2/20 Max amps 360 pmps 338

I increased Max’s dose today so I’ll give it a chance to work. He bounces at the end of the cycle no matter what and how much I feed him. He’s also gotten a little bit of an upset tummy. I want to know if I did start the R, would it have to be at preshot time? The reason I ask is because I believe that would cause the bouncing to be worse since he onsets early. Could it be given sometime in the last part of the cycle so it would onset and nadir before the Lev onsets since he drops so fast? I know thats not typically the way it’s started, but if it could be done, then we could start with a lower PS number. Hopefully then he would have a more flat cycle? If that can be done, when would be the best time to start that since I just increased his Lev? @Wendy&Neko
 
We don't use R on the same cycle as a L increase. We try to avoid using R on any situation where he might drop fast, so that also includes cycles where he's breaking bounces. I'd prefer to start the first trial at PS time. How long until that? Are you feeling up to staying up until at least +4, possibly +5?

Sometimes cycles following R can be more active too.
 
I wasn’t asking about starting it now, because I did increase the Lev. I should have asked how soon after an increase would you start R, if there was no change in the numbers? I can and usually do stay up that long anyway. I’m just hesitant about giving it at preshot time, because of how quickly he drops with Lev. That’s the only hesitation. I keep going back to thinking about R because I want to do something about these high numbers when he bounces at the end of the cycle. I’m just asking would that be helpful for Max and if so, how soon after the increase should I start?
 
He breaks his bounces quickly usually but then bounces again before the next cycle starts, so I am not sure how the R would work for Max. That’s what I want to find out.
 
You can start R the second cycle after an increase, which can be NDW time anyway. Unless of course it looks like a bounce breaking cycle. And one other caveat. Normally we build an R scale based on the R preshot (which eventually may or may not be PMPS or AMPS). The R scale tells you how much R to shoot based on the R preshot. At this point, I wouldn't be shooting anything under 250 to start. And only for the PM cycle, at this point 250 is too low for the AM as he seems to drop if starting even higher than that.

And we start low (0.1 units) and go from there based on how the data of a couple experiments. Note, at one point I was giving drops of R to Neko. Cats on lower L doses tend to need less R.

If a cat is breaking bounces too quickly, R may not be the tool to use.
 
Thank you and I understand. Would you try R if your cat was having patterns as Max is, if the numbers were high enough? Just your opinion.
 
When I started using R, it was well into Neko's FD journey, and her doses were increases relatively quickly as her tumour was coming back 3 years after SRT. She also was taking longer to clear bounces. So the R was used to try and keep up to the dose increases as best I could, while still increasing the L as fast as made sense with TR. And all following a dental that she needed for a bony growth on her jaw (thankfully benign) that had caused sudden higher numbers. Only once I got a handle on R under those circumstances, did I try to tamp down the bounces.

Neko's reaction to R was not normal, her onsets were a lot later and duration later as a result. So I ended up quite frequently shooting a couple hours before PMPS, to try to make sure her R onset was before L onset. The other thing you want to do is make sure the R and L onsets and R and L nadirs are not at the same time. Again, trying to avoid big drops from combined action in the same time slot. This does argue for eventually using R before PMPS for Max most of the time.

For most people, we wouldn't suggest R for a cat clearing bounces so quickly as Max usually does. Most caregivers aren't nurses either. I'd kind of like to see how Max does on the 5.5 units for a while before going ahead with any R experiment.
 
Okay I agree with that. We will see how he does on the 5.5 units of Lev. I believe I can grasp the concept of when and when not to use R on Max with some training. I have become used to knowing when there’s a bounce, NDW, bounce clearing cycles, etc…..although Max does throw curve balls at times. I would never do anything I wasn’t absolutely sure of because I know the power of R and how it behaves. I don’t know now how it’s used in cats, but I can learn. When you mentioned using R before PMPS in Max most of the time is exactly what I am interested in doing, but as always I value your opinions in what would best help Max. Thanks so much for answering all my questions.
 
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