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We've decided on SRT for Rocket.

Discussion in 'Acromegaly / IAA / Cushings Cats' started by Keskat&Rocket, Jul 24, 2019.

  1. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    This is a tough one, but after a lot of reading, talking with fellow members here, and much soul-searching, my husband and I have decided on SRT for Rocket's acromegaly. His results (IGF-1 = 331) came to us on July 5th, but looking back, he may have had symptoms as far back as last October. The first thing I noticed then was his meow changed, from a low-pitched, loudish meow to more of higher-pitched squeak. I mentioned it to two vets during office visits, but they both pretty much shrugged it off. In retrospect, I wonder if he might have some tissue growth in his windpipe that is causing this. Around the same time I noticed that on occasion his front claws grow in super thick. One grew into almost a circle.

    Fast-forward to now - we're barely starting to get a better handle on his numbers, since switching to Levemir on July 16th. But his back legs are getting weak, and he's having accidents from time to time. We were originally thinking of traveling to CSU, but I'm having surgery this Friday and we don't know when I'd be able to handle a road trip. So we've decided to go with Dr. Bommarito at a veterinary cancer treatment center here in Orange County CA, about 30 miles away from home. We've compared his protocols to those at CSU, and they're very similar. Rocket is scheduled for a CT scan on Monday the 29th, with five SRT sessions Mon-Fri the week of August 5th.

    This was not an easy decision to come by, as most of you know how expensive this is. We're getting a little help from family, as my mom used to have a beautiful ginger kitty who had her stomach cancer treated at the same facility. But the real decision-maker was the fact that Rocket is only 10 years old. I love him immensely. And I just think he deserves more time.

    Thank you so much to (putting these on separate lines; not sure if they tag otherwise)
    @JeffJ
    @Wendy&Neko
    edit: tagging @Bronx's dad too 'cause gray kitties are the best ;) (and because I remembered you had SRT too)

    and anyone else I'm not thinking of right at the moment - I know there are more - your stories have really helped us come to this decision as well. I just hope Rocket's story is a good one, and that maybe we can help someone down the line too. Unfortunately I won't see everything first hand since my husband and my folks will be taking him for treatments, but I will document and share as much as I can.

    Big hugs to all of you. :bighug::bighug::bighug::bighug::bighug:
     
    Last edited: Jul 24, 2019
  2. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    I am so glad to hear you have SRT near you. When we made the decision, I had two choices, one three days drive (CSU) and one 13 hours drive, but a lot more expensive with no acro experience. Sounds like Rocket will be in very experienced hands.
     
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  3. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Good for you guys! It is never an easy decision for SRT, especially because of the costs. Pricing is useful to others too.
    Can you please re-summarize the expected costs at the Orange County center?
    What is the name and website of that center?

    Some of the symptoms you described are common. Leo's paws grew, and his nails were super thick (even until the end). And neuropathy is just no fun - resolvable with lower BG nadirs and Zobaline in many cases.

    I think that closer SRT center will work out great for you. Rocket will have a much better prognosis after SRT.

    Best of luck with the surgery this Friday. We are lucky. We live in an age of modern medicine, and reap the benefits from it.:bighug::bighug::bighug::bighug:
     
  4. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Thank you. :bighug::bighug::bighug:

    Sure - costs for CT scan and five treatments (MRI, if needed, is extra): approx. $8300. Not quite as bad as I'd thought (they had originally given us an estimate of around 9700, but that was a clerical error!). Tagging @Deena and Malby about this - she's in CA too, and we had talked about costs.

    http://vetcancergroup.com/contact-us.html (we're going to the Orange County location, in Tustin CA)
    http://vetcancergroup.com/services/radiation-therapy/stereotactic-radiation-therapy.html

    I've thought about trying Zobaline too; we'll buy it after his treatments if needed.

