11/21 Methos amps 540;+2 331; +4 382; +8 356; pmps 305

[SmallestSparrow]

Mostly posting in the hope it magically prevents what I fear will be a repeat of the previous two nights. Even doing my best to slow down the descent and stay well clear of double digits he still bounced—the worst yet. We’re both severely sleep deprived and grumpy. I fell asleep despite 6 cups of espresso last night and woke up in a panic and disoriented almost an hour later…luckily had not missed a test or feeding. God i wish I could put a Libre on him.

also worried right now at +1 bc he’s looking to get into things which usually means he’s in the 100s…please don’t be yet, please don’t be yet

 

[Staci & Ivy]

Mostly posting in the hope it magically prevents what I fear will be a repeat of the previous two nights. Even doing my best to slow down the descent and stay well clear of double digits he still bounced—the worst yet. We’re both severely sleep deprived and grumpy. I fell asleep despite 6 cups of espresso last night and woke up in a panic and disoriented almost an hour later…luckily had not missed a test or feeding. God i wish I could put a Libre on him.

also worried right now at +1 bc he’s looking to get into things which usually means he’s in the 100s…please don’t be yet, please don’t be yet

Hi Colleen, I’m posting to also wish you well tonight and send good vibes to you and Methos. I know you need some sleep. I really hope you both can get some rest.
Can you remind me why he can’t use a Libre?
Big hugs to both of you, you’re doing such an incredible job with him

 

[Wendy&Neko]

That +2 tonight looks promising for sleep for you. . It was the 6th cycle last time that he broke the bounce, that's tomorrow.

 

[SmallestSparrow]

That +2 tonight looks promising for sleep for you. . It was the 6th cycle last time that he broke the bounce, that's tomorrow.

thank you

 

[SmallestSparrow]

Hi Colleen, I’m posting to also wish you well tonight and send good vibes to you and Methos. I know you need some sleep. I really hope you both can get some rest.
Can you remind me why he can’t use a Libre?
Big hugs to both of you, you’re doing such an incredible job with him

Thank you so much. Fourbglorious hours of sleep. Extremely fragile skin and blood vessels from the Cushing’s. So each test is a trade off in protecting him vs hurting him and I spend a lot of emotional energy debating how badly I need to know vs how much damage I do knowing.
Just picking him up covers him with bruises so I try to get him to lay down on little cat mats scattered around the house so if I need to readjust for testing or move him to the scales for a weight etc I pick up the mat and he rides like a cat taco.

 

[Wendy&Neko]

FYI - you could have stopped testing after +4 last night, and +4 during the day yesterday. If he's high and rising by +4, give his skin a break.

 

[SmallestSparrow]

FYI - you could have stopped testing after +4 last night, and +4 during the day yesterday. If he's high and rising by +4, give his skin a break.

One of my debates…but since he’s often not at nadir yet and on some days made a mad dive at the end it’s difficult to risk it especially if I’m going to sleep, since he doesn’t wake me and in fact slept through some of his low readings. He refuses to follow rules. Takes after his mom I guess.
I’m hoping once I no longer have to worry about an amps of 70 I can test once or twice after pmps (and for that matter once or twice after amps). But AS SOON as I start cutting back on testing he drops like a rock. Then I curse myself and “giving his ears a break” as I shove food in his mouth and test every 30-60. So for now I feel like an extra test per cycle to stay ahead of a drop is better than many extra tests trying to pull him back up

the only person who’s more anxious for me to just go to bed at +4 than me is Methos. We start the morning before 0300 and by 2100 I’d practically kill for sleep.

 

[Staci & Ivy]

Thank you so much. Fourbglorious hours of sleep. Extremely fragile skin and blood vessels from the Cushing’s. So each test is a trade off in protecting him vs hurting him and I spend a lot of emotional energy debating how badly I need to know vs how much damage I do knowing.
Just picking him up covers him with bruises so I try to get him to lay down on little cat mats scattered around the house so if I need to readjust for testing or move him to the scales for a weight etc I pick up the mat and he rides like a cat taco.

Ugh. I wonder if the one poke of the Libre at installation would be far better than having to poke him constantly as a treat off. (Not trying to push you or anything, I know you know much more about his condition than I do.)
And I don’t know if the Libre would be too damaging to his skin. I think you tried it at the beginning is that correct?

