? 12/4 Eddie AMPS 380 +3 340 PMPS 311 +2 418 +3 360

The more I look, I'm not really seeing a clear relationship between when pred is given and how his cycles go. He's been having those early PM drops since before you changed pred to PM on the 29th. As well as those high AM preshots.

From what I've read it usually reaches it's peak around 2 hours...but perhaps the BG lags that because otherwise I wouldn't expect such large early drops

I'm going to tag @Katherine&Ruby , she might be better at reading pred influence it than I am. She may also have a thought as to when to give it, I think she played with timing with Ruby's pred
 
So, here we are at +3 340 and the "pattern" on the spreadsheet is a mystery to me, maybe because I'm not entirely sure of what I'm looking for. Beyond fluctuations with dose change?? We're not at 8.5u, but it's only the 2nd day in the cycle. Eddie's bouncing around seems to happen in the middle of the night and I'm nearing exhaustion testing at night when I also have to get up relatively early in the morning.

I'm not impatient, really... I'm just tired. And, there's no emoji here for that.
 
He's bouncing today for sure. A +5 or so today would probably be blue.

Unfortunately no real advice for nighttime. Are you able to sleep between tests? Nights you need to catch up on sleep can always leave some MC out

I'm sort of hoping we can stop these dives over the next few nights and maybe even him out, but not sure.
 
Hi Jodie. I just stopped by to see how your Eddie was doing and to tell you that I have been very impressed with how you word your concerns for others - like Cassie and Sassie. You are obviously very "well spoken" and compassionate and I wish the best for you and Eddie.
 
FrostD said:
He's bouncing today for sure. A +5 or so today would probably be blue.

Unfortunately no real advice for nighttime. Are you able to sleep between tests? Nights you need to catch up on sleep can always leave some MC out

I'm sort of hoping we can stop these dives over the next few nights and maybe even him out, but not sure.
Click to expand...

If only I could sleep between tests! Last night wasn't really an option as I was testing every hour in response to Bhooma's guidance. I'm pooched today. I find that the nightly follies are a challenge because even when testing two hours apart, the alarm breaks into REM.

I'm also hoping to do something about the dives. It's just, well, weird, right? Last night I think even Eddie was weighing getting food against sleeping. He was starting to look pretty drowsy...

I mentioned having a Zoom meeting with the folks from WSU (Tina Owen (surgeon), Annie Chen Allen (neurosurgeon), Linda Martin (critical care) and Sarah Guess (internist). We were talking about Eddie and because we were on Zoom I was able to share his SS and, as I mentioned, they loved it! It was great to have that response instead of the one I get from the vet here who is grumpy about the "colours".

Anyway, Annie Chen-Allen sent a synopsis of our talk:

J
Sarah was pretty happy with where Eddie’s glucose is at so Jodey will continue to trend out the glucose and adjust insulin dosing accordingly. We are all very happy that the insulin requirement has steadily decreased. Even without the CT now, we suspect SRT is working given the reduce insulin requirement.

Jodey will get an IGF-1 to see where we are at now. This will give us a good baseline for comparison for later.

The plan then is to continue what we are doing and then to repeat everything in about another 3 months, at the 1 year mark post SRT. At that time, hopefully the roads will be open so that Jodey can get Eddie a CT. if necessary. With that info, along with another IGF-1 and knowing how the glucose control is going, we will then decide what our next steps are.
We discussed that if at 1 year all the values are still trending for the better and a CT does not show anything concerning, then likely we will just continue monitoring since SRT can potentially be effective past 1 year. If everything continues to go well, we will then repeat everything at 1.5 years post SRT.
If at the 1 year mark we decide based on the results that things have plateaued or the mass is bigger, then Jodey can talk with the SRT facility to see if more SRT can be done.
Obviously if at any point Eddies starts to trend for the worse, our plan may change accordingly.
Hope this plan sounds good to everyone! Feel free to input more Sarah and Linda as you see fit!

What I really appreciate about these folks is that all of them joined a one-hour Zoom meeting so we could talk about Eddie. No charge.

Anyway, I will get an IGF-1. That will tell us something about the SRT-tumour choreography. In the meantime, he's snoozing by the fire and quite content. He gets to catch up on his sleep.
 
