12/1 Eddie AMPS 410 +3 319 PMPS 355 +3 295

Jodey&Eddie&Blue

Jodey&Eddie&Blue

Member Since 2021
Good morning,
here's yesterday's story:
https://felinediabetes.com/FDMB/thr...149-7-178-back-to-blue-pmps-374-3-436.256097/

Today, we are still going sky-high: AMPS 410. Did he go down at all last night?

I hate to ask but does it look likes he's heading for an increase? I hope not.

I've recently been contacted by the radiation oncologist from Victoria, BC, where Eddie was to have had a CT scan to determine the status of the tumour after SRT, which he had in February. The oncologist wanted to recommend that Eddie get a CT scan here in the Okanagan because we cannot drive to the coast because of the floods and the road closures.

Eddie had SRT in mid-February. I'm seeking advice from @Wendy&Neko or anyone whose kitty had SRT for acromegaly. I'm not convinced that it's soon enough to have the CT scan but given his wild fluctuations maybe it's better to know what's going on in there and if I have to start planning to get him somewhere for further radiation.

@FrostD @Wendy&Neko
 
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Fact 1: acrokitties post SRT are often bouncy. Fact 2: Eddie could possibly have gone lower the night of the 29th and is bouncing. Fact 3: you need to learn patience and wait out the bounce. Fact 4: Eddie's dose has gone from 15 units to 8 units in a month and a half. Sounds to me like SRT is working. Fact 5: SRT is a slow process, can take a couple of years for full effect. You really need those patience pants. Get a comfy pair on.

IMHO, you do NOT need a follow on CT scan, now, or even later. I know of absolutely no one who has had a follow on CT after SRT. Unless like me/Neko, the tumour was clearly taking off and the dose skyrocketing up and I did the CT scan prior to follow on SRT. Just so you know, Neko was the first cat, ever, to have a second SRT and that was over 3 years after the first one. Since then there has been less than a handful. The CT scan results will tell you almost nothing. If the tumour is smaller than before, does it means it's just gone down in size a bit, or does it mean it went down more and then grew up to where it is now? Meaning, the CT scan would be useless and wouldn't tell you what to do next.

The risks to CT scan are in the anaesthesia. Far too many acros have heart conditions, not all of them detected yet. I have seen too many acro kitties here show heart symptoms too late. :( Has Eddie been checked out lately by a cardiologist? Neko was checked out by a good cardio vet a few weeks before her second SRT, cleared for anaesthesia, and still had a heart block during her CT scan. Thankfully she was revived. Needless to say, I am not a fan of anaesthesia for acrokitties unless necessary, and satisfying a vet's curiosity does not rank up there in my list of necessary conditions.
 
Wendy&Neko said:
Fact 1: acrokitties post SRT are often bouncy. Fact 2: Eddie could possibly have gone lower the night of the 29th and is bouncing. Fact 3: you need to learn patience and wait out the bounce. Fact 4: Eddie's dose has gone from 15 units to 8 units in a month and a half. Sounds to me like SRT is working. Fact 5: SRT is a slow process, can take a couple of years for full effect. You really need those patience pants. Get a comfy pair on.

Thank you for this detailed explanation. I do hear you about the possibility of the 29th. It's odd because he was doing really well until we went to the vet for his blood test. But here we have it. I'm trying with the patience pants and for some reason am ok with low numbers. The high numbers concern me for obvious reasons. When they happen I'm trying to weigh the possibility the SRT is working against the possibility the SRT got only part of the tumour and it's wreaking havoc again. He had 3 sessions of SRT.

IMHO, you do NOT need a follow on CT scan, now, or even later. I know of absolutely no one who has had a follow on CT after SRT. Unless like me/Neko, the tumour was clearly taking off and the dose skyrocketing up and I did the CT scan prior to follow on SRT. Just so you know, Neko was the first cat, ever, to have a second SRT and that was over 3 years after the first one. Since then there has been less than a handful. The CT scan results will tell you almost nothing. If the tumour is smaller than before, does it means it's just gone down in size a bit, or does it mean it went down more and then grew up to where it is now? Meaning, the CT scan would be useless and wouldn't tell you what to do next.

The reason given to me re: the follow up CT scan is, as you know, that they want to determine the status of the tumour. Regarding radiation, I would have to share that Eddie's brother had hypophysectomy in 2018, Fractionated radiotherapy at the end of 2018 and then following an MRI in 2020 had SRT (1 session). So, he's had two radiation therapies at different times. I supposed the rationale is that if Blue's tumour was caught and finally (?) eradicated, then there's the possibility Eddie might be going the same route.
I've been meaning to ask you if you thought Cabergoline would help with the situation?

The risks to CT scan are in the anaesthesia. I totally hear you about this. With Eddie, the problem is with opioids used in anaesthesia. Apparently he has the "paradox effect", meaning that instead of being sedated, he goes in the opposite direction and gets intensely hyperactive.

Far too many acros have heart conditions, not all of them detected yet. I have seen too many acro kitties here show heart symptoms too late. :( Has Eddie been checked out lately by a cardiologist?
Eddie was checked out by a cardiologist at Washington State U before his hypophysectomy in 2020 but how he is now, I cannot say.
Neko was checked out by a good cardio vet a few weeks before her second SRT, cleared for anaesthesia, and still had a heart block during her CT scan. Thankfully she was revived. That would have been terrifying!!

