01/17 Eddie AMPS 328 +3 211 +5 160 +7 202 PMPS 374 +2 364 (stress day)

Good morning,
Here's thread from yesterday:

https://felinediabetes.com/FDMB/thr...e-to-reassess-pmps-and-3.257927/#post-2901883

I think we are going to have to reassess dose...

 

I really don't know what Eddie is up to for here we are @+3 211 , that is, low yellow zone. I will of course test again but would love to hear what others think here??? Does this suggest a breaking of the loooooooong bounce or just a hiatus?

Eddie no longer has diarrhea thanks to @Bandit's Mom Bhooma's recommendation of S. Boulardii. He's been on it for the second day and zero diarrhea. Thank you, Bhooma!!

Also, thanks to @FrostD Melissa for those encyclopedic webpages on CKD. I think I'll have to read these in depth before I bring Eddie for his checkup so that I know what tests to ask for. I was even wondering about another IAA test to see if there's any change there. In any case, I'd be really grateful to hear what further tests others might recommend, such as what Wendy (@Wendy&Neko) was mentioning.

Can't tell you how grateful I am that you (plural) are out there.

 

I can't take credit! Not sure who posted it, I'd have to go look. About the only thing I know about CKD is fluids fluids fluids and low phosphorus foods (and at some point phos binder possibly, or if he's a picky eater).

I am not sure about IAA retest, Wendy would know. I know the IGF-1 test is pointless to repeat, not sure about IAA.

Hoping he's breaking the bounce/clearing the water, let's see how he does.

 

Save your money, the result will be the same as long as he's on insulin.

Too early to say what today will bring.

 

We just hit @ +5 160. What are you doing Eddie?

 

As for further tests … you might consider a thyroid panel. Have they been monitoring his thyroid levels post-SRT? There have been a handful of cats who have become hypothyroid (very uncommon in cats) after SRT. We monitored Tubby closely and, though his values ran in the lower end, never needed to supplement.

We did however run into kidney issues post-SRT. We did all of the baseline work ahead of time so it’s pretty clear that the deltas were likely related to SRT and/or the dental he had shortly after. That’s one of the reasons I’m hesitant about any unnecessary anesthesia. Kidney issues are what took Tubby from me. It can get tricky to give subQ fluids to assist the kidneys if there are cardiac issues, and of course heart issues aren’t uncommon in acros. I don’t want to give you more to analyze/worry about, but I would monitor the kidney stuff closely and take whatever small, proactive steps you can.

Kidney/thyroid can interrelate — higher thyroid values, such as with hyperthyroidism (common in older cats), can mask kidney issues. The IM vet and I had multiple detailed conversations about the reverse — ie, whether treating/supplementing the lower thyroid values could improve perfusion of the kidneys. It’s all a dance, often without direct cause/effect. All we can do is try and do the best we can do.

 

JL makes an excellent point. CSU suggested that we get thyroid tests done every 3 months after SRT. In this paper on SRT by folks at CSU, 14% of SRT cats were found to have hypoT.

Neko also got CKD, but not until 2 years after her first SRT. CKD is a common finding in acros. She was one of the study cats in the above.

 

Thanks, Wendy and JL. I think you have given me the terms of reference I need to take Eddie for his checkup. I will have them do a thyroid panel and a further CKD. I note on his previous panel in January, SDMA was 12 out of a 0 - 14 μg/dL reference value.

Note, however, that @ +7, Eddie is 202. I do think we are in for an increase tonight? Like maybe .5u since we can pretty much see that nadir was @ +5 (160) or +6, at least and he's not going to be lower by PMPS.

 

Yes, I think you can increase.

 

Tubby was supposed to have been included in that study but they mistakenly had him listed as a dog. They finally figured it out and contacted me only a week or two before they were set to publish; unfortunately I couldn’t get the data to them in time. I would have liked to see his data included as it was probably somewhat different than some of the other cats.

 

Thanks, Wendy, I'll go to 6.5u tonight.

 

So, we went to 6.5u after PMPS 374.

 

Hi Bhooma,
Just in case you haven't seen this, we're now at 6.5u as of tonight's PMPS and onwards. I have to thank you, though, for recommendation of S. Boulardii. It worked like a charm.
Guess we'll have to wait until he settles into the 6.5u before we get any more big action. Phew.
@Bandit's Mom

 

Just seeing these messages. You are most welcome

Looks like you get a night off!