

In Barnbuddy's thread, there is a link to a recent article on acromegaly --it was pretty good, and pointed out that another telling factor is spacing of the teeth. Our friendly resident Acrobean, Megan, said that her teeth changed spacing too.

more tomorrow -it's been a LONG day today and I need to hit the hay

 

Re: Should I consider testing Pablo? 5u Lantus and increasing

Hey Holly,
Welcome to HD. I am not one of the "experienced" acro moms, but I have had quite a crash course this past 6 weeks and am probably the most recently diagnosed acro mom. Hopefully, some of them will stop by this weekend, but in the meantime you could check out the all the links here, and a related website catacromegaly.com. There is also an article which I read online about feline acromegaly in the Jan 2010 Journal of Feline Medicine and Surgery (this link 'gets you close' to that new acromegaly article. You can open it as a pdf and save it to your computer, but I don't think the article is published online as a link
http://www.sciencedirect.com/science?_o ... 58b97d9ea5 )

It would help if you tell them more about him, his size, shape, habits, and any other little things. The fact that you have had a hard time regulating, and it would be easy for you to have the tests done, just go for it.

These are some tips I picked up along the way:
-as you know, MSU is apparently the main/only place that tests, so have the vet call them directly.
-I was told NOT to use the post office because university mail rooms can be very slow. Send it via next day delivery (Federal Express ?) so it goes straight to the lab and doesn't get lost in the mail room.
-I provided the vet with my Fed Ex number so I paid the shipping
-draw it in time to be delivered Tuesday, they test on Wed only. Be sure its packed in an insulated shipper with frozen gel packs
-If the vet thinks you are crazy, (many of us have gotten that) print some of the vet articles.

Welcome

Welcome!

 

Re: Should I consider testing Pablo? 5u Lantus and increasing

I'd have the test done. None of my vets thought Cecil (GA) had because Acro, but I could never get him regulated. JoJo urged me to get the test when he got up to 5 or 6 units BID. I switched vets and had the test ran, sure enough he had Acro. I think Acro is under diagnosed in cats, because most vets are not up to speed on the disease. I joined Lantusland back in March of 2008, and since then there have been several cats DX with acro. So, it is not a rare freakish condition like most vets think. :-x

 

Re: Should I consider testing Pablo? 5u Lantus and increasing

Okay, here goes.

I adopted Pablo in December 2008 when he was turned in to a shelter because he was "diabetic." His vet records showed that his BG in August 2008 was close to 500 (however, he gets is really stressed at the vet, so I have no idea if this is accurate). There are no additional records to indicate that his BG was ever tested again or that his owners initiated treatment. He weighed 10.75 pounds When I adopted him, we started him on Vetsulin and Purina DM canned and dry at the animal hospital where I work. I did not know about him testing until months later, so he was "regulated" at the vet where he was put on 7 units of Vetsulin initially and increased to 8 units within a few days. I know eyebrows are being raised at that dose, but luckily my vet is a moron and had me using U-1oo syringes to give the U-40 insulin, so Pablo was really only getting 3.2 units. ohmygod_smile

Anyway, I digress. All of his initial curves were done at the vet and the numbers never got below 400, and his fructosamines were both bad on those high doses. By that point, I found the board and switched him to EVO wet and dry and decreased the Vetsulin dose to 1 unit BID, and I home tested a few times. Honestly, last year is kind of a blur, so I'm fuzzy on the details. In May, I switched him to BCP's PZI after I realized that the people here don't really like Vetsulin and how "harsh" it is. Pablo basically free-fed and frequently got into my other cats' dry food, so his weight increased to 13.75lb by May. I rarely tested him, and in general did a pretty poor job of treating him like I was supposed to.