    I'll be off and on the website today; getting ready for Friday. But I'll be around if anyone has more questions. Thanks again :) :bighug::bighug::bighug:
     
    JeffJ likes this.
  5. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    That is a pretty price for the overall treatment plan. I'm glad it is working out for you. Thanks for posting that info and the website.

    For Zobaline, really you should start it now. It won't hurt. You just mortar-and-pestle crush the pill and sprinkle it on the food. It is tasteless. Rocket will need supplemental B12 to get over the neuropathy, and Zobaline is easy to give.
     
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  6. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Has Rocket ever been checked for arthritis? It is very common in acros. Not all acros get neuropathy, Neko did not. No need to give something if it is not needed.

    Sorry the vets didn’t see the signs earlier, but neither did mine. Neko’s only symptom was one teary eye from soft tissue growth I found out later and the vet dismissed, and a savage hunger. Thick claws are common in acros. And if it helps any, many acros show symptoms before becoming diabetic. Neko’s teary eye started months before the peeing increased.

    Let us know if you get a list of what to expect after SRT. If not, I can list some things. Resulting insulin needs post SRT are variable by cat, so no harm in safe dosing now. Neko needed her first reduction on the way home from Colorado, some kitties need a few months of increases before coming down. I was told it takes a couple weeks at least, my girl was a rule breaker. :p It all depends where the tumour cells are in their life cycle when radiated. Radiation in effect neuters them so they don’t reproduce.

    Great news the costs seem to have stabilized for SRT, guess it helps it is getting more available now.
     
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  7. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Ok, I'll order it so it will arrive when I'm back home.

    He hasn't been checked for arthritis, but I can hear creaking in his shoulders sometimes. :( And he definitely has neuropathy in his back legs, though at this point some days are worse than others. I'm hoping it will reverse or at least get better with better numbers and Zobaline.

    We haven't gotten a list yet, so any info is appreciated! I do know that we'll need to really monitor his numbers after the treatments. Nice that Neko responded so quickly! Thank you. :)
     
  8. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    I hope you get awesome results
     
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  9. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Thank you so much. Hugs to you and C.C.! :bighug::cat::bighug:
     
  10. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Glad to hear you’re able to swing the SRT! Great that it is available so close to home, that should make it easier.

    Hope all goes well Friday and you have a quick recovery
     
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  11. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
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  12. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Thinking about you and sending you healing vines for a quick recovery from your surgery. :bighug::bighug:

    And such exciting news about Rocket! :joyful:
     
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  13. Teresa & Cricket

    Teresa & Cricket Member

    Joined:
    Nov 5, 2018
    /Good to hear you are getting SRT.

    I definitely would've done that or surgery if I had gotten Cricket's diagnosis before she had Congestive Heart Failure.
    Keep us posted and good luck!
     
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  14. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Hope your post surgery recovery is going well, and that we hear from you soon.:bighug:
     
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  15. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Thank you all so much -- I was back from surgery the same night (Friday), but it was a longer/more complicated surgery than expected so my energy levels are pretty low. BUT! I'm so happy to be home and focusing on just two things -- getting some good rest/recovery time in, and taking care of Rocket! :) Unfortunately we had to move his appointments back a bit (his CT scan is now scheduled for Aug. 7, with SRT the week of Aug. 12), but this means that I might actually get to go with him now too.

    My only other wish is that he was more regulated before we start all this. We have him on 6U of Levemir now, which he seems to like much better than Prozinc, and even though his numbers have come down a bit they're still not good. At least they're much flatter now. But it's frustrating. I just hope we're doing the right thing.

