06/06 Eddie AMPS 216 +2.5 223 PMPS 313 +2.5 212

I'm looking at Eddie's SS and thinking that in the current round of 10.5 Eddie hits nadir around +4 or +4.5 and these are in the relatively mid- to high blue range. We've been 10.5 (counting tonight) for 4 days and I'm wondering, yet again, if we need to increase again to 11.0.

I'm also thinking I'm going in search of another IM specialist since this one seems somewhat uninterested in spreadsheets or TR, meanwhile Eddie's insulin is staying relatively high. The possibility the acromegaly tumour isn't entirely "dead" comes to mind and I feel as if the vets here have just decided we (well, me, if not Eddie) are a bit too much. The question that interests me is why does Eddie still need insulin? And increasingly so...

@Wendy&Neko ?
 
Did you expect an IM specialist to be interested in dosing, or did you want a vet poking their nose in those decisions? I much preferred making dosing decisions on my own. Neko's IM was interested in looking at her spreadsheet, but the decisions of what to do he left to me, which is what I wanted. Especially since she'd been diabetic over 4 years with me managing it by the time I first saw him. He was concerned she was going too low the first time he saw her, and I reluctantly let him BG test her (and charge me for the privilege :rolleyes:) but I told him what range of numbers she was going to be in when he did the test. I was right, and we never discussed BG's again. Or dosing methods. And her records said her diabetes was well managed.

Jodey&Eddie said:
The question that interests me is why does Eddie still need insulin? And increasingly so...
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You do know that the majority of cats that have SRT do not go into remission. You were lucky with Blue. And that SRT takes around 2-3 years to completely work. Eddie's SRT is barely over a year old. I would have loved Neko to go into remission, but having a much better quality of life and a lower dose were still good results for us. You've also got IAA you are battling and possibly glucose toxicity. With Neko, I couldn't let her go more than 5 days without seeing green before I'd have to inch up her dose. I'll sum this up as "have patience".;)

What are your target nadirs for Eddie? Is he seeing them or above them? If above, increase per the protocol. Neko needed to have nadirs in the 70's (human meter) to stay mostly under renal threshold, so that was my goal for her. ECID, what works for Eddie?
 
Wendy&Neko said:
Did you expect an IM specialist to be interested in dosing, or did you want a vet poking their nose in those decisions? I much preferred making dosing decisions on my own. Neko's IM was interested in looking at her spreadsheet, but the decisions of what to do he left to me, which is what I wanted. Especially since she'd been diabetic over 4 years with me managing it by the time I first saw him. He was concerned she was going too low the first time he saw her, and I reluctantly let him BG test her (and charge me for the privilege :rolleyes:) but I told him what range of numbers she was going to be in when he did the test. I was right, and we never discussed BG's again. Or dosing methods. And her records said her diabetes was well managed.

I guess I am used to the kind of care and attention that Blue and I and Eddie and I received from the team at Washington State University. I can still call upon them to respond and they do but in the everyday, I have no veterinarian here that I can depend upon. I don't want a vet poking their nose in but I do want someone who respects that I am deeply involved in Eddie's care, even when I don't always fully understand the physiological aspects of our situation, although I try my best to educate myself. But I also feel there are complexities that I am not always equipped to handle or, for that matter, to interpet.




You do know that the majority of cats that have SRT do not go into remission. You were lucky with Blue. And that SRT takes around 2-3 years to completely work.
I've heard 18 months but, really, who actually knows for, as you say, ECID. I was lucky with Blue but Eddie's tumour was larger and at the moment it is unclear what's actually happening. The CT shows a smaller area than before the SRT, much smaller. It may be scar tissue; it may be something else. Time and imaging are the only ways to know.

Eddie's SRT is barely over a year old. I would have loved Neko to go into remission, but having a much better quality of life and a lower dose were still good results for us. You've also got IAA you are battling and possibly glucose toxicity. With Neko, I couldn't let her go more than 5 days without seeing green before I'd have to inch up her dose. I'll sum this up as "have patience".;)
Although it may not seem like it, I do have patience. :cool: I also have questions and currently when I look at Eddie's numbers I wonder what's going on. Tumour-driven DM? IAA? I also have to say that Eddie is who he is now and that is a function of whatever happened to him during surgery, I would say. Eddie now is not the Eddie he was. He made me his focus. He sought me out to sit on my desk, my lap or on the chair behind me when I was working. He loved to be touched. No more, really. There's all kinds of reasons for this but the main one I think is injury to the hypothalamus. But that's who he is now and it's on me to give him that.

What are your target nadirs for Eddie? Is he seeing them or above them?
I didn't really think I had target nadirs. I would be very happy if they were say 90-108, but that's like ideal, I guess, and maybe not for a cat with acromegaly.
If above, increase per the protocol. Neko needed to have nadirs in the 70's (human meter) to stay mostly under renal threshold, so that was my goal for her. ECID, what works for Eddie?
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I'm not entirely sure how to arrive at what is the best renal threshold, to be honest. How ought I to know this? I worry about glucose toxicity but don't know much beyond my own worry, although I'm reading, reading, reading...
I guess I'm hearing you say that an increase is up to me based on target nadirs...Hmmm.
 
To get close to what Eddie's renal threshold is, you have a couple options. One is to buy some Ketodiastix and see when he does and does not spill sugar into his urine, and see what his BG is at that time. It'll be close, not exact, as there is some delay between sugar in the blood and into the urine. I was even less precise, I tested Neko's BG before she went in to get urinalysis done at the vet, then based on that and whether the urinalysis had high glucose, I figure it out. For me, since Neko had kidney disease, I really wanted to give her kidneys as much of a break as possible by keeping her under renal threshold.

