Leo (Leoberry) - the high doser

JeffJ

JeffJ

Very Active Member
Leo is addicted to insulin. But he's a sweet cat, so we feed his addiction. Who knows, maybe he will get better someday. In the meantime, he gets brushed and rubbed multiple times a day. This week, he is feeling very chipper since he responded well to higher doses of PZI.

On Aug 25 (2016), he decided to switch his addiction to Levemir. He didn't like the high cost, and special ordering for PZI. He didn't like the fat U-40 needles either. Who can blame him? Now he's on Levemir.

Today he goes to an internist veterinarian. And he'll get blood tested for acro and IAA.

Leo used to be on the PZI forum. His previous thread was here:
http://www.felinediabetes.com/FDMB/threads/leoberry-aka-leo.162132/

Spreadsheet started July 2016 - linked here
- includes graphs on second tab

History:
  • Leo is 10 years old, and he was the cutest black tabby kitty ever - a true heart melter
  • Inside-only kitty
  • High-dose kitty
  • Insulin started August 2015 , after he dropped to skin and bones weight (and he had acid ketosis)
  • Insulin was low dose (3 units/day) initially, with 150-200 nadirs
  • Started on 1.0 Lantus/day then over 8 months ramped to 9 units twice daily - without low nadirs.
  • Kept him at 18 units/Lantus for too long - his nadirs ramped to 250/300
  • 2016-07-06 thru 2016-08-25 Prozinc - responded at higher doses
  • 2016-08-26 started Levemir
  • Our vet has never had a high-dose kitty, but she is a very experienced vet
  • Never a single hypo incident
  • Low carb, wet food only, currently Fancy Feast and cooked chicken
 
Hi Jeff, this is s pretty quiet forum, mostly information only. The high dose Lev and Lantus kitties post over in the Lantus and Levemir forum.

Good luck with the new juice - I hope you can get to a dose that moves him soon. And I hope you have a successful internist visit.
JeffJ said:
Our vet has never had a high-dose kitty, but she is a very experienced vet
Click to expand...
Same with Neko's vet, until I started educating her. Then she quickly found another acrocat in her practice. One in four diabetic cats has acromegaly. Neko's acupuncture vet the same story. Never seen one until I started with her - now she thinks one of her previous pets was acro.
 
The vet visit went well. Dr. Sharon Theissen of http://www.ctvsh.com/ in Round Rock, just north of Austin, TX.

She knows her diabetic and acromegaly stuff. She has had multiple Acro patients. She said Leo's symptoms are typical acro. And her physical exam indicated his lower jaw had grown excessively forward, separating the lower canines to a forward position of the upper canines. There is a pronounced gap. The blood work will be available in 2-3 business days. She was very familiar with SRT in Colorado, and will help us with that course of action if we pursue it. She also took personal care of an acro cat. She said the radiation therapy in San Antonio is linear, and hits a larger region. She didn't recommend it because it takes too many doses, each of which requires anesthesia.

It was so refreshing to have a vet educate me, instead of the other way around. I have learned an enormous amount on this forum, and gotten great help as well. It is just nice to talk to a specialist. Followup results will include:
- full blood panel, which I'll type in
- acro test results

She said to target 150-200 for nadirs, to avoid potential hypos. And she said 200-300 is a good general target for high-dose kitties.

@Wendy - is there online data which shows that 1/4 of diabetic cats are Acro? I'd like to read it. I'm also going to reread the Neko-journal of the SRT sessions.
.
 
Yeah for having a specialist who actually knows something! Are you also getting the IAA (insulin auto antibodies) test done? A fair number of acros have it too, and we slightly tweak our dosing suggestions if Leo has that too. BTW, bloodwork must be received by Wednesday at MSU which is when they start running the IGF-1 tests, so it'll be next Friday or Saturday at the earliest you get results, not 2-3 days.

I'm not sure if anyone gave you the link to this post - it's a collection of articles on acromegaly. It contains a link to the study in England showing 1 in 4 cats was diabetic. Similar, but smaller scale studies have been done in the US. Julie has a record of Punkin's SRT journey in her signature. I've done it twice now at CSU, but you'd have to go searching through posts for it. I agree with your vet on SRT being better. The linear radiation isn't as tight an area and can impact neighbouring tissue, and the SRT is a lot few anesthesia sessions.

