Leo (Leoberry) - the high doser

Thanks
1) Tube site - cleaning with chlorhexidine and then applying a salve. Reviewing daily. I'll look into silver Sulfadiazine.
2) eating - Leo ate about 1/3 normal today. And was a bit more active.
3) Chlor - we are getting liquid. I will be applying it thru the feeding tube.
We receive it on Monday. I was surprised it was so inexpensive - $25 for 2 month supply. Heck, flea medicine costs more than that.

LD was helping Leo feel better tonight. Our sweet boys.
 

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Chlor - we are getting liquid. I will be applying it thru the feeding tube.
We receive it on Monday. I was surprised it was so inexpensive - $25 for 2 month supply. Heck, flea medicine costs more than that.
Is that "Chlor" liquid chlorambucil? The SCL group is very much against using the liquid form. It is too easy to contact it yourself. Chlorambucil is a carcinogen so you need to be very careful when handling it. And when I inquired about it, the shelf life of the liquid form was something like a week. In the US you can get the dose compounded into a capsule. I just used the Leukeran pills (which have a coating) and used gloves to handle it.

Leo looks pretty relaxed in that photo. Good to hear he's eating a bit. :)
 
We will be using gloves, and maybe a mask just in case. It is compounded into a liquid - chlorambucil.

It sounds kinda weird that a chemo drug that kills cancer is itself a carcinogen. I haven't read much about it. Here is it 1:20am, and I finished working around 12:30am. Trying to get a data center (set of servers) ready for an audit.
 
I posted a Q and A about SRT on the Acro forum here.

Leo got his tummy stitches out on Monday - from the biopsy surgery. His shaved belly is NAKED! and so soft. The wound is hardly there. I know everyone wants to rub it, so I rubbed his tummy for all of you :D

Leo has been getting prednisolone as a precursor treatment for his Small Cell Lymphoma (SCL), a few days ago. The good side effect was an immediate appetite increase. He has been eating a lot. He lost a lot of weight in just a month, so we are happy with the increased eating.

Leo started chemo today. We are doing the "Every Other Day" EOD protocol with Chlorambucil liquid to start. No side effects yet since he just started. I hope we can knock this cruddy cancer into submission. My sweet boy, my little trooper.

Spreadsheet - new leftmost tab for 2nd half 2017.
Drugs today: Insulin, prednisolone, chlorambucil, cerenia (for nausea)
 

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Good to hear the pred had an almost immediate effect on his appetite! Good luck with the chlorambucil - I found the day after was when the nausea hit the worst, though it did last a few days.
 
Been peeking in on the thread. It's amazing what you and Theresa are doing for your boys :). One of our Prozinc members had the same diagnosis but her kitty wasn't an Acro cat. I hope Leoberry is feeling a little better with the meds :bighug:
 
Thanks Yong. Someday, Leo will be gone. I hope this historical thread helps someone.

Leo has stabilized. He is pretty tolerant of the chemo. The prednisolone is helping a lot - creating a great appetite. His weight is stable. If the chemo puts the SCL into remission, Leo could be loving us for years to come! I am hopeful for at least one more year.

A new second tab on Leo's spreadsheet - shows meds and feeding method. We have a vet visit in the morning. I hope his feeding tube comes out. It smells, and he keeps trying to pull it out. I had to push it back in multiple times and affix it. I don't like the design, but won't rant further about it.

I estimate we spend 90-120 minutes a day feeding, cleaning, medicating, etc, including the other 2 healthy cats. Aside from the high vet bill, the medicine costs are pretty small. Overall, the cost to keep a sick cat healthy is mostly a lot of personnel time. So I can understand why some people can't do it.

June vet bills were $3,000. That's $2,000 for Leo's exploratory surgery, biopsies, tests, and the esophagus surgical implant of the e-tube. Plus the meds from the vet. And ~$800 for Little Dude's surgery and recovery from his outside 3am fight (he lost). Now LD is a 99% inside cat except for doing his duty. We have almost converted a wild cat to a safe inside kitteh. Lots of happiness there. Plus LD loves Leo. :)
 

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Feeding tube out today - YAY. The insertion site looks bad, but with luck it will heal nicely. Weight is stable at 16.5 - last column on main sheet. Leo is real happy to have the e-tube collar off. :)

Rewarded with a no-eating period after return from vet, then a minor Hypo. Recovery was fast, and eating resumed. Chart updated.

Then dogs and Theresa were making noise and moving around during PM shot - and I probably did a fur shot. First one in 6 months. No more of that. We will now resume former protocol - they all need to be out of the room. So Leo will probably be 450 in the morning.