My thinking was just that if he was high, you wouldn’t have to keep poking him because there’s no need to poke because you wouldn’t be doing anything any different.

That’s kind of how I work it with Ivy, if she’s high, I don’t keep poking her.
It’s only if she goes low that I really have to poke her to know how low she is.
So it keeps my poking to minimum situation since she’s so hard to handle.

 

[SmallestSparrow]

Sometimes I think the AT app better catches what life with him can be—a recent day when he was fine at +2 and +4…and 75 at PS resulting in MC food and a bunch of tests to get a reduced shot and still trying to go lower after extra food and before the reduced dose kicked in

all those ear sticks and my heart rate!

I don’t know if in the long run it’s better or worse to risk it…and I alternate my choice and invariably make the wrong one. I’m just hoping he levels out somewhere and we will be a 4x a day test

edit: in fact this particular day I debated a +7 or 8 test and said “Colleen stop letting your anxiety drive this. His +2 and +4 say he will be fine. He’s sleeping because he’s old and tired bc we were up so late the other day. Let him sleep and test at pmps like a normal cat mom ffs” and then 75 at PMPS, me cursing myself, shoving food, testing and texting my vet, putting insulin back in fridge, etc etc. The WRONG decision. EVERY. SINGLE. TIME.

 

[SmallestSparrow]

Ugh. I wonder if the one poke of the Libre at installation would be far better than having to poke him constantly as a treat off. (Not trying to push you or anything, I know you know much more about his condition than I do.)
And I don’t know if the Libre would be too damaging to his skin. I think you tried it at the beginning is that correct?

My thinking was just that if he was high, you wouldn’t have to keep poking him because there’s no need to poke because you wouldn’t be doing anything any different.

That’s kind of how I work it with Ivy, if she’s high, I don’t keep poking her.
It’s only if she goes low that I really have to poke her to know how low she is.
So it keeps my poking to minimum situation since she’s so hard to handle.

Luckily he’s easy to test. But it makes us both sad

my concern is two fold but I do keep wondering if I should take the chance: i think it’s put in with adhesive, and has a needle in place. Should it be dislodged the adhesive could take his skin with it or the needle rip open a big wound. I think another member once posted their Cushing cat had such damage just from being put in their carrier near the end that they didn’t recover. Some vets have warned scuffing can scalp a Cushing cat (ask me how anxious I get at the vet with new techs)

of course I also worry the many ear sticks will cause an infection. So many anxieties so many bad choices.

he’s essentially a cat on high dose steroids but the dose is being altered and administered randomly so no way to know for certain how much is on board or may be on board at any given time—or how his adrenals (really adrenal—he’s got a huge tumor filled right and an atrophied left) will react to a challenge—go all in or give up.

which is why I know I ask a lot from kind mods like @Wendy&Neko or @tiffmaxee or @Suzanne & Darcy because it’s hard to predict the unpredictable—yet I keep hoping and trying. So a Libre would be so useful (and a break for both of us, all the extra testing has put huge fissures on my fingertips so I can’t really feel the strips or meter anymore —but definitely feel the skin ripping open more as I push the strip in, open a ketone foil pack, or hold a 2x2 on his poke site). I suppose if his ear gets infected will curse myself, my decision, and be forced to try a Libre

 

[SmallestSparrow]

It was the 6th cycle last time that he broke the bounce, that's tomorrow.

His lunch BG says there’s a good chance you’re correct and if so it may be another PS of 75. Which I’d like to avoid

he normally gets one last snack at around +8 —usually 30-35 calories of an essentially no carb tiki choice like shredded salmon or chicken in consommé. If it looks like he’s on track to follow the pattern from earlier this week should I instead feed him a 10-11% mousse instead? I usually go heavier in mousse mid cycle and more shreds at each end (unless of course I’m feeding his beloved proplan to get him into triple digits )

and if despite my efforts he’s again 75 at PS what would you suggest doing—I’ve stalled before and can again BUT not for long bc all the other stalls he’s only dropped more and if 75 I can’t let him go much lower—-I can easily stall for like 115.