I'm also going to argue about desired nadirs for an acro cat. I know you are using the AlphaTrak which reads a little higher, but the folks at CSU told me that it's best to keep Neko at a dose where she spends as much time as possible under renal threshold - for her, under low 200's on the human meter. You are home testing, you don't need to worry as much about hypos as someone who isn't testing. The acro tumor can wax and wane, so yes, you do have to keep up the home testing. But I find that if Neko's nadirs are lower (70 ish on the human meter), I can keep her overall numbers much lower and she bounces less. And keeping an acro kitty in better numbers does seem to help how high a dose they have to go to. That is especially true if IAA is in the picture as well. There you absolutely have to aim for lower numbers.
 
That's good feedback Wendy. We will think strongly about SRT. Leo is only 10. If the tumor is aggressive, then this could give him an opportunity at age 16.

I guess we'll wait to see the blood results. I asked about IAA and she didn't recommend it. But maybe I misunderstood. Since vets provide dosing advice, they probably stay conservative. As she reiterated, a single hypo incident can be fatal, but slightly elevated levels are not. Let's see if I can get Leo regulated on Levemir. He was real close on PZI. I'll dose 4 times at current level before increasing.

Lemme go read those links. I appreciate the feedback and info. If anything, the vet session today reassured Theresa that I knew almost as much as the vet. And most of my info has come from the forum here. The spreadsheets here are good. I think it kinda forces one to keep up with testing.
 
Sounds like you found a good vet! Colin has the jaw symptom too. In fact I noticed it quite awhile before the diabetes diagnosis. I thought maybe he had a bad tooth so took him in. Was told teeth were fine, he's just a big cat, by two vets. When he got the diabetes Dx, and was at such a high dose, I again pointed it out and was told again that he's just a big cat. I had to insist on the test. Then the vet got an attitude when the test came back positive and he was wrong. He's no longer my vet.....
 
Yes, this makes me think about who should be Leo's primary vet as well. The jaw symptom is called "prognathia inferior (protrusion of the mandible)". Or we could just speak English and call it a protruding jaw. I read through 3 of the scientific articles today. Good articles, but written in science-speak. The main article Wendy recommended - that definitely showed 1/4 of diabetic cats are acros. A lot of work went into the study. Nice article but with lots of jargon.

I think Leo also shows 2 other symptoms:
- slightly clubbed feet
- more snoring than previously, probably due to tissue growth (jargon = reduced diameter of the nasopharynx)
 
My vet didn't think I needed to get the tests until we got to 10 units - which we never did. I asked her to humor me. She was very surpsrised at the results (I wasn't) at what the senior vet at the clinic called "exotic tests". But she's willing to work with me and willing to learn, which is worth a lot to me. And the senior vet now admits I know more than him about acromegaly - admitedly a low bar. :p But he's great at many other things so I respect him for that too. Neko's now sees an internal medicine vet whose knowledge of acromegaly is leaps and bounds above her regular vet.

If it's not too late, I'd see if I could get the IAA test tagged on. It's not much more expensive when done at the same time as the IGF-1 test.

And yes, a single hypo event can be fatal - it's the number 1 cause of death of acro cats. Probably in non acros too. Most caregivers of acros do not home test. Heart and kidneys are also risk factors, which is why I try to keep Neko under renal threshold as much as possible.

It'll take at least six cycles, maybe more to see what the current dose of Levemir can do. You might want to read the sticky notes at the top of the Lantus/Levemir forum if you haven't already.
 
Hi Wendy, I just read the printed report. The acro test is next week. I'll call the vet and have them add the IAA test. Also I'll wait 6 cycles to adjust the first dose. In summary:
Aug 24: PZI completed at 13.0 units/dose
Aug 25: Levemir started at 10.0 units/dose
Aug 25: PMPS was ~310. It's in the other room, and I have Chinus on lap so I'm stuck for awhile.

That's good your vet is flexible. Leo's regular vet is fine, but I don't feel I should pay her to educate her. I've been cautious and lucky so far. No true hypo for Leo since August 2015 inception.

The internist said a better hypo treatment is food if possible and to use Karo as last resort. She did praise me for home testing preshots and nadirs. I don't know how one would "guess" dosage without testing. I will also target keeping Leo below the renal threshold (240-270).
 
JeffJ said:
The internist said a better hypo treatment is food if possible and to use Karo as last resort.
Click to expand...
It also depends how carb sensitive your cat is. Some acros need really high carbs (more than 20% carb wet food) to get them up. Neko does fine with 16%, but if she's below 40 (human meter), I jump for the karo. One day soon (I hope) you'll learn what works for Leo.

