Leo (Leoberry) - the high doser

[JeffJ]

Day 3 CSU
- 7:30am checkin
- 2:00pm anesthesia wearing off
- 2:45pm depart facility

Leo is doing good, but is still woozy from sedation. His BG is a bit lower today.
He is eating real well, and eliminating well.

The effects of radiation will not be immediately apparent. Over the next 2-3 weeks, the irradiated cells will stop producing extra IGH-1, and his diabetes symptoms will diminish.

Days 4-5:
- 10:00am day 4 checkin tbd
- 11:00am treatment
- I will get a tour of the radiation facility

I have not spoken to the radiology team today, but I will meet with them again tomorrow. I discussed the potential hypothyroid conditions (post SRT) with Dr. Cauley. He agreed it is something to monitor.

Discussed "resolveable" with Dr. Cauley. He said they apply marker fluid, and the tumor(s) show up and are resolveable that way. That is how they make a distinction between the normal cells and the tumor cells. He said they were able to determine the distinct tumor cells. I'll bring it up with the radiology team tomorrow.

 

[julie & punkin (ga)]

Hmm, interesting on the "resolvable" comments.

I don't think I ever told Dr. Griffin that Punkin had developed hypothyroidism. You can let her know. I can send her the link to punkin's labs if she is interested in seeing them.

 

[JeffJ]

Sounds good Julie. In the meeting yesterday, Dr. Griffin said she might followup with previous SRT patients. I'll let her know. Like I said, I only had the one meeting with her and team, and I will have time with them tomorrow.

I call them the CSU group the Dream Team. They are making our dreams come true.

 

[JeffJ]

Leo at BG=150 at 8am today. Dosed 5.0 units as maintenance dose. Will have CSU monitor BG.

Leo slept good last night, but looked peaked. He is used to eating small meals throughout the day. These evenings of fasting are tough on him.
.

 

[Alexi]

The treatment may also be contributing to some tiredness. Looks as though it is starting to have an effect though. Keeping everything crossed for you, I do check in every day even if I don't post.

 

[MrWorfMen's Mom]

Jeff, I am following Leo's treatment too although I was missing in action for a bit. You are contributing more to this site than you realize with your daily reports. We are all cheering Leo and you on. Leo is sooooo lucky to have you for his 'bean'.

 

[JeffJ]

Thanks everyone for the continued support. Today was busy, and included direct interaction with the SRT team and a tour. Tomorrow busier because we are driving from Ft.Collins to Amarillo after the treatment. Since tomorrow will be full, I might be too tired to post here. I'll ensure a followup on Sunday. From Tue 9/27 - Thur 10/6, I'm going to Sequim to handle my Mom's household and prep the house for sale.

Day 4 CSU
- Leo doing well, this was day 2 (of 3) for SRT
- Leo's BG was low today, so we tested a few times. Skipping PM dose per direct advice from Dr. Cawley.
- Leo's side effect from yesterday and today is runny and squinty eyes. Dr. Cawley said it is from the ointment applied to his eyes to keep them moist during treatment.
- Leo is very tired, and just interested in eating and sleeping near the food area. He is usually more active.
- Leo will get a full writeup for post-SRT treatment from Dr. Wormhoudt. I will receive that write-up, and the offer to call Dr. Wormhoudt or Dr. Cawley any time. It doesn't get better than that! Leo's Dream Team. I totally mean that. This means so much to us.

Notes from today
Dr. Tiffany Wormhoudt is Leo's permanent Radiologist here.
I spent an hour with her, including a tour of the facilities. She has a vibrant smile, is highly focused on her work and career, and cares about her patients. These doctors and staff are life savers. With all the crud that happens in our lives, it is so rewarding to interact with this team.

Notes on SRT and Leo's treatment:

