Leo (Leoberry) - the high doser

Discussion in 'Acromegaly / IAA / Cushings Cats' started by JeffJ, Aug 25, 2016.

  1. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    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.
     
  2. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

    Joined:
    Feb 17, 2011
    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.
     
  3. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    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.
     

    Attached Files:

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  4. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    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.
    .
     
  5. Alexi

    Alexi Member

    Joined:
    Apr 10, 2016
    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. :bighug::cat:
     
  6. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    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'.
     
  7. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    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
     

    Attached Files:

  8. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    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
     

    Attached Files:

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  9. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

    Joined:
    Feb 17, 2011
    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.
     
  10. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    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.
     
  11. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    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.
     
  12. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    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.:joyful:

    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 :eek:

    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.
     
  13. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    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.
     
  14. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    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
     
  15. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    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.
     

    Attached Files:

  16. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    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. :cool: Sorry about the follow on bounce. Hopefully his body will start getting more used to those blues.
     
  17. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    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.
     
  18. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    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".
     
  19. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

    Joined:
    Feb 17, 2011
    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.
     
  20. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    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.
     
  21. saltycat

    saltycat Well-Known Member

    Joined:
    Apr 18, 2016
    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.
     
  22. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    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
     
  23. Ruby&Baco

    Ruby&Baco Well-Known Member

    Joined:
    Apr 21, 2016
    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!
     
  24. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    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.
     
  25. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    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.
     
  26. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    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.
     
  27. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Good to hear from you Jeff. Sounds like Leo is doing well:cat:
     
  28. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    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.
     
  29. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    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.
     
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  30. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    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.
     
  31. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

    Joined:
    Feb 17, 2011
    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.
     
  32. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    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.
     

    Attached Files:

    Last edited: Oct 17, 2016
    Jill & Alex (GA) and Sharon14 like this.
  33. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Jeff, how are Leo and Little Dude doing?
     
  34. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    I'll post an update tomorrow. Leo is doing quite well. Thank you for asking.
     
  35. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    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.
     

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  36. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    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.
     
  37. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    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
     
    Last edited: Nov 15, 2016
  38. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    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.
     
  39. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    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.
     

    Attached Files:

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  40. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    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.
     
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  41. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    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.
     

    Attached Files:

    Last edited: Nov 18, 2016
    Reason for edit: fixed formattting in pre-srt and post srt table
  42. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    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.
     
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  43. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    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.
     

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  44. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    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.
     

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  45. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    So glad he's doing well, Jeff.
     
  46. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    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.
     
  47. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    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.
     
  48. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    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
    .
     
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  49. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    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 :joyful:

    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
     

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  50. Phoebe_TiggyGA_NortonGA

    Phoebe_TiggyGA_NortonGA Well-Known Member

    Joined:
    Dec 29, 2009
    Many of the acro-cats are over on Facebook. https://www.facebook.com/groups/acromegaly/


    Any Facebook group(s) for cats with acromegaly are not affiliated with FelineDiabetes.com or the Feline Diabetes Message Board.
    _Moderator
     
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  51. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    On the Feline Diabetes Message Board, most of the acrokitties are over on the Lantus/Levemir forum. Many of us have chosen not to go over to Facebook because it is a closed forum there.

    Jeff, I love how Leo's dose is coming down.:) And such an adorable picture of Theresa with the furbabies! :kiss: It took a little while for Neko's constant hunger to die down after her SRT. As Leo's numbers get more even and lower, you'll find the hunger improves. Good luck with the mast cell removals.:bighug:
     
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  52. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Thanks Wendy. Leo is digging at the bump/growth on his head. So it will come off in the next 2 weeks. The new picture shows him hanging with his bud Little Dude - they are good friends.

    This week Leo is doing good. Pretty stable. I just updated his numbers. His P.M. numbers went up this week. He has never had good (5-9) hour nadirs. The second tab shows his graphs - a definite trend down for insulin, very noticeable in December 2016.

    His hunger has subsided a little this week. And we gave him like 6 tiny pieces of Little Dude's food. Not again! You can smell the results a block away when he poops! OMG - they could use that for crowd control:eek:

    Tonight, everyone got cooked fish. Two days ago, everyone got cooked chicken. What a life.