Feel free to post on the Lantus/lev forum if you have any questions, including what to do about the dose.
 
I read through the end of your thread on the PZI group and hope we can convince you to come over to the Lantus/Lev group to post. There are a lot of good reasons for including high dose cats in the regular group. As I mentioned to you before, the high dose cats used to have their own group here but people got their knickers in a twist and left. As I heard the story it was because someone with a non-high-dose cat criticized the amount of insulin a high dose cat got.

With the change to having the kitties just stay with the insulin support group for the insulin they are using, it has become the norm to see a huge variety of dosages. Someone who has a cat on 1u might be surprised, but there is no criticism of giving the dose the cat needs. It has helped to normalize the idea that cats need as much as they need.

Yes, it is a busy group but it's not too busy that you'll get lost. I'd encourage you to read other people's threads and you'll find other cats also getting larger-than-typical doses. With one in 4 diabetic cats having acro, there are many. I rarely look outside the Lantus/Lev group because I already spend more time than I want just looking at threads in that group.

I bought a friskies' gravy lover's that was 25% carbs and that became my go-to for raising blood sugar. It worked fast and well for punkin. I had started out with a 16% and it didn't cut it. One more option is to add karo/honey/maple syrup to a low carb food. You always want to have a large stock of high carb supplies, just in case.

Yay on finding a doctor that knows her stuff on acro. I would also disagree about the goals for his nadirs. While you're not expecting an acro cat to go into remission by holding their blood sugar in normal range, and the same time it seems pretty clear that keeping the blood sugar at least somewhat lower helps to keep the dose under control. In the German Katzen group they don't recommend people test their cats for high dose conditions, the cats follow the Tight Reg protocol, and it's very uncommon for them to have a cat go over 8u. Glucose Toxicity causes the dose to have to go up, and it occurs when a cat isn't getting into normal numbers. I think the best thing to do is to make observations yourself on how leo responds to high carbs so you have some confidence about being able to bring his blood sugar up and steer him. It's less nerve-wracking to do that when a cat is at a lower dose than higher - so that's an idea for you to consider, anyway.

We have a lot of examples of cats on high doses who were kept mostly below 150ish. Suki's Crystal was one, Lauren's Tommy was another. Of course, Wendy has done a fantastic job with Neko. I let punkin's blood sugar drift up, having gotten advice similar to what your specialist said, and the result was a runaway dose. I was behind him the entire summer of 2011, trying to keep him in blue but not succeeding. This is one of those "if you can't be a good example, be a terrible warning" things that people post on facebook, lol. I wish we could've been the good example, but I was unnerved by the people telling me that "blue was the acro cat's green." The trouble is that you can't usually get a cat to be flat in blue. Once in a while one will, but mostly it takes getting them into green numbers to have their blood sugar flatten out.

I didn't mean to write a book . . . welcome to the world of the high dose kitties! We're happy to help you - just tag one of us if you need help and we don't see your questions.
 
Hi Wendy and Julie,

I surveyed the most recent 100 threads in the Lantus/Levemir group. I looked for dosages over 8units. What did I find?
100 threads
1 of them = high dose = Titi
1 of them = Neko (former high dose)

So out of 100 threads, only 1%. Sure that could vary over time. Maybe I missed one. However, I'll follow the defacto protocol, and I'll post over there. Seems it would be useful for current high-dosers to have a grouping of threads here for reference. It feels to me that this protocol is being driven by events of the past by people who are no longer even on the forum.

Glucose: I tend to agree on your recommendations for glucose curves. Leo has crept back up with the switch to Levemir. I'll let it stabilize and will increase slowly. At his high dose of 10 units, a 0.5 increase is only 5%.

Hypos: We have some gravy-lovers food for our new outside cat Little Dude. He loves gravy. I can use that for Leo if we have an episode. Thanks for the tip on that. I'll mix in some Karo if the numbers go way low.

Acro: I read a bunch of the content, including the scientific jargon articles. A horrible condition. We will get Leo's confirmed diagnosis by Sept 2 (Friday). Then we'll consider SRT.

...and I agree that Wendy has done a superb job with Neko. A great example of treatment and nuture, showing the condition can be mostly cured. 40 weeks post SRT and down to 1.25 units. Wow.

@Wendy, I think you can take this out of your signature now "do not copy dosing" :)
.
 