• The Varian SRT is $5M instrument, with $100k-$200k/year maintenance. It is awesome. There was equipment all over. A true geek heaven.
• An individual setup (mould and jaw restraint) is custom made per patient. That holds the patience fully still, and in the exact same location for each treatment. They will give me the mould/setup after treatment tomorrow since they are custom for each cat.
• The SRT includes a built-in cone beam CT that is used to re-verify exact position before dose. If fine tuning is needed, the CT on the SRT machine is used to help adjust.
• Each SRT is prefaced by an SRT plan. The residents, including Dr. Wormhoudt, setup 3-5 proposed plans. a full time staff such as Dr. Griffin reviews and approves one of the plans.
• Each cat gets 5-7 beams of radiation. Leo's plan is 5 beams. This means the machine moves it's arms to a specified location, the radiation is applied. The radiation is stopped, the arms move again, and the radiation is re-applied. This is done 5-7 times.
• Radiation is done to the entire pituitary, except the boundaries. Boundaries are established in the SRT plan (ie 1mm layer) around the entire pituitary. That way, healthy tissue is not dosed.
• Dr. Wormhoudt was very specific about that - the entire pituitary is irradiated, not just the tumor. I politely asked her to verify. She said that is the SRT practice - to irradiate the entire pituitary. So this is not a typo. The pituitary tumors have bad cells spread throughout the pituitary.
• Dr. Wormhoudt said Leo's treatment was very safe, with no surrounding tissue to be affected. YAY!
• Three personnel run the SRT, and one is an anesthesiologist. I am sorry, I didn't get their names and titles. They are part of the Leo's Dream Team.
• The first day of SRT takes the longest. That day includes the SRT plan setup, review/approval, bite/skull moulds, then actual SRT. Subsequent days 2 and 3 are faster because the SRT team is just replicating the actual SRT from day 1, and the other work is not repeated.

Other:
Dr. Wormhoudt is a 1st or 2nd year resident. She will be here at least this year and next. She is very pleasant and answered all my questions. Also, I had Zero doubts after the discussion. These radiation residents are very specialized and knowledgeable. Their SRT plans are reviewed and approved. This is not experimentation, but is directly supervised SRT by a highly competent and caring team.

To summarize, Leo's SRT "Dream Team" consists of:
> Dr. Jacob Cawley - as the general vet in charge of health
> Sarah Von Mater - 4th year student, helping with everything
> Dr. Tiffany Wormhoudt- responsible for SRT plan
> Dr. Lynn Griffin - responsible for SRT plan review and approval, and overseeing SRT
> Anesthesiologist Dr.
> Two Personnel, probably also full DVM Drs, doing setup and actual SRT treatment

Dr. Wormhoudt intends to do a paper, including Leo. They may be contacting previous SRT patients. If any East Coast SRT patients want to volunteer info, I'll relay contact info.

Food and other:
- Mulligans Pub is on College and Drake, 1/4 mile away. They have lots of food and brew. I had a nitro Guiness, burger, and fries there. The service was good. Of course the Guinness was too!!
- From all the U.S. news I thought there would be a pot store on every corner. I haven't even seen one. However I did go to an inexpensive car wash. The dude (I mean attendant) there was totally "baked". If his eyes were any redder, they could be used on a color chart. Ha ha.
- I did a 45 minute round trip to HorseTooth Reservoir in the foothills today. A nice quick break. You can just drive up, take pics, and drive back.
- I went to Old Chicago in Old Town on Tuesday night. I had a nitro porter finished with Chocolate. OMG!

Pics:
- Dr. Jacob Cawley - part of CSU Dream Team
- Leo's 5 SRT beams
- SRT control room
- SRT team setting up cat patient
- SRT team, Dr. Wormhoudt on right
- Guinness nitro from Mulligans Pub

 

[JeffJ]

End of Day 2 SRT (end of Day 4 CSU)
Leo totally wiped out. Just ate the last of his food - 3 2/3 cans of food from 2pm - 10pm. He is quite listless. Pic attached.
BG = 330 ~8pm, 8 hours after treatment

 

[julie & punkin (ga)]

poor little guy. He should perk up once the treatment is finished. Have you reported back to them that he's so wiped out? I'd want to let them know. I don't think Punkin took the treatment quite that hard.

I'm also thinking Punkin might have gotten to eat until midnight. But one way or another, you're almost done with all of it. Thanks for posting the pictures - basically looks the same as when we were there, although we never saw a cat patient in progress. Very cool.

Safe travels home tomorrow.

 

[JeffJ]

Thanks Julie. I'll relay the info tomorrow about his tiredness. At home we are 2 adults and 5 total animals. It is pretty quiet, and maybe the excitement has just plain worn him out. It is definitely unusual.