 

[Wendy&Neko]

Looking at Methos's spreadsheet, if he's high(pink) and flat or rising from PS to +4, he doesn't drop that cycle. If he's lower at +4 than PS, then you night need more tests. Today looks more like the 19th, a bounce breaking cycle.

 

[JL and Chip]

I won’t tackle your dosing questions, but I will say I agree with your concerns about putting on a libre and would personally be averse to the gamble. It’s hard to understand the paper-thin skin of Cushings until you’ve been there and I’d be afraid you might open a can of worms. Just my two cents.

On the insulin dosing front, I do wonder if the dose jumping has made it harder to interpret the numbers. Sometimes when we know there’s another issue at hand (like an adrenal tumor), we focus on that as being the culprit when, maybe, that’s not always the case. Don’t get me wrong, I wouldn’t say it’s *not* a contributing factor, but it sure would be nice to find a “safe(ish)” insulin dose where you have a bit of breathing room and can have some “clean” BG data that’s free from variable dosing. I know you said you can’t easily do 2.75u (or similar quarter increments) on your current syringes but perhaps you could try. I’ve MacGuyvered markings on a piece of paper in a pinch, or you could get calipers just so you can be consistent. It’s just a suggestion.

I’m also going to ask a delicate question. Is it truly too late to remove the adrenal? I know you’ve addressed this before, I’m just asking from a quality of life standpoint for you both. I’m sure you’re not going to make a risky decision for your own sake, but I’m wondering how far things go before you revisit the surgical option (if it’s even an option). I get the risk of Addisons given the other adrenal is small/withering. Is there a chance it might come back at all once the diseased adrenal is gone?

I faced a similar dilemma in my dog years ago. She had atypical Cushings and I medically managed as long as I could, but by the time we finally got the ultrasound, she had passed the rubicon. The adrenal tumor had surrounded and infiltrated the vena cava and she was bleeding internally. Even a “Hail Mary pass to the end zone” surgery was off the table at that point. I regretted pushing things as long as I had, but she had been doing “ok” so I didn’t worry too terribly much when the ultrasound kept getting pushed due to terrible weather conditions. I do wonder had I been able to get her there sooner whether I’d have opted for surgery (and the risk of losing her on the table) or let things ride as ultimately happened.

Nothing is ever easy. And we just love them so darned much. I hope Wendy’s insight can give you some guidance and peace of mind.

 

[SmallestSparrow]

I do wonder had I been able to get her there sooner whether I’d have opted for surgery (and the risk of losing her on the table) or let things ride as ultimately happened

This of course has been a haunting debate for over a year. I will end the end hate myself I’m sure. He was old and fragile when diagnosed—he hasn’t gotten younger or healthier since. I have the “advantage” of knowing what it felt like to lose a Cushing cat during surgery for his adrenal tumor—that the last thing Erik knew was me handing him over to strangers who hurt him after I left him there—and while he never woke up—did he hurt while lingering in the ICU? Did he hear me say good bye as they unhooked him? Was he even alive then or was that for my comfort.

so I know any minute he can start bleeding horribly and I pray if it happens he goes quickly without pain. I debated getting a CT more than once—but couldn’t honestly answer if it was more to reassure me should it show inoperable —vs the risk of anesthesia to get it. And do i shorten his life to avoid a potentially bad end—what if instead he just dies of old age or kidney issues waiting on that potential bad outcome.

I know his dose has been shorted a few times but only twice without me asking his vet. The academic answer isn’t worth the risk to him—all the data in the world doesn’t 100 percent (or probably 80%) guarantee an outcome. Hypo in all cats is a much greater risk than hyper but especially for him—if I can’t pull him up fast enough he won’t survive an admission. The stress would kill him.

for a cat not wearing a Libre he’s had a fair amount of BG data. Because he’s a sweet forgiving boy.

I was told Erik needed surgery or he’d die a horrible death when the tumor invaded. He’d already been a diabetic for 3 years. He instead died a horrible death as far as he knew alone and abandoned. I read about cats who survived their surgery and wonder if Methos lost his chance at a better quality of life, or longer life, because of Erik. Then I read of cats that died during less risky surgery, or from anesthesia getting their teeth removed and look at him enjoying life when he gets to eat proplan for low BG.

i will hate myself no matter what choice I make in any of this so I just struggle day by day and try to save the crying for once it’s over. Not sure how long any cat has made it post diagnosis but we are trying to set a record.

