04/04 Eddie AMPS 436 PMPS 376 2.5 416 (worried)

You need to give him six cycles at this dose before increasing and with yellow nadirs, I'd go up 0.5 units for his size of dose, if you need to increase.
 
Wendy&Neko said:
You need to give him six cycles at this dose before increasing and with yellow nadirs, I'd go up 0.5 units for his size of dose, if you need to increase.
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We're now at PMPs +3 427. Nothing yellow about that.
Am I understanding you correctly: Tonight he will be at six cycles of 8u. An increase tomorrow (?) to 8.5u? Is this correct???
 
Do you think there is a medical issue? I suspect IAA antibodies and glucose toxicity are part of it.
 
IAA acts independently of the pituitary tumour. Been a while since he's seen green, so glucose toxicity is also part of the picture.
 
Wendy&Neko said:
IAA acts independently of the pituitary tumour. Been a while since he's seen green, so glucose toxicity is also part of the picture.
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I wonder if the glucose toxicity is associated with Prednisolone, a steroid... Also, IAA is related is it not to acromegaly as is impaired glucose tolerance?

I think it's a complex situation where cause/effect are intertwined....

You'll recall his last IGF-1 was lower than the test prior to SRT but still slightly raised.
 
I'm sorry he's in such high numbers. Eddie is a tough one to manage. You do such a wonderful job. You wouldn't think that the prednisolone would be doing anything unexpected at this point... since he's been on it for a long time now. How does he seem to you lately?
 
Suzanne & Darcy said:
I'm sorry he's in such high numbers. Eddie is a tough one to manage. You do such a wonderful job. You wouldn't think that the prednisolone would be doing anything unexpected at this point... since he's been on it for a long time now. How does he seem to you lately?
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Eddie really is a tough one…at this point, I’m grasping at straws , so there could be any number of factors and/or combinations.
He seems totally normal. The only clue is that he’s impatient one moment snd purring the next. He is drinking water and peeing in equal measure but he’s been doing that since the beginning of all this. He’s not only a tough one but a mystery. Will see what tonight and AMPS tomorrow brings. :cat:
 
Jodey&Eddie said:
Eddie really is a tough one…at this point, I’m grasping at straws , so there could be any number of factors and/or combinations.
He seems totally normal. The only clue is that he’s impatient one moment snd purring the next. He is drinking water and peeing in equal measure but he’s been doing that since the beginning of all this. He’s not only a tough one but a mystery. Will see what tonight and AMPS tomorrow brings. :cat:
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Well, I know you love him soooo much! I do hope the increase will help. Does he take desmopressin too? Has he been like that since his surgery? Impatient one minute and happy the next. Or is that more recent?
 
Glucose toxicity is associated with time in higher numbers. I don't think you've changed the pred dose have you? As Suzanne, I don't think it would be doing anything new now.

There are many conditions that cause some form of insulin resistance, glucose toxicity, acromegaly, iAA, Cushings, heart disease, hyperthyroidism, CKD, bad teeth (ie, infection/inflammation), pancreatitis, to name a few. Having multiple of these at once is challenging.
 
Suzanne & Darcy said:
Well, I know you love him soooo much! I do hope the increase will help. Does he take desmopressin too? Has he been like that since his surgery? Impatient one minute and happy the next. Or is that more recent?
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It’s true. I do love him. He’s high again at PMPS so for sure tomorrow we’ll be increasing. He is on Desmopressin (BiD) as well as Thyroxine.
This impatience/purring dynamic is in the last six months. He was a wreck coming out of the surgery. His incision had dehiscence twice and he was in the hospital for 28 days. It was awful. To prevent further opening of the incision they put an esophageal feeding tube in him so he wouldn’t be disturbing the incision by eating. It was heartbreaking but we got through all that and SRT, too.
Now we are in this new territory. But we’re in it together. So grateful too for all the FDMB support.
 
So objectively (I'm always lurking!) here's what I see - he spent a lot of time in green/yellow/blue earlier this month, was looking really good. He never technically earned a reduction but you were away those two days so there was a vacation dose. He seems to have not yet bounced back from that - and we know with both IAA and acro in the picture, the tumor can pulse and those antibodies can run away from you...and it takes some increases to get past those and back into good numbers. You've also got the pred confusing his liver and spitting out glucose. That said he's had some nice nighttime numbers in the mix!