 

[Wendy&Neko]

Sorry I missed the last couple of days. Dr. Lynn Griffin was our radiation oncologist too. She was great, very informative. One ofher of her patients that I know of, Grayson (mom Lu-Ann) also went hypothyroid. But it is still a small percent of the cats doing SRT. Neko had it done twice and so far lucky twice (antijinx). I joined one of the on line thyroid groups and Hemopet is the go-to place for getting bloodwork done for thyroid testing. You want the T4 and the TSH tested. Early this year Neko was off her food and I got blood work done, her T4 was low normal and T3 was too low, TSH was normal, but there are some conditions that can look like hypoT, but are not. Here is a link to a paper on diagnosing feline hypothyroidism. Note that the vast majority of cats that go hypothyroid are those that are given i131 treatment for hyperthyroidism. And it's another one of those diseases your vet may not know a lot about.

Safe travels home. Neko needed reductions within a week (actually days) of the first treatment and 2 weeks of the second. But her dose at the time was such that she was seeing some green so closer to a good dose. She was also pretty tired after her first day, we needed rest days before treatment.

 

[JeffJ]

Summary of whole trip:
- Leo more lethargic than normal
- One day of low BG. Most dosages far lower than normal.
- Food intake and elimination generally good. Leo would not use litter box during car stops.
- Leo's eyes still watery from SRT, possibly from the gel applied to the eyes during treatment.
- Fairly tiring trip for Leo and JJ.
- CSU DREAM TEAM is awesome.

Day 3 SRT
This was a "normal SRT" day for Leo. He was fine the whole day. His BG was pretty low, maybe from not absorbing food. As a result, his insulin was reduced.

I'll post in his spreadsheet by EOB today, with notes for historical purposes. The radiologist (Dr. Wormhoudt) and the assigned vet (Dr. Cawley) both said the SRT effects should not be noticeable for 2 weeks. We will test and update the sheet daily.

Day 5 CSU including Day 3 SRT
4:00am wake up
7:45 checkin CSU
~11am SRT procedure
1:00pm Leo in recovery room with Sarah Von Mater and Dr. Cawley
- checkout instructions discussed
- got Leo's litter box, and he peed in it, what a very good boy
- fed 2 doses of 1/2 can each
2:00pm Checkout, and Sarah Von Mater helped carry stuff to the car.
- Leo was Sarah's first real patient (she is 4th year student). It was special for her, and for me and Leo as well. She was great. Her future is bright.
- The checkout was easy. I did not get to meet with the SRT team again. They did a good job. I got Leo's bite mold that they used to fix his head in position.
- Billing and payment checkout took about 15 minutes, which is fine. I made sure to get a copy of the day 1 estimate.

Day 7 Driving
This includes Day 5 CSU. Times in Mountain time
Leo did well this whole trip. Even peed in the litter box during the drive one time. Did not drink, so his food got extra water.
4:00am wakeup
7:45am checkin at CSU
2:00pm checkout of CSU
2:30pm start drive
- 2 hours of stop and go traffic thru Denver and Colorado Springs
- so I will NEVER take that route again, how frustrating
12:25am-12:45am check into hotel at Amarillo, yes frustrating
- Leo peed twice in the litter box in the hotel.
1:15am sleep
- Leo crashed out pretty well
5:30am for a food break for Leo
Summary:
- 10 hours in the car.
- 21 hour day for Leo and JJ

Day 8 Driving
12:30pm CST depart Amarillo
- Leo pooped and peed at hotel
- Leo unhappy most of trip
- Major hail and torrential rain near Post, TX, southeast of Lubbock. I thought my car was damaged, but got lucky.
- The water temporarily blasted off all the dirt. Highway traffic went to 0.0 mph, it was undriveable.
- Texas gets up to 1.0" hail. We had it at our house in Austin once. It really is that big and it nukes everything including cars, trees, animals, roofs.
- Leo was majorly traumatized from the rain and hail. He "hid" in the smallest spot in the big dog cage.
- Leo ate ~2 cans thru the trip. BG somewhat normal. No pee or poop in litter box, he just wouldn't go.
- "saved" a dog near Winters, TX. The dog was obviously escaped and walking along 2 lane highway. I stopped at the nearest public facility, a small roadside church. Five women were talking outside. They said they were from the area and would rescue the dog.
8:30pm CST arrive Austin
11:00pm JJ crashed out for 10 hours until 9:00am.

Day 9 - back home
- Leo is so happy to be home. His mommy Theresa is happy too.
- BG back up above 400 today.
- Leo eating and eliminating well.
- Little Dude is now in the house. No cat fights. But Chinus and Leo are pretty unhappy with the new kid.

