? 2/10 Howie PM nadir=62, PMPS=64, BCS question

[Howiesmom]

@Wendy&Neko
For anyone who is experienced with giving BCS (big chicken shot)...how frequently can you do it? Wendy gave me advice to give it on Sunday as his depot is just so large and his levels are dropping (acromegaly, IAA, 38 units BID). But how often can I do it? His nadir is normally between +10-12 and was 62 tonight. He is on cabergoline so am giving dose decreases if he drops below 70. So he clearly earned a reduction tonight to 35 units but was afraid that the reduction would still drop him pretty low tonight. I did the BCS anyway so I own my actions! But for future reference, it would be good to keep some recommended rules in mind (if those exist)! I also mixed in a little MC food in his supper, so I might have really screwed him up tonight!

 

[Lisa & Oberon]

Don't take this as general advice, but just as one data point: the last time Oberon headed down the dosing scale I was doing either a BCS or a skip about every 6 cycles. Pretty much every time he earned a reduction I was also giving a BCS/skip to lower the depot. I don't think there are any hard and fast rules other than doing what you need to do to keep the cat safe. But Wendy or others may have better guidelines for you.

 

[Wendy&Neko]

But how often can I do it?

If cabergoline is starting to work, you can break all the rules, especially if on higher doses. BCS when you feel you need to. Skips are OK too. Frequency, as needed. Back to back reductions also OK. I found when Neko was screaming down the dosing scale it was about every 4 cycles, but sometimes even after two. I didn't BCS much, cause she was guaranteed to bounce to the moon. Maybe even think about 15% dose reductions instead of 10%. You'll be down to a single syringe in no time. It is so much easier to go back up in dose if you need to, than fight a large overfull depot.

 

[Howiesmom]

If cabergoline is starting to work, you can break all the rules, especially if on higher doses. BCS when you feel you need to. Skips are OK too. Frequency, as needed. Back to back reductions also OK. I found when Neko was screaming down the dosing scale it was about every 4 cycles, but sometimes even after two. I didn't BCS much, cause she was guaranteed to bounce to the moon. Maybe even think about 15% dose reductions instead of 10%. You'll be down to a single syringe in no time. It is so much easier to go back up in dose if you need to, than fight a large overfull depot.

Thanks to you and @Lisa & Oberon for the feedback and confidence! I was wondering if I could do large dose decreases. I started him on 35 units this morning but may drop him lower. Last night after doing a half-dose, his +3 was 133 and +4 was 124. His AMPS today was 112. So not massive BG increases. I know the BCS may take a couple cycles to really settle in. Have a great day!

 

[Howiesmom]

@Wendy&Neko
Given the fact that the BCS raised him a bit and then he was back down to a nadir of 86 tonight (got home from work late so only could get a +10.5), is there anything to be said for dropping him down to the 19 units (the BCS) for a few cycles since we are trying to get his nadir closer to 100 to see what happens? Or is that too drastic of a drop for multiple cycles? I gave him 35 units this AM and PM but have a feeling I could have decreased further.

 

[Wendy&Neko]

I kind of like 30 as his new dose. Up to you if you want to BCS a bit first tonight. Like I said, rules are meant to be broken if cabergoline (or something) is causing kitty to race down dose.

 

[Wendy&Neko]

Note for any lurkers, my suggests around only for Howie - he is a in a pretty unique situation.

@Howiesmom Been meaning to ask, you have a first name I could use? Up to you if not.

 

[Howiesmom]

I kind of like 30 as his new dose. Up to you if you want to BCS a bit first tonight. Like I said, rules are meant to be broken if cabergoline (or something) is causing kitty to race down dose.

I was thinking of just going down to 30 units tomorrow (woo hoo! 1 syringe!). I’ll try that for a couple cycles to see how it goes. Luckily I’m working from home Friday and Monday so can monitor more closely. And my name is Tracy!

 

[Wendy&Neko]

Hi Tracy.

30 units is a big drop, and there could be a bit of the 38 unit depot still there, but he was on a 10 unit higher dose just a week ago. You need a break! And he keeps on wanting to show off those greens.

While not what every cat does, it might be worth looking at Marvin's SS, starting end of June when he started cabergoline. He was on a lower dose to stop, but you can see the % dose reductions, BCS's and skips she had to do to keep him safe. As I kept saying to Nat, you can always go back up if you need to.

 

[Howiesmom]

Hi Tracy.

30 units is a big drop, and there could be a bit of the 38 unit depot still there, but he was on a 10 unit higher dose just a week ago. You need a break! And he keeps on wanting to show off those greens.

While not what every cat does, it might be worth looking at Marvin's SS, starting end of June when he started cabergoline. He was on a lower dose to stop, but you can see the % dose reductions, BCS's and skips she had to do to keep him safe. As I kept saying to Nat, you can always go back up if you need to.

It’s hard to believe that he was at 55 units a couple weeks ago and now am looking at almost half that amount. Yes, I keep reminding myself that once I find a better lower dose, I can always go up. It will be interesting to see where we land over the next few weeks when the cabergoline really kicks in! Thanks for all your guidance! It is truly appreciated!