 

[SmallestSparrow]

Looking at Methos's spreadsheet, if he's high(pink) and flat or rising from PS to +4, he doesn't drop that cycle. If he's lower at +4 than PS, then you night need more tests. Today looks more like the 19th, a bounce breaking cycle.

So do I try to feed him more carbs now? Just about to test him so standby for that—do give him 3U if he’s 75 again at pmps?

 

[tiffmaxee]

I’d be afraid of the Libre for the obvious reasons plus if it does its thing and sets off a low alarm it would possibly not be for real. So difficult.

 

[Wendy&Neko]

So do I try to feed him more carbs now?

Not yet, I'd wait to see if he's got another drop happening later this cycle.

do give him 3U if he’s 75 again at pmps?

If he's below your reduction point, I'd give the 2.75 units JL also mentioned above, as his new dose. But if below 90, wait until he's above 90 before shooting. With Cushings, you want to find a dose where he's getting some good numbers, but not enough that it means you have to test more.

 

[SmallestSparrow]

242 which IF he repeats 3 days ago puts him on track for a 75 pmps. Due for a 30-40 cal snack now. Should I use the highest of my low carb options?

 

[SmallestSparrow]

Not yet, I'd wait to see if he's got another drop happening later this cycle.


If he's below your reduction point, I'd give the 2.75 units JL also mentioned above, as his new dose. But if below 90, wait until he's above 90 before shooting. With Cushings, you want to find a dose where he's getting some good numbers, but not enough that it means you have to test more.

He’s due some food now. Usually it’s very low (0 on your list but it’s higher than 0) but I have some 10% options (I think maybe they’re 7% if in your list idr)

 

[SmallestSparrow]

But if below 90, wait until he's above 90 before shooting.

If he’s below 90 he won’t come up with stalling. Or maybe he will if install like 3 hours but o/w once he’s low he stays there

Edit: on days I skipped it took a while to come up and on days I shot partial dose he continued to drop in the hour post food and shot

 

[SmallestSparrow]

Tbh if he’s 90 and doesn’t come up in 30 he’s going to get fed something. I will stall in triple digits. Stall briefly at maybe 85 and above but below that he’s getting fed as soon as I can open a can

 

[Wendy&Neko]

Feed him if he's due. Write down on the spreadsheet remarks if you do something different from what you usually do, so you can see what effect it has on him.

 

[Staci & Ivy]

Luckily he’s easy to test. But it makes us both sad

my concern is two fold but I do keep wondering if I should take the chance: i think it’s put in with adhesive, and has a needle in place. Should it be dislodged the adhesive could take his skin with it or the needle rip open a big wound. I think another member once posted their Cushing cat had such damage just from being put in their carrier near the end that they didn’t recover. Some vets have warned scuffing can scalp a Cushing cat (ask me how anxious I get at the vet with new techs)

of course I also worry the many ear sticks will cause an infection. So many anxieties so many bad choices.

he’s essentially a cat on high dose steroids but the dose is being altered and administered randomly so no way to know for certain how much is on board or may be on board at any given time—or how his adrenals (really adrenal—he’s got a huge tumor filled right and an atrophied left) will react to a challenge—go all in or give up.

which is why I know I ask a lot from kind mods like @Wendy&Neko or @tiffmaxee or @Suzanne & Darcy because it’s hard to predict the unpredictable—yet I keep hoping and trying. So a Libre would be so useful (and a break for both of us, all the extra testing has put huge fissures on my fingertips so I can’t really feel the strips or meter anymore —but definitely feel the skin ripping open more as I push the strip in, open a ketone foil pack, or hold a 2x2 on his poke site). I suppose if his ear gets infected will curse myself, my decision, and be forced to try a Libre

God Colleen. It’s so damned complicated. You’re damned if you do and damned if you don’t.

