? 01/28 Eddie AMPS 414 +3 473 +4 477 +6.5 477 +9 439 PMPS 464 +2 353 +4 182 (change cartridge

Jodey&Eddie&Blue

Jodey&Eddie&Blue

Member Since 2021
Good morning,
Here's yesterday's story about increasing to 7.5 u

https://felinediabetes.com/FDMB/thr...3-248-pmps-448-2-421-increase-tonight.258466/

I emailed the vet who agrees the matter of high AMPS-PMPS with blues in the middle is a matter of duration. He also suggests it is not to do with acromegaly tumour activity (regrowth) because there are so many blues in between AMPS-PMPS. Eddie will be having the blood panel on Tuesday and hopefully that will provide some clarity.

Thank you, everyone, for your support and good words. :):cat:
 
Now the vet backtracks: maybe it is tumour-related and he's releasing IGF-1.

It's so easy to get confused here. At first he says it's not tumour-related because of good numbers; now he's saying today's high numbers may well be IGF-1 related.
 
Jodey&Eddie said:
Now he wants the IGF-1 test, which I know many here think is useless.
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What would you differently if you knew what his IGF-1 number is now? Ask your vet that question too. If nothing, it's just money out of your pocketbook. The IGF-1 number has nothing to do with tumour size.

Today is New Dose Wonkiness. Glad you are going to see the vet and get blood work. I'd get him to do a physical and take a look at his teeth too.
 
Jodey&Eddie said:
Yes, I hope so! Now he wants the IGF-1 test, which I know many here think is useless. I’m kind of caught in the crossfire. :cat:
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Not necessarily useless, just not exactly helpful. Like Wendy said what is it going to tell you really? Would you do another hypophosectomy or SRT? From where I sit, it doesn't affect the future in any way. If it comes back outside of normal range - ok is it regrowth, or is it just high because the tumor is obviously still there, as we can see with the dose and his BG? Back at square one and $$ gone. I don't see it coming back in normal range

I would also ask him what made him rethink it?

I suspect he's still bouncing as well.
 
Wendy&Neko said:
What would you differently if you knew what his IGF-1 number is now? Ask your vet that question too. If nothing, it's just money out of your pocketbook. The IGF-1 number has nothing to do with tumour size.

Today is New Dose Wonkiness. Glad you are going to see the vet and get blood work. I'd get him to do a physical and take a look at his teeth too.
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I totally hear you about IGF-1. If it was high I guess I’d be looking at next steps. I don’t know.
I’m looking forward to getting the blood work and physical done . One step at a time. He’s ok re: 5Ps but astronomical BGs get me really worried and these seem out of the park.
 
FrostD said:
Not necessarily useless, just not exactly helpful. Like Wendy said what is it going to tell you really? Would you do another hypophosectomy or SRT? From where I sit, it doesn't affect the future in any way. If it comes back outside of normal range - ok is it regrowth, or is it just high because the tumor is obviously still there, as we can see with the dose and his BG? Back at square one and $$ gone. I don't see it coming back in normal range

I would also ask him what made him rethink it?

I suspect he's still bouncing as well.
Click to expand...

So, here we are @6.5 477. BG hasn't budged. I did not do a fur shot.
 
I’m skeptical that an IGF-1 might end up being a red herring … and misleading.

In additional to standard bloodwork (by which I mean CBC and Chemistry), I’d want to add a full thyroid panel and probably also a GI panel, given the trend toward higher BG numbers and recent diarrhea. Probably also an SDMA to see where the kidneys are as well. And a urinalysis (via cystocentesis) and C&S, just in case there’s a brewing UTI.

Remember, a percentage of post-SRT cats go hypoT, which is why the thyroid panel is warranted.

Hey, data is good, right?
 
Jodey I am so sorry and I totally understand the worry right now! Id be a hot mess! Having said that try not to get yourself to overworked and obsessed with the numbers. Right now his 5 p's are ok and you have a vet visit in just a few days. I'd be more concerned if he was overall in a bad way.
 
