Sophie's New York Adventure

Discussion in 'Acromegaly / IAA / Cushings Cats' started by sbluhrs, Oct 4, 2018.

  1. sbluhrs

    sbluhrs Member

    Joined:
    Jun 7, 2012
    [​IMG]

    We left for AMC on 9/23. Sophie was not thrilled with riding in the car, but, from our practice drives, I found that she didn’t like riding in a carrier and was happier out of it. Also, we had found that she needed meds for both anxiety and motion sickness, so she was dosed up with Cerenia and Gabapentin to help her with the drive.

    Poor girlie was restless the entire time – moving from sitting in my lap to on the passenger seat to sitting on top of her kitty condo (her favorite place). Total drive was 7 hours with stops. When I stopped for gas and to stretch my legs, she was relegated to the condo, zipped close. She didn’t mind too much.

    She used the litter box, with a pee pad in it, once, almost at the end of the trip.

    We got to AMC around 3:30 PM. I was exhausted. I checked the girl in with the hospital personnel. I had estimated how much food to leave for her and gave that to them, along with the mega kitty mat that had made the trip with us, and a couple of Levemir pens. I just really didn’t want to wait around to chat, so I left to ride out to my friends’ on Long Island.

    Nothing much for Monday. Dr. McCue called after she had all her scans done. The tumor was bigger than they anticipated, but it was encapsuled in a membrane, not infiltrating the pituitary or other surrounding tissues. Her EKG shows that she had some thickening of the heart walls and some enlargement, but hopefully that would decrease after the growth hormone was eliminated from her system.

    Tuesday was the surgery. Got a call around 4ish, she came through it fine, everything looked good, she had awakened well from the anesthesia, and there didn’t appear to be any problems. I was on schedule to be able to see her on Wednesday, in the late afternoon.

    So, Wednesday, I packed up my gear and drove into Queens, to my AirBnB. I was lucky to find a very reasonably priced location with free parking close to a station on the F line, which was the subway line I needed to take to AMC.

    Between the walk to the subway, the subway ride and the walk to AMC – about an hour. Got there around 3:30. Took a little while before I saw her, but Dr. McCue appeared with her around 4. My girlie looked a little worse for wear. All of her facial hair had been shaved and she had an odd incision on her forehead. This was from the marker they had to insert for her scans on Monday and during surgery. Her eyes were dilated and Dr. M. explained that this was normal, that the optic nerves get a bit irritated from the surgery, and the surrounding tissues take a while to settle down. She also had a boot on her left hind leg, which covered a catheter they were using for blood draws, instead of having to stick her every time they need to do one. She was wearing a cone that day as she had been fussing with the boot. We had a nice chat, and he clearly really liked his little patient. He reported that she was eating well, and peeing/pooping on pads as I had told them she liked to use those instead of a regular box. She was actually using the box for sleeping

    More visits with the girl on Thursday and Friday. The cone was gone on Thursday, and on Friday, so was the boot. Her caretakers at AMC clearly really liked her. Everyone seemed to know Sophie and always had a smile on their face when speaking with her. They mentioned that she was allowed to roam their work room and once they found her asleep on a pile of their backpacks.

    I originally didn’t think I’d be taking her home until Sunday, but, when I visited on Friday, it was clear that she was getting bored and felt good enough to travel. She didn’t want to sit still and just be loved on, she wanted to see what was happening all around her and insisted on checking out what was in the hall by the visiting room.

    Since Dr. M was not working on Saturday, I saw one of the residents in the Neuro program then. Took a little while before we could leave, as I had to wait for her because she had other patients to attend to. They gave me a complete listing of what her post op care was, with dosage levels for her new meds and suggested follow up visits, etc. I had been filling Sophie’s Maine vet, Tracy Filler, in with her care in NYC and Dr. McCue and she had been emailing back and forth.

    I had asked AMC to dose her with the Gaba and Cerenia like I had done on the ride down, and that was no problem.

    Amazingly, I didn’t hear one complaint from Sophie on the way home. She slept in her condo most of the time, occasionally venturing out to the front seat to drink water and sit in my lap. Used the same tactic of locking her in the condo when I stopped. Also fed her a couple of times en route. She was not super hungry, but seemed happy to eat. Her biggest issue was her thirst.

    We got home around 6 and she seemed happy to return.

    So far, since we are home, Sophie has been doing well. She’s been eating well, except for not having much of an appetite today. Generally we feed our cats at 7, 11, 3, 7 and 11 before bed, but she didn’t want her morning elevenses. I took her to her Maine vet as a precaution and they didn’t find anything wrong. The biggest change is that she actually seemed to enjoy riding in the car and sat on my lap for at least ½ of the trip down and the same on the trip home.