Jodey&Eddie said:
If only I could sleep between tests! Last night wasn't really an option as I was testing every hour in response to Bhooma's guidance. I'm pooched today. I find that the nightly follies are a challenge because even when testing two hours apart, the alarm breaks into REM.

I'm also hoping to do something about the dives. It's just, well, weird, right? Last night I think even Eddie was weighing getting food against sleeping. He was starting to look pretty drowsy...

I mentioned having a Zoom meeting with the folks from WSU (Tina Owen (surgeon), Annie Chen Allen (neurosurgeon), Linda Martin (critical care) and Sarah Guess (internist). We were talking about Eddie and because we were on Zoom I was able to share his SS and, as I mentioned, they loved it! It was great to have that response instead of the one I get from the vet here who is grumpy about the "colours".

Anyway, Annie Chen-Allen sent a synopsis of our talk:

J
Sarah was pretty happy with where Eddie’s glucose is at so Jodey will continue to trend out the glucose and adjust insulin dosing accordingly. We are all very happy that the insulin requirement has steadily decreased. Even without the CT now, we suspect SRT is working given the reduce insulin requirement.

Jodey will get an IGF-1 to see where we are at now. This will give us a good baseline for comparison for later.

The plan then is to continue what we are doing and then to repeat everything in about another 3 months, at the 1 year mark post SRT. At that time, hopefully the roads will be open so that Jodey can get Eddie a CT. if necessary. With that info, along with another IGF-1 and knowing how the glucose control is going, we will then decide what our next steps are.
We discussed that if at 1 year all the values are still trending for the better and a CT does not show anything concerning, then likely we will just continue monitoring since SRT can potentially be effective past 1 year. If everything continues to go well, we will then repeat everything at 1.5 years post SRT.
If at the 1 year mark we decide based on the results that things have plateaued or the mass is bigger, then Jodey can talk with the SRT facility to see if more SRT can be done.
Obviously if at any point Eddies starts to trend for the worse, our plan may change accordingly.
Hope this plan sounds good to everyone! Feel free to input more Sarah and Linda as you see fit!

What I really appreciate about these folks is that all of them joined a one-hour Zoom meeting so we could talk about Eddie. No charge.

Anyway, I will get an IGF-1. That will tell us something about the SRT-tumour choreography. In the meantime, he's snoozing by the fire and quite content. He gets to catch up on his sleep.
Click to expand...
Awesome!

I've got two little kids, so broken sleep is just par for the course. But I know how hard it is!

About the IGF...I thought I remember Wendy saying it's pointless to redraw because takes tome to come down, but that MAY be specifically cabergoline related
 
FrostD said:
Awesome!

I've got two little kids, so broken sleep is just par for the course. But I know how hard it is!

About the IGF...I thought I remember Wendy saying it's pointless to redraw because takes tome to come down, but that MAY be specifically cabergoline related
Click to expand...
I can see their (WSU) rationale for the IGF-1 test in that it's been over a year since he had one. For me, it's the least invasive and there's no risk with anesthesia...

The sleep thing: just don't know what to do. I'm hoping we aren't having fun again tonight...:D:cat:
 
Jodey&Eddie said:
Jodey will get an IGF-1 to see where we are at now. This will give us a good baseline for comparison for later.
Click to expand...
Bad idea. It will tell you absolutely nothing. The majority of people I see get the IGF-1 done after SRT in fact see it go up! Which just disheartens people. The IGF-1 has zero relation to size of the tumour. All it tells you is if over 100 he has acromegaly. Wait! You already know that. :rolleyes:
Jodey&Eddie said:
At that time, hopefully the roads will be open so that Jodey can get Eddie a CT.
Click to expand...
Still a bad idea then too, the reasons I stated in my previous post on this will still hold. Will tell you nothing and anaesthesia can possibly cause harm.
Jodey&Eddie said:
SRT can potentially be effective past 1 year. If everything continues to go well, we will then repeat everything at 1.5 years post SRT.
Click to expand...
SRT often takes up to two years. Not sure I'd even do a CT scan even at 2 years, reasons will still hold on the dangers and probably even more so. I know of no one who has had a repeat scan and no one else who has even had it suggested.
 
