Valentino's SRT Update

Discussion in 'Acromegaly / IAA / Cushings Cats' started by Tillie and Valentino, Jan 5, 2021.

  1. Tillie and Valentino

    Tillie and Valentino Member

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    Nov 25, 2020
    Valentino went in for his high-dose radiation this morning and came out with flying colors! He didn't even really seem tired until just now. Just wondering what I can expect in the next days, weeks, months in terms of what to watch for and manage his insulin?

    Also, he just discovered Goat Cheese (as I dropped some) and it is like ecstasy to him, apparently. Does anyone know how that influences blood sugars?
     
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  2. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    I don't know about goat cheese. We used to give little slivers of cheese to Leo and Scoobs (both now gone). Just so they could taste it and not get overloaded.

    Great news on Valentino's SRT. With Leo, that week of SRT wiped him out - noisy vet center (Colorado), sedation, strange hotel room. But he bounced back pretty quickly. Overall, you just have to monitor insulin usage and then expect insulin reductions.

    The SRT is not immediate. Leo was at 16-18 units/dose going in. Then within 6-8 weeks some definite reductions. You can see Leo's 2016 chart. He wasn't very well regulated. I was working 12+ hour days.
    Week 0 = 18 units/dose
    By week 20 - 7.0-8.0 units/dose
    At SRT+9 months, he was down to 2.0-3.0 units/dose
    See the tab "Graphs Oct-Mar 2016-2017" showing a graphed curve of insulin reduction over 5 months

    Another example - look at Rocket's SS
    https://docs.google.com/spreadsheet...Zp_kJ9PM6197ZJz2PGti-2D8kMJRF2aiP2KX/pubhtml#
    August 2019 SRT - 13.0 units./dose
    Week 8 - 8.0 units/dose
    Week 20 - 3.0-4.0 units
     
  3. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Woohoo! So glad it's done and he's home. :joyful::joyful:
    Unfortunately you won't like the answer. It's ECID. I was told it would take at least a couple weeks to have an effect and could take up to a couple months. I reduced Neko's dose for the road trip home and she held the reduction and had another one soon after. She liked being different.:p There might have been some IAA/glucose toxicity breaking too, who knows. I've also seen cats that have had to climb in dose for a couple months before changes started happening. So just continue to be vigilant in testing. You are lucky to be already on a fairly small dose for an acrocat, so don't have to worry too much about a huge depot when reductions start coming.

    Neko's reductions came in fits and spurts. A bunch, then a pause, then more, repeat. It really depends on how fast the tumour cells die off. SRT actually "neuters" the cells so they can't reproduce and the tumour shrinks as they come to the end of their normal life cycle. I haven't seen such a low dose acro with SRT, so it'll be novel to me too. One thing I did when Neko's reductions were coming fast and furious was to raise the reduction point a little bit to give me some breathing room. I was following TR for dosing (Lantus) and raised the reduction point from 50 to 70. You'll have to think about whether you want to tweak the dosing methodology for Valentino. It can take up to a couple years for the full effect of SRT to be seen.

    In terms of things to watch for, Neko was skittish/tired after her first day of SRT, but fine for the ones after that. There is some small possibility of the radiation hitting brain tissue around the pituitary, or causing some inflammation there. Those cats might get headaches or seem off, seen that on here a couple times, but not common. Prednisolone for a few days was what the IM vet at CSU told me would be what to give if it happened - luckily it didn't for us. I've also seen one or two cats with a bit of hoarse voice/coughing from the intubation. Some acros have soft tissue growth in the pharynx/throat so small tubes are best for anaesthesia. It goes away after a couple days, your regular vet should be able to figure out what is needed it that happens.

    I don't know if they mentioned it today, but one possible side effect of radiation therapy is hypothyroidism, so I was told to get a T4 test every 3 months for the first year. Seen a few cats with that happen.

    You might be interested in this paper called "Stereotactic radiation therapy for the treatment of functional pituitary adenomas associated with feline acromegaly". Neko was in that study. :) Section 3.3 that talks about a cat treated with 3 days of radiation being retreated with one - that was her.
     
  4. Tillie and Valentino

    Tillie and Valentino Member

    Joined:
    Nov 25, 2020
    Thanks so much for your guidance @JeffJ and @Wendy&Neko! I do appreciate it. I didn't realize that about the possibility of hypothyroidism, that's a very good thing to be aware of. I will mention it to my vet. He's still on ear drops for an ear infection but I can mention it when I see her next week. It's amazing that the changes keep happening over time. That is interesting about upping the reduction dose, too. It makes sense. I'm hoping that this will work for him, we will see.
     
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  5. Karen&Rocket

    Karen&Rocket Member

    Joined:
    Feb 4, 2019
    Hello Tillie! I hope you and Valentino are both doing well today. :) Rocket had SRT in August of 2019, and is doing pretty well, all things considered. Like Wendy said, ECID -- and especially after SRT. I see you're testing frequently -- you probably don't need to test quite so much, especially when he's in the 300s+, but I definitely understand, being just a week out from his procedure. At some point you'll be able to get a feel for how fast he can drop (with Rocket, it's around 50pts / hr max, unless he's sick, which has been ~65 pts /hr). Anyway my two cents was going to be that they can fluctuate a lot after SRT, but you're testing, so you have that covered.