Next 12 days
Sunday 9/25 and Monday 9/26 - at home
Tuesday 9/27 - Thursday 10/6 - Sacramento and Sequim to handle Mom's house with Jennifer
- during this period, Theresa will care for Leo
- will not have much time to post here

WHEW!
We are very hopeful Leo's treatment will extend his life beyond the 600 day median. He is such a good boy. Purrs when we love on him. Give us leg lovin' all the time. We will be lovin' on him every day like there is no tomorrow.

 

[JeffJ]

Thanks for the info Wendy. We will monitor closely. I will be in daily contact with Theresa. I will writeup recommendations in one of Leo's spreadsheet tabs, and ask for review here.

 

[JeffJ]

I only met with Dr. Lynne Griffin the one hour on Tuesday. The only other meeting with radiology was the 1.5 hour meeting/tour with Leo's radiologist Dr. Wormhoudt. In total, radiology meetings:
- 30 min consultation prior to trip with Dr. Jenai
- 1 hour meeting with Dr. Griffin, and radiology residents on Day 2 CSU prior to SRT
> residents Dr. Tiffany Wormhoudt, Dr. Beatrix Jenai, Dr. Carolynne Kruchman
- 1.5 hour meeting/tour with Leo's assigned radiologist Dr. Wormhoudt

 

[JeffJ]

I sent a followup thank you email to the CSU Dream Team, with the post-SRT pics attached. The bandana states:
"Hug Me! I've had radiation therapy at Colorado State University"

I bought the CSU Vet cap at the CSU Vet hospital.

 

[Wendy&Neko]

Love the pics. Neko got a red bandana. I missed seeing where they were selling caps. In the first pic, it looks like Leo is getting a thorough sniff over.

Nice to see blue popping up on Leo's spreadsheet. Sorry about the follow on bounce. Hopefully his body will start getting more used to those blues.

 

[JeffJ]

Thanks Wendy. There is a small merchandise booth at the checkout counter. It is below eye level. I was there for a week, so I pretty much saw everything.

Yes, let's hope we can regulate Leo now. Target for next 10 days is 200-400 because Theresa will be handling. I'm hoping the 18 units will start taking hold.

I will mark the spreadsheet by week, ie: "Week 1 post-SRT", etc.

 

[JeffJ]

Here are instructions for Theresa while I'm gone. Input welcome. She will have my cell number. The animal hospital is open 24 hours and is 1 mile away.
The crate is ready.
The karo and food are ready.

See tab on Leo's spreadsheet "Leo Dosages".

 

[julie & punkin (ga)]

Did the CSU folks create that sliding chart for Leo's dosages?

I would really encourage you and Theresa to get in the habit of one test in the pm cycle right before you go to bed. It is extremely common for cats to have their lowest numbers in the pm cycle. You could skip one of those day time tests and test in the pm cycle instead.

 

[JeffJ]

No they didn't create that chart. Leo is now getting dosed at 7:30a/7:30p, so a PM test is feasible. I'll work it with Theresa.

Leo probably won't change BG too much, so the chart shows reductions to avoid huge drops. Even at 18 units his BG has mostly been up.

 

[saltycat]

Jeff, wandering the boards and somehow found this thread. Great writeup on you and Leo's long journey! I hope he continues to be a trooper and the SRT is able to give it to the tumor. Jack got dx'd acro a few months ago and will be following Leo's progress.

 

[JeffJ]

Thanks SaltyCat. I see you have Jack pretty well regulated, which is something I struggled with big time for Leo. Where Jack is at 16-18 units and regulated, Leo is at 18 units and not regulated. Except Leo is not at BG=550, which would occur without insulin.

I've gotten a lot of good advice from this forum. And the SRT went well. Too bad it is so expensive and far away. I guess Texas doesn't have everything!

Leo had squinty and weepy eyes post SRT. This is from the gel/fluid they put in their eyes during the procedures to keep them moist. Specifically:
SRT days 1, 2, 3 (Wed - Fri) - weepy eyes
Post SRT 4, 5 (Sat, Sun) - weepy eyes
Post SRT 6 (Mon) - mostly cleared up

Leo is a bit perkier today. He played with a catnip toy. His BG is still pretty high, but we are going to stick with 18 units. We hope to see some BG reduction post SRT weeks 2 and 3. I'm going out of town tomorrow for 9 days, so will not be posting as much here. I will maintain his spreadsheet.