    For Facebook. I never joined. I learned about diabetes and Acro here, and have received gobs of help. I'm probably like a lot of other diabetic or Acro owners - we just wish we had normal kitties. I help a little bit with some of the newbies' questions here.
     

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  53. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Week 20 after SRT treatment
    Leo is still getting lots of lovin', and his Acromegaly symptoms are receding.
    Now = ~15 units/day of insulin (Levimir)
    Pre-SRT = 36 units/day pre-SRT.

    Some nice side effects of recovery:
    1) Neuropathy
    Prior to SRT, his neuropathy symptoms were real bad, he was walking on his hind hocks a lot. He had trouble climbing.
    Now he often runs to get food. And he is no longer walking on his hind hocks. He has drastically improved but is not fully recovered. We are really happy this recovery happened.

    2) Food anxiety
    Prior to SRT he was "dying" for food all the time, even with proper insulin doses.
    Now he is hungry a lot. But he doesn't live in the kitchen all the time. He seems to get enough calories. As a result he comes to visit with us in other parts of the house. Leo seems more contented now that he hangs out with us more in the rest of the house.

    Insulin usage:
    His recent insulin usage is listed below. The reduced insulin also means the pituitary tumor is putting out less growth hormone (Insulin-like Growth Hormone (IGH-1))...making for a healthier Leo.
    Insulin usage summaries:
    ~15.0 units/day in 3rd week of Jan 2017
    20.3 units/day from 10/23/2016 - 1/5/2017 (last 2 months)
    22.6 units/day from 8/25/2016 - 1/5/2017 (last 4 months)
    36.0 units/day in Sept 2016 before SRT therapy

    In the picture, Leo looks small. It's perspective. He is actually bigger than (orange) Little Dude. Theresa loves it when they hang with her at night. Who wouldn't ???
     

    Attached Files:

  54. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Awesome update on Leo. It's so nice when there becomes life outside of food! :)
     
  55. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Mast cell growths - surgery today
    Poor sweet Leo said "Halp - I don't want surgery!" as I drove him to the vet. In reality, he didn't make any noise going or returning from the vet. He stayed there overnight last night. Then had surgery early this morning. The vet removed 5 mast cell skin growths. Well, one of them was just a cyst. Part of his head is shaved and part of his front legs are shaved. We paid to have the largest growth sent for histology.

    They didn't give insulin this morning. I picked him up in the afternoon.
    BG = 550+ Whoa!
    So he got 9.0 units. Poor kitteh. At least we know the levemir is effective since he never gets that high with current daily doses. He will get pain medication for the next 2 days to help recovery.

    He also stored up a present for his arrival at home. Phewie. That sweet kitteh could probably clear out a bar room! How can such sweet cats drop such vile deposits in the litter box!?:eek:
     

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  56. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    I hope the biopsy comes back as boring. Poor little Leo. I'm glad he's home now.

    One of the things I love about a raw food diet - very little smell!
     
  57. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Poor Leo, he's been through a lot. You and Theresa are doing a great job!
     
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  58. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Thanks. Leo is such a sweet fur kid. He is so happy to be back home - purring up a storm when we have been rubbing on him.

    Another high BG reading this morning:
    AMPS = 395
    We are ensuring he gets plenty of food. He didn't eat much yesterday. But his figure is hardly svelte, so if we're lucky he lost an ounce or two over the last 2 days :-0
     
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  59. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    I took a couple of nadir measurements in the past few days. Leo doesn't nadir very much on Levemir. He is doing well.

    He is now several days post-surgery for the mast cell growths. All he seems to do is purr when I rub him. Plus he hangs with Little Dude and is sweet all the time. Who could ask for more?
     

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  60. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Jeff how is Leo doing?
     
  61. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Hi Sharon (and all), thanks for asking. I was off the forum for a few days, mostly working.