FrostD said:
Not necessarily useless, just not exactly helpful. Like Wendy said what is it going to tell you really? Would you do another hypophosectomy or SRT? From where I sit, it doesn't affect the future in any way. If it comes back outside of normal range - ok is it regrowth, or is it just high because the tumor is obviously still there, as we can see with the dose and his BG? Back at square one and $$ gone. I don't see it coming back in normal range

I would also ask him what made him rethink it?

I suspect he's still bouncing as well.
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Also, the vet rethought it because he really doesn't keep very good records, knows little about Eddie, refuses to look at spread sheet ("too many colours") and can't recall what medications he's prescribed...
 
Rainbow Conti said:
Jodey I am so sorry and I totally understand the worry right now! Id be a hot mess! Having said that try not to get yourself to overworked and obsessed with the numbers. Right now his 5 p's are ok and you have a vet visit in just a few days. I'd be more concerned if he was overall in a bad way.
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Thank you! Hot mess is right! And now I have to go and teach online.
 
JL and Chip said:
I’m skeptical that an IGF-1 might end up being a red herring … and misleading.

In additional to standard bloodwork (by which I mean CBC and Chemistry), I’d want to add a full thyroid panel and probably also a GI panel, given the trend toward higher BG numbers and recent diarrhea. Probably also an SDMA to see where the kidneys are as well. And a urinalysis (via cystocentesis) and C&S, just in case there’s a brewing UTI.

Remember, a percentage of post-SRT cats go hypoT, which is why the thyroid panel is warranted.

Hey, data is good, right?
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I will definitely make sure those are the tests that are done. Thank you, JL!
 
The geri-panel (a standard Idexx panel in BC) includes the T4 and SDMA tests. What you'd be adding extra is the GI panel, which might need to be fasted. I used to take Neko in for b/w just before PMPS.

I don't know if you've ever browsed the Acrotracker (a SS started years ago to support a researcher at CSU, not now as up to date), but there are records of a couple people who did multiple IGF-1 tests following SRT or Cyberknife. A couple the IGF-1 numbers stayed mostly similar or went up, one (Milo) who went OTJ, his IGF-1 came down but not into normal range. Tony also came down 16 weeks after SRT, but only lived 9 months after SRT, still on insulin - he had some other issues (heart). Interestingly enough, both of those cats were Canadian.
 
You want to know where the vet is coming from? I just got this in an email when I sent Eddie's numbers in anticipation of the appointment:

"Short term this means that there is a setback and that the insulin needs to be increased. It can be resurgence of GH secretion, an infection, insulin not working or a combination of all 3. Eddie’s numbers show no effect from the insulin at this time.

Good news is that Eddie is not acting sick.I recommend to go up 2IU to 9IU (so actually 1.5 IU)"

I already told him I have increased the insulin from 7u to 7.5u last night.

@Wendy&Neko @FrostD : how would you deal with this?
 
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Did not get the tag sorry, will tag @Wendy&Neko since she probably didn't get it either

If this is the same vet who doesn't like looking at spreadsheet, I'd just say thank you and move on while doing whatever it is I felt was right...which if it were me is increasing by 0.5U as needed, with a proper wait time (8-10 cycles) to see what the increases do for him

Despite whatever is happening with him, he is seeing low blues (nearly green!) recently. So anything larger than a 0.5U increase is too drastic.
 
FrostD said:
Did not get the tag sorry, will tag @Wendy&Neko since she probably didn't get it either

If this is the same vet who doesn't like looking at spreadsheet, I'd just say thank you and move on while doing whatever it is I felt was right...which if it were me is increasing by 0.5U as needed, with a proper wait time (8-10 cycles) to see what the increases do for him

Despite whatever is happening with him, he is seeing low blues (nearly green!) recently. So anything larger than a 0.5U increase is too drastic.
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Yes, thank you, I agree with you... I posted that just to demonstrate, with regards to dosage, for example, what I'm dealing with on the veterinary side of things. There is no way in hell that I would up Eddie's insulin by 2u over a 24 hour period.
I need this vet, however, to get tests done, or at least at this clinic. There is another vet at this clinic that I'm going to get to meet on Tuesday, however, the vet I've been discussing is the only internal medicine vet in the entire area.
 