Regrowth is always possible, I'm not dismissing that. I sense your anxiety and your worries, but I think you have set the bar for yourself too high. Our cats are getting older, they have multiple conditions to try to balance that very often fight against each other...we can't expect to keep them in perfect health all the time, as much as we dearly wish we could. Worry about the things you CAN control - dose increases, medications, regular lab work, etc. The rest is just stress that just wears you down.

I know you also have Blue as a comparator, but draw the lines to humans as well. I have a sister with colitis, another with thyroid troubles, another with celiac, and so far the others are perfectly fine. Although it's the same gene pool, it just combines differently to make the individual.

I think perhaps your field of study may be complicating things for you?

Mr Kitty currently has a cocktail of meds, all of which interfere with another med or condition he has. I realize I am often overly practical but I simply look at him overall. In my signature he looks like Franken-cat, but the cat in front of me is happy, zoom-y, and a little obnoxious lately due to thyroid. That is the best I can hope for at the moment.

I feel we've been missing an "aha" moment for you in the sense of helping to alleviate worries and concerns. Is it that you're worried you'll miss something in all this that could have been treated/prevented? Or worried about the longer term implications of possible regrowth, etc?
 
Always lurking too. :)

Will be looking for that +2 or +3 tonight to get a clue whether he might have been dropping into that PMPS or rising into it...

Hang in there. Given the last few days, that PMPS isn’t that bad.
 
FrostD said:
So objectively (I'm always lurking!) here's what I see - he spent a lot of time in green/yellow/blue earlier this month, was looking really good. He never technically earned a reduction but you were away those two days so there was a vacation dose. He seems to have not yet bounced back from that - and we know with both IAA and acro in the picture, the tumor can pulse and those antibodies can run away from you...and it takes some increases to get past those and back into good numbers. You've also got the pred confusing his liver and spitting out glucose. That said he's had some nice nighttime numbers in the mix!

I am in agreement that something went haywire during those two days. The issue, the big concern, the worry is that there is regrowth but that remains to be seen.

Regrowth is always possible, I'm not dismissing that. I sense your anxiety and your worries, but I think you have set the bar for yourself too high. Our cats are getting older, they have multiple conditions to try to balance that very often fight against each other...we can't expect to keep them in perfect health all the time, as much as we dearly wish we could. Worry about the things you CAN control - dose increases, medications, regular lab work, etc. The rest is just stress that just wears you down.

Mostly, it's the not knowing and worrying that my lack of knowledge might be working against him. If I've set the bar too high, it's because that's all I know. I didn't give up on Blue and now I won't give up on Eddie. I just don't know any other way. Blue and Eddie are different to be sure, but the lowest common denominator in the equation is me.

I know you also have Blue as a comparator, but draw the lines to humans as well. I have a sister with colitis, another with thyroid troubles, another with celiac, and so far the others are perfectly fine. Although it's the same gene pool, it just combines differently to make the individual.

I think perhaps your field of study may be complicating things for you?
Do you mean critical animal studies? I'm curious what you mean...

Mr Kitty currently has a cocktail of meds, all of which interfere with another med or condition he has. I realize I am often overly practical but I simply look at him overall. In my signature he looks like Franken-cat, but the cat in front of me is happy, zoom-y, and a little obnoxious lately due to thyroid. That is the best I can hope for at the moment.
It might not look like it but I am honestly looking at Eddie holistically, although they say the devil is in the details and this thing called TR has me in laser-focus mode. I'm not so fixated on AMPS and PMPS but have learned to see the relationship between TR and nadir but right now he's just not going down.

I feel we've been missing an "aha" moment for you in the sense of helping to alleviate worries and concerns. Is it that you're worried you'll miss something in all this that could have been treated/prevented? Or worried about the longer term implications of possible regrowth, etc?
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This really is the crux of the matter, Melissa, although it's not really that I'm going to miss something. I know folks are against further testing but I have a radiation oncologist who is really encouraging me to go forward with a CT to determine what's happening with the tumour (or not) and to see him as a candidate for further SRT. Blue had radiation twice after hypophysectomy. I know that this option is not seen favourably but I am considering it. You might recall it was all arranged some months ago but the CT scanner went down and the appointment was cancelled. Maybe what you are sensing is my hesitation to a) talk about it and b) to actually go through with it. I'm holding the tension between a + b and weighing them out. I hope this makes sense. If there's not an "aha" moment, it's not the fault of anyone here.
 