2 other high dose acrocats are Karen & Lily and Saltycat(Wes and Jack) Karen doesn't post often, but Wes does. Neither of them have had SRT treatment. Also, be sure if you need to tag Wendy for advice, to use Wendy&Neko, not just Wendy who is another member. I'll look for your L&L posts.
 
You may want to check urine for glucose and ketones, as the renal threshold can vary among cats.
 
Thank you for asking. His BG is high. I was probably too conservative dropping from 13.0 to 10.0 when he was switched to Levemir. Now up to 12.0. Will continue a strong ramp until a decent nadir is achieved.

Acromegaly:
We expect blood test results Thursday or Friday. If Acro is confirmed, we will proceed with SRT asap. We unexpectedly lost Scoobs on July 1. We can't bear the thought of losing both our tabby boys in the same year. Scoobs was ~8 years old. Leo is 10.5 years old.
 
Thanks Sharon. I'll keep some picture and text logs as we go thru SRT if that occurs. Probably not as good of records as Wendy.
 
Good luck with the tests. I do not know much on the 2 conditions. Just wanted to offer support.

So sorry about Scoobs. He/she will keep an eye on you.
 
Hi Jeff, how do you find the levemir working for Leo? Does it seems to do better than Prozinc? Or is it too soon to tell?
 
Thanks for asking Ruby. I have had to ramp him to 13.5 to get some reduction. Will continue the increase tomorrow. I want to get him in the 150-200 range.

Tomorrow is Friday and we hope to get the Acromegaly test results. I don't want them to be positive, but at this point it is unlikely to be insulin antibodies. If Acro is confirmed, we will proceed with SRT within 2 weeks as soon as it can be scheduled. That will be roundtrip driving from Austin, TX to Fort Collins, Colorado (north Colorado). One would think Texas has lots of people and technology. Not sure why SRT is not at Texas A&M Veterinary School - 2 hours east of Austin.

Leo's neuropathy is pretty bad now. We need to fix him. I brush him and love on him frequently thru the day. Theresa does too.

On a positive note. Little Dude (the lovebug) has gone from being a stray to a leg lovin' magnetic purr box. He just got his second ear mite treatment yesterday. Another 2 weeks and he can come inside. He is dying to come inside and be part of the family. Pic of Little Dude is attached. He is leaning on my leg, and is making dough on the towel on our front porch. We think he must have gotten lost. He is 6-8 years old. We know he was stray for over 8 months.
 

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Leo is confirmed to have Acromegaly by our veterinarian internist. IAA was not tested.
IGH-1 for Leo = 305
IGH-1 normal cat = 92 or less

Acromegaly confirmation:
The following article lists IGH-1 over 1000 ng/ml as confirmation of Acromegaly
Hypersomatotropism, Acromegaly, and Hyperadrenocorticism and Feline Diabetes Mellitus

I will call Colorado State on Tuesday after the holiday using the contact number in the "Sept 2015" posting.

Pricing and cat longevity:
@Wendy&Neko - I saw the cost listed in your post here
as "I was given a quote of low end $5908 to high end $7213"

For some reason I thought it was $4,000. This was the main thread that had those prices:
Places to get Acro treated and notes I took in Sept 2015

The doctor quoted in that thread said that most untreated Acro-cats only live 18-36 months after diagnosis. It's possible those Acro-cats were not being regulated with insulin very well.

Leo and IGH-1 vs insulin
Leo summary history:
- 4/2015 symptoms
- 8/8/2015 diagnosed, and Lantus insulin started
- 7/7/2016 Prozinc started, and Lantus stopped
- 8/25/2016 Levemir started, and ProZinc stopped

Leo is now at 14.0 units/dose, and is just now responding to the Levemir. See chart in my signature.

It is possible to overanalyze everything. I wonder what happens in a cat (or human) body. If you dose such high insulin, how is the insulin competing with the IGH-1? Maybe the excess IGH-1 gets displaced and affects other parts of the body to make those grow even faster. That would mean a high-dose insulin would cause the acromegaly symptoms to accelerate.
 
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Sorry about the diagnosis, but probably not too surprising. And now you have answers and can move ahead.:bighug: Neko's diagnosis launched me into action too. When I talked to the folks at CSU first time there, 4 years ago, the average life expectancy was 2 years, but they hadn't been using the technology long enough and they didn't have enough data to say that was the real numbers. Many of these cats are older and pass from other conditions (such as cancer, kidney disease), not acromegaly once treated. And yes, getting cats into better numbers, more time under renal threshold, really helps.

