7/15 Ruby AMPS 249/+3 248/+7 226/+9 224/PMPS 222/+3 248 no UTI

Katherine&Ruby

Katherine&Ruby

Member Since 2020
Yesterday on The Ruby Saga.

Tomlin said:
The great news is you have access to a thought leader and will be able to share the latest info—an opportunity to learn, gain new insights into the current treatment perspectives & why they are changing:) ! Stay strong and keep the faith:bighug:!
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Thank you so much for all of the information, Amy. :bighug: What you say does make me feel better. I am certain that there are very good reasons for Ruby's oncologist to have made the decision to not administer the chlorambucil right now. (Can't access that article you site, would love to read the whole thing.) This is not to discount your experiences @Wendy&Neko, as I hope you know how much I respect your opinions and thoughts on everything, but I really do want to trust this doctor who is a leader in her field. If she doesn't know what she's doing, I really don't know who would. :bighug:
 
Thinking of increasing Ruby's dose tonight to 1.5. I know I only recently reduced her pred and she's got a potential infection, but this string of yellows and high blues really worries me. Should I do it? Too many changing variables?
 
I am happy the information is helpful is some way. Unfortunately, as you know, they are working hard to try to understand & define the disease state better and that will then allow them to determine optimal/better treatment approaches. It is a work in progress. The same drugs are pretty much on the table, but the timing regarding the use of the drugs is changing and may even be specific to a cat.

To note, it is only as of late (2020-2021) that the pharmacokinetic data for Chlorambucil in cats was finally studied. Both UC Davis and Colorado State University ran two of the studies. The UC Davis study closed its recruitment in Nov 2020 and the CO State trial closed June 2021, so the data from those studies will be helpful. I am uncertain as to whether there were additional studies or study sites. One issue that CO State noted, is that the goal of treatment is to resolve the symptoms of the disease such as vomiting, diarrhea and weight loss yet the drug causes these same issues in some cats which then makes it challenging to determine if its the disease or the treatment that is the issue. Clearly not all cats experience the side effects, so if they can gain more understanding of how the drug is metabolized and the variability of the metabolization of the drug within cats, it will be helpful moving forward.

Your oncologist may have access to some early data which will be good to ask her about at some point if/when the drug is needed/prescribed. Again, you are blessed to have access to an expert:bighug:. It is a great opportunity to ask questions, understand the approach.....especially if you are reading or hearing info that is different. Leaders engage and are always open to discussion...they welcome it. They won’t mind or care if you share what you know & express any concerns & want to know/understand more. They want you to be confident in decisions being made & sometimes that requires further discussion :). It’s not “pushing”, it is simply seeking to understand what you need to know to care for your cat.

The fact that the science in this area is continuing to evolve explains why there is such variability with treatment, treatment responses, stories of what worked, what didn’t work, and a change by some specialists regarding the approach to treatment with particular cats. If there a slam dunk approach existed, every provider would be using it and all the cats would respond. That would be nice, but it isn’t happening which is why the science continues.

PerfumedCatMom said:
Can't access that article you site, would love to read the whole thing.
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You are actually able to access it :). If you click on purchase the article, it will take you through the steps. Another option is to email your oncologist for it. Also, for future note....some publications are available to rent via DeepDyve (this particular one is not available). There will be an option to rent noted when it is available. In addition, some publications also have an option to request a copy from the authors. They are for personal use when purchased/aka copyrighted.
 
Tomlin said:
I am happy the information is helpful is some way. Unfortunately, as you know, they are working hard to try to understand & define the disease state better and that will then allow them to determine optimal/better treatment approaches. It is a work in progress. The same drugs are pretty much on the table, but the timing regarding the use of the drugs is changing and may even be specific to a cat.

To note, it is only as of late (2020-2021) that the pharmacokinetic data for Chlorambucil in cats was finally studied. Both UC Davis and Colorado State University ran two of the studies. The UC Davis study closed its recruitment in Nov 2020 and the CO State trial closed June 2021, so the data from those studies will be helpful. I am uncertain as to whether there were additional studies or study sites. One issue that CO State noted, is that the goal of treatment is to resolve the symptoms of the disease such as vomiting, diarrhea and weight loss yet the drug causes these same issues in some cats which then makes it challenging to determine if its the disease or the treatment that is the issue. Clearly not all cats experience the side effects, so if they can gain more understanding of how the drug is metabolized and the variability of the metabolization of the drug within cats, it will be helpful moving forward.

Your oncologist may have access to some early data which will be good to ask her about at some point if/when the drug is needed/prescribed. Again, you are blessed to have access to an expert:bighug:. It is a great opportunity to ask questions, understand the approach.....especially if you are reading or hearing info that is different. Leaders engage and are always open to discussion...they welcome it. They won’t mind or care if you share what you know & express any concerns & want to know/understand more. They want you to be confident in decisions being made & sometimes that requires further discussion :). It’s not “pushing”, it is simply seeking to understand what you need to know to care for your cat.

The fact that the science in this area is continuing to evolve explains why there is such variability with treatment, treatment responses, stories of what worked, what didn’t work, and a change by some specialists regarding the approach to treatment with particular cats. If there a slam dunk approach existed, every provider would be using it and all the cats would respond. That would be nice, but it isn’t happening which is why the science continues.



You are actually able to access it :). If you click on purchase the article, it will take you through the steps. Another option is to email your oncologist for it. Also, for future note....some publications are available to rent via DeepDyve (this particular one is not available). There will be an option to rent noted when it is available. In addition, some publications also have an option to request a copy from the authors. They are for personal use when purchased/aka copyrighted.
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I really appreciate this perspective, Amy. Despite my concerns and worries, I actually like the fact that the doctor is doing something a bit out of the box of what is conventionally thought even just 5 years ago, and I figured that she has good reason for it in the form of scientific literature that she doesn't want to bother me with, not knowing that I really do want to read everything. When I get her on the phone again, I will ask her to forward me any studies I should know about. Ultimately, though, it will be up to me to keep tracking how Ruby feels, how she is eating and behaving otherwise, and report all of that back to the oncologist to assess.

She sent me the lab results and there are a few reds. :( I'm particularly concerned about her urine PH level. I have asked her in an email what she thinks that might be about, as a high PH means a bad breeding ground for bacteria even though there aren't any in the culture.
 

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Good news on the no UTI! Not surprising you have to increase because of the pred/disease inflammation. I am glad you are staying on top of it.

And thank you for thinking of asking the oncology vet for any studies. As I said before, I would love to see anything new beyond current “best practice”.I have had Leukeran in the fridge for six years - getting tired of it and would love to know of alternatives that might work. Unfortunately, increased pred is not an option cause it means eye ulcers here. :(
 
Wendy&Neko said:
And thank you for thinking of asking the oncology vet for any studies. As I said before, I would love to see anything new beyond current “best practice”.I have had Leukeran in the fridge for six years - getting tired of it and would love to know of alternatives that might work. Unfortunately, increased pred is not an option cause it means eye ulcers here. :(
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Wendy, as soon as I have any news you can be sure that I will share it. :bighug: I didn't realize pred could cause eye ulcers as I thought it was one of the treatments for it?
 
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Pred doesn't so much cause eye ulcers, but does make cats immunocompromised. Cats with previous herpes can have more flares on pred, which can include eye ulcers as a symptom. There are meds (eye drops) to treat it, but it's painful, so I'd rather prevent them. So I'm working on finding a lower pred dose that doesn't cause flares.
 
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