Needless to say, I am not a fan of anaesthesia for acrokitties unless necessary, and satisfying a vet's curiosity does not rank up there in my list of necessary conditions.
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Again, I'm with out on the resisting curiosity. The only thing I am concerned with is the question of the return of the tumour but then, as you say, SRT can take months even years. They told me it would take 9-12 months and we are just at the 9month mark now. I have to gauge the difference between that fact and the possibility of tumour return. It's hard to determine which side to come down on as the fluctuation of his BG tells one story and then another. The field is ambiguous.

I feel like a juggler and I'm trying to keep all the balls in the air while putting my face in Eddie's fur and breathing deeply. The balls are marked: SRT, hypophysectomy, acromegaly, IAA, BG & SS numbers and TR while living with this amazing being who is Eddie.

Thank you, Wendy. We go on.
 
CSU told me up to 2 years, and I have seen the SRT effects last longer here. The change when Neko's tumour came back took more than a couple cycles. ;) More like months. It is possible you are seeing some IAA effects though. And that you cannot measure.

Keep on enjoying Eddie. He is so much more than his numbers. I know it took me a while to not stress about BG numbers and just accept them for what they are. It's a process.:bighug:
 
Wendy&Neko said:
CSU told me up to 2 years, and I have seen the SRT effects last longer here. The change when Neko's tumour came back took more than a couple cycles. ;) More like months. It is possible you are seeing some IAA effects though. And that you cannot measure.

Keep on enjoying Eddie. He is so much more than his numbers. I know it took me a while to not stress about BG numbers and just accept them for what they are. It's a process.:bighug:
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He really is. Thank you. It was easier with Blue, who has had no insulin since August 11th. Eddie's journey has been traumatic for him and so I guess I tend to worry more. Even though Blue has had more procedures done than Eddie, Eddie had a really hard time of it. In fact, when he came onto my lap the other day and started purring I could hardly move. He has not done that for 5 months. I'll keep with the dance. Thanks, again. :cat::) {where is the wine glass emoji?).
 
Echoing what Wendy said. We had good days, and not so good days. He would break through into nice numbers, then shoot right back up again. But I've nearly lost him so many times already, that I truly am thankful just to have him here.
 
I’m with @Wendy&Neko on all points.

Jodey, I do sooo feel for you. It’s easy, when one wants to do everything humanly possible, to be lured into yet more tests. But sometimes more isn’t better … it’s just, well, more.

And sometimes more really can be harmful.

Tubby went through scores of tests both prior to and after SRT. The bottom line is that Tubby’s is a difficult story and I don’t talk about it much. But, I now have a very strong aversion to anesthetizing acro/SRT kitties unless absolutely necessary. And I’ll repeat that — unless absolutely necessary.

Tubby didn’t have a follow-up CT either. It wasn’t even mentioned as a possibility, thank goodness, because I’d probably have been hell-bent on having it done if it had. It’s the “protective caregiver / do everything possible” instinct in us, I suppose. But for the third time (am I being redundant yet, lol?), anesthesia isn’t innocuous. And I agree with Wendy that the results might give you many more questions than answers.

Part of the problem with acros is that nothing is “normal”, so interpreting somewhat subjective results can be even more challenging. Another problem is that most vets, even specialists, haven’t seen a large enough caseload to offer truly experienced and well-versed guidance.

So if it were my cat (and given the clarity of hindsight and time), I’d take a follow-up CT off the table. If that sounds too final, maybe add the words “for now” to the previous sentence, then mark your calendar for 6 months or a year down the road (the longest timeframe your brain will allow), then force yourself not to entertain it before then. Just my two cents.
 
So another thought, and this is like cognitive behavioral therapy I guess ha

Keeping in mind what Wendy said as far as they really can't discern much about tumor growth vs regrowth - what would the tumor return tell you even if they could tell you it's growing? How would it make anything different? Would you put him through another round of SRT? Based on his experiences and what I know of you, I don't think you would...but I could be wrong. So all things considered, all you can do for the near term (few years it sounds like) is manage with insulin.

It sucks when so many things are beyond our ability to control, or veterinary medicine to treat/fix. I just take my cues from Mr Kitty and go from there.
 
Wow, thank you Wendy, JL and Melissa. Your words carry a lot of weight. I particularly resonate with the "protective caregiver/do everything possible". That sounds like me and how I've been living with two acrokitties for these past years.

I'm going to follow the one-day-at-a-time as well as I can given my propensity for protective action. I'm going to take Max, the dog, out for a walk. Then I'll come back and do a PMPS and then make Eddie happy with some food. I had the impulse to test him earlier and I thought to myself, I'll just give him a break. Me, too.

Thank you for being there. :bighug::bighug::bighug:
 
So probably next to last post for the night since PMPS is 355.

This marks the sixth cycle at 8u. I'll test again before bed.

Good night.
 
FrostD said:
I count 8 cycles at 8U?
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Yes, yes, you are right. I'm a bit distracted. I had a major computer crash this morning and I'm using a loaner from the university IT and it's been a bit haywire.
Ok, so, as you said, if he doesn't get close to green tonight/show up unusually low in the AM, ... take him up to 8.5U tomorrow."
I have to learn this is about adaptation and not failure. Sheesh.
Thanks, Melissa. If I hear nothing different from @Wendy&Neko and there's no green or low at AMPS, I will take him to 8.5u.
 
Given those low blues a couple night ago, I'd hold until the bounce is over. End of tomorrow marks end of six cycles.
 
Wendy&Neko said:
Given those low blues a couple night ago, I'd hold until the bounce is over. End of tomorrow marks end of six cycles.
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Curious why it reads bounce to you? I had thought the same a few days ago, but lately he's been showing red/pink down to blue in same cycle, even when +2/+3 doesn't indicate that's what will happen.
 
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