    Post SRT +25 weeks

    Leo and Little Dude are almost inseparable now. They hang out all the time. We are happy that Leo has regained a kitteh brother. There is a lot of purring going on, lots of co-grooming, and sometimes a little wrestling, and they usually sleep together. They often go into the fenced backyard together and hang out - looking for bugs and mice. It is great, just plain great.:)

    SRT +6 months (almost):
    - ambulatory with almost no neuropathy
    - still hungry a lot, and still overweight- and he often trots or runs to get food
    - stable at 4.5-5.5 Units/dose, less than 1/3 of his pre-SRT doses (18.0 units/dose)
    - regular with urine and poop, so no issues there
    - skin is recovered from non-cancerous growth removals
    - very soft and love-able

    His chart is updated, including the graphs on tab 2. He was recently at 7.0-8.0 Units, so he is still coming down in dosage. His body still resists nadirs. If we give him a little more insulin, he tends to nadir at the 12 hour mark. That makes it hard for us to dose him. I'm keeping him safe, and not dosing under BG=200. I suspect Leo may have some pancreatic diabetes. He has never had a true hypo event, although he did get to BG=60 once last year.

    Fur regrowth (from Feb 8 to March 4):
    His fur is slow to regrow back over the mast cell growth removals. So he still has several velvety soft patches (2 on legs, one on head). We rub them to make the fur grow back. :woot: The lab results were negative for malignancy - YAY!:joyful:

    Neuropathy recovery
    He had real bad neuropathy pre-SRT. To the extent that the "big decision" was in play. His neuropathy is almost gone. We sometimes feed on the washing machine.There is:
    - 1.5 foot high wood step,
    - then another 1.5 feet to the washing machine.
    He now has very little trouble getting up there. This week, he voluntarily jumped from a coffee table to the top of the couch (2.0 to 2.5 feet). Not amazing for a 6 month old kitty, but pretty good recovery for Leo. He often gets on a chair and begs at the kitchen table - and 3 months ago, he couldn't do that. If any one is reading this, and your cat has neuropathy, there is hope. Your cat can recover almost completely with proper BG regulation and some B12.

    The same 1.5 foot high step/block by the washing machine - blocks the droolers (aka doglets) from poop wrangling. So Leo has to jump over each time to use the litter box. It's good exercise for his hind legs.

    We love our fur kids and Leo is still making good progress. We hope he is outside the bell curve of "expected 600 days of extra life after SRT". He is almost 11 years old and I hope he is with us for many more years. A dose of cuteness (picture) is attached.
     

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  62. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Sounds like good news all around! So happy that Leo is doing well and that he and Little Dude have become so close.
     
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  63. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Neko had almost 4.5 years after her SRT. The 600 days is an average, but remember that many acro kitties are seniors and often it's other things that take them. I hope the same for Leo.

    There is nothing wrong with a nadir at +12 or preshot time. Neko often did it on Levemir. Consistent dosing will really help their blood sugars. With acrokitties, you do want to try to keep their blood sugar under renal threshold as much as safely possible. Even after SRT, kidney disease is common for acros so you want to try to prevent them from having to do extra work.

    Love the pic of Leo and Little Dude. :) And I am so happy the biopsy came back negative. :woot:
     
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  64. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Thanks Wendy and Sharon.

    Leo is not as active as his younger days. But he still likes to play with toys (mouse on a string, etc). We try to keep him active, and I think the exercise is good. I'll work on getting his BG down a bit more. It can be challenging with our work schedules. Our target is consistent dosing like you said.

    We were not sure Leo would bond with Little Dude. Just in the past month, they started sitting and sleeping next to each other. Now we have hundreds of pictures of them already. No pictures from tonight though - Little Dude caught a mouse and ate it on the back porch. Leo watched intently. Our sweet boys.
     
  65. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Leo was doing pretty fine until a month ago. In general, his insulin demand went down to 5.0-6.0, achieving 150-300 BG ranges. And he always had a healthy appetite.

    His recent weight was 17 pounds. But in the past 4 weeks he reduced his eating, and he is now 16.5 pounds. And now, he stopped eating for 3 days because the food always came back up. We have been to the vet multiple times. He is on anti-nausea and hunger-stim pills starting today (cerenia and cypro). I've read all the "not eating" threads and always hoped it wouldn't happen to Leo. I'm giving him minimal insulin to keep BG down, targeting 150-250, but avoiding any potential hypos.