Jeff, could you post over in the Lantus and Levemir forum? You are more likely to get dose advice over there - this forum is very quiet. I didn't get you other tag. BTW, other high dose kitties include Polly (@pollydoodle ), who got over 10 units, had SRT almost two years ago and is now down to 0.1u of insulin. Yes, that is not a typo. :cool: MissMeows (Gabrielle) and Oren (Megan) are both around 10 units dose now but infrequent posters. We've also had confirmed acrocats around 4 units - not all are high dosers. And one over 60 units with 20+ units of R. When you at the size dose you are currently, you can increase by 1 unit every 4 cycles (2 days), until you start to see blue or maybe low yellow, then slow down and hold doses longer - at least 3 days (6 cycles).

If you want to see spreadsheets of other acrocats, let me know - I can point you to a lot of them, past and present.

When I first took Neko to CSU 4 years ago, it cost around $4,000. Prices were higher 3 years later. The original quote varied so much because they weren't sure whether she'd need an MRI. The tumor is not always visible on CT (though most are), and if not, they also need at MRI before proceeding. The folks at CSU are great, know their stuff and very compassionate.

I don't know the answers to your IGF-1 question, but protecting the kidneys with lower BG is a good idea. Keep your eyes on Health the next couple of days I'll be posting about a new drug trial at the Royal Veterinary College in London to help our acrocats. They are doing great work there that I hope will one day help our cats too.
 
Thanks for the followup and details Wendy. I'm not really looking for dosing advice, but I appreciate it. I'll continue the ramp to drive him down into a decent range.

That is interesting about the cost. I hope Leo doesn't need an MRI. I'll call Tuesday, and post updated price estimates here. These treatments seem to be priced for well-to-do middle class or upper class.

That is also interesting about the 0.1u of insulin after treatment. I don't want to sound selfish, but all the insulin and testing for Leo is very time consuming. It would be nice to get some time back.

Thanks for the info. Grainy pic of a squirmy Leo's prognathia from today. Over 1/8" separation of the canines. The lower jaw has grown out that much. When you live with them everyday, the Acro symptoms are not that obvious.
 

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Hi Jeff. Sorry for the diagnosis, but at least you know and can get started on the treatment. Good luck with the SRT. Hope he doesn't need the MRI and that things go as smoothly as possible. Keep us posted.
 
JeffJ said:
I'm not really looking for dosing advice, but I appreciate it.
Click to expand...
Just trying to keep him safe. Playing with high doses and the large depot is a different ball game. A lot of kitties get down to much smaller doses after treatment, and fortunately, get more predictable. However, the ride down from high doses can be rather crazy.

I compared their MRI and CT scan costs to those from the specialty clinic here, and they are reasonably close. Those and the radiation are the big dicket items. When I was first there, they had some studies going on that made some items cheaper. At the time, if we'd needed an MRI, it would have been free. They will want a recent bloodwork before proceeding and for Neko's second visit, they wanted an echocardiogram done first.
 
Thanks for the support. I'll keep him safe. And I'll update this thread with info.

It feels odd to dose 14.0 and have little effect. But now that he's around BG=300, he seems more responsive. It sure beats his days in the 450-550 range. He was totally out of it then.
 
I investigated the cost of pasireotide. In Canada it would have cost me $5,000 for each three month supply. It's more expensive in the US according to a researcher I contacted. Even though they've had some cats go into remission on pasireotide, the RVC folks realize it's not a cost affortable option for most, hence their latest study to look at a new drug option.
 
I look forwards to hearing more - I know they are also doing surgery but was quite surprised to read that they are one of only a very few centres worldwide to offer surgery for acromegaly. The costs of the drugs are eye watering.
 
Thanks for the feedback. No viable news here. PZI was more effective than Levemir for Leo. Dosage is now at 14.5u, and BG hovering between 300-420. Levemir is drastically cheaper than PZI, so I'll stay with Levemir.

The pasireotide looks interesting. I read the study that was provided. It has a side effect of requiring more insulin. Perhaps it has the same effect as IGH-1, and displaces the insulin at each blood cell as well. Too expensive to use though.