    Sorry if I sound a little scattered - I'm not quite myself yet. :)
     
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  16. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Glad to hear your surgery is over and I hope you can be with Rocket for his SRT. For you it'll be a whole lot of waiting around, so it's not that important if you can't go, though it is nice to be there for the first meetings to hear what will happen. If only your DH can go, see if he has a recording app for his phone. I had to use that when I talked to the radiation oncologist, it was miles above my head and I needed to review it. Make sure you have a list of questions prepared before hand to. I found that really helped me organize my conversation.
    Slow and steady is the way to go. The L insulins teach you patience. I would hold each dose at least six cycles (three days) at this point, and increase by 0.5 units if you don't see low blues. With low blues, you would hold the dose a bit longer. You did zip by the 5.5 unit dose, but that was probably OK. It does take the depot 4-6 cycles to stabilize, hence the need to hold the dose 6 cycles. It's great to see Rocket out of those blacks and reds now.
     
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  17. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Welcome back! Glad the surgery went well! Sending vines for your complete recovery and positive thoughts for Rockets upcoming SRT.
     
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  18. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Just a quick update - Rocket is home from his CT scan this afternoon. He's a little wobbly, but is up and eating :cat: Good news is, his tumor was visible in the scan, and we'll be going ahead with treatments starting this Monday. I don't know if this is the best photo to see what is going on, but we saw a few different views while we were there. Now for some rest. :)
     

    Attached Files:

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  19. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    It's great news that the tumour was visible. I know I was glad to know there was a positive ID on the acromegaly when I saw Neko's CT scan. The tumour also looks fairly regular in shape which should be easier for planning the radiation.

    Rest and recover, it's a long week next week. :bighug: The CT scan day is usually the longest one.
     
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  20. Bronx's dad

    Bronx's dad Well-Known Member

    Joined:
    Nov 30, 2016
    Just catching up on this forum, glad you decided on SRT Karen. I am very happy I made that decision, Bronx would probably not be here right now if I didn't. Yes, it wasn't cheap but down from 37u to 3u is a money saver if you look at it that way. But more importantly, Bronx is here and happy and finally regulated w/o a pulsing tumor, you can't put a price tag on that!
     
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  21. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Thank you so much... I’m so glad to hear Bronx is doing so well! I love hearing the success stories. That’s all we want, a healthier and happier Rocket. He used to be such an active kitty; he always had to be a part of everything. Hoping he’ll get back some of his old self. :cat:
     
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  22. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Ok we're a couple days away from Rocket's actual SRT. I just wanted to put this out there because it keeps rolling around in my head - we've been increasing his Levemir dose, with mixed results. Some days are better than others, but his numbers are all still too high. This morning was his 3rd shot at 8U of Levemir - if we keep going with increases, we would be going to 8.5 on Sunday morning (the day before his 1st SRT). Should we go ahead with the scheduled increase, or just stay at 8.0 since he'll be having radiation all this week? And what about during the week of treatment? Continue on to 9.0 on Wednesday?

    I'm also starting to wonder how it will be after treatment, and how those of you who have gone through this have handled changing numbers, especially with a depot insulin like Levemir. I realize change (most likely) won't happen immediately, but would like some ideas so I can be somewhat prepared. :)
     
  23. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    If you had been seeing greens or lower blues, I might be more cautious, but not where Rocket is at this point. Downward dose changes dues to SRT typically take at least two weeks, and many cats go up in dose for a while, maybe months, before SRT takes effect. I think I would go to 8,5, then hold it there.
     
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  24. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    That sounds like a good solid plan. Thank you Wendy.
     
  25. Bronx's dad

    Bronx's dad Well-Known Member

    Joined:
    Nov 30, 2016
    SRT vines for Rocket this week, it will be over before you know it! :bighug::bighug::bighug:
     
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  26. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Thank you SO much. His appointments are at 3:00 (Pacific time) each day, so I'll update in the evening. Just wish I could explain to him why he can't get any more food this morning! :)
    :bighug::bighug::bighug:
     
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  27. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Well, SRT pt. 1 went very smoothly! We're back home already, Rocket is just a little wobbly, but getting better by the minute. He's had a little bit to eat and is drinking water. Not much else to say except that everyone at the office was super friendly and kept us informed as to exactly what was going on, and how Rocket was doing. I'm feeling much better about the whole thing. Hopefully the rest of the week will go well too. :bighug::cat::bighug:
    IMG_4351.JPG
     
  28. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Hmm... we just now hit our first blue (146) since switching to Levemir. I'm assuming this is from the long day, little food, anesthesia, etc.? Gotta keep a good eye on him this week.
     