If anyone is thinking about SRT, I would advise "treat as early as possible". Theresa and I regret not doing this sooner. The sooner you do the SRT, the less longterm acro effects. Leo has effects which are permanent:
- lower jaw prognathia
- tissue growth around windpipe/nasal, making it harder to breath
- slightly clubbed feet
- heavier bone thickness around his forehead, only determined via CT scan
- thicker jaws
- neuropathy in hind legs - we may be able to reverse some of this

 

[Ruby&Baco]

Wooww Jeff, I just saw your journey with Leo! How lucky is Leo to have a parent like you!
I will continue to read your story!
Love all the pictures!

 

[JeffJ]

Thanks Ruby. I'm currently away for 10 days, until Oct 7, packing and clearing my Mom's household.

Leo is being a good boy. Good appetite, easy to treat. He is bouncing a bit. Theresa has a full time job, so I gave her a sliding scale that is very conservative. As a result, Leo may get underdosed a few times, but this will reduce the risk of a hypo.

Leo's numbers are being maintained in his spreadsheet. He was 345 - 455 yesterday. Then bounced down to 125 this morning. We are so happy to have such a sweet purrbox for a patient. Leo has also been accepting of Little Dude coming in the house. They are not buds yet, but there has been no fighting and we don't think there will be.

 

[JeffJ]

Post SRT - week 2
- Leo is being taken care of by Theresa.
- Leo is responding well to less insulin. Theresa is pretty new to this, so we are not taking him to the 120-200 range to avoid hypos.
- Leo is eating well, and is active in the house. He gave leg lovin' and is actively hanging out with Trinket, his favorite little (real) dog.

We are hopeful the last few days (9/30 - 10/2/2016) showing smaller doses and lower BG is a response to the SRT.

 

[JeffJ]

This status is going to several groups (CSU, primary vet, internist vet, FDMB forum).

Post SRT - week 3
- 2 weeks have passed since SRT
- Leo seems to be fine. His BG numbers seem to vary more than before SRT.
- He recently has had more BG readings below 200, after SRT, than the measurements before SRT.
- His appetite is good. He consumes 3-4 cans of fancy feast per day. No other treats or dry food.
- Weight is still heavy. He is 16.5 - 17.0 pounds. We may reduce food intake by 1/2 can per day.
> We have 2 other cats, so we have to actively ensure he doesn't eat their food.
- Neuropathy is unchanged. He is ambulatory.
- He is eliminating fine. Still lots of urine with the high BG values.
- His top dose of 18 units is now reduced to 16 units. Some of the low BG values may be occurring from the higher 18.0 dose.
- He still enjoys getting brushed, with purrs as a reward.

I have not updated the graphs or other tabs on the spreadsheet recently. The main sheet is being maintained - preshot BG, nadirs, and doses. I am now back in Austin, after handling my Mom's household and attending the memorial.

 

[Sharon14]

Good to hear from you Jeff. Sounds like Leo is doing well

 

[JeffJ]

Thanks Sharon. Leo is doing great. This is an exciting week - to see him start responding to the SRT.
265 last night PMPS
160 AMPS today

Since Acro onset he has always been hard to regulate into good numbers. When he does have lower numbers (80-200) he is more alert and chipper, like his pre-Acro days. We have been lucky that his appetite has always been good, and he is not a picky eater.

 

[JeffJ]

Three complete weeks since SRT, and the radiation is having its effect.

What an exciting week for Leo. Just look at his chart.

• He is now obviously responding to the SRT.
• With the lower BG levels, he has been more chipper and active.
• He has seemed a bit more ravenous the last few days this week.
• The diabetes symptoms have receded somewhat.
• In the 3rd tab on the spreadsheet "Leo dosages", I've reduced the doses applied for his sliding scale.

We are so happy to see the SRT taking effect. We have not seen any side effects. Our sweet boy is becoming healthier.

 

[JeffJ]

Aug 22 - Oct 22 (forecasted)
Leo is just about done with the 5x Flextouch pens I received from Alan on Aug 24. If Leo stays on track, he will have used:
1,500 units of insulin over 60 days
= ~25 units/day

His usage is slowing a bit. But I have ordered another 1,500 units to have the supply on hand. The expiration is 2018.

 

[julie & punkin (ga)]

just an fyi - punkin's stridor (the breathing sound that comes from excess tissue in the respiratory tract) went away after his SRT.

