Some thoughts from Dr Lunn on acro
Recently I asked Dr Lunn some questions that I had always thought about. I hope maybe some of this will be interesting to some of you...
One study at Harvard on HUMANS with acromegaly reports:
A specific acromegaly-related cardiomyopathy has been described, characterized in part by increased left ventricular mass (LVM)."
Article: New acromegaly study findings reported from Harvard University.
http://www.unboundmedicine.com/nursingcentral/ub/view/Diseases-and-Disorders/73507/all/acromegaly
http://pituitary.mgh.harvard.edu/NCBV4I2.htm#Acromegalic
http://pituitary.mgh.harvard.edu/NCBV11I1.htm#Acromegaly
http://pituitary.mgh.harvard.edu/NCBV5I1.htm#Acromegaly
http://pituitary.mgh.harvard.edu/APED2008.htm
Do you think this is true for our cats too?
Yes - it is known that cats with acromegaly can have cardiac hypertrophy. It has previously been described in publications on feline acromegaly. One of the residents here at CSU is planning a project to define the problem and also hopefully follow cats after SRT to see if the cardiac changes can improve.
It seems almost all the articles on humans refer to hypertension/CHF/cardiac disease being prevalent in the humans with acro - would it be worthwhile to have any of our cats on supplements for their hearts?
coq10 and or taurine
I don't think those supplements would make a difference in this kind of heart disease.
And would it be worth offering denamarin to our cats too - to protect their livers at all? - I know it's sometimes recommended for "regular" diabetics to support the liver and knowing that acrocats aren't true diabetics - but still - would it be something to help?
Denamarin is probably pretty safe, but no evidence for or against its use in diabetics. I don't recommend it in my diabetics. Mainly because cats don't like to take a lot of pills, and adding one thing that they don't necessarily need is not well tolerated by many cats.
What about Vitamin B12 injections, fish oil - any thoughts on any of these?
It is possible to measure serum B12, and so if that was low I would give injections. Otherwise again, no - I hesitate to add on more medications when there is no clear evidence they are necessary. I think fish oil is a good supplement for many reasons. For example, kidney disease goes along with acromegaly, and fish oil can be helpful for that. So if I had to prioritise the supplements, fish oil would be at the top of my list.
I know that there really isn't anything to stop the disease from progressing aside from treating with the SRT or octreotide or the surgery - but would supplements possible help the progression of the disease process - the complications from the organ enlargement? Protecting/supporting the health as much as possible of all the other systems.
I don't think supplements will significantly reduce progression. Without addressing the tumor in the pituitary, everything else will have a minimal effect.
And do you know - do all the organs enlarge at the same rate? I couldn't find any of that in the human information either. Or are they affected differently - it just depends on each cat so to speak?
No - I don't know. Based on the cats I have seen I think there is a lot of variability. I would guess that organs and soft tissues will enlarge first, and bony changes will take longer.
One thing I noticed in the cats we have lost that have not had other treatments since I've been involved in this group - the cat has suddenly started to need less and less insulin over the last several months of their lives. With my Merlin - 4 months before we lost him - I needed to cut his sliding scale down a fair amount. But even then he was requiring less insulin /day than he had for the 2 years before. The week before we lost him - he had a serious hypo - on a dose that he had gotten many times before for a blood glucose level that I had always felt comfortable shooting him at. After this he needed very little insulin the last 2 weeks of his life. I have noticed similar dose reductions in other cats who have died. I can't seem to figure out a reason for this. Could it be the tumor dying? becoming so large - but then some of the cats just become so ill - just seem to have multi organ system failure.
Yes - I have observed that too. I have wondered if it was the tumor outgrowing its blood supply. Or maybe the multi-organ failure comes first (due to the acromegaly and organ damage) and that leads to clotting problems, with a clot perhaps affecting blood supply to the tumor.
Thank you again for all your help and support
You are all welcome. Thanks for all that you do for these cats and their people.