    Diagnosis included blood work and ultrasound:
    - thickened abdominal walls (intestine)
    - high white blood cell count
    - normal kidneys
    - enlarged adrenal
    - small nodule on spleen, which the vet said, can be a regenerative nodule, but could also be a tumor
    - no blockage in intestines
    - no pain upon probing areas of his soft body

    I just syringe-fed him. If the food stays in him, he will get more. If he stays in this poor shape, he will get exploratory surgery next week. I'm not sure that would be fruitful unless a tumor is removed. If they find his intestines are shot, there is no real solution there.

    Acromegaly causes different issues. It is possible one or more of the abdominal issues has caught up with him. Our vet is a very good cat-only, 40 year old vet with great experience. She is helping us with good advice and answers all our questions. She is having a training day on Monday, but said that if Leo is still pretty bad, she will treat just Leo that day. That's the kind of vet we have - great. We are hopeful for the best.
     

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  66. Olive & Paula

    Olive & Paula Well-Known Member

    Joined:
    Sep 6, 2015
    Have you tried smaller meals given more often?
     
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  67. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    It's not uncommon for acrocats to have thickened bowels. Actually, since Neko was diagnosed with thickened bowels I started seeing a lot more cats everywhere with it. It could be IBD, or small cell lymphoma that causes the thickness. Maybe even the acromegaly. To determine which it is, the vet will need to take a sample of the bowels, either with surgical biopsy or endoscopy if the thickness is in a location the scope can reach. Possibly as part of the exploratory surgery. Both IBD and SCL are treatable. My civie had IBD that morphed in SCL. He ended up with one prednisolone a day and every two weeks a chemo (pills). SCL kitties can live 3-4 years past diagnosis, so it's definitely worth treating. My guy ended up with pancreatic cancer after 1.5 years, it wasn't the SCL that did him in. :( Neko couldn't have a biopsy due to her heart condition, so they just treated for SCL. In her case she got budesonide instead of pred, again due to her heart. Budesonide also has less impact on the BG's. She also took the chemo (Leukeran or chlorambucil) every two weeks.

    You might want to see if your vet will give you a prescription for ondansetron (Zofran). You get it from human pharmacies. It's an alternate for nausea that sometimes works better than Cerenia. The two drugs target different nausea receptors. I find it good to have both on hand, especially before the weekend.

    Did the vet also run a SpecfPL blood test? Thats to check for pancreatitis - another common condition with our diabetics and with kitties with GI issues. If positive for pancreatitis, it can be very painful, so you'd want to add pain meds (buprenorphine) and possibly fluids to the mix.

    Sending many healing vines for Leo. I hope things turn around soon. :bighug: I often had to syringe feed Neko and most time just getting a little food in her kick started her appetite.
     
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  68. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Oh Jeff, I'm so sorry Leo isn't feeling well. Sending prayers and healing vines:bighug:
     
  69. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Thanks Sharon. And thanks Wendy for the detailed backgrounds. Much appreciated and I will discuss with the vet next week. The cerenia and cypro started today. I also hope this syringe feeding jump starts his appetite. The vet did say something about small cell sarcoma being treatable.

    Well...Leo got syringe fed 3 times (4pm, 7pm, 10pm) and so far that food is still in him. Also
    BG= 400
    Dosed 4.0 units 9pm

    Those syringe feeding videos should start by saying "First go buy a bunch of towels, and a case of paper towels."
     
  70. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Good one Jeff. I remember the first few times was equal parts food in the cat and on me. :p Getting a good feeding syringe also made a big difference. I am glad the food is staying in.

    You might want to keep a log book of what proteins you are feeding and what the output looks like or if there is vomiting. IBD is one possible diagnosis, and it can be a food allergy that makes it worse.
     
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  71. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    and thanks Woodsywife. Yes, Leo gets a bunch of small meals every day...usually.

    I'll keep a log of the health activities. I might even get off my butt and start typing it in again. It was pretty boring for awhile....5.0-6.0 almost every dose. I hope it gets boring again.
     
  72. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Leo is not accepting the syringe feeding well. Over 3 sessions, probably 3 table spoons. And we are dosing him water with a syringe too. He seems to have trouble swallowing. He will probably go to emergency vet tomorrow so they can hydrate him. Then to the vet on Monday for exploratory surgery. He is not doing well at all, and is as listless as I have ever seen. We are pretty worried at this point about the outcome. :(

    Even if they find an issue, but he won't eat or drink - or accept syringe feeding, then we can't inject food and water into his stomach on a daily basis.