I got really serious in November and started Lantus, testing before every shot and several times a day. I switched him to only "approved" low-carb Fancy Feast, and his weight is still 13.75lbs. I have increased in increments of 0.25 since December without a lot of response. I had a dental performed in December at which point his upper canines were surgically extracted. All else looks fine with him. Bloodwork seems fine. I had a full feline senior wellness profile run with CBC, Chem, T4, FIV/FELV, Heartworm Ab/Ag, and Urinalysis w/Microalbumin before the dental. He had very-slightly elevated pancreatic enzymes which neither my vet nor the dental specialist deemed significant enough to be a problem. He also had slight anemia, so I started Petinic in December too. Other than that the bloodwork looked great.

Regarding the weight gain: I have a strong suspicion that Pablo actually weighed a lot more than 10.75lb BEFORE I adopted him. He has a lot of excess skin in his "arm"pits that shouldn't be there. I know that most acrocats gain weight after dx, and I just wanted to point out that the 3lbs he gained with me may have been following a large weight LOSS with his owners. I don't know. Unfortunately, there are a lot of blanks I can't fill in because I don't know his history before December 2008.

Nothing seems to have changed in the last month except that I stopped seeing blues and greens and actually started seeing reds again for the first time in a long time. Except he seems hungrier and thirstier in the last few weeks since his numbers went haywire. Negative for ketones yesterday. Also, I have not noticed any physical changes like enlarging chin, forehead, feet, etc. And I can't look in his mouth, so I can't see if his teeth are more spaced out. The dentist didn't note any abnormalities when she examined him during the dental two months ago.

Anything pop out that might indicate acromegaly? Other than the high dose? I have access to any and all bloodwork needed at cost since I work at an animal hospital. However, my vet knows virtually NOTHING about diabetes nor does he seem interested in learning. We have a nice system going...I do any and all tests recommended on this board or that I see fit, and he looks at the results and gives an opinion. Sometimes I listen, other times I ignore his advice completely and do what I want. If we have access to it at our clinic, I can have it done. If not, and it becomes apparent that Pablo needs to see a specialist, I can refer myself from our office to a larger hospital about an hour away.

I guess I just need advice for now, especially regarding what tests need to be run currently. I know the IGF is one, and I can draw the blood and send it to the company myself next week. So what else?

Thanks for reading if you got this far into the post!

 

Re: Should I consider testing Pablo? 5u Lantus and increasing

IGF-1 and IAA (insulin autoimmune antibodies) are both run by MSU, and really are the best -- first two tests that should be run on an insulin resistant cat. (least expensive and good accuracy)

The IGF-1 test costs $44 and the IAA is less than $20 (like $14 or so) and both tests require a blood sample.

We've seen more cats here dx'd with Acromegaly than IAA, but some have both and a few have ONLY IAA. So -- saves on shipping to have both tests done at the same time.

Acro is more commonly seen in male cats - Cushings is more commonly seen in female cats and the tests are not as clearly definitive for a Cushings diagnosis.

The Acro test (IGF-1) has been pretty well verified that a positive diagnosis is 95% accurate or better. There is no ONE test that confirms Cushings with that level of accuracy.

With cushings, the skin gets very fragile - you can tear the skin open just by picking up your kitty or trying to comb mats.


ETA: my vet did not think Norton had acromegaly, even though he was insulin resistant, was very stocky/muscular with big feet and had a brain tumor. She humored me and had the test done, and was surprised by the result.
He also had respiratory distress (stridor) when laying on his back and got panicky.

 

Re: Should I consider testing Pablo? 5u Lantus and increasing

Hi Holly,
have thought about you guys and how Pablo was getting on.
Glad to see you've posted here.

One other sign that a number of high dose mommas have commented on is that kitty snores.

Good luck to you guys :YMHUG:

 

Re: Should I consider testing Pablo? 5u Lantus and increasing

:shock:

Pablo snores. And he makes audible noises similar to snoring when he's stressed (like at the vet's). Will definitely be testing this week. Now I'm worried.

 

Re: Should I consider testing Pablo? 5u Lantus and increasing

Don't worry, it may explain your frustrations with regulation...

