Given that I focus heavily on *glucose toxicity* - which Copper was/is showing serious signs of (unless he has an ortho problem that we are not aware of) -
*and* the report from Copper's mom that he was *doing better as the dosage was being increased* -
*and* my past experience with other cases like Copper's -
the decision was made to slowly raise the dose - with sincere acknowledgement that "a lower dose may very well be needed" as already stated on a previous thread.
I know that I am preaching to the choir here but Lori had made several mentions of Copper doing better, clinically, at higher doses. This was factored into the decision as it should always be. We can't just look at the numbers - especially without that magical 24/7 monitor.
I am going to digress again here: Regarding the word "slowly" - Unfortunately, my colleagues rarely raise or lower a dosage by any amount less than a full unit. I am trying VERY hard on VIN to change this mindset and to remind them that there really are smaller doses. I am having luck with getting them to embrace 0.5 unit increments but forget anything lower. I get laughed at when I mention anything lower than 0.5 units….mainly because they feel that it is impossible to accurately measure. I also got laughed at when using "fat" and "skinny". On a good note, at least they are now discussing syringes with half unit marks.
i would lower dose on a lower blue number. but thats me. cut in half in necessary.
Are you talking about simply a blue PS? Or a mid cycle number? If you are referring to a PS, then yes, a lower dosage is warranted - for that shot - but you see a slant as a failure…an indication that a previous dose was automatically too high…whereas I don't. I just see it as a great PS/long duration….with the need to establish direction and shoot accordingly…..the need to be flexible (not rigid with the dosing) and closer to natural physiology as stated above.
Glucose toxicity:
Why am I sometimes more aggressive than most? It is because I can't stand to watch cats drown in sugar. There is, understandably, a fear of hypo but, on the flip side, I rarely see glucose toxicity discussed. Yes, I know that patience is definitely a virtue with this disease but, as noted above, I have also seen the 'start low go slow' mantra seriously overdone in some cases when I used to spend more time here. I have no idea how it is now since I am not here much. Compared to some of my colleagues, I move like a damn snail but others think I move too fast.
Lori - I know that you see this case as very clear and very straight forward when looking at the previous data but If Copper's case was so straight forward then what would that say about my other cases that have shown his pattern (including downward slants) that have been well-managed right into remission with gradually increasing dosages? That is certainly not meant to sound defensive but it is simply a valid question/comment/fact.
I may follow a 'road less traveled' but it sure has gotten a lot of cats into remission just as other 'roads' have accomplished.
I really do appreciate your questions which only results in more learning for all of us. I don't think that any of us come away from any case without learning from it. But that said, I have often asked: "why are we so wise once we are on our death bed"? That seems like such a waste of experience and knowledge! I always wish that we could have a dry run at life…gather all the wisdom we need….then start again. But since we can't, we just all have to do the best that we can and expect to be thrown curve balls on occasion since we can't predict or control everything.
Oh…and could we add on a crystal ball and a continuous glucose monitor to that wish list?
