9/20 Chewie AMPS 399/ +3 353/ +6 277/ +8 238/ PMPS 236/ +3 323

Just sent the vet a PDF copy of her spreadsheet, a copy of the TR protocol as well as the explanations @Wendy&Neko gave me yesterday... my go-to vet has no availability before we move, so wish us luck with this vet who prescribed Chewie's insulin!
 
353 at +3

One question I have regarding yesterday's condo:
Wendy&Neko said:
Bhooma reminded me (@Bandit's Mom ), you might not want to be in a rush for testing. There is some research in the UK that shows that up to 1/3 of cats tested before 73 days on insulin can test negative for acromegaly, when they are in fact positive. Can't remember the details now, but something to do with starting insulin and how it affects IGF-1. We did have one cat here, Howie, who tested negative for acro but positive for IAA when tested too early. A retest showed positive. So, to save money on a possible retest, you might want to start the conversation with the vet, but schedule it for later. I think today is just day 37 on insulin? Though I guess you'll be on the other coast by day 73?
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So, if she continues to stay high and flat in the next 40 days, do we keep on increasing her dose as per TR?

This worries me for a few reasons:
1) during road trip I won't be able to monitor and feed as often
2) new vet in VA will likely blow a gasket seeing her on 10 or 11 units without an actual diagnosis of acromegaly/IAA
3) without a vet on board, it's going to be very difficult to get refills that often (we'll see what her current vet's response to seeing her spreadsheet is next week)
4) cost - related to above - it's a lot of money to go through insulin this fast, and if current vet refuses to give me a prescription for 5 pens at once, we're kinda screwed
5) sting - since glargine seems to sting at higher doses, I wouldn't want to go too high with it

Thoughts?

ETA: vet clinic just called me and scheduled a phone call to go over everything with Chewie’s vet next Wednesday.
 
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Nice to see yellows. :) And good that you can talk to the vet you want to.

Where are you buying your insulin now? My understanding was that if you order if from Mark's online, they ask for a prescription the first time. But don't worry so much about refill prescriptions.

As for the concerns:
1) I took Neko on her road trip to Colorado State University (3 days) and tested her at our lunch and gas or rest stops if needed. Neko had just earned her first reduction before we left, and earned more on her way back. With Chewie not seeing greens yet, you don't to test as much. If she was angling for a reducie, I'd be more concerned.
2) You could always do the tests now, with the risk that the one for acro would be negative, and you might have to retest again. But it'll cost more to do that.
3) See my comment about Mark's above.
4) Mark's is cheaper, also talk to the vet about Levemir. If it gets to it, we might be able to entertain the concept of using R or Regular insulin. It's a short acting insulin that lowers the numbers enough for the L insulins (Lantus or Levemir) to grab onto and do a better job. R you don't need a prescription. But there are risks to go with the benefits, we ask that people work with someone experienced in R before trying it.
5) Not all cats see the sting, but a lot do. Neko started walking away when I was injecting. My fur shots increased. She purred though Lev shots. How is Chewie reacting to the shot?
 
Wendy&Neko said:
Where are you buying your insulin now? My understanding was that if you order if from Mark's online, they ask for a prescription the first time. But don't worry so much about refill prescriptions.
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Right now, because the vet wouldn't approve more than a single pen, I had to get it locally for $99 a pen (ouch).

Wendy&Neko said:
As for the concerns:
1) I took Neko on her road trip to Colorado State University (3 days) and tested her at our lunch and gas or rest stops if needed. Neko had just earned her first reduction before we left, and earned more on her way back. With Chewie not seeing greens yet, you don't to test as much. If she was angling for a reducie, I'd be more concerned.
2) You could always do the tests now, with the risk that the one for acro would be negative, and you might have to retest again. But it'll cost more to do that.
3) See my comment about Mark's above.
4) Mark's is cheaper, also talk to the vet about Levemir. If it gets to it, we might be able to entertain the concept of using R or Regular insulin. It's a short acting insulin that lowers the numbers enough for the L insulins (Lantus or Levemir) to grab onto and do a better job. R you don't need a prescription. But there are risks to go with the benefits, we ask that people work with someone experienced in R before trying it.
5) Not all cats see the sting, but a lot do. Neko started walking away when I was injecting. My fur shots increased. She purred though Lev shots. How is Chewie reacting to the shot?
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1) Good to know - I really hope she won't need to pee giant clumps too often, but the plan is to get a +2 or 3 at least for each cycle, and a litter break every couple of hours in the car when we change drivers.
2) Since there's a one in three chance of false negative, doesn't seem worth testing now. But I could ask the vet to document that concern in her records for when we do find a new vet I guess?
3) My vet's assistant specified in the email that she wanted a glucose curve before authorizing more refills. Really hoping that after our conversation next week she will agree to give me a non-limited prescription so I can start ordering from Mark's (or using GoodRx).
4) Agreed for Levemir, but I was under the impression that a cat should get a few months at least on one insulin to give it time to work? So a Levemir change would be if acromegaly or IAA were confirmed, right?
5) So far she is doing well if I inject behind her shoulder blade or mid-flank. She tenses for a second when she knows it's coming, but only jerks away when the injection site is too far or down on her flank (probably more sensitive). I give her churu spread on a plate to lick while I'm tenting the skin and injecting, and she knows exactly what the order of operation is. No running away for now (knock on wood).
 
1) ECID, but Neko only used the LB when we stopped for gas or good breaks. When I did the plane trip, she held it the entire day, even though I gave her a chance with a portable LB at the airport. Then she flooded it when we arrived at the hotel. :p
2) yes, good idea. The vet records should belong to you and you should get a copy of them before you go. Hopefully to give the new vet some background, and save you some time/money.
3) good thing you did a curve yesterday.
4) the switch to Levemir is tied to higher doses, not so much secondary conditions. For cats on lower doses, we suggest trying an insulin for several months before switching. If a cat is uncomfortable on Lantus, we don't make them wait to switch.
5) Neko had issues about injecting elsewhere too. Good idea on the Churu! Some people give the shots while the cat is eating their main meal.
 
1) When I drove from LA to Portland 8 years ago, none of the cats wanted to use the box or eat or anything while in the car. Once in the hotel room they would run to the box, then inhale dinner, then crash hard in their donut beds. But they were literally half the age they are now, so I expect they'll want to be let out of the kennels to use the box when we change drivers. It's going to be quite the circus :p I hope they do as good as your girl Neko did!
3) I'll do another one next Tuesday too, and send the vet the updated spreadsheet. Give her aaaaall the data.
4) I'll keep an eye out for potential reactions if she needs more dose increases (please please please Chewie start coming down).
5) Poor kitties, can't be pleasant at all... That's why I picked churu instead of her meal, I wanted to associate all needle pricks with tasty tasty tuna treat, so she doesn't start dreading mealtimes or something down the line. So far so good (knock on every possible wood surface).
 
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