Also take a close look at figure 4 in that article I mentioned
http://www.sciencedirect.com/science?_o ... 58b97d9ea5

Pablo does seem to have a "wider than some" whisker area. If you draw blood Monday, you will know on Friday evening.

 

Re: Should I consider testing Pablo? 5u Lantus and increasing

and he is ABSOLUTELY adorable! What a sweetie!

 

Re: Should I consider testing Pablo? 5u Lantus and increasing

Oh Holly, I'm sorry, I didn't mean to make you worried.

He's still your Pablo and he isn't going anywhere.

The test will just let you know one way or the other and also if he is +ive you can be more aggressive with your dosing.
Hang in there, you have lots of support :YMHUG:

 

Re: Should I consider testing Pablo? 5u Lantus and increasing

Hi Holly,

In my opinion, any cat that reaches 5-6 units should be tested, if only to rule out causes for his insulin resistance. I can't tell you how terrible I felt when all the other kitties were achieving some form of regulation and Boo was still in the yellows, pinks, and reds! While the actual diagnosis devastated me, it also allowed me to look at my options. I took Boo to CSU, thanks to Jojo and to the ones that went ahead of us (Joan & Maddie, Sandy & Cecil, Wendi & Milo, Sarah & Dusty), and the treatment was successful.

 

Re: Should I consider testing Pablo? 5u Lantus and increasing

Holly,
In case you want the links for the two tests:
http://www.animalhealth.msu.edu/Bin/Cat ... st&Id=1401
http://www.animalhealth.msu.edu/Bin/Cat ... st&Id=1494

I spoke to my vet today, and we are in process of having both tests done on Shadoe maybe the week after next.

I figure I would rather know the cause of a situation than always be wondering how come and what's going on. You can deal with what you know.

 

Re: Should I consider testing Pablo? 5u Lantus and increasing

angry(2)_cat

I love Pablo to death, but SERIOUSLY. Four of us tried for 45 minutes to get blood from Pablo and couldn't. He will not sit still for anything. We do this every time. And I couldn't sedate him (like usual) because he'd eaten lunch already. So now I won't get results until next Friday because I can't afford to send the blood overnight for $80, meaning it won't get there for Wednesday set up this week.

So tomorrow he is getting sedated, and I'm getting blood for the IGF-1 and IAA, a CBC, Chem, urinalysis, and full-body x-rays. HA! Take that, Pablo!

But seriously, I am frustrated. Again.

 

Re: Should I consider testing Pablo? 5u Lantus and increasing

I use a cat sack for Buster. Get one with a belly zipper.

The vet can pull a rear leg thru the zipper for the blood draw

Also, in the last 6 months, we've added a mask / muzzle. It helps Buster remain calmer, and insures the vet and techs don't get bitten, so they are calmer and gentler too.

 

Re: Should I consider testing Pablo? 5u Lantus and increasing

:lol: Oh, believe me, we've tried that. It's just that the volume of blood needed really needs to be from his jugular because all his peripheral veins bleed so slowly/poorly. We blew both front legs and tried the jugular, but it just wasn't happening. I have seriously had to sedate him every single time we needed to get blood from him. He just squirms all over the place and flinches enough to keep the needle from going or staying in the right place. He is one of the worst cats I've ever seen. It's embarrassing...my own cat is "that" cat at the vet. It's a good thing my coworkers love him so much.

 

Re: Should I consider testing Pablo? 5u Lantus and increasing

I'm sorry to laugh, but I look at that SWEET face and I just can't picture him being "THAT" cat! :smile: I used to work the kennel at our vet hospital and I'm remembering "those" cats that I could barely open the cage to clean it. Mine are such total babies that I just wasn't prepared for that...

Holly, are you a nursing student at Clemson? My daughter is trying to get into nursing school - sooooo competitive!

 

Re: Should I consider testing Pablo? 5u Lantus and increasing

Indeed, I am a Clemson nursing student! Go Tigers! Ha. Like I give a crap about team sports...