From what I understand about the Libre, it’s a filament that stays under the skin, not the needle. There’s an initial poke and then that retracts and the filament stays under the skin and that’s what does the reading.
I do not apply any adhesive to Ivy’s skin to attach the libre. The only adhesive is what’s on the backing of the Libre.
It is advised never to use tissue glue or anything like that, which many vets do use.
On the Facebook group where I have learned all of the instructions and techniques, they very specifically tell you not to use any glue whatsoever.
So maybe that is something to think about since if it could be used on Method without any additional glue, maybe it wouldn’t harm his skin.
When I take a Libre off of Ivy, I use baby oil and coconut oil on a Q-tip and very gently work around the circumference slowly slowly a little bit at a time Since of course, I’m trying to be very gentle on her skin. It seems to work well, but of course she doesn’t have all of the issues that Methos has.
I understand why you wouldn’t want to harm his skin as it is so fragile.
Have you read through at all the instructions on the Facebook group about Libre’s?

Frankly, I don’t know how you would have time to read up on anything with all that you are doing 24/7.
You have my complete admiration for your incredible caregiving and dedication.

We are sending both of you gentle hugs and best wishes for rest

 

[SmallestSparrow]

Btw he ate 10% carb food at his usual +8 snack vs his close to 0 carb snack food. Which seems to (hopefully) slowed the descent —nothing like the 50-60/hr he’s been doing. Fingers crossed for pmps, no +11 test since it’s not going to be below 100 and I’m not going to feed him that close to 2 PM PS

 

[SmallestSparrow]

Comic relief: this is what I used to feed at 75:

greenies soaked in Karo

now it’s proplan ….mmmm, wheat gluten and meat by products but I’m grateful he loves it. A few days ago when he got an entire can he couldn’t believe his luck. Of course the next normal meal he was like “ no thanks I’ll wait for the meat by products mom”

 

[Suzanne & Darcy]

Luckily he’s easy to test. But it makes us both sad

my concern is two fold but I do keep wondering if I should take the chance: i think it’s put in with adhesive, and has a needle in place. Should it be dislodged the adhesive could take his skin with it or the needle rip open a big wound. I think another member once posted their Cushing cat had such damage just from being put in their carrier near the end that they didn’t recover. Some vets have warned scuffing can scalp a Cushing cat (ask me how anxious I get at the vet with new techs)

of course I also worry the many ear sticks will cause an infection. So many anxieties so many bad choices.

he’s essentially a cat on high dose steroids but the dose is being altered and administered randomly so no way to know for certain how much is on board or may be on board at any given time—or how his adrenals (really adrenal—he’s got a huge tumor filled right and an atrophied left) will react to a challenge—go all in or give up.

which is why I know I ask a lot from kind mods like @Wendy&Neko or @tiffmaxee or @Suzanne & Darcy because it’s hard to predict the unpredictable—yet I keep hoping and trying. So a Libre would be so useful (and a break for both of us, all the extra testing has put huge fissures on my fingertips so I can’t really feel the strips or meter anymore —but definitely feel the skin ripping open more as I push the strip in, open a ketone foil pack, or hold a 2x2 on his poke site). I suppose if his ear gets infected will curse myself, my decision, and be forced to try a Libre

I do think a Libre would be a bad choice for Methos. I have heard of members here tearing their Cushings cat’s skin accidentally. I think an ear tear is less bad than an injury on his body. My heart just goes out to you, Colleen.

 

[Suzanne & Darcy]

Comic relief: this is what I used to feed at 75:
View attachment 71482
greenies soaked in Karo

now it’s proplan ….mmmm, wheat gluten and meat by products but I’m grateful he loves it. A few days ago when he got an entire can he couldn’t believe his luck. Of course the next normal meal he was like “ no thanks I’ll wait for the meat by products mom”

I definitely have never heard of Greenies soaked in Karo. I am going to have to remember that one!

What is his dose of steroids by the way? I have missed that in his complicated story.

 

[JL and Chip]

What is his dose of steroids by the way? I have missed that in his complicated story.

Methos has adrenal-based Cushings, so the adrenal tumor is pumping out steroids (rather than him being “dosed” with them from an external source).

Sorry Colleen, didn’t mean to speak for you…

I'm seriously putting the greenies/Karo trick in my arsenal for the future, lol.

 

[SmallestSparrow]

I definitely have never heard of Greenies soaked in Karo. I am going to have to remember that one!