    We’re on the usual up and down of insulin since getting home, but, instead of being on 20 units of Levemir twice a day, she is on, at most, 1 unit. It seems that even that amount is too much, and I’ve decreased it down to .5 unit, after a brief stop at .75. I’m hoping she’ll be OTJ within a week or two.

    Her urine output has decreased nicely, and she is spontaneously using the litter boxes which is a huge relief. Sophie had decided about 6 months ago that she didn’t like litter boxes anymore, so we had resorted to pee pads from Petco to avoid problems. It is such a relief that she decided that they are ok to use again. Just had them do a urine specific gravity at the vet’s when she was there today and it was nicely concentrated. Hoping that the desmopressin will be a temporary thing, then, even though, I know, the steroid pill and the thyroid pill she gets with meals twice a day will be life long.

    That’s her story. She really didn’t mind her adventure. Well, yeah, she complained a lot on the ride down, but not a peep coming home, and no complains on her trip to the vet today.
     

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  2. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    Thanks for the update. I was wondering how you and sweet Sophie were doing. She sounds like she is recovering nicely.:) My Neko hated travel before we drove to SRT and was a champion traveller afterwards. Maybe you'll be able to go more places with her now.

    Interesting on the tumour not infiltrating the pituitary and being encapsulated. I wonder how common that is.

    Love her spreadsheet lately. :cool: I hope Sophie continues to recover as well as she has done so far. But hoping her appetite will perk up a bit. Same thing happened to @Amanda & Shmee
     
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  3. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    Wonderful ! Interesting about the tumour, and the marker on her forehead. I saw Shmee had an incision there too.. I would be interested to know full details about the thyroid pills, because we are adding liquid to Titan's meals and although he eats it fine, its a bit of a fiddle to measure out, and pills would be much easier for the lady where he boards if we go away. We asked about pills at the vet today, but the only ones available were far too big and would have to be divided into 40 parts!
    We hope all goes well at home and that Sophie recovers steadily. Please keep posting information on BG levels and everything else. Best wishes from John Irene and TITAN !
    EDIT the pills that were too high-dose were for the urine concentration , not thyroid stimulation. Sorry to create confusion!!
     
    Last edited: Oct 6, 2018
    Reason for edit: Correcting an error
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  4. Olive & Paula

    Olive & Paula Well-Known Member

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    Sep 6, 2015
    @John Irene and TITAN what about thyroid transdermal gel you can rub in ear? Is that an option for you?
     
  5. Olive & Paula

    Olive & Paula Well-Known Member

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    Sep 6, 2015
    Sounds like Sophie is doing well.
     
  6. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    The only transdermal gel I've seen so far is for hyperthyroidism, i.e. to reduce the action of the thyroid. But the medication we are giving (leventa) is for the opposite, to increase the action of the thyroid now that the pituitary gland has been taken out and is no longer stimulating the thyroid. But if there is a different gel, I would look at it.
     
  7. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    Odd.....Titan took to sleeping on the mat right outside the litter tray when his diabetes was at its worst. Sometimes with his tail inside the tray.
     
  8. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Thanks for updating us on Sophie's experience and the followup period. She looks odd with the shaved head. Poor kitteh. I hope Sophie gets on well with recovery.
     
  9. Amanda & Shmee

    Amanda & Shmee Well-Known Member

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    Feb 18, 2018
    I get liquid for his hormones too. If I remember correctly Dr. McCue gave us the option between pills and liquid, so I assume its just the same hormone (Levothyroxine) in pill form. You mentioned Titan is getting Leventa - maybe this med comes with a different dose, which is why it would have to be split up so tiny (40 pieces wow! :eek:). I am curious now - the difference between Levothyroxine and Leventa, they sound like different versions of the same medicine pretty much, but I wonder why ours is different.
     