I can vouch for nursing school being competitive. I came in as a transfer student from a small Christian university about 15 minutes away, and at that time (two years ago), Clemson accepted 10 transfer students per year. That's right...10 per YEAR into the program. I was accepted with a 3.8 GPA, if that tells you anything about who actually gets in. And I've heard that they're taking even fewer now. How that's possible, I'm not sure!

Even the tech schools have waiting lists now to get into nursing around here. Within an hour's drive from Clemson, there are SEVEN schools with nursing programs (Bachelor's and Associate's degrees), and it's still competitive. You have to have an amazing GPA to even be looked at! I wish her luck.

 

Re: Should I consider testing Pablo? 5u Lantus and increasing

UPDATE: We got blood without sedating! party_cat Of course, it took another 45 minutes and me nearly squeezing the life out of him, but the vet tech STUDENT got his jugular. God, I love her!

And we even got enough to send out a CBC/Chem. I mean, he had them at the end of December, but I've become hypervigilant about having bloodwork done. It's such an easy (and inexpensive, for me) way to see what's going on internally. If I'd had to sedate him, I wanted to get x-rays too. They're free for me. ;-) Of course, they're not digital, but hey...it's free! But we nixed that since he was kicking and "screaming" by the time we were done.

So I sent away the blood for the IGF-1 and IAA. Won't know the IGF until next Friday; what's the turnaround time on the IAA? I suppose if he's an acro kitty, he'll need to have some high-quality x-rays or an ultrasound done to determine organ enlargement/heart damage, right? Maybe I shouldn't even think about crossing that bridge until we have an answer. My fingers are almost dialing the specialists' offices already! :lol:

Maybe I should start collecting cans for CSU instead...how many cans would I have to collect to cover $5,000? Kidding...I just might be eating canned soup for the next few years if it comes to that!

 

Re: Should I consider testing Pablo? 5u Lantus and increasing

Originally, they told me that IAA is set up on thursdays and available on friday. But, when I called Friday at 4:40 the only thing they could tell me was the Acro test. My vet called sometime M-TH the following week and they had the result for the IAA, so I don't really know what happened there. If the blood is there to set up thursday, I would be calling friday, late afternoon. (maybe they will remember to do yours :roll: ) IAA is pretty rare I think.
DId you send it fed ex or UPS, rather than us mail?

 

Re: Should I consider testing Pablo? 5u Lantus and increasing

Oh, and with 2 that attended Auburn WAR EAGLE! Go other tigers!

don't hate me but it is fun- and I never watched football until I married my husband :lol:

 

Re: Should I consider testing Pablo? 5u Lantus and increasing

UPDATE: Pablo's IAA is 0. The IGF is still pending. Interestingly enough, though, he's suddenly decided to respond to 5.5 units of Lantus afterall. He was blue the whole weekend with a few hours of green yesterday. A small ray of sunshine for me!

I'll keep you updated.

 

Re: Should I consider testing Pablo? 5u Lantus and increasing

That's great news! Paws crossed you get more good news soon! ;-)

 

Re: Should I consider testing Pablo? 5u Lantus and increasing

i have a feeling after all the wrestling he did with you guys and talk of sedation he figured he'd better straighten up some and give you something good

 

Preliminary Results are back...

After checking Michigan State's website multiple times for results this afternoon and not seeing any, I decided to give them a call. I was losing my mind waiting on the results.

The person who answered the phone said that the NUMERIC results were back for Pablo. There is no endocrinology interpretation yet, but is one needed? His IGF-1 is 397. :cry:

Edited to add interpretation by the endocrinologist:
The serum concentration of insulin-like growth factor 1 (IGF1) is elevated and acromegaly
remains as a differential diagnosis. Does this cat show physical changes that are consistent with acromegaly? It is
recognized that elevations of this hormone may occur as a metabolic response to diabetes mellitus in some cats, but I think
this result is higher than what would be expected in that latter scenario.