    He does seem to have trouble swallowing. And he had issues with that over the past month or so.
     
  73. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    The vet can always put in a feeding tube to help with nutrition and even medicating. I haven't had to deal with one yet, though have come close. Luckily my crew were good with assist feeding. From what I have hear from others the feeding tubes have been life savers.

    Thinking of you and Leo. :bighug:
     
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  74. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Thanks Wendy. We'll ask them to tube feed him tomorrow then.

    For syringe feeding - he is spitting the food out. And for water syringe, he had trouble swallowing.
     
  75. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
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  76. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Thanks Sharon. That doesn't look like fun, but we may be at last resort on this.
     
  77. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Yay. Team effort with Theresa - we got 1/4 cup of liquidy food into Leo (science diet AD). Almost all of it got into Leo. Then he ate 4 Dental Diet crunchies by himself as a followup. :joyful:

    There is a real art to syringe feeding - maybe just persistence and rolls of paper towels. Still not out of the woods - we'll definitely have a vet visit on Mon if emergency, or Tue for deeper diagnostics. Will update thread with significant stuff.

    Whew.
     
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  78. Sharon14

    Sharon14 Well-Known Member

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    Aug 16, 2015
    Great news! Keep it up Leo!!!
     
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  79. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Summary of last few days, and cruddy day today.

    - Limited success with syringe feeding
    - Variable BG, resulting in some no-dose periods
    - Not drinking enough water, and urine very dark yellow as a result

    Then a darned HYPO. I never, ever get him that low. He is always 100-300, like clockwork the last 4 months.

    Yesterday, 3 syringe feeding sessions, about 3/4 cup of food total. Last feeding was 9pm last night.
    BG - 450, which is super high for Leo. His range in the last 2 months is 150-300
    No Dose yesterday a.m,.
    So lastnight 9pm dose was 4 units, where a normal dose is 6.

    Tested him at 7am...earlier than normal
    BG = 40
    Emergency Karo syrup, and rush to Emergency clinic.
    Immediate glucose injection given. He is on a glucose drip all day today.
    BG = 140 now

    Our objective is to get him stable enough for emergency exploratory surgery to find the underlying cause of his non-eating. And we'll have them put in an esophagus feeding tube. The vet called it an e-tube. Cautiously optimistic we can pull thru the next 2 days. Our boy...we love him so much. He can't go now.
     
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  80. saltycat

    saltycat Well-Known Member

    Joined:
    Apr 18, 2016
    Keeping Leo in my thoughts. He is a tough guy to be going through all this. I don't know if it was mentioned above, but if he is put on a feeding tube I seem to recall with Acro cats it is advised to use a size smaller tube due to the tissue buildup.

    Prayers for your little guy:bighug:
     
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  81. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Jeff, sending prayers and healing vines for sweet Leo:bighug:
     
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  82. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Spreadsheet updated thru today. Hypo was 10 hours after PM dose. Leo hardly ever hits a real nadir.

    Thanks all. We will know more in the morning, whether he is healthy enough for exploratory surgery. If we can just get him eating again, we can work through other issues. He has not vomited any of the syringe-fed food in the last 3 days, so the anti-nausea was working. I hope I didn't damage his body with that damned hypo.

    Picture: Leo (black tabby) with Little Dude (orange) on 6/11/2017 just a few days ago.
     

    Attached Files:

  83. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Colin has had a few out of nowhere hypos and seems none the worse for them. Maybe try to start doing a few before bed tests at night to see where he's heading. Sending tons of prayers for Leo, you and Theresa:bighug:
     
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  84. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Thanks Sharon, I agree. Leo is stable, and does not seem affected by the Hypo. Chart comments are updated.

    Leo was eating some "kitty McDonald's" at the hospital -> Friskies. At least he was eating. There was also Classic Pate there - in case he wants "normal".

    Current plan is to take him off glucose drip tomorrow 7am and take him to regular vet for further evaluation. We need to diagnose the underlying issue of not eating.
     
  85. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Glad he was eating some. Colin loves Friskies but it spikes his glucose, so I give him some when he has lower numbers. I hope you can find the cause and fix it and hopefully without surgery. Keep us posted.
     