  10. Amanda & Shmee

    Amanda & Shmee Well-Known Member

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    Feb 18, 2018
    I am so happy Sophie is back home and doing well. Shmee was like a new cat on the ride home too... he meowed almost the entire way there and wanted to get out and look around. Not on the way home... no meowing and no moving around. I hope you have better luck with the Desmopressin then I have!!! That insulin number ….. 20 units to 1. How incredible. Dr. McCue wants me to do the IGF 1 test.... I told him I am sorry but I don't think its worth the money. No matter what the result is I can't change it. Although I do feel bad, because I know he wants the information for their study :(
     
  11. sbluhrs

    sbluhrs Member

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    Jun 7, 2012
    Sophie is having the usual ups and down that happen in recovery at this point. Thursday and Friday were not good days - she didn't want to eat much Thursday morning. Was able to make a vet appt for that afternoon, and, in the mean time, gave her half a Cerenia pill, added Fortiflora to her meals, and got her to eat. She was acting more normally, and the vet didn't see anything wrong. Her mouth incision looked really good, except for a little red area at the very back, by her throat. They were able to get a good urine sample and her specific gravity was showing that it was nicely concentrated. I had another appt scheduled with them the next day for her post-op blood draws, so we called it good for the day.

    She ate well at 11pm and ate her overnight meal at 3AM, but come morning, it was a different story. She wanted nothing to do with food, and I found she had stool in the box that was formed, but a portion was very runny. The last time this happened, she had a rebound yeast infection after her dental this spring. I kicked myself for not being more aggressive with the probiotics, but what's done is done, and at least we can recover from that.

    I got her to eat about a healthy tablespoon of food with probiotics added, but no meds per Dr. McCue, and we set off to our 8:30 appt for her blood draws. She snuggled on my lap during most of the 20 minute ride, which is a new thing, and no complains about the drive. I guess when you've dealt with 7 hours in a car twice, a trip to the vet is a piece of cake. Good girl as normal at the vet's with everyone loving on her and commenting on how good she looked. I was able to get her the prescription antifungal that we had used in the spring, but they told me to hold off administering until the vet called with the blood test results. A few hours later, her Maine vet, Dr. Filler, called with the results, sans Cortisol as that had to be sent to Idexx for processing. Her numbers were good except for the white blood cell count. She was clearly running an infection. Dr. Filler had consulted with Dr. McCue and Dr. McCue sent directions to double her steroid amount, and for the dosage of the anti-fungal. He also wanted Sophie to be on Veraflox, an antibiotic that is different than most as it crosses the blood/brain barrier. I was familiar with the necessity of that sort of antibiotic as I had Lyme disease back in 1989 and needed an antibiotic that did the same thing.

    Dr. Filler located the antibiotic for me, but I had to drive down to Portland (45 minutes away) to get it. By the time I got back (after combining the trip with various other stops that I had been waiting to do), got home and administered that med an hour before her usual dinner time.

    By dinner, she was ready to eat, wanted to eat, and ate like a little pig. Since her BG was low, no shot, but regular desmo shot, gave her some gravy food along with the regular, plus her regular meds and let her eat until she decided she had enough. Good appetite at 11pm, too, and she cleaned up her overnight meal.

    Of course, with the increased steroid and all the food she had in the pm, her BG is up again, and she had some insulin this morning, with her regular desmo shot. Regular thyroid and the increased steroid pills and she was definitely eating and acting like herself. Now the whole crew is sleeping off breakfast.

    Recovery from surgery, whether it be for a human or animal, is never in a straight line. It is often many ups and downs and the trends are the important thing.
     
  12. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Another good report with good progress. The BG chart reflects great results - down from 19.0 units to around 1.0 unit. I hope she regulates to OTJ (off the juice).

    Glad to hear she is eating. Always an issue with our kittehs and different medical situations.
     
  13. Dyana

    Dyana Well-Known Member

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    Dec 28, 2009
    My kitty Ginger had the i131 and now has to take thyroid hormone pills twice a day. The pills she gets are called Thyro-tabs and the generic for them is Levothyroxine Sodium. Her pills are tasteless and dissolve instantly in water. I put the pill in her bowl add a small splash of water and swirl it around and then mix a few bites of her food into it and feed her. After that is eaten, she gets the rest of her meal. She is on 0.1mg.
     
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  14. sbluhrs

    sbluhrs Member

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    Jun 7, 2012
    Sophie is on the same med. Levothyroxine Sodium is the generic name for the med. I take the same med for my hypothyroidism, only, obviously, at a much higher dosage. Sophie is on 1/4 of a .3 mg pill, and her most recent T4 came back at a 2.3, with normal levels ranging between .07 to 5.2. So we are spot on with the Thyroid level, but working on getting the steroid right. And the insulin is a work in process as is the desmopressin.

    I just stick the pill bit in her food, along with her half a steroid pill and she gobbles it up. When she is feeling good, she is a champion eater! Sophie also gets her Thyroid med twice a day (as with the steroids).
     