Leo finished the day by eating a 1/2 can of Fancy Feast, 4 hours after chemo. We can't ask more than that!:cat:
 

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Thanks Kris. It is a rewarding experience. Little Dude is totally healed, and acts like a kitten. It's great. He is a gravy loving addict.

Leo is doing good. 7 chemo doses given since 7/5/2017. He doesn't have much nausea at all. The prednisolone is helping a lot with hunger, and maybe nausea. He is active, and plays a bit with LD. I'm keeping Leo's BG a bit high to avoid hypo territory. There is a threshold with Leo's insulin and if I cross it, his BG drops like a stone.

I rarely talk about Chinus. She is Daddy's girl and stays by my side all the time.
 
Thanks for asking. Leo is now
- week 5 of chemo + prednisolone
- 11th month post-SRT
- 24 months insulin treatment

He is doing great.
- good appetite, probably from prednisolone, eats a lot, loves cooked/diced chicken and Fancy Feast, table scraps
- good normal weight (16.5 - 17.0) with a little fat
- alert, responsive, hydrated, nimble, playful
- plays and wrestles with Little Dude daily...a sick cat wouldn't
- CBC (blood eval) taken on Friday 8/4/2017...need to check results
- BG is a bit high, hard to regulate, now at 4.0-5.5/dose, partly due to prednisolone
- no noticeable neuropathy
- thickened claws, that never became normal

He has a small trouble eating. I feed him on stacked platters (4 inches high). I think soft tissue growth in his throat makes it hard to swallow. If I was a visitor to the house, he would appear as a normal healthy kitteh. We are approaching his 1 year SRT anniversary. Without SRT, he probably would be gone by now. Compared to last year, his improvement is dramatic. There were 2 or 3 times in the past 2 years we considered the "big decision". Leo is proof that dedicated and proper treatment can resolve deep issues for some kittehs, providing some life extension.:)

Overall, it seems Leo is responding to the prednisolone. The blood work will verify if there is some chemo response. I believe the general goal is Small Cell Lymphoma (SCL) remission. He may be permanently on these drugs. The chemo is EOD (every other day), chicken flavored Leukeran in liquid suspension.

Leo and Little Dude are the best brothers; it's great. They hang out quite a bit. I think a healthy social life with people and other cats is a contributor to cat (and human) health. About once a day they get supervised "out back" into a 40' x 100' fenced backyard for stimulation. Attached pic - 'Hi everyone, we are "outside" ' (10 feet from the back door). Our sweet boys.
 

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Thank you. It's easy to get complacent about the online photo albums. Just updated LD's pics with last 2016 pics. (LD's 2016-2017 flickr page)

Leo's health summary - January 2018
- on chemo since July 2017 (6 months) and doing well, dose is now every third day as approved by oncologist
- daily prednisolone tabs, no issues
- BG averages: AMPS = 300, Nadir = 130, PMPS = 220
- Levemir averages: AM = 4.5U, PM = 3.0U
- 18.2-18.5 pounds (good), and good appetite
- no noticeable neuropathy
- December 2017 CBC values mostly normal

Leo still appears externally to be a healthy kitteh. He is fairly active, and hangs out with Little Dude inside and on the back porch. Leo still loves people, and loves to sit in your lap when it's TV time. Leo has a big appetite, but still has swallowing issues. If we continue with this streak of luck, Leo will achieve his 12th birthday in April 2018. We are looking forward to it.

(late edit - added pic)
 

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That album is so beautiful @JeffJ ! :bighug:

Jeff your photos were fantastic!!! Very heart warming I loved seeing your two cats so close! Sleeping together! I wish I could have another cat too but Maji is highly aggressive towards other cats other than her Timba who she grew up with since she was 9 weeks. He passed 3 years ago.
 
Thanks. Yes, Leo is quite the lovebug. He has always wanted to sleep with a person or one of the other pets. So we are lucky that Little Dude has become his junior mascot. Leo loves the heck out of him! It makes us happy every day. I have held back on the pictures. We probably take 3-10 pictures a day!

It has been 2 months since Leo's health report here. There is little to report
- responsive to the meds, no bad signs
- fairly stable insulin doses...4.0-4.5 in AM and 2.0 in the PM
- good appetite and maintaining weight

He is relatively healthy despite the underlying issues. We continue to hope each day that the chemo continues to stay effective on his SCL and that he will be with us for months/years to come. Here is Leo on his favorite chair - just 3 feet from the back door. Silly boy cries "Dad I really need to go outside." Then he goes out 3 feet and jumps up in the chair. It doesn't get any better than that.
 