I hear you on the level of interaction with WSU compared to the local guy. I had a great relationship with CSU and emailed them several times. As well one of the researchers who had been at CSU but moved to NCSU. Plus I did a lot of reading and research on my own. Internal medicine covers a wide variety of topics. Finding someone who is a specialist in endocrine diseases and diabetes, much less acromegaly is hard to do.

For more on SRT, this is a good article:
Stereotactic radiation therapy for the treatment of functional pituitary adenomas associated with feline acromegaly
By Tiffany L. Wormhoudt, Mary-Keara Boss, Katharine Lunn, Lynn Griffin, Del Leary, Kristy Dowers, Sangeeta Rao and Susan M. LaRue, Journal Vet Internal Medicine, 2018 Jul-Aug; 32(4): 1383–1391.

Neko was a part of this study. They refer to her a couple times, including the paragraph on the last page talking about a cat getting SRT two times.

Sometimes we just have to accept that we cannot understand everything that is happening inside our cats, and likely the vets won't know either. Especially in the more complicated cases. The hardest thing to accept is that even if you did know what is happening, there isn't much you can do about it, other than manage the diabetes. It is sad to hear about the change in his personality. We had one other member whose cat had hypophysectomy that changed personality. The surgery was successful other than the tumour came back, not nearly the trauma that Eddie went through.
 
Wendy&Neko said:
To get close to what Eddie's renal threshold is, you have a couple options. One is to buy some Ketodiastix and see when he does and does not spill sugar into his urine, and see what his BG is at that time. It'll be close, not exact, as there is some delay between sugar in the blood and into the urine. I was even less precise, I tested Neko's BG before she went in to get urinalysis done at the vet, then based on that and whether the urinalysis had high glucose, I figure it out. For me, since Neko had kidney disease, I really wanted to give her kidneys as much of a break as possible by keeping her under renal threshold.
Ok, but once I have determined when he does (or does not) spill sugar into his urine, what do I do about it? How do I associate that read with BG? And how then does that determine dose?

I hear you on the level of interaction with WSU compared to the local guy. I had a great relationship with CSU and emailed them several times. As well one of the researchers who had been at CSU but moved to NCSU. Plus I did a lot of reading and research on my own. Internal medicine covers a wide variety of topics. Finding someone who is a specialist in endocrine diseases and diabetes, much less acromegaly is hard to do.
They really are incredible at WSU. Blue had surgery in 2018 and fractionated radiotherapy that year as well. Then in 2020 he had SRT, so he's pretty amazing. May I ask why you decided to get SRT twice?

For more on SRT, this is a good article:
Stereotactic radiation therapy for the treatment of functional pituitary adenomas associated with feline acromegaly
By Tiffany L. Wormhoudt, Mary-Keara Boss, Katharine Lunn, Lynn Griffin, Del Leary, Kristy Dowers, Sangeeta Rao and Susan M. LaRue, Journal Vet Internal Medicine, 2018 Jul-Aug; 32(4): 1383–1391.

Neko was a part of this study. They refer to her a couple times, including the paragraph on the last page talking about a cat getting SRT two times.

Sometimes we just have to accept that we cannot understand everything that is happening inside our cats, and likely the vets won't know either. Especially in the more complicated cases.
I'm finding that the regular vets, as well as the IM vet, realize they would have to actually give over time and attention and I don't think they are really willing to do that. It means keeping up and actually reading the medical record and paying close attention to nuances.
The hardest thing to accept is that even if you did know what is happening, there isn't much you can do about it, other than manage the diabetes.
It is sad to hear about the change in his personality. We had one other member whose cat had hypophysectomy that changed personality. The surgery was successful other than the tumour came back, not nearly the trauma that Eddie went through.
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Every once in awhile I catch a glimpse of him. I also see that he has come a really, really, really long way since he first had that surgery in Dec. 2020. He was unrecognizable when he came home. I feel incredibly happy and grateful when I see him enjoying the sun in his cat tower...
 
First a housekeeping note. It's easier if you select the text you want to reply to, and pick the Reply balloon. Putting coloured text inside a quote makes it harder for me to respond back. So rather than quoting, I'll answer in order where I can.

My goal was to keep Neko at a dose where she safely spent as little time as possible above renal threshold. Once I had an idea what that point was for her, I observed where her nadirs generally landed. For her, and it may not be the same for Eddie, her nadirs needed to be in the 70's. So I'd change dose to achieve that.

If you read the paper on SRT I linked, and the last page, the explanation for why I went to CSU twice for SRT is in there. In summary, her dose went charging up in a very short period of time. There were other physical symptoms that the acromegaly was returning too.

I wouldn't expect a general purpose vet to spend a lot of time understanding a condition they don't see that often. Having said that, I found a really good vet that does acupuncture, who liked to take on special projects each year. She had done a lot of reading on acromegaly before my first acupuncture visit with Neko, and was happy to read other papers I sent her. We also talked about acromegaly quite a bit during the sessions. Turns out she might have had one that was a local stray she adopted, he had been a diabetic on higher doses and a heart condition. Anyway, she's now my general practice vet.
Jodey&Eddie said:
I feel incredibly happy and grateful when I see him enjoying the sun in his cat tower...
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Celebrate those times, I hope you see a lot more of them.
 
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