Patricia A. Schenck, DVM PhD
Assistant Professor
Endocrinology Section Chief

HELP. What do I do next? My vet (boss) doesn't even know I did these tests, and he wouldn't have a clue how to even address acromegaly. Can those of you who've been at this for a while give me some guidance? I'd love to know what having the radiation at CSU means for his lifespan vs. treating only the symptoms of it, disregarding insulin usage. I mean, what are the eventual effects of acro (heart failure? kidney failure?)?

What do I do from here? I'm so sad.

 

((((((((Holly & Pablo))))))))

I know this is a hard dx to take.

It may be years before Pablo suffers any ill effects from the Acromegaly other than Insulin Resistance.

The acromegaly dx is not a death sentence. It will help you take care of Pablo more effectively and give him a better quality of life by recognizing earlier if and when he has some complication crop up.

I don't know what the statistics are for the Stereotactic Radiation treatment at CSU, but Milo and Boo have had excellent success.

So -- you can treat the diabetes more aggressively - maybe start R if you haven't already

And love your super-sweet boy...

BTW, Norton did not die from Acromegaly. He developed an aggressive cancer that was inoperable. When we couldn't control his pain, we helped him cross the bridge.

 

(((((Holly)))) I agree with what Phoebe said. It IS a hard diagnosis to take in, but it isn't a helpless one. You now know just why he needs more insulin and it frees up your mindset to give him what he needs.

I can't give any input to the SRS (although I wanted with all my heart to be able to do it for my boy, we couldn't because of the required positioning and because he's a "different" acrocat that goes on and off insulin), but Wendy, Heather and Joan can definitely answer your questions.

And, to give you hope--- last month Fletcher celebrated 3 YEARS post acro diagnosis. We're still learning more about this and what we can do to make our acrocats' lives as wonderful as possible, but we already know so much more than we did when Fletch and I got the diagnosis. So don't give up hope. There's another learning curve, but we'll be here with you all the way.


(((((hugs)))))

 

Hi Holly,

I'm sorry about the diagnosis. I know it's scary and depressing, but it's not as hopeless as it appeared to me a year ago. As Carolynn said, there are many acrocats here being treated with insulin and while they may require large doses, they are doing well overall. Yes, without treatment, the growth-hormone-related symptoms do progress, but none of us know how fast.

Joan&Madison, Wendi&Milo, and Boo all had the SRS. Boo went off insulin about 14 weeks after the treatment; Milo is still on insulin, but they think he's now a "normal" diabetic. Both Wendi and I are awaiting IGF-1 results as well to see how things look (1 yr for Milo; 6 mo for Boo). This is an experimental treatment....Boo was number 9 in the country. We don't have any idea of long term prognosis. If Pablo is young and otherwise healthy, I would try the SRS. It will take you just one week in Ft. Collins, CO. You do not want to try any other type of radiation therapy...it costs the same yet doesn't work as well and is harder on the kitties.

You are welcome to e-mail me at kayroletta@hotmail.com if you want to ask questions or talk (Gayle, you too when you get your results). I also recommend that you and your vet contact Dr. Lunn @ Colorado State University. She's the contact for SRS; she's thinking of doing a drug trial at some point as well. Finally, if you are considering SRS, Dr. Lunn is going to ask you to get another test - Growth Hormone...see stickies for info on where that test is done.

Heather

 

Thanks, all, for the kind words of encouragement. I'm still not sure of what I'll do about the SRS. For one thing, $5,000 is half of what I made last year...I'm a 22y/o student paying for everything out of my pocket and that's a lot of money. I'm going to be chastised by my family. I'm actually leaning toward doing it, but it won't be until May if I do, when class is out. (And I guess I'm kissing my European vacation goodbye too! Darn adorable, love-of-my-life cat...)

My immediate concern is assessing the degree of the disease progression. I immediately started thinking about have full-body digital radiographs completed as well as possibly referring myself to a cardiologist for an EKG. Is this too extreme? Like I've always said, I'm not sure you can ever be TOO proactive in doing diagnostic tests and, if nothing else, getting a baseline against which you measure future tests. This is the reason why I have a CBC and chemistry done every three months and a urinalysis at least every six months.