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Thanks. Yes, Leo is quite the lovebug. He has always wanted to sleep with a person or one of the other pets. So we are lucky that Little Dude has become his junior mascot. Leo loves the heck out of him! It makes us happy every day. I have held back on the pictures. We probably take 3-10 pictures a day!

It has been 2 months since Leo's health report here. There is little to report
- responsive to the meds, no bad signs
- fairly stable insulin doses...4.0-4.5 in AM and 2.0 in the PM
- good appetite and maintaining weight

He is relatively healthy despite the underlying issues. We continue to hope each day that the chemo continues to stay effective on his SCL and that he will be with us for months/years to come. Here is Leo on his favorite chair - just 3 feet from the back door. Silly boy cries "Dad I really need to go outside." Then he goes out 3 feet and jumps up in the chair. It doesn't get any better than that.

He is so lucky to have you AND he looks happy!! He really does!!!

You are so lucky to have found little dude and the two cats are so compatible! What I wouldn’t give to have the same. And you saved a feral cat on top of that! So cool - pls share your pics !!!

It looks like little dude is a hunter - Timba’s mom was feral and taught him to hunt - i had to keep him in during the day occasionally he would bend screens and get out gone for 3 days - he would stay at a distance but he could hunt successfully unfortunately... and self feed but eventually he would get hungry enough to come home... I would let him out only at night where birds were safe. He occasionally caught bats.

I love your pics and all that you have done with Leo is amazing!!!

Did you have to trap little dude because he was feral?
 
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I'll respond when I get back. This was a long day while on business travel. There is a thread where I listed how we got LD. He is a true sweetheart.
 
A 2 month, positive update on Leo. He is now missing some teeth.

April 2018: Leo's general health is good.
- 3/21 liver toxicity check - all good, no issues
- Daily insulin and BG averages
.....AMPS 300, then 4.0 - 4.5 units (often AMPS is food influenced by leftovers)
.....AMPS+6 = 110-150
.....PMPS 180-250, then 2.0 - 2.5 units, PMPS

In general, Leo's BG and insulin are pretty stable.
- Great appetite
- 17.5 - 18.0 pounds
- Chemo given every 3rd day, prednisolone every day

3/28/2018 Dental summary
- resorption in multiple teeth
- minor abcesses on the teeth removed
- both upper canines removed, and a single upper premolar removed
- Leo has not had many dentals thru the years, my bad

3/6/2018 Hypo
- I had to go to NYC for business
- Leo's normal PM dose is 2.0-2.5 units
- Theresa gave him 4.0 units
- He hypoed down to 50. We were on the phone together until 2am when he stabilized.
- There was no bounce the next day. The next day, Leo said: "What was all the fuss about Mom?"

Spring 2018 - Leo and Little Dude - best buds
Aside from the medical crud, Leo is doing very well. He loves to eat. And he adores Little Dude, who in turn loves the attention. Leo also loves attention, and he gets daily brushings. Leo and LD are almost inseparable. They are usually within 5 feet of each other. We like it when they wrestle on the ground, then they both get up and look the other way like "we weren't really doing that Dad".

I also sneak Leo a few crunchies every day. You never know if this will be his last month. We are taking the gift of his daily life with us and going with it. Leo and Little Dude's daily antics are so much fun. How did we get so lucky? Our sweet kitteh boys.....now picture time.
 

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A 2 month, positive update on Leo. He is now missing some teeth.

April 2018: Leo's general health is good.
- 3/21 liver toxicity check - all good, no issues
- Daily insulin and BG averages
.....AMPS 300, then 4.0 - 4.5 units (often AMPS is food influenced by leftovers)
.....AMPS+6 = 110-150
.....PMPS 180-250, then 2.0 - 2.5 units, PMPS

In general, Leo's BG and insulin are pretty stable.
- Great appetite
- 17.5 - 18.0 pounds
- Chemo given every 3rd day, prednisolone every day

3/28/2018 Dental summary
- resorption in multiple teeth
- minor abcesses on the teeth removed
- both upper canines removed, and a single upper premolar removed
- Leo has not had many dentals thru the years, my bad

3/6/2018 Hypo
- I had to go to NYC for business
- Leo's normal PM dose is 2.0-2.5 units
- Theresa gave him 4.0 units
- He hypoed down to 50. We were on the phone together until 2am when he stabilized.
- There was no bounce the next day. The next day, Leo said: "What was all the fuss about Mom?"