I saw you mentioned this in the symptoms above about the things that won't go away.

 

[JeffJ]

Thanks Julie.

Leo
Leo still has stridor. But he had it as a kitten and young adult as well. I think he either got some of it at the rescue center or it is inherited. He did get more stridor and obvious snoring in the past 2 years. I'm hoping that recedes.

I saw Leo's primary general vet today during a visit for Little Dude. I gave her a recent AMPS/PMPS chart, and she is getting info from a internist. Leo's numbers are varying quite a bit. My objective is to keep him safe but lower his numbers. To do this, I'm reducing his sliding scale dosage. See the "Leo doses" tab. For the super high BG values, he will now get 10.0 units instead of 14.0 units.

The objective is to give 2 shots a day at lower numbers. I think the recent 14.0 unit shots drove his numbers way down past the 12 hour mark.

Little Dude is doing well. He still has crud and bacteria in his ears from the chronic ear mites. And his outer right ear at the base is infected from him digging on it. So he will be getting ear drops and liquid penicillin (forgot the brand). The vet tech said he has seen far, far worse ear cases.

This has been a great success for us. L.D. was totally wild until July 5 when we started taming him. Now he sleeps with us and watches TV with us. He purrs anytime we touch him. He follows us around the house and outside as well. Such a love bug. So sad to think he was lonesome all the previous years. I think someone must have owned him. He was wild for at least a year that we noticed. L.D. is also buddies with Leo, but they haven't cuddled yet. They just hang out.

Tonight is Monday night. I lit the candle on Scoobs memorial shelf. He is ever present in my thoughts. My sweet boy Scoobs.

 

[Sharon14]

Jeff, how are Leo and Little Dude doing?

 

[JeffJ]

I'll post an update tomorrow. Leo is doing quite well. Thank you for asking.

 

[JeffJ]

Post-SRT Week 5 completed

Five full weeks have passed since SRT for Leo.

• He is a bit more active generally. Today, he was catching a string toy that we swished around. (mouse on the end of a string, attached to a stick)
• His BG is variable. This has made him harder to regulate and dose.
• His insulin demand is smaller. His max dose is now 14 units, down from 18 units. Good progress here.
• He has come into the 100-200 range multiple times this week. Previously, he never achieved that.
• His weight is fairly stable.
• He gets loved on 10 times a day, and brushed 5 times....I know...not really a symptom or response

There are no negative side effects from the SRT at this point. If you review his graph, look at the second tab "graphs Oct 2016". The graphs show values thru today. We are hopeful for more BG and insulin reductions. I guess patience will help here.

Aside from SRT and diabetes, Leo has become buddies with our adopted stray cat Little Dude. This is a big win for us and for Leo since Leo used to hang out with Scoobs (who died on July 1). We are incredibly happy with Leo's progress, and hopeful to see more.

As another aside, we have spent $10,000 - $10,500 on our cats this year. Theresa just added it up. We care deeply for our fur-kids. Our big win has been adopting the stray, Little Dude. And our major loss this year was Scoobs. Unfortunately no money in the world could have saved our boy Scoobs, and I miss him everyday.

To end with a positive note, just look at Leo and Little Dude sleeping next to each other. Our big win of the year.

 

[JeffJ]

It's days like today that make me happy I took Leo for treatment.
AMPS 325 then dosed 12 units
nadir 245
PMPS 325 then dosed 13 units

Leo was back to normal today, and fairly chipper. And he's getting lots less insulin. So all 3 kittehs got baked chicken tenders. Their favorite.

 

[JeffJ]

It is easy to get complacent posting updates here. I'm pretty busy at work. I have his recent BG values, and will get caught up typing them in - the next 2 days.

Leo is doing fine. I'll post an update this weekend. He is bouncing around. Sometimes he will go for 3-5 doses and be somewhat fine. Sometimes we test him, and he is 120 or 150 - so no dose. We are not trying to get his nadirs super low because of these bounces. We are not always home during mid-day for the nadir test.

Leo's weight is steady, and he is eating well. His overall health is good. His neuropathy is slighty better. Maybe he has learned to walk with the neuropathy.

I looked at other SRT kitties, and it takes a few months for viable reductions. Leo was a very high doser when he got SRT. He still often gets more than 10 units. With time, we are hopeful of some reduction. If he does get to lower doses, I might switch him back to Prozinc. He was more responsive with Prozinc, but it was too expensive at high doses.