So my specific questions are:
1. How many of you are treating with little/no input from a vet? Or, if you have a vet you see regularly, do you make most of the suggestions for treatment because many vets have NO CLUE about acro?
2. If you regularly see a vet, are they a specialist or just a generalist?
3. How often do you take your acro cat to the vet? Just when something's wrong or for routine check-ups?
4. What are the immediate steps I need to take from here? Full-body x-rays? Ultrasound? EKG?

At this point, Pablo's only had two physical exams and no heart murmurs were noted...but this was just my vet listening with a plain old stethoscope. All of his bloodwork has been fine. He recently had just about every blood test you could think to have (CBC,Chem, HW ab/ag, FELV/FIV, Hemoplasma panel) and a urinalysis with microalbumin.

I'm feeling overwhelmed. My biggest fear is that I won't do something that I should have and he'll die because of it. I want to get a move on things because it's like every day is another day of damage done to his body. At best guess, he's between 11 and 12 years old. I'd hoped to keep him around for many more years, and it's crushing me to think his life could be cut short because of this.

 

I had to leave my first vet over the "acro-thing". She refused to run the test. My new vet (cat generalist) knows only what she's read, but she will read and ask questions on VIN and talk to Dr. Lunn. Quite frankly, NO vet out there is going to know much about treating an acro cat, besides the vet schools that are doing research. Additionally, there's not much that can be done besides controlling BGs and zapping the tumor.

Boo gets bloodwork every 3 months, but this is due to CRF and because Dr. Lunn is paying for IGF-1 tests for the year. If it were not for those two things, I would take her once a year or if she were sick.

X-rays would be a great idea - you want to look for organ enlargement. I don't know that the others are necessary, unless you get them nice and cheap. Do NOT pay for an MRI/CT - if you do decide to go to CSU, they will have to do it there (it feeds into the SRS machine) and you don't want to waste the money.

I'm so sorry. I do know how you are feeling. I was devastated! However, acro is caused by a very slow-growing tumor on the pituitary. Nothing drastic will happen quickly...just concentrate on getting his BGs under control and spend time deciding if you want to (or are able to) treat.

Also, if you don't have R, get some and ask Carolyn to help you. Be aggressive with your dosing and just love him extra right now.

 

Norton went to a cat generalist mostly, on an as needed basis. We didn't find FDMB until after Norton had been diabetic for over a year.

When he started walking in circles, we took him to a neurologist who confirmed the presence of a brain tumor. We decided to wait on the MRI that was suggested.

Norton was very difficult to x-ray - he had to be sedated because he panicked when held on his back. I think he had difficulty breathing in that position (in the last year or so)

Norton did not have heart problems or notably enlarged organs. He did have larger than average feet and was very muscular build.

We took the brain tumor dx as confirmation of acro and treated his FD and pain more aggressively to help him feel better.

He developed an aggressive intestinal cancer that was inoperable (unrelated to the acromegaly). We got his positive IGF-1 results after he crossed the bridge.

It just occurred to me that we should maybe add a worksheet to the ACROTRACKER

on the left column - cat's name
across the top - primary symptoms

then X the boxes that are appropriate

This would not replace the ACROTRACKER - just add to it, and be a quick summary to analyze things like --
how many acrocats have cardio problems
how many acrocats have breathing problems
etc

 

Holly,

Sorry, just checking in while we're out of town, and saw your update. You have lots of great responses here and I just want to add that you are so far ahead of the game by figuring this out so fast. If it makes you feel any better, Cody has had high bg for 3 years, diagnosed FD 2 1/2 years, not well regulated most or all of that time, diagnosed Acro in Feb 2010, so obviously acro over 3 years, and he's still doing pretty well. He does take blood pressure meds and aspirin for platelets, and megacolon meds, but he's decently ok and looks good. Hes just been treated by the same vet all along.

Sorry, gotta go now . hang in there cat_pet_icon