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  86. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Leo still not eating. Without a root cause, that is a death sentence since we can't force him to eat all his life. Bullets:

    Discussed options 45 minutes with primary vet
    Selected exploratory surgery, which was done today.

    Findings
    Intestines have no sign of blockage from stomach to colon, looks normal.
    No blockage at all. No hairballs, no grass, nothing.
    Overall - looked like normal abdomen
    Discoloration of liver, which is fatty liver.
    Various biopsies taken.
    intestinal walls thickened - biopsied
    lymph node was enlarged - biopsied, potential issue
    samples take 7 - 14 days to evaluate

    If ulcerative colitis or lymphoma -> causes no eating
    Ulcerative colitis -> same

    Could be worse. Last year Scoobs had similar procedure on July 1. His intestines were shot, and we made the "hard decision" since there were no options. My sweet boy Scoobs, I miss him so much.

    For Leo:

    Vet believes the issue is either
    IBD or lymphoma

    Esophageal feeding tube was inserted at neck area.
    We will force feed him for a least a month.
    has esophagus tube in
    feed in 12-24 hours

    Surgery recovery -
    2 weeks for scars to heal up

    Followups:
    - act upon biopsy results
    - tonight on glucose drip at animal hospital
    - tomorrow am, JJ and Theresa learn how to feed Leo thru tube

    Our sweet boy Leo is a trooper. We'll get through this.
     
  87. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    :bighug: Sending healing vines for sweet Leo

    What have you been feeding him? I know several people here with kitties that have belly troubles try to feed foods with out carrageenan, and limited, novel protein ingredients.
     
  88. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Thanks Sharon. The house kittehs all get Fancy Feast Classic - maybe 10 different types. Also once a week cooked chicken. He was fine with all of that for a year. Then one month ago, he would eat a little, then run from the food - of all types. Then 1 week ago, barfing the food up.

    I suspect something in his gut is wrong. He won't eat anything for the past week or so. We disliked cutting him open, but this will allow us to know pathology of his intestines.
     
  89. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    How's Leo?
     
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  90. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    6/20/2017 (Tuesday)
    - Leo's exploratory surgery occurred
    - tissue samples sent out, results in 7-10 days
    - esophagus feeding tube surgically setup
    - overnight stay at hospital with glucose and 24/7 monitoring

    6/21/2017 (Wednesday)
    - Leo transferred to vet for the day, did well, stayed on glucose until 4pm
    - Leo came home for remaining recovery
    - Alert but subdued, did not fight during e-tube feeding, happy to be home
    - on Bupe for pain
    - chart updated, doses will be 1.0-1.5 for time being to ensure no hypo
     
  91. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Now that he is "feeding", his immediate downhill issues are resolved. (No eating is the end).

    He was pretty bad before the hypo. All the fluids, glucose, and food have pretty much brought him back to the good state he was in - one month ago. I sure hope the test results uncover some issue that we can treat directly. Attached pic of Leo recovering at home tonight. Our sweet kid is home!
     

    Attached Files:

  92. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Glad he's home! Hope you get the results back soon and it's easily treated. Keep us posted.
     
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  93. Phoebes

    Phoebes Well-Known Member

    Joined:
    Jan 16, 2017
    Prayers for Leoberry!! Head bumps and hugs for daddy bean.:cat::cat::bighug::bighug:
     
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  94. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Thanks all.
    He is doing much better now that he is getting food. Today, he of course ate some crunchies and Fancy Feast...which he wouldn't touch pre-tube. He doesn't like the e-tube, but he is not trying to remove it.

    He is still subdued, probably from the morphine. He does not seem to be in pain at all....probably because he is higher than a kite. Very responsive to being brushed 10 times a day:bighug:

    Pee - normal
    Poop - pretty runny, but at least it happened
    Chart updated.
     
  95. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    I am glad Leo is back home again.:bighug:

    The results of the biopsy of the bowel walls will tell you which you are dealing with. Did the vet talk about treatment plans? At some point, if you aren't already, you might consider talking to an internal medicine vet. The IBD/lymphoma in addition to acromegaly/diabetes may not be something your vet is familar with. My vet directed me to an IM vet at that point.
     
  96. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Hi all.