    (edit: was just informed you're using the Libre -- d'oh! :facepalm: )

    As for Rocket, well, I have to make frequent dose adjustments because he is incredibly bouncy. There was a point where I was trying to follow TR, but it just doesn't work for Rocket unfortunately. Only mentioning this because I don't want anyone to look at Rocket's spreadsheet for dosing advice, though feel free just to see what another acro kitty's chart looks like of course. :cat:

    For the past few months he's been dealing with what we think is IBD, so he started on Budesonide a week ago -- which adds another variable to the mix. So this week has been... interesting. But he's happy, eating, and getting... occasional blues and greens. It can be challenging but you're doing a fantastic job. Hugs to you both.

    Oh! On the cheese issue -- cheese is low-carb, so it should be fine. Rocket gets some occasional cream cheese (just a lick or two, not a bowlful LOL) and he loves that too.
     
    Last edited: Jan 12, 2021
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  6. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    @Karen&Rocket GI issues are relatively common with acros. You should probably get him tested to see if it's IBD or small cell lymphoma, while you can. Neko got to the point where her heart wouldn't let us test. The two conditions look alike, but both are treatable although with different treatments. Budesonide did not impact Neko's blood sugars, though it's ECID. I think cats do better blood sugar wise on budesonide vs. pred. Sorry to hijack Tillie, but GI issues are just another on the list of things to keep an eye on for Valentino. Also Karen, Valentino has the Libre on right now, hence the ton of data.
     
  7. Karen&Rocket

    Karen&Rocket Member

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    Feb 4, 2019
    Ahhhhh... I've seen a few of Tillie's posts but missed the fact that they're using the Libre. And here I thought I found someone who tests more than I do. :rolleyes:

    Thanks for the advice on testing for SCL... this would be a biopsy, right? His regular vet has been so hard to reach during these Covid times, but yeah, it's a good idea. I'll see what I can do.
     
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  8. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    Testing, depending where the inflammation is, can possible be done by endoscopy. Otherwise it's surgical biopsy. And yes, COVID does not make things easy. :(
     
  9. Tillie and Valentino

    Tillie and Valentino Member

    Joined:
    Nov 25, 2020
    HI Karen! Thanks for touching base!

    It's so helpful to hear about how Rocket is doing as he was relatively recently been diagnosed and treated with SRT, too. I would like to see his chart and how you handle the variable numbers. I've noticed Valentino bounce from very high numbers to low numbers on Prozinc, too, and I definitely need to keep an eye on him. I like the Freestyle Libre for now, but also do intermittent blood tests to keep him used to it, and I assume I'll switch to that at some point for cost reasons. It's been pretty helpful to get a ton of data and see if he's dropping overnight, etc.

    I'm so sorry to hear about Rocket's IBD too. Valentino has been having intermittent soft stools since starting on the Purina DM for diabetes management, and I don't "think" he had issues before all this started, although he was inside/outside at the time. Mostly inside now. Lately he's had more severe diarrhea and my vet also prescribed the Budesonine. I think that I would like to try perhaps a novel protein and a probiotic before starting these meds, knowing I can start them if necessary. He has lost some weight and does have the intestinal thickening as per the abdominal ultrasound. I guess if we don't see improvement and he's on Budesonine without improvement, she might suspect lymphoma. I don't know if I can stand to put him through surgery and anesthesia now, and I don't think my bank account could stand it either! She made it sound as though the treatment for both is similar - and that we could just start the Budesonine to see if it helps. She also stated that it's thought to be more targeted to the stomach and less systemic so should have less impact on blood sugars. Good to know about the goat cheese not being a major issue as he loves it so much. I use it as a treat for testing and also to got him to eat a Gabapentin pill before the SRT treatment.

    Really hopeful that he'll have success on the SRT treatment as Rocket has had. It's been such a lot to deal with, and I'm hopeful we're turning a corner now. He is taking an afternoon nap and doesn't seem to have any side effects from the SRT at all.
     
    Last edited: Jan 12, 2021
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  10. Tillie and Valentino

    Tillie and Valentino Member

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    Nov 25, 2020
    [Sorry to hijack Tillie, but GI issues are just another on the list of things to keep an eye on for Valentino. Also Karen, Valentino has the Libre on right now, hence the ton of data.[/QUOTE]

    Thanks for mentioning this, @Wendy&Neko. He does seem to be struggling with that now, though I'm not sure how serious it is. I guess if we do try the Budesonide and it doesn't work too well we might have to do the surgery to see if it's Lymphoma, or perhaps she will just make that assumption and start treating it as if it is? I'd like to see if probiotics and a change in diet helps at all before the med if possible. I've emailed her asking if that would work for now. I don't want it to progress, though, so am prepared to start them if things don't improve quickly.
     
  11. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    Budesonide did help Neko, so it working or not does not help you determine if IBD or SCL. In fact, the use of a steroid can temporarily mask the inflammation and make it harder to diagnose. Typically the steroid has to be stopped for a while before biopsy or endoscopy is done.

    You can try novel protein and probiotics first and see if that works, as long as that is independent of a steroid trial. Purina DM is not a great food and not required at all. Plenty of commercially available novel protein low carb wet or raw foods out there.
     
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  12. Tillie and Valentino

    Tillie and Valentino Member

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    Nov 25, 2020
    Yes, from what I can tell the DM doesn't seem like it has the best ingredients and there do seem to be more novel protein with low carbs that look like very good quality food. I don't mind spending the money if it's for great quality, but I don't think the DM really is that great.

    Good to know about the steroid possibly masking the inflammation and making it hard to diagnose. I/ll have to keep that in mind if at some point we do need to do a biopsy.
     
  13. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Ziwipeak, Nature's Variety Instinct, Rawz to name just a few brands that have low carb novel protein. And that's just canned food, raw food opens up even more novel protein options.
     

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