02/16 Eddie AMPS 167 +2 126 +3 76 +6 124 PMPS 293 +2 250 +3 176 (lab report re'cd)

Jodey&Eddie&Blue

Jodey&Eddie&Blue

Member Since 2021
Good morning, here's yesterday + the complete lab report which I received by email this morning.

https://felinediabetes.com/FDMB/threads/02-15-eddie-amps-317-3-288-pmps-328-igf-1.259409/

Please note history:
As for the IGF-1. I also knew it was going to be elevated but I also knew that I'd have to have it done if other treatment plans for Eddie were in the mix, so I agreed.

October 2020 IGF-1 355 (Hypophysectomy Dec 2020)
June 2021 IGF-1 235. (SRT February 2021)
February 2022 IGF-1 156

AMPS this morning, 167. Attached are the complete lab results which I received by email this morning. This message was included in a separate email:

Name:Eddie Breed:Shorthair, Domestic Species:Feline DOB:8/21/2012 Sex:Neutered Male Weight: 10.2 KG Additional results re: Eddie: Both IGF1 and Fructosamine are elevated Fructosamine 515 (RV 191-364) IGF1 156 (RV 12-92). Previous 235 Fructosamine levels indicate BG control is not ideal yet Elevated IGF1 is lower than previous- less likely tumour re-growth but CT next step for imaging Will relay results at time of appt. Thursday Recommend back to IM specialist for discussion on augmenting insulin protocol. Dr. Gelens is aware. Generally Eddie is clinically doing well If there are specific questions that require attention prior to tomorrow's appt please relay directly to reception IDEXX results emailed CO
 

Attachments

Nice AMPS today.:cool:

Good to see Eddie's IGF-1 number is coming down. In a lot of cases, it doesn't go down when people get it retested, in spite of the cat's dose going down. Like I said before, it doesn't really mean anything, but I think it makes the caregiver feel good to see it go down. There is no correlation between IGF-1 number and size of the tumour When Neko had her SRT done, her tumour was called "tiny" by the radiation oncologist, but her IGF-1 number was much higher than that of two other cats who had SRT a couple weeks before her. Those two cats had much larger tumours than hers in spite of IGF-1 numbers half of hers. She outlived both of them too, by a couple years. The IM vets at CSU told me there is no correlation between tumour size and IGF-1 number. They had been trying to find a correlation and had lots of experience with acros undergoing SRT. They were the ones who told me to save my money and not bother retesting.

Whether you decide to go for CT is whether you decide you like spending money to satisfy the IM's curiousity. It won't do anything to change Eddie's treatment. And I'd avoid the risk of anaesthesia unless medically necessary. But I think I'm repeating myself. ;)

As for labs, what food is Eddie eating? His kidney values look good at this point, but the phosphorus is on the upper side. Just wondering if there's wiggle room with the food to bring the P down with a change of food. That more a "just in case" you need to if his kidneys deteriorate.

Out of curiosity, has Eddie had his blood pressure tested?
 
Wendy&Neko said:
Nice AMPS today.:cool:

Yes, and look at +2 126. Gave some LC and I'm home today until 3:00 pm in case of any shenanigans.

Good to see Eddie's IGF-1 number is coming down. In a lot of cases, it doesn't go down when people get it retested, in spite of the cat's dose going down. Like I said before, it doesn't really mean anything, but I think it makes the caregiver feel good to see it go down. There is no correlation between IGF-1 number and size of the tumour When Neko had her SRT done, her tumour was called "tiny" by the radiation oncologist, but her IGF-1 number was much higher than that of two other cats who had SRT a couple weeks before her. Those two cats had much larger tumours than hers in spite of IGF-1 numbers half of hers. She outlived both of them too, by a couple years. The IM vets at CSU told me there is no correlation between tumour size and IGF-1 number. They had been trying to find a correlation and had lots of experience with acros undergoing SRT. They were the ones who told me to save my money and not bother retesting.
Right, I agree there's no correlation between IGF-1 number and size of tumour but the numbers do give a snapshot of the condition of the tumour and its viability regarding pulsing, I would think.


Whether you decide to go for CT is whether you decide you like spending money to satisfy the IM's curiousity. It won't do anything to change Eddie's treatment. And I'd avoid the risk of anaesthesia unless medically necessary. But I think I'm repeating myself. ;)
If we go for the CT, it would only be to determine further treatment, such as SRT, which is now available in Victoria. The IM here is not helpful and in fact wrote in response to my email yesterday asking him about the test results: "Regular health questions Dr. Primary Vet, tumor related Dr. Radiaton Oncology, endocrine related me. " As if these were all discrete. For one thing the radiation oncologist does not advise on anything but SRT design and protocol. I'm experiencing his response as a shell game. Who you gonna call?

As for labs, what food is Eddie eating? His kidney values look good at this point, but the phosphorus is on the upper side. Just wondering if there's wiggle room with the food to bring the P down with a change of food. That more a "just in case" you need to if his kidneys deteriorate.
Eddie is eating Tiki Cat Chicken & Egg Mousse mixed with some Fancy Feast pate. He sometimes gets a few Stella and Chewy's freeze dried pellets mixed in (with lots of water). I feed him 4x daily unless he drops and he gets more food accordingly. Can you recommend another food to bring the P down?

Out of curiosity, has Eddie had his blood pressure tested?
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This is curious. I will ask about it tomorrow when he goes in for the urinalysis.
Thank you.
 