Spring 2018 - Leo and Little Dude - best buds
Aside from the medical crud, Leo is doing very well. He loves to eat. And he adores Little Dude, who in turn loves the attention. Leo also loves attention, and he gets daily brushings. Leo and LD are almost inseparable. They are usually within 5 feet of each other. We like it when they wrestle on the ground, then they both get up and look the other way like "we weren't really doing that Dad".

I also sneak Leo a few crunchies every day. You never know if this will be his last month. We are taking the gift of his daily life with us and going with it. Leo and Little Dude's daily antics are so much fun. How did we get so lucky? Our sweet kitteh boys.....now picture time.

So adorable!!! Loved all the pics!

Great to hear all of the updates in one place!
 
Out of curiosity, was Leo seeing hypo symptoms at 50? Cats not on insulin can test in the 40's. We just don't like them to go there because it gives no room for margin of error. Neko often wouldn't show symptoms in the 30's, other than hunger. More than once I woke her up in the 30's. :eek: Having said that, some cats show hypo symptoms at higher numbers than others.

Glad to hear Leo is enjoying life with a happier mouth.
 
Thanks for the kudos.

Leo was not showing any hypo symptoms in the Feb 2018 hypo. Theresa told me about the dosing, then we measured him and it was 50. To avoid going lower, we treated it like a hypo until he was 80 and rising.

Leo's worst hypo was last year when he wasn't eating. He was 30 or 40. He was yowling in the morning and that resulted in an ER visit. That was a nightmare. Mostly because he had not been eating. The followup on that was the feeding tube, then the SCL diagnosis, and subsequent (permanent) medicine treatments. Leo had a tough time last year, but he's a trooper and he's doing real good now.

I do not expect Leo's insulin demand to drop any further. It has been ~18 months since SRT. I just hope we don't get resurgence of the Acro. We have already decided that if Leo gets into another state where he needs a feeding tube, then we will let him cross. I hope that is 3 years from now.
 
It is now 22 months after Leo's SRT (radiation) for Acromegaly, and ~2.5 years as a diabetic.
18.0 units/dose - Sept 2016
8.0 units/dose - July 2017
2.3 units/dose - July 2018 - YAY:D:D:D (20 day average)

The SRT was all worth it. Leo is much healthier now. He is still challenging to dose as his BG fluctuates. The daily prednisolone also influences his day time cycle.

6-8 weeks ago he stopped purring. We thought it was due to stridor, from the Acro. We had our cat-only vet evaluate it, and had another round of blood work. He had some minor infection with low White Blood Count (WBC). He got Orbax for 2 weeks, and his purr is back:bighug: while the stridor (throat growths) still adversely impact his eating.

His appetite remains pretty good for the past month. He had issues eating earlier this year. We are rotating meals:
- FF classics
- cooked chicken or cooked white fish
- Weruva Cats in the Kitchen varieties
Leo and Little Dude inside - 07-22-2018c.JPG

Leo and Little Dude outside - 07-22-2018c.JPG
 
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It is now 22 months after Leo's SRT (radiation) for Acromegaly, and ~3.5 years as a diabetic.
18.0 units/dose - Sept 2016
8.0 units/dose - July 2017
2.3 units/dose - July 2018 - YAY:D:D:D (20 day average)

The SRT was all worth it. Leo is much healthier now. He is still challenging to dose as his BG fluctuates. The daily prednisolone also influences his day time cycle.

6-8 weeks ago he stopped purring. We thought it was due to stridor, from the Acro. We had our cat-only vet evaluate it, and had another round of blood work. He had some minor infection with low White Blood Count (WBC). He got Orbax for 2 weeks, and his purr is back:bighug: while the stridor (throat growths) still adversely impact his eating.

His appetite remains pretty good for the past month. He had issues eating earlier this year. We are rotating meals:
- FF classics
- cooked chicken or cooked white fish
- Weruva Cats in the Kitchen varieties
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God... I love this ... so adorable!!!!!
 
Nice to hear Leo is doing better and giving you those sweet sweet purrs again. Here is to his and little dude's continued journey with their loving bean snd playing the classic cat game of "no I changed my mind again".
 
We have them still - That picture above is probably the best in the last 18 months. As soon as I get a camera out, one of them always moves.

Little Dude and Leo always give the little doggies some head butts. Whenever we take the dogs out back, Little Dude tags along like a third dog. He's so funny.

Leo is slowing down. But he goes in the backyard too.
 
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