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  15. sbluhrs

    sbluhrs Member

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    Jun 7, 2012
    Another thing I have noticed with Sophie since we are home. She looks physically smaller. Seriously. She was about 12.5 lbs when admitted to the hospital and she is about 11 lbs now. She is big for a girl, but is looking more girly, less massive. Eating very well, though not quite as much as pre-surgery. Amanda & Jeff, do your guys look any smaller since their surgery?
     
  16. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Leo had SRT (radiation) in September 2016. He is about the same size and weight. He had a larger gut from the Acro before the SRT. That has now mostly evolved into some fat.

    Theresa mentioned this week, that Leo's eyes appear bigger now, compared to pre-Acro. Leo was 10.5 years old during SRT. So we have pictures from all the years, and the Acro did change his physical appearance some.
     
  17. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    Amanda has commented how Shmee has lost weight, more than she'd like. Neko also had SRT, and lost about a pound fairly quickly, then stabilized and gained it back. :rolleyes:
     
  18. Amanda & Shmee

    Amanda & Shmee Well-Known Member

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    Feb 18, 2018
    Shmee is going up and down in weight, its been odd. But to me personally, he looks bigger. Almost like bloated on the sides.

    I am glad Sophie is doing well overall since surgery :)
     
  19. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    Sorry I was talking rubbish about pills for thyroid stimulation. The pills we decided we couldn't use because they were too big a dose were for the urine concentration, to replace the desmopressin eye drops.
     
  20. Amanda and a Loudogg

    Amanda and a Loudogg Well-Known Member

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    Jun 16, 2017
    I am so excited to read such great reports about Sophie! I'm so glad you nipped that infection in the bud! I'm a little bit surprised that Dr. McCue wants a repeat IGF-1 test for the study, especially so soon after surgery. I'd tell him I'd be happy to repeat the test if they cover it. ;) I'm looking forward to hearing more about Sophie's recovery. Sending healing vines! :bighug::bighug:
     
  21. sbluhrs

    sbluhrs Member

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  22. JeffJ

    JeffJ Well-Known Member

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    Thanks for posting this Sue. It is a good article. They said the surgery has not gained in popularity, and I would guess cost is a main factor in that. I liked the photo of kinesthes... wrapping of the dog. The dog looked pretty happy, so maybe that fixed the problem there too.
     
  23. John Irene and TITAN

    John Irene and TITAN Member

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    Written by Dr McCue! No mention of his colleagues across the pond in the UK. A very interesting read .....thanks for posting.
     
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  24. sbluhrs

    sbluhrs Member

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    Heading out this Thursday for Sophie's 6 month checkup with Dr. McCue - since they won't be charging for the MRI and other stuff there if I go to AMC, I'll take the drive with her. Was actually supposed to be after 5 months, but due to weather issues, and then I got sick, and then, last week the MRI machine was getting maintenance, going this week.

    Probably going to rain on the trip home, but I can deal with that. Better than the snow and freezing rain that we were getting up here in New England until just recently.

    They are also going to do an echocardiogram as her heart had some changes they hadn't expected due to acromegaly. I want them to do a complete blood panel, too, including thyroid. She is still on Desmopressin (as are the other two kitties who had their surgery just weeks before her), but she seems to be getting closer and closer to getting off of it. She is down to needle juice just once every 48 hours. I've tried a couple of trials of close to 100 hours, but the last 24, she really ramps up her drinking and peeing, so she is definitely not ready yet.

    I want the thyroid levels as she hasn't had that done since November and I just changed when she gets her thyroid meds to be either an hour before or two hours after her 7 AM and 7 PM meals so that she gets in on an empty stomach. Just want to make sure her T4 level isn't up too high, which could contribute to the issue of getting her off of the desmo.

    She's been off insulin for months now. Very stable. Only issue was when she got a drop for her ears and that sent out her of remission. We stopped that, gave her insulin for a couple of days, and she was back OTJ. Check out her spreadsheet if you are interest.
     
  25. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Nice status on Sophie. It will be interesting to hear about all the test results. It seems with Sophie, that you got pretty lucky, and the pituitary removal worked out fairly well.
     
  26. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    Good luck with the trip. Have you seen returns to her former purrsonality?
     
  27. sbluhrs

    sbluhrs Member

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    Wendy, I have no idea what her former purrsonality is, as I adopted her after she had been diagnosed diabetic and, little did we know, she actually had acromegaly. Her major personality trait prior to her surgery was to be totally food focused, so much so that we had to make sure that we cleaned up promptly after we made dinner, and also put all food away. Also, we had to feed our other cats in another room behind closed doors.