Wendy&Neko said:
Bad idea. It will tell you absolutely nothing. The majority of people I see get the IGF-1 done after SRT in fact see it go up! Which just disheartens people. The IGF-1 has zero relation to size of the tumour. All it tells you is if over 100 he has acromegaly. Wait! You already know that. :rolleyes:

Still a bad idea then too, the reasons I stated in my previous post on this will still hold. Will tell you nothing and anaesthesia can possibly cause harm.

SRT often takes up to two years. Not sure I'd even do a CT scan even at 2 years, reasons will still hold on the dangers and probably even more so. I know of no one who has had a repeat scan and no one else who has even had it suggested.
Click to expand...
Hope all is well with you

If you get a chance - is this also the case for cats that have had a hypophysectomy? I would assume since tumor is removed, IGF should be normal? Unless of course they couldn't get it all or it regrows?
 
FrostD said:
is this also the case for cats that have had a hypophysectomy? I would assume since tumor is removed, IGF should be normal? Unless of course they couldn't get it all or it regrows?
Click to expand...
They didn't get it all, hence the subsequent SRT.
 
FrostD said:
Hope all is well with you

If you get a chance - is this also the case for cats that have had a hypophysectomy? I would assume since tumor is removed, IGF should be normal? Unless of course they couldn't get it all or it regrows?
Click to expand...

So many things to speak to here. I guess I want to address the IGF-1 test but I'll refer to Blue's case rather than Eddie's at the moment. As I've said, Blue (Eddie's brother) was the first to have hypophysectomy in February 2018. In August of 2018, he had a check up MRI, which showed a regrowth of the tumour so he went for Fractionated Radiotherapy at the end of 2018. He had an IGF-1 about 8 months following that therapy and it was determined he had a small regrowth of the tumour, for which he then received one SRT session. He still needed insulin after that and he was getting about 2u/twice daily until he nearly went hypo after which he no longer needs insulin (I check him randomly). Blue's last IGF-1 test was normal range. The issue of regrowth never goes away because they are dealing with cells and the surgery, no matter how precise, can't always get the whole thing, which is why they go for radiation. It's much more precise.

Eddie is another matter. As you know hypophysectomy in Dec 2020. They could get only 60% of the tumour because it was too close to the hypothalamus to risk any further removal. So, SRT was recommended at the time of surgery as a follow up because the tumour was pretty active even after the 60% was removed. So, he got SRT (3 sessions) only a few months after the surgery, which is unusual but because in Eddie's case the tumour was quite large, an observation that was made to by more than one practitioner. I felt a lot of dread. I do not want Eddie to be anesthetized just for a test, which is why, I guess, I'd go for the IGF-1 if anything. Make no mistake: even the radiation oncologist told me that research has shown that IGF-1 is not considered as significant a finding after surgery, so I get that. I'm not going to rush out and get any tests done, at all, but I've worked with those people at WSU and I respect them. They saved Blue's life and Eddie's as well since the tumour was so large. I appreciate they respond to a call from me to have a meeting over a year later, even after Eddie has received treatment from another unrelated veterinarian.

All I know is that I'm here, with Eddie and I'm so grateful for the support. I'm taking to heart every bit of advice I'm given and consider it very carefully as it's about Eddie, not me. So, I'm doing my best.

If only we didn't have night time shenanigans, as Melissa calls.

Just did PMPS 311.

Thank you everyone!
 
If I hedge my bets, I think he probably touched blue again today. Possibly a repeat of 30th or 1st...though I'm guessing he went lower later the night of the 1st into the 2nd
 
FrostD said:
If I hedge my bets, I think he probably touched blue again today. Possibly a repeat of 30th or 1st...though I'm guessing he went lower later the night of the 1st into the 2nd
Click to expand...
Do you read shenanigans or no? I mean I sure like Eddie's +4 PMPS last night.
It must be time for you to get horizontal. Have a good night...Thank you.
 
Sorry I didn't respond earlier. Was out and didn't see the tags. He is bouncing from the greens of last night. An opportunity to sleep and recharge for the next active cycle. :-)
 
Bandit's Mom said:
Sorry I didn't respond earlier. Was out and didn't see the tags. He is bouncing from the greens of last night. An opportunity to sleep and recharge for the next active cycle. :)
Click to expand...
You would think though that more insulin would mean lower numbers. It's hard to get my mind to see it inversely.
 
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