@Wendy&Neko
We just hit 76 @+3, which is the new earned dose number. As you know, I've changed the earned reduction to 2x 76.
My question is: should this be in a row? He hit 68 two nights ago so something is going on but I don't want to prematurely go with a reduction given his pattern: hit the earned number, get a reduction and then have to increase in the next cycle. Or is this the pattern we need to accept and live with; that is, with varying ups and down and commensurate decreases and increases?
I hope this makes sense.
Ps. gave some MC + a dash of HC
 
I would take the reduction. When people do the "multiple under" rule, it's on different days and he satisfies that.

Presuming you've stopped the drop and he doesn't go lower, an option is a 0.25 unit reduction. If he continues lower, might go for that 0.5 unit reduction.

I agree, the IM vet is not the one to answer questions about the tumour, that is the radiation oncologist's domain and area of experience. Radiation oncologists at CSU also told me no correlation between IGF-1 and tumour size. Where in Victoria is there SRT? Love to know about local options.

As for food, in general the Tiki Cat's are OK, I think. Some of the FF are higher P, and the freeze dried depends on the meats. I don't think you need to make changes now. A lot of the Weruva are also low P.
 
Wendy&Neko said:
I would take the reduction. When people do the "multiple under" rule, it's on different days and he satisfies that.

Presuming you've stopped the drop and he doesn't go lower, an option is a 0.25 unit reduction. If he continues lower, might go for that 0.5 unit reduction.

I agree, the IM vet is not the one to answer questions about the tumour, that is the radiation oncologist's domain and area of experience. Radiation oncologists at CSU also told me no correlation between IGF-1 and tumour size. Where in Victoria is there SRT? Love to know about local options.

As for food, in general the Tiki Cat's are OK, I think. Some of the FF are higher P, and the freeze dried depends on the meats. I don't think you need to make changes now. A lot of the Weruva are also low P.
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I'll check him again @+4 as he's eaten and is sitting by the fireplace. I agree with the 0.25u reduction for tonight but we'll see.

Good to hear about the food. I'll check out the Weruva, though.

The new VCA clinic in Victoria now does SRT: https://vcacanada.com/centralvictoria
Dr. Genevieve Hammond is the lead and is Eddie's (and Blue's) radiation oncology vet.
Thanks, Wendy.
 
OK, found the place in Victoria, article about it here. I've met the other vet mentioned, Dr. Charney. She is double ticketed in oncology and I saw her a few times with a friend who was getting her dog treated. Dr. Charney also was on the board at Cyberknife and we had some good chats about Neko and her SRT which I was about to do when I met her. At that time Cyberknife was only in New York and way out of my price range.
 
If phosphorus levels become an issue, you can consider adding a phosphorus binder to his food. No need to add another thing to the mix just yet, but wanted to toss it out there for future consideration.

I second the blood pressure check.
 
Wendy&Neko said:
I wonder if augmentation means using R. Also curious where he went after +3 today.
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I was in meetings and didn't get the +4 but I did get the +6 124 (then I was teaching until +9 and then I fed everyone). I'll see what's what @ PMPS but more than likely will go to 7.75u.

Also, I emailed the IM vet and said "I do have a question that seems to concern you. A statement on the lab results: 'Previous 235 Fructosamine levels indicate BG control is not ideal yet Elevated IGF1 is lower than previous- less likely tumour re-growth but CT next step for imaging Will relay results at time of appt. Thursday Recommend back to IM specialist for discussion on augmenting insulin protocol. Dr. [Internal Medicine] is aware. Generally Eddie is clinically doing well If there are specific questions that require attention prior to tomorrow's appt please relay directly to reception IDEXX results emailed CO'

Would you kindly explain what 'augmenting insulin protocol' means and what needs to be discussed by you as the IM specialist."

He wrote back to say: "Fructosamine = average blood glucose level. Normal value does not mean BG is normal. If elevated means that ‘on average’ BG were too high. Not the case right now and augmenting insulin is what we constantly do, we call it tweaking and tuning. Nothing new beyond what we already do."

I wrote him back to say, it sounds like what I've described to him as "tight regulation" (TR). I'll find out more tomorrow.
 
FrostD said:
I was wondering the same thing but...do his numbers/patterns really warrant that? Seems a bit unsafe to me
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You can see +6 124. I was in meetings and then had to teach so couldn’t get +4. If the vet means additional or different insulin we are not going there. No.
 
Jodey&Eddie said:
You can see +6 124. I was in meetings and then had to teach so couldn’t get +4. If the vet means additional or different insulin we are not going there. No.
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Ha!

I have no experience with R (a fast acting insulin) beyond what I've seen people do on spreadsheets. As I understand it, and I'm sure Wendy will clarify, it's mostly in higher-dose, ketone-prone cats who get kind of stuck in high numbers and need a little nudge to come down. Eddie doesn't quite seem to need it to me but I truthfully have no idea
 
Jodey&Eddie said:
If the vet means additional or different insulin we are not going there. No.
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The only different thing I could think of that might be relevant is Levemir. R could be used, but I wouldn't say there is a great argument for it. A better argument could be made for Levemir. I used R with Neko, first started using it when her tumour revved up 3 years after SRT. Later I used it to help her stay under renal threshold, but she was well into her CKD by then so it was worth it. As Melissa said, it is something we suggest for kitties showing ketones, as well as some with higher doses that have IAA and/or acromegaly to help them get to a good dose faster. None of those situations describes Eddie.

I bet if you were to take his fructosamine again now, he'd be much lower. Unfortunate timing on the last test as he's had a couple weeks of higher numbers before hand. I am NOT suggesting you need to get it done, your spreadsheet tells the tale.
 
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