Jodey&Eddie said:
Yes, thank you, I agree with you... I posted that just to demonstrate, with regards to dosage, for example, what I'm dealing with on the veterinary side of things. There is no way in hell that I would up Eddie's insulin by 2u over a 24 hour period.
I need this vet, however, to get tests done, or at least at this clinic. There is another vet at this clinic that I'm going to get to meet on Tuesday, however, the vet I've been discussing is the only internal medicine vet in the entire area.
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Unfortunately he sounds like a lot of vets on this forum :/ if he presses you about exact dose, just tell him you weren't comfortable increasing that much that quickly until you had the lab results back...or something like that. Or tell him you thought there was a miscommunication and wanted to discuss in person. Ill never say to lie...but sometimes it sure would be convenient lol

Just remember, the vet is providing YOU a service. If there is something YOU want done, and there's no obvious harm to the cat, it shouldn't be an issue. Perhaps that's an American way of thinking, just blame our human healthcare system for that ;)
 
FrostD said:
Unfortunately he sounds like a lot of vets on this forum :/ if he presses you about exact dose, just tell him you weren't comfortable increasing that much that quickly until you had the lab results back...or something like that. Or tell him you thought there was a miscommunication and wanted to discuss in person. Ill never say to lie...but sometimes it sure would be convenient lol

Just remember, the vet is providing YOU a service. If there is something YOU want done, and there's no obvious harm to the cat, it shouldn't be an issue. Perhaps that's an American way of thinking, just blame our human healthcare system for that ;)
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Quick question: I would like to ditch this insulin cartridge and use a fresh one. Can I inject cold insulin?
Ok, I held the cartridge close to armpit and warmed to body temperature. I just thought, with all the crazy things going on,, what if there was a faulty cartridge or one that had lost its potency. It was after all the last cartridge of the last pack in the fridge. I just now opened the new pack from the new prescription (Dec 2021) and gave him insulin from the new cartridge.
@Bandit's Mom if @FrostD isn't around still.
 
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Jodey&Eddie said:
how would you deal with this?
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Smile and nod my head, or "I'll take that under advisement/thank you for your suggestion". Dosing wasn't part of my vet's domain. If the vet doesn't like looking at the spreadsheet, he has no way of knowing what you are dosing.

Sure, you can inject cold insulin, just not as pleasant for the cat. I used to hold it between my fingers for a bit to warm. I always recorded in the Remarks when I started a new cartridge, so I could go back and count the number of days I'd used it, or to see if there were any patterns related to the numbers. Most of the time it's not that, unless the cartridge somehow got frozen in the fridge. However, peace of mind, not a bad thing to start a new cartridge.
 
@Bandit's Mom
Hi Bhooma, I think you're the only one that's up. Above I wrote:

"Quick question: I would like to ditch this insulin cartridge and use a fresh one. Can I inject cold insulin?
Ok, I held the cartridge close to armpit and warmed to body temperature. I just thought, with all the crazy things going on,, what if there was a faulty cartridge or one that had lost its potency. It was after all the last cartridge of the last pack in the fridge. I just now opened the new pack from the new prescription (Dec 2021) and gave him insulin from the new cartridge."

Well, I just had a feeling and now @+4 he's in the blue with 182. Do you believe my intuition about the insulin was right? Or did we just break a BIG bounce?
 
I don't think it's related to the cartridge but too early to tell. Will take a few cycles to see if duration improves
 
@Jodey&Eddie how are you and Eddie doing today? That was a pretty significant drop last night from a PS of 464 to 182 at +4 … the blue was nice to see; I wonder how low he ultimately went.

I’ve been looking for a new condo today might have missed it, so am posting to yesterday’s. Hope you two had a good day.
 
JL and Chip said:
@Jodey&Eddie how are you and Eddie doing today? That was a pretty significant drop last night from a PS of 464 to 182 at +4 … the blue was nice to see; I wonder how low he ultimately went.

I’ve been looking for a new condo today might have missed it, so am posting to yesterday’s. Hope you two had a good day.
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Hi JL,
not the best of days:
AMPS 376
8:20 am 7.5u Lantus

10:20am 444

12:20pm 415

2:20 pm 415

4:20 pm 426

PMPS 446

8:20 pm 8u Lantus

11:20 311
 
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