    We just got confirmation that Leo has small cell lymphoma (SCL). It is spread thru his intestines, lymph gland, and 2 other organs. The vet estimates he has had SCL for 3-6 months. Maybe as a side effect of Acro, or even the Acro SRT.

    All cats and humans die. Our objective is to treat Leo until his quality of life is reduced. He is doing pretty good now. Just last night he ate 3/4 bowl of food. And he was playing with me and Little Dude with a stick/string toy. For the time being, we will continue to use the esophageal feeding tube. His eyes are alert, and he has perked up from the additional feedings.

    Our vet has direct experience with SCL. She even had a personal cat with diabetes and lymphoma, which lasted another 4 years after initial treatment. We don't expect that timeframe with Leo. Another 6-24 months would be amazing. We are going to treat Leo with Chlorambucil (chemo) and Prednisolone and love. We will start with the additional chemicals this week (I hope). The vet said she would refer us to an IM vet, but I just don't think we need that for sufficient treatment.
     
  97. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    I am so sorry about the diagnosis. :bighug: There is an online feline small cell lymphoma group you may wish to join. They are very knowledgeable and an intermal medicine vet well versed in SCL watches and sometimes comments. It's great your vet has personal experience. I am glad Leo is feeling better and feeling like playing a bit. That's a great sign.

    Neko took budesonide instead of prednisolone for her SCL, due both to her diabetes and her heart condition. Prednisolone can impact the blood sugar. But that's OK, it may just mean you have to increase Leo's insulin dose a bit to compensate. As you will see in the small cell group, there is a newer protocol for giving chlorambucil (Leukeran is the brand name), and it is given every two weeks in a slightly larger dose. The chances for remission are as good as the older protocol of giving it every other day. The advantage is giving the meds less often. Chlorambucil can cause nausea for 1-4 days after it is given. Neko was originally on the EOD (every other day) protocol and never got away from nausea. The every two weeks protocol meant that after 4 days of nausea, she felt good for 10 days until the next dose. You will want to get some ondansetron (Zofran) from the vet. Cerenia can also work, though I've seen ondansetron do a better job. With Neko, I found she needed both ondansetron and Cerenia towards the end. The civie with SCL hardly got any nausea. I gave him some ondansetron before the dose to block the nausea receptors, and one the day after, and he was fine.

    Wishing you all the best. Neko only lasted 6 months after her SCL diagnosis, but she also had kidney and heart conditions. The civie lasted 1.5 years after his diagnosis, but was taken by something completely different. He went into remission after starting treatment for his SCL and had great QOL. Hoping for the same for Leo.
     
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  98. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Thanks for the detailed information Wendy. It is hard news for us. But in a way, I'm glad the vet found something, which is somewhat treatable.

    I just joined that SCL group, thanks. We will pass that dosing info to the vet. Leo and Theresa are going to the vet tomorrow for a checkup on the tube and current condition.

    The ongoing pre-drug nausea from the SCL must be causing the non-eating issues. We will probably leave the tube in for awhile. It sure makes oral dosing easy.
     

    Attached Files:

  99. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    :bighug:
    I'm glad he's feeling better. Sending prayers and vines for Leo, you and Theresa. You're doing a great job with him.
     
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  100. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Updated status:
    • Leo a bit subdued last 2 days.
    • Ate a bit of food, mostly tube-fed.
    • He will get abdomen stitches out next Mon or Tue.
    • There is a small infection at the tube entry, we cleaned it and are doing daily cleaning and ointment.
    Met with vet, for ~30 minutes. She is a dedicated vet and spent time with us to review Leo's future health and treatment. Summary:
    - Prednisolone to start, we'll see how that goes
    - Chlorambucil - we'll do the EveryOtherDay (EOD) regimen
    - Cerenia to start for nausea
    - B12 weekly injections (at home) starting this week

    Chlorambucil is ordered. Will start treatment regimen probably Monday. We discussed Pulsed Dosing Method. The vet verified EOD regimen with the vet network and an internist. She does not want Leo's white blood cell count or bone marrow to be affected.

    She told us expectations are to see some improvement in 2-4 weeks. If no improvement in 6-8 weeks, then he may be too advanced. He has SCL in - intestines, lymph gland, pancreas.
     

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