donnahc said:
Should we not back off when he goes low/has a good day?
Not necessarily. The reasons people back off are 1) general chickenness (guilty!
) 2) safety & data collection, especially on a lower PS 3) signs the dose may be too high.
The reasons you *shouldn't* back off are 1) sometimes it's the breakthrough you seek and if you back off you lose that and 2) sometimes you get WOW factor on a new dose and that will be lost on the next cycle, and it turns out that dose is still too low even though you got a good nadir once upon a time.
The difficulty IMO is really the safety factor. If you got a good nadir on shot one, you don't know if you will get an even better one on shot two. So if you won't be home to monitor, or will be asleep, there's a safety reason to pull back on the dose, even if it does result in loss of progress.
So it's often a tough choice what to do. Since you got a 75% drop on that good cycle, and were now presumably going off to sleep, it seemed to me reducing the dose was the right move. But that call could have been wrong. I only made progress with Bix when I *stopped* reducing out of fear everytime I got a good nadir.
donnahc said:
Is backing off on dose always the thing to do when the kitty gets a bounce?
There are 2 kinds of bounce and it's important to distinguish, b/c the answer is different for each. I think I'll make it my new pet peeve :mrgreen: that we use the same term for both. I usually try to distinguish "rebound" from "liver training" but I realize that really isn't clear either.
Somogyi rebound is caused by either dangerously low #s or an overly steep drop that causes their body to go into actual defense against possible hypo. If you have that, your dose is too high, and an immediate dose reduction is warranted.
Liver training rebound is caused by their body going into safe numbers that are lower than what they are used to. So generally blues or greens that they haven't seen in a long time. Their body freaks out & thinks there is a hypo danger when there isn't any actual danger. If you have that, your dose is not too high (unless it's high for other reasons, but leaving aside complexities), and you should *not* back off the dose. Backing off the dose allows their body to continue to hang out in higher #s and from what I have seen it delays regulation. This kind of rebound never wears off on it's own, and the only solution is to get them in good #s for long enough that they get used to them and their liver settles down. Some of us here on the board disagree (I think?) on how aggressively you should shoot through this kind of rebound - take it gently and gradually vs. just go for the good #s (if you can in terms of safety & monitoring) and be done with it. But regardless of the degree of aggressiveness in dealing with it, the general concept is the same I think.
As far as the dose, I think I'm in the other camp from Rob on this one. Although the drop on 4/23 I think is too much in % terms (meaning if you got a PS of 150 you could be in hypo #s by nadir time), the drop doesn't look too steep to me (can't know for sure, but basically 200 points over a few hours seems likely). You've barely gotten any action since then, and you have U-curves that look too shallow.
That said, I can't say for sure that you need 2.8, it's really just guesswork. If it were me, I would probably be trying 2.7 or a skinny 2.8, with nadir monitoring as many cycles as I could manage it.