The cost of this whole situation is eye watering. On Leo's spreadsheet there is a "prices and notes" tab. At 12u doses, the insulin options are:
$3,000/year Prozinc - direct from vet, and each vial only lasting ~2.0 weeks
$2,200/year Lantus - from pharmacy
$1,100/year Levemir - via web

The July and August expenses:
$600 - board Leo while we were on vacation, and they let him lose a whole pound over 9 days
$1,600 - Little Dude, rescue, catch up treatments, dental extractions, neuter... now rewarded by his extreme sweetness
$1,050 - Scoobs emergency treatment and surgery, then we lost him anyhow. Oh my sweet Scoobs, I miss you so much :-(
$700 - 2 Leo followup exams and bloodwork in July and August

Then this week, a neighbor found a dying totally emaciated Siamese cat. Literally almost dead, flies landing on him. Theresa got involved. I got the kitty and took him to the emergency clinic. The owner was found via microchip, only 10 houses away. But the owner decided to euthanize. Theresa wanted to fund the recovery. We both lost sleep over it. But we just couldn't afford it. His name was Puma, and he was lost for 2 months. He was 10 years old, and he is with Scoobs at the Rainbow Bridge. Sadness.

In summary, we want the SRT to give Leo more life. It will be expensive. Over 2 years, it will be more cost effective than time and costs involved with high-dose insulin.
 
Sweet little Puma - I'm so sorry for him. It's too bad his owner didn't come through for him. You gotta wonder about people.

I don't remember if you saw or not, but I do have the link to Punkin's SRT adventure in my signature line - lots of details and pics in it, including a few of CSU and the staff. I went through the number crunching and decided it was worth it to have punkin treated with the SRT. Even not treating is expensive, and the only thing that protects their body is doing the SRT. I was glad we did it, even though punkin only lived 2.5 years after the treatment. I was afraid I'd be consumed by guilt if I hadn't done everything I could to help him. Punkin was an old soul, like a wise old monk, and he deserved the best.

In any case, I hope all goes well for you with Leo's treatment. I thought the folks at CSU were incredibly competent.

Other high dose kitties that post in LLL include Jenks (no diagnosis), Doodles (iaa), Tuxie (Cushing's), Purrdy (Cushing's), Fritz (no diagnosis) - there might be others but it's not uncommon for people to learn what they need to know, then not to necessarily post every day.

Just ask if you need anything!
 
Puma:
I accidentally left something out about Puma. It was a budget decision, and the person indicated they just couldn't afford it. I don't want to give details that might identify the owner. And Puma was really toast. It is possible with all the money in the world, that he would not make it. It seemed like he was only 3-5 pounds, and should have been 11-13 pounds. We wish he had come just 3 houses closer and we would have fed him, but we never saw him in those 2 months. People like you, me, the others on this forum - I think we sacrifice ourselves and our budget. Others may care for their pets but not go quite that far. Thanks for the condolences. Scoobs' given name was Duma. So for 2 sad nights we lit the memorial candle for Duma and Puma, even though we only knew Puma for 2 hours. The poor sweet kitties who departed our lives this summer. More sadness.

Punkin and SRT:
I think it is amazing what you did for Punkin. And what Wendy did for Neko (twice). I read your SRT posts twice now, as well as others. What a great life Punkin had.

My trip to Fort Collins is still tbd for scheduling. It will be 15-16 hours for Austin to Ft. Collins (950 miles). To stay sane, it will probably be 2 days each way. We have relatives in south Denver, but I'll probably stay in the same hotel you did. This will be my first road trip since Austin <-> El Paso in 2003.
 
It was something like 1300 miles each way for us to drive to Ft. Collins. We also did it in 2 days each way. Breaking it up definitely helped - even with that it was still a really long drive!

JeffJ said:
This will be my first road trip since Austin <-> El Paso in 2003.
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It must be time, then! That's a long time without traveling!

So sad when the decisions are based on money. It's an unfortunate reality. We all have to live within our budget, but I hate to hear that a kitty died because of that. Thinking of your Scooby/Duma and Puma.
 
I called Colorado State today. They are mostly on holiday. I'll call them back tomorrow. Their website is pretty good. Their phone menus and updated website indicate they receive a lot of calls.
http://www.csuanimalcancercenter.org/
http://www.csuanimalcancercenter.org/radiation-therapy

The webpages include current clinical trials - which are all for dawgs. What's up with that? :-)

Their numbers are:
appointment line at 970-297-5000 option 2 - http://www.csuanimalcancercenter.org/make-an-appointment
consult line at (970) 297-4195 - http://www.csuanimalcancercenter.org/preparing-for-your-visit
 
Just burnt thru the first Levemir flextouch pen in 12 days.
I calculated Leo received 302 units actual out of the 300 units that were in that pen, so that's good.