What is his dose of steroids by the way? I have missed that in his complicated story.

I’m sorry because of my thumbs I’m dictating these so I’m not very clear. He’s not getting steroids but his cortisol producing tumor isn’t controlled so it’s randomly adding extra cortisol to his system so it’s like having steroids ids every day but not a set amount of steroids just kind of like a random reach in the skittles bowl and see how much you pull out kind of dose.

 

[Suzanne & Darcy]

I’m sorry because of my thumbs I’m dictating these so I’m not very clear. He’s not getting steroids but his cortisol producing tumor isn’t controlled so it’s randomly adding extra cortisol to his system so it’s like having steroids ids every day but not a set amount of steroids just kind of like a random reach in the skittles bowl and see how much you pull out kind of dose.

Okay. I gotcha. That is enormously problematic. I thought you meant adding in extra steroids PO… and I didn’t get that at all. I don’t even know how you are coping honestly. You are amazing.

 

[SmallestSparrow]

Methos has adrenal-based Cushings, so the adrenal tumor is pumping out steroids (rather than him being “dosed” with them from an external source).

Sorry Colleen, didn’t mean to speak for you…

I'm seriously putting the greenies/Karo trick in my arsenal for the future, lol.

id texted my vet when he first went low. I think I may have posted here but prob didn’t. You can see remnants of low carb food on his plate. First I fed him that. Then panicked it wasn’t working and gave him a greenie (45% btw) and then went “f this “ and poured karo on the greenies. He was soooo happy. So my vet texted back and said “ you didn’t give greenies again did you” bc the last time he was 75 I’d given greenies then texted her.
I texted back “maybe” and then I texted a picture of the remaining greenies and karo and said does this count?
She texted back “you can stop.“

 

[SmallestSparrow]

Okay. I gotcha. That is enormously problematic. I thought you meant adding in extra steroids PO… and I didn’t get that at all. I don’t even know how you are coping honestly. You are amazing.

Th thank you, but no, I just whine a lot. You guys are all so supportive it means the world to me.

 

[SmallestSparrow]

Sorry Colleen, didn’t mean to speak for you

I just wish I’d seen you already answered, and I wouldn’t have had to try and dictate because this phone does not understand my voice.

 

[Suzanne & Darcy]

Have you been pricking your thumbs? I am sure they sell some kind of silicone thumb protectors. I even think I have some from a few years ago when I had problems with my thumb after I broke it. I had a splint at first but needed some additional protection later on.

 

[Suzanne & Darcy]

Th thank you, but no, I just whine a lot. You guys are all so supportive it means the world to me.

Nope. You are pretty amazing!

 

[SmallestSparrow]

Have you been pricking your thumbs? I am sure they sell some kind of silicone thumb protectors. I even think I have some from a few years ago when I had problems with my thumb after I broke it. I had a splint at first but needed some additional protection later on.

No. For every blood test I’ve washed my hands twice—for the test and 30 min later to wash off his ear. And wash before fixing food so I’m sure not contaminating w/ his brothers or my food. And when doing meds (twice a day for each boy) wash between each pill pocket to avoid cross contamination. That’s not counting washing hummingbird feeders then really wash my hands because SUGAR SYRUP IN MY KITCHEN.
Skin split open and doing things that puts pressure (open vetoryl blister pack, split K tabs, push strip into Meyer or the worst, open foil on ketone strip) and they split more. And if it’s any fingers that touch strip I put bandaid over just before testing then what goes on must come off before next test.
And the sun was in my eyes and a pebble in my shoe

 

[Suzanne & Darcy]

No. For every blood test I’ve washed my hands twice—for the test and 30 min later to wash off his ear. And wash before fixing food so I’m sure not contaminating w/ his brothers or my food. And when doing meds (twice a day for each boy) wash between each pill pocket to avoid cross contamination. That’s not counting washing hummingbird feeders then really wash my hands because SUGAR SYRUP IN MY KITCHEN.
Skin split open and doing things that puts pressure (open vetoryl blister pack, split K tabs, push strip into Meyer or the worst, open foil on ketone strip) and they split more. And if it’s any fingers that touch strip I put bandaid over just before testing then what goes on must come off before next test.
And the sun was in my eyes and a pebble in my shoe