    At least now she isn't so greedy that we have to immediately clean up, but we still can't leave stuff out that might tempt her.

    She seems to be turning into a rather talkative stilly girl. We'll see how that progresses.
     
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  28. sbluhrs

    sbluhrs Member

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    Jun 7, 2012
    So, the medical part of our second trip to NYC is done. Her echocardiogram shows that the changes she had showing during her first one have basically resolved, so she just has a normal kitty heart. And her MRI shows that her brain has healed well. She still has some stuffiness in her sinuses, but it doesn't affect her breathing and she doesn't snore. It seems that most of the abnormal soft tissue growth from the acromegaly has reversed. IGF-1 still zero. Good news. She is still on her desmopressin, but Dr. McCue is optimistic that she will eventually come off of it. Her blood tests were good, thyroid level good, kidneys good. Healthy kitty. She has had a grand old time visiting with the staff there, making new friends and connecting with old ones from her last visit. Next time she will be back will be in September for another MRI, but Dr. McCue does want her IGF-1 tested before then. We will figure out the schedule.

    Tomorrow is the drive home. The drive in wasn't too bad, and, tomorrow's should be even easier, as it is the weekend.
     
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  29. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    What a great report! It sounds like Sophie is one of the best surgery patients (that we know of). I'm glad to hear that Sophie's brain healed and the sinus issues have also reduced. There is a lot of pain and issues on this forum, it is so nice to read of such a great recovery.:bighug::bighug::bighug:
     
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  30. sbluhrs

    sbluhrs Member

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    Jun 7, 2012
    Soph and I got home safely at around 4 pm yesterday after the drive down to AMC for her 6 month checkup. She has become a very calm, rather bored traveler. We are both exhausted from all the traveling in just a few days. Figure we will both just chill for a bit. Only thing left on the plate to figure out is how to wean her completely from the Desmopressin, but that will happen in its own good time, like everything else with her.
     
  31. Amanda and a Loudogg

    Amanda and a Loudogg Well-Known Member

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    Wahoo! What a great report! So glad things are going well and that you and Miss Sophie are home safe!
     
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  32. Noah & me (GA)

    Noah & me (GA) Well-Known Member

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    Dec 3, 2016
    There's nothing better in life than the cat who loves the car.
    Marco has to put in the car, Nigel would follow me out the door and jump in the car.
    And of course there are the kids in other cars, "Mom look, it's a cat!"
     
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  33. John Irene and TITAN

    John Irene and TITAN Member

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    Aug 6, 2018
    It all sounds very satisfactory. We are very pleased for you!
     
  34. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    What a good news update. Well done Sophie!
     
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  35. Olive & Paula

    Olive & Paula Well-Known Member

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    Wonderful news.
     
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  36. sbluhrs

    sbluhrs Member

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    Jun 7, 2012
    It's always something. Got Sophie's blood test info from her most recent visit to AMC and from the day before her surgery. Interesting info, and some things are consistent with my observations. For one thing, she is definitely OTJ with regards to insulin. BG 117!!!

    Second thing is that her T4 this time around was consistent with November - 1.5. She had been up to 2.3 and 2.4 in October, just a month or so after surgery, and wasn't getting tubby at that time. Then, November rolls around ans she is gaining weight and her T4 is 1.5. She continued to gain weight until I put her on a diet and changed the timing of her thyroid med to 1 hr before or 2 hours after meals (depending on how it fit into my schedule).

    I take a thyroid replacement myself as I was diagnosed with hypothyroidism back in 2000. I know how crappy it feels to be hypo or even just subclinical hypo. In general, humans with low thyroid feel better if their T4 is at the top quarter of normal range and I find that is true for me. When you are feeling under medicated, you feel cold, you feel lethargic and you gain weight easily, plus you tend to be grumpy. Soph has been rather lazy/lethargic, and the weight issue has been a real concern. The poor darling doesn't get very big meals, and I only am feeding her Tikicat Chicken or Chicken and egg, not because of the carb thing, but because of the lower calories.

    So, after consulting with Dr. McCue today, we are slightly increasing her meds to 1/2 of a .3 mg pill once a day, and 1/4 of the .3 mg pill once a day. I'm going to go back to giving the pills in her meals as the change in timing doesn't seem like it has done anything to help her levels.

    Go take a look at her labs on her spreadsheet if you are interested.
     
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  37. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    Interesting to see the effects on the thyroid too. Sophie is lucky you knew what to look for.
     

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