Now at 15.0 units/dose. Up in the same range that Colin was for awhile (for Sharon), but at least Colin exhibited some nadirs for all that trouble. It is obvious to me that Leo was far more responsive to PZI. For 300 units that works out to:
PZI = $0.325/unit x 300 units -> $97.50 for 12 days, if Leo stayed on PZI
Levemir = $0.123/unit x 300 units -> $36.90 for 12 days actual
.
 
JeffJ said:
I calculated Leo received 302 units actual out of the 300 units that were in that pen, so that's good.
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Nicely done! That's kind of like getting blood out of a stone, right?!

Punkin got up to 15.5u before he had the SRT. He had nadirs but everything was high. I thought the biggest mistake I made was in not giving large enough increases. I continued giving the 0,25u increases even after 10u. It seems to me that it's most successful to think in terms of "getting on top" of numbers. I think I spent the entire summer of 2011 running behind Punkin trying to catch up.
 
Thanks Julie. It was fun trying to get that last bit out of the flextouch pen. I'm going to dissect the pen to see what it looks like inside.

I'm looking forward to talking to CSU tomorrow. If we are lucky, I can schedule it for next week.

For Leo, I'm going to try to get to a 220-250 nadir at least once this week.

Other cats:
We are both missing on Scoobs. He used to walk with Theresa and the dogs. She went walking with the dogs tonight, then texted me that she turned around and accidentally waited for Scoobs to catch up to her :-( He used to sometimes wait and come running to catch up. We lit the Monday night memorial candle for Scoobs (Duma) and Puma tonight. Our cats touch our lives so much. The other shining light in our life is Little Dude, who we "tamed" just in the last month. Little Dude's flickr page is here. Does he look tamed yet?
 
Little Dude is adorable, he seems to really like those tummy rubs. You and your wife have done a great job!
Sorry Leo is so hard to regulate, I hope you find a good dose soon. I too get every last drop from each pen. Even when the plunger looks like it's as far as it can go, there are a few more units in there! Let us know what CSU says.
 
Called CSU today ~11am, and spoke to a real person. Leo now has a case number. Then I was referred to consultation services. I will consult with them and they will establish the treatment, and schedule the appointments. Their scheduling protocol is to return the call within 24-48 hours. They must be pretty busy.

Leo's ramp continues tomorrow. Overall he is kinda cranky, and generally ravenous. I made his litter box easier to get to. His neuropathy is bad.
15.5u current dose
280 - "low" nadir achieved today.
16.0u - tomorrow's dose

Little Dude is just about as sweet as they get. He will probably go to the vet this week. I want confirmation the mites are gone. I might pay to have his ears flushed.
 
Good luck moving ahead with CSU. As it's the new school year, they are probably quite busy. Once I got an email contact, things moved quite quickly for us.

Typical Lev nadir is +8 (though Neko's is later), you might want to try some tests a little later in the cycle. Evening or "before bed" spot checks are a good idea. Many cats go lower at night. Is he on Zobaline for his neuropathy?
 
Thanks Wendy. Leo is on 3 tabs Zobaline a day. I'll test him tomorrow at +8 after AM shot. As of 4:30pm, no call back from CSU today.

My Mom died last week, at age 80. So this has been another sad week. And a sad summer, losing Scoobs, then the stray Puma. Too many tears.
 
Leo is tentatively scheduled for Monday 9/26 - YAY.

Sandra Larson just called. She is the Colo State Oncology Coordinator.

Sandra told me estimated costs are $7,500 - $8,500. Now rereading thread "Places to get acro treated...", the quote was:
CT & 3 days SRT treatment - $7500
Internist consult extra

Next step 1: Oncologist calls me for brief consultation by Monday afternoon. I have Sandra's email and phone number in case it does not occur.

Next step 2: Prep for trip, and setup hotel reservation there.
 
Thanks Julie and BJM. I'm almost done with Mom's tribute website. I setup obits in 4 cities (expensive), as she spent about 1/4 of her life in each. At age 60, I am now parentless. I was lucky to have pretty good parents at all. I sure miss my parents and my step-parents. They all gave me great encouragement and support through my 3 college degrees and computer career.
 
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