Spreadsheet is updated thru 11/15/2016

 

[Sharon14]

Hi Jeff, good to hear from you and Leo. Glad he's doing well. How's Little Dude?
How did you come up with your dosing regimen? I don't know about dosing post SRT, and I'm curious. For Colin I was told not to change the dose and to shoot anything over 50- of course that's without SRT! All in all it does look like Leo's numbers are coming down and I hope that trend continues and he gets to a 'normal' dose soon.

 

[JeffJ]

Hi Sharon

Little Dude is totally integrated into our family. He has gone from being 100% stray, to 100% love-bug. He stays inside 95% of the time. He only goes out to do his business, and occasional 2 hour forays during the early evening. He sleeps with us. He has made friends with the 2 little dogs and with Leo. This is a 100% success story for us. At one point, someone must have owned him. A total feral probably wouldn't convert this quick, or this much. He is a joy to have in our family. Attached pic shows Little Dude ready for bed. His tail is very long and fluffy.

Leo is doing well. I adjust the dose range every 4 days depending on his response. But he is fluctuating. The fluctuations seem independent of dose. We have tried reducing the dose but that usually results in a flat nadir. We have had a difficult time getting him into the 100-200 range nadirs. We do not dose him when he is under 200.

If you look at his August 2016 numbers, he was very responsive to Prozinc. I will probably take him back to Prozinc once his doses go down a bit. At high doses, it is too expensive. And I would have to pick it up from the vet every 3 weeks.

 

[Wendy&Neko]

Levemir is a depot insulin and works much better if you shoot the same dose every time, instead of a sliding scale like Prozinc. Otherwise you will end up with wonky numbers if you don't keep the same dose. You might want to read this post on the insulin depot.

@Sharon14 - Many of us who had cats that went through SRT still followed the Tight Regulation Protocol, with some mods. I decided to change my reduction number to 70 (on advice from the IM vet at CSU that we saw), and I was fine with taking reductions that were close to back to back. It seemed to work both times.

Things to remember, with Levemir, the nadir can be at shot time. I can shoot lower numbers because I know she'll go up until onset 5 hours later. Jeff, if you are around to monitor, try changing your no shot number to 150 and see what happens. Skipping doses doesn't help consistency and he seems to go black when you do so. And when you shoot lower numbers with the depot insulins, the cycle tends to be a lot flatter. I like giving insulin when Neko is in the 80's, because she'll often move no more than 10 points the entire cycle. But shooting low is not something you do out of the gate, you work down your comfort level and see what happens.

 

[JeffJ]

Leo is bouncing around like crazy. I just updated his spreadsheet.

Shot time is showing us peak BG levels, and also nadir levels. He is bouncing around. I re-reviewed Neko's first SRT and post-SRT. Comparison:
Cat___(pre-SRT)___(2 month post-SRT)
Neko___9 units____4.5 units
Leo____18 units____12.0 average (8.0 (AM), 15.0 (PM))

Leo is not at the half dosage yet. Leo probably could have used more insulin pre-SRT, so not a perfect comparison.

I'm going to reduce his dose curve. Yes, I know Levemir is an insulin depot...i've read it multiple times in the past. I'm not always around mid-day. And even when I'm home I don't have time to test him every hour - I work from home a lot.

I'll move his no-shot down to at least 180. But it will be cautious. I'm dreadfully afraid of a hypo.

Are Theresa and I happy with the SRT treatment?? You bet. We couldn't lose both our boys in the same year. We talk about it everyday. We still miss Scooby everyday. We have given Leo critical treatment. I might even give Leo SRT again, if it reoccurs. We don't have human kids, so these fur-babies are it, for us. Little Dude is now also good friends with Leo, which is the best of all worlds.

 

[Wendy&Neko]

I am glad you took the dose down tonight. It would be good to find a dose you can shoot twice a day. I never have tested Neko every hour, except if she's really low. I typically do about 3 tests during the day (2 if she's high) and 2 at night, unless the before bed test says she's going low.

ECID when it comes to responding to SRT. I've seen some cats have to have their insulin needs increase for several months after SRT, before it finally started kicking in. Neko responded unusually quickly to it. The fact that Leo has had as much dose reduction as he has within 2 months is really good progress.

