08/02 - KOBE - AMPS 232, AM+7 193

Kobe (Dean and Lesley)

Kobe (Dean and Lesley)

Member Since 2025
Good afternoon!

This is the first time I have caught Kobe under 200 since he started Prednisolone. He has been floating in the mid 200's for over a week. According to SLGS, he should be getting a 0.25 unit dose increase tonight. However, his Prednisolone is decreasing to every other day starting today. It makes me nervous to decrease Prednisolone and increase Lantus at the same time. Especially because his current dose just brought him under 200 today.

Anyone think it is a mistake to hold 1 unit for a few more days? Thanks for your input!
 
The goal is numbers between 90 and 150. He barely cracked 200 today. But if you want to see how he does without pred today without that increase, that's OK. Could be that he went below 200 today because he didn't have pred today.

With SLGS, you are supposed to do a curve before considering what to do with the dose. Any change of getting a +2 or +3 tonight? Many cats drop lower at night.
 
Thank you for the reply! I went with the 1 unit about an hour and a half ago. I have been giving the prednisolone in the evening, so we haven't seen the effect of no prednisolone in the evening. I will get some more mid cycle numbers!

Kobe has a prescription for Chlorambucil on the way. His vet wants to do 2mg Chlorambucil every other day and see how it goes. Use Budesonide at some point if needed.
 
Kobe (Dean and Lesley) said:
2mg Chlorambucil every other day
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Ugh, that's an older protocol that will eventually lead to a lot of nausea. The effect is cumulative. Make sure you have a lot of ondansetron around the house. Neko did horribly on the EOD dosing until I managed to convince her vet to let me try the newer every two week protocol my other cat was on. My third cat with SCL (sigh!) only did the every two week protocol.
 
Wendy&Neko said:
Ugh, that's an older protocol that will eventually lead to a lot of nausea.
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😭
Okay. I emailed the vet asking for the pulse protocol. Thank you. We haven't started yet. If the vet wants to be difficult and won't change the script, can I administer the Chlorambucil on a pulse schedule anyway and find a different vet?
 
Wendy&Neko said:
Ugh, that's an older protocol that will eventually lead to a lot of nausea. The effect is cumulative. Make sure you have a lot of ondansetron around the house. Neko did horribly on the EOD dosing until I managed to convince her vet to let me try the newer every two week protocol my other cat was on. My third cat with SCL (sigh!) only did the every two week protocol.
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She doesn't want to change it. Do I need to get Kobe to a different vet?
 
Why doesn't your vet want to change it? Do you think she could be presuaded?

Are you going to a specialist or a regular vet? Neko saw an IM vet (who consulted with an oncologist), my other cats just went to my regular vet who was willing to use the every two weeks protocol once I showed her the research on it. In the US, typically the every two weeks dose is compounded, so you can't go it your own. Plus you should have your vets agreement on what you are doing as it is chemo.
 
This is a regular vet. She said, "Unfortunately, I am not comfortable prescribing the pulse protocol for chlorambucil for Kobe. I do not recommend that course of action. The standard protocol is well tolerated with the most concerning side effect being a lab value change (bone marrow suppression) that we will follow with blood work 14 days after starting the medication."

I am starting to panic. With the decrease in Prednisolone, his appetite hasn't been as strong. Stools are looser. He's eaten 7 grams today where he had been eating 20 so far. I gave 12 mg Cerenia and 2mg Ondansetron 2 hours ago. He's sitting in loaf position.
 
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By far the most common side effect of chlorambucil EOD is nausea. The last two versions of the vet oncology textbook recommend the every other week dosing of chlorambucil. It is also called the 20 mg/m2 every two weeks protocol. There was an even older dosing method of chlorambucil that was a way higher dose that should be avoided. This is the paper that recommends the 20 mg/m2 every 2 weeks protocol: Treatment of Feline Gastrointestinal Small-Cell Lymphoma With Chlorambucil and Glucocorticoids - PMC

Remind me, how much does Kobe weigh? And could you start a new post for today.
 
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