7/28 Rachel’s George AMPS 464

[George’s Mom]

Yesterday’s link

@Wendy&Neko I think the R has lost some efficacy. Vet put 1 unit in each of multiple syringes but I’ve read that can render it ineffective. I was told to get Novilin R instead (no prescription required). So I am going to switch to that at the next +6 shot.

Also, getting George retested for Acro and IAA. Appt Tuesday (8/2) to have blood drawn. Also vet recommended doing the following for his heart (pasting from the estimate and left pricing for a gut check):

Procedure or Dispensed

1. Medical Progress Exam 50.50
2. Echocardiogram with Specialist 606.00
3. Sedation & Monitoring Level 1 145.04
4. X-Ray 3 Views 318.50
5. Radiology Consult 139.50
6. STAT Consultion Fee 105.50
7. Blood Pressure Measurement 58.80
8. Electrocardiogram 115.59
9. Total estimate charges... $1539.43

Will this provide info needed to confirm heart is in well enough condition to have SRT? I feel like we’re making sure his heart is okay for sedation with SRT… but by sedating him ??? (#3 above)??? Love to hear your thoughts. Thanks!

 

[Wendy&Neko]

You don't need the x-rays or electrocardiogram (ECG). Which means no radiology consult. If lucky, may not need sedation either. Not sure what STAT consultation fee is. Basic requirement for most places for SRT is recent blood work (to check kidneys) and an echocardiogram from a cardiologist. A blood pressure measurement is a good thing to have.

Edit: I just reread your message above and sounds like the .5R @ AMPS was maybe not my best choice. Steep decrease = steep bounce. Shoot. I ask for your patience as I am learning but so much to take in. It has sunk in to my thick skull now. I am going to keep close watch of him. And will probably give R and +6 to help with a bounce.

My advice is to slow down. You don't need to give R every cycle, especially not twice a cycle. You also need to get a better handle on the L cycles by themselves, which means the odd cycle with no R. You are trying to avoid steep drops in the combination of L plus R action. Shooting too much, to cause a bounce, then shooting R to lower the bounce leads into a viscous cycle. R use should be strategic. To start with, if he's under 400, lower the dose of R. Maybe start with if over 300 do 0.5 units R, 350-400 do 0.75 units, then over 400 do 1 unit.

Other things to consider, do not give R if it's a cycle you think he'll break a bounce, cause there'll be lots of downward momentum on that cycle alone. Tonight is the 6th cycle since his blues, he could break the bounce either tonight or tomorrow morning.

 

[George’s Mom]

You don't need the x-rays or electrocardiogram (ECG). Which means no radiology consult. If lucky, may not need sedation either. Not sure what STAT consultation fee is. Basic requirement for most places for SRT is recent blood work (to check kidneys) and an echocardiogram from a cardiologist. A blood pressure measurement is a good thing to have.

Okay, got it. I will push that direction with the vet. She’s pretty reasonable, so hopefully she’ll agree.

You also need to get a better handle on the L cycles by themselves, which means the odd cycle with no R. You are trying to avoid steep drops in the combination of L plus R action. Shooting too much, to cause a bounce, then shooting R to lower the bounce leads into a viscous cycle.

This part, I’m not fully following you. I understand not creating a steep drop. I also understand I should be increasing the Lantus instead of giving more R. I don’t understand what you mean about an odd cycle.

R use should be strategic. To start with, if he's under 400, lower the dose of R. Maybe start with if over 300 do 0.5 units R, 350-400 do 0.75 units, then over 400 do 1 unit.

Now this I can follow. Got it. And I assume you’re talking about this being given with the Lantus (as opposed to +6)

Other things to consider, do not give R if it's a cycle you think he'll break a bounce, cause there'll be lots of downward momentum on that cycle alone. Tonight is the 6th cycle since his blues, he could break the bounce either tonight or tomorrow morning.

I am not familiar with breaking a bounce. You are so smart and I feel so dumb! Lol.

Overall, I am hearing that I need to layoff the R. Even if it’s to curb a bounce? In general that would be the +6 R shots I am giving him. He just feels like crap when he’s in the 400s or 500s.

I do think he’s dropping quite a bit tonight (318 right now), so likely he’ll bounce in the am then I think is what you said.

 

[Wendy&Neko]

I don’t understand what you mean about an odd cycle.

It's OK to have cycle where you don't shoot R. It's not required each cycle.

From the New to the Group Sticky Note: (also break = clear)
Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

Overall, I am hearing that I need to layoff the R. Even if it’s to curb a bounce? In general that would be the +6 R shots I am giving him. He just feels like crap when he’s in the 400s or 500s.

You need to learn when to give R, and when to not give R. You want to avoid situations where giving R causes those steep drops. If you are mid cycle and see his numbers are going up steadily, R is OK then. In that case, you'd hope that R would keep him flat or prevent him from going so high. Lantus is great at taking lower numbers and keeping them flat. Not so good and yanking down higher numbers. R is used to gently take the numbers down, and give the Lantus better numbers to work with when it onsets.

Another R fact, don't expect it to act exactly the same each time you use it. There is the underlying L action also influencing what happens with the numbers of L+R.