One more thing I think we've learned about Eddie, as is true in general with cats with IAA, you have to wield the hammer instead of a light tap. When you go up in dose, you go up by 0.5 units and not 0.25 units, at least at this size of dose. I found the same with Neko. I could sneak the dose down in smaller amounts, but increases needed to be full amounts, unless I really was just tweaking an almost perfect dose. Note, doses with any number above 300 did not meet my criteria of almost perfect dose.

In the same theme as that, I wouldn't hold any dose extra long if all it's giving you is the odd flash of high greens every few days. You beat IAA and glucose toxicity by constant time in normal numbers. Since you are using AT, very low blues are probably acceptable. I'd like to see if there is a way with a combination of the right dose and food that you could get him surfing for longer times in normal BG number range.

The downside of being more aggressive to get Eddie into normal numbers is your work schedule. It's a tough balance. Plus you have to be aware that there will be times when SRT is doing its thing, though at present it seems the tumour cells are in pause mode. Do you have an autofeeder that you can use to make sure he's got food available when he might need it?

And I'll say again about the CT scan, ignoring for the moment the risks of anaesthesia, what will a CT scan really tell you? If the tumour is a bit smaller than when he first had radiation therapy, does it mean it's only gone down that little bit, or that it's gone down then back up but not back to the full size it was before? There are so many scenarios where CT scan results will tell you nothing. Only if it's larger than it was before his first radiation therapy will it mean something and since he's well down from his max of 14 units, I think that scenario unlikely. The scenario I described first was what happened to me. The tumour was smaller on the CT three years later but I didn't know if it had grown up to that size from smaller or that's as small as it had gone. But and this was the big clue, her dose had gone from 8.75 units down to 0.75 units for a long time, and in the space of a few months gone from a couple units back up to 7 units and rising fast. In comparison, Eddie has mostly been within a unit or two of his lowest dose, and ranging up and down. Right now he's only 0.5 unit away from where he was in January.

One last thing, the folks at CSU told me that it takes 2-3 years for SRT to fully work, and similarly, that length of time to know it's no longer working. It's barely been a year for Eddie. Plus you have the complication that you wouldn't be going back to WSU who did the first SRT, so not sure Victoria would have the data they need to make good comparisons.
 
Jodey&Eddie said:
This really is the crux of the matter, Melissa, although it's not really that I'm going to miss something. I know folks are against further testing but I have a radiation oncologist who is really encouraging me to go forward with a CT to determine what's happening with the tumour (or not) and to see him as a candidate for further SRT. Blue had radiation twice after hypophysectomy. I know that this option is not seen favourably but I am considering it. You might recall it was all arranged some months ago but the CT scanner went down and the appointment was cancelled. Maybe what you are sensing is my hesitation to a) talk about it and b) to actually go through with it. I'm holding the tension between a + b and weighing them out. I hope this makes sense. If there's not an "aha" moment, it's not the fault of anyone here.
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It's not so much that it's not seen favorably, it's moreso that from where we sit (objectively), it doesn't appear worth it at this time. In addition to what Wendy said, if it is bigger what's the protocol? Will they do repeat SRT so soon after the first one? Or would you have to wait and get yet another CT scan closer to when they would do it? Or perhaps another option is to give this SRT its time and give cab a try?

I don't have the answers obviously, it's all very personal decisions. But I do know Mr Kitty was always fine with anesthesia until he wasn't - and the one he stopped breathing was just a quick thing to twilight him to drain his chest (after having just had it done successfully a month prior). So it's something I'm overly cautious about.

And while it's not something I would do if Eddie were my cat - he's not my cat lol you'll get no judgment from me as long as youre making informed decisions and weighing the pros/cons as best you can. I'm sure others would do things differently with Mr Kitty (where's that shrug emoji...)
 
I certainly would not judge you one way or the other. I already second guess myself enough on every cat decision that I make... especially the ones that, in hindsight, didn't turn out as I had hoped.... so I give myself enough grief. Nobody here has ever heaped any more guilt or grief on me, thankfully. I am not in a position to question others making difficult and well-considered decisions.

I probably would not want to put his kidneys under the stress of general anesthesia without a compelling reason (even if the bloodwork says it's okay). Big hugs to you!
 
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