It's been over 4 years since Neko's first SRT, and one year today since her second. Without it, she wouldn't still be here. It's been worth it to me too.

 

[JeffJ]

2.5 months since SRT. Leo is doing fine.
- eating about the same amount
- now getting less insulin overall, 10-12 units instead of18 units
- pretty happy kitty, fairly active for an indoor 10.5 year old

He seems to have peaks and valleys with blood sugar. Last week, a lot of good low points in the morning. This week, back up during AMPS. He is still heavy, he has a great appetite. We try to keep his calorie count low, counterbalanced with keeping sane. When he doesn't get food he yowls. Truly challenging. I'm hoping his insulin needs continue to decrease.

Leo hangs out with Little Dude sometimes. They don't like to cuddle but they are buds. It is great to see them together, licking each other. Leo was real good buddies with Scoobs, so it is great he has a new cat buddy as he continues to fight the Acromegaly tumor.

 

[JeffJ]

Leo is now SRT + 3 months. His insulin needs are down to 1/2. He is happier. But he is a different kitty than pre-acro. He lives in the kitchen, and he is always hungry.

Leo does pee less now. So there are fewer incidents of litter/pee getting stuck to his back paws. And we think his neuropathy is slightly better. He is fairly ambulatory.

We are fortunate. SRT resolves acro pretty well, and I was able to afford the cost and the time. We are rewarded by a sweet lovable 10.5 year old Leo, and he may have expired by now without the treatment.

Just this evening, our recent adoptee Little Dude was laying on the living room floor. Leo went over and laid next to him and started licking him. Our holidays are warmed by the extension of life provided by the CSU Dream Team, and the great personalities our cats have with each other. It doesn't get better than that.

 

[Sharon14]

So glad he's doing well, Jeff.

 

[JeffJ]

Thanks. Leo's numbers are updated. I got lazy typing them for a week. If you look at the second tab, the graphs are updated. He has a definite trend showing insulin reduction. The BG numbers are pretty bouncy. He refuses to provide good nadirs with Levemir. If he gets down to 5 units/shot, I'll consider moving him back to the more expensive Prozinc. His body was more responsive to it. By that I mean, he gave definite nadirs.

 

[Sharon14]

I see some nice green PS's there! One thing I have found with Lev is that sometimes the nadir is at PS instead of during the cycle. Maybe that's why you don't see a typical mid cycle nadir.

 

[JeffJ]

Thanks Sharon, I guess I forgot that Levemir nadirs can occur at PS. I've read so many articles and forum posts in the last year.

Leo had 3 AMPS nadirs this week, including today. So he got small Levemir supplements at (AMPS +2-4 hours). He has always been hard to get low. At the 200-220 range he tends to pee a lot less. Some analysis numbers:

17.5 units/shot = Insulin average the week before SRT.
7.8 units/shot = Insulin average this week (week 15 post-SRT)

357 = BG nadir average (week before SRT), and rarely below 250
225 = BG nadir average (week 15 post-SRT), and often between 60-220
.

 

[JeffJ]

Leo is doing well. He usually sleeps in the kitchen and sometimes goes in the living room. That is behavior from the past year.

Leo has 2 mast cell growths on his forehead. And 1 small fleshy growth on his right front arm. Maybe from the Acro. We will probably get them cut off in the next 2 weeks. The one on his forehead is 1/2" round and 1/4" to 1/2" raised. He scratches it and makes it seep a little blood. But we still love him anyhow

This week, Leo has been feeling especially friendly. He has been sitting on our laps in the living room - which is rare in the last year. And he hangs out with Little Dude on the living room couches - a lot this week. Then tonight, all the stars (I mean animals aligned). Leo, Little Dude, and the 2 doglets were watching TV with Theresa. How great is that? We cherish these good times because we know they are the best of times.

Insulin usage during this period summary:
22.6 units/day from 8/25/2016 - 1/5/2017 (last 4 months)
20.3 units/day from 10/23/2016 - 1/5/2017 (last 2 months)

Insulin usage this period, details:
3,000 units (10 levemir pens used)
= day 238 of 365, and 6 days of 2017 = 133 days
= 3,000 / 133
= 22.6 units/day

Most recent 1,500 units, started 10/23/2016, used up 1/5/2017
= day 297 of 365, and 6 days of 2017 = 68 + 6 = 74 days
= 1,500 / 74
= 20.3 units/day

 

[Phoebe_TiggyGA_NortonGA]

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