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  29. Bronx's dad

    Bronx's dad Well-Known Member

    Joined:
    Nov 30, 2016
    Day 1 down, great to hear it went well!
     
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  30. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Glad it went well! Hope the rest of the week is as smooth!!!
     
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  31. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Great pic of Rocket. I'm glad to hear all went well. I wouldn't sweat that blue - like you said, probably not enough food. Heck, it's probably good he got a break below the 200's! Go Rocket!:bighug:
     
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  32. Olive & Paula

    Olive & Paula Well-Known Member

    Joined:
    Sep 6, 2015
    Good to hear all is going well.
     
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  33. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Thank you all <3 Leaving for treatment #2 in two hours.
    :bighug::bighug::bighug:
     
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  34. Tina Marie and Jan

    Tina Marie and Jan Well-Known Member

    Joined:
    Jul 24, 2019
    Karen,
    Prayers and tears of joy for the beautiful and young Rocket! I hope all goes well :bighug:
     
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  35. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Following along on Rocket's treatment and wishing you great success! :bighug::bighug::bighug::bighug:
     
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  36. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Thank you! :bighug: Day 2 went well; we were home by 5:30 or so, Rocket ate, and a little later we went out for his usual sunset "walk" (he's harness trained). His numbers are still the same (of course, I don't expect anything to change this early), but interestingly he seems to feel better. Coincidence? He woke me up early this morning and seemed almost his old self. Even got snuggly. :) Unfortunately, he now knows something is up, and seems to have disappeared under the couch. We're not leaving for a few hours yet so it's all good.
     
  37. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    I'm glad to hear the SRT sessions are going well for Rocket. They were harder on Leo because of the travel and the hotel room - he was toast that week.

    Rocket's numbers can get adjusted after SRT. Rocket is pretty stable in general with his numbers. At least he got a couple of blue nadirs this week!:bighug:
     
    Last edited: Aug 14, 2019
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  38. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Ok! Day 3 update. Yesterday was tougher. We got there a little early like the previous days, but the office was busier and had an emergency critical case that came in (a beautiful Australian Shepherd - we saw him leave, and it looked like he was going to be ok). So, Rocket had to wait almost an hour before they took him in. Which was fine, but that meant going longer without eating, and we hit much worse traffic going home. Plus, I guess since it was his third day of anesthesia, etc., he had a harder time waking up than the day before. His blood sugar was low again (by Rocket's standards anyway) when we got home, but it shot up again like "normal." His appetite was good, and was this morning too, for the most part. He just seems more tired than usual.

    For what it's worth, I'm pretty pooped too. I have to keep reminding myself that I'm still recovering from surgery. I know I haven't been getting enough sleep, and I had some pain yesterday that is reminding me that I have to take care of myself too. =/ Luckily I'm feeling a little better today, and I have a great hubby who is doing the driving for us, and who loves to cook! Woohoo. Pretty soon this week will be over, hopefully evertying will have gone well, and we can do some serious relaxing this weekend! :)
     
  39. Idjit's mom

    Idjit's mom Well-Known Member

    Joined:
    Apr 3, 2018
    Karen, I've been reading along and tracking charming Rocket's new adventures. Please do rest some more and take good care of yourself. You are a lucky lady that DH is doing the driving and the cooking, a big thanks to him for being such a great guy.

    Best of luck and good fortune going forward. Soft head bumps and chin scritches to Rocket, healing energies and calming vibes for you and gratitude to hubby for loving and caring for you both.
     
  40. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Thank you so much, Lou. I read what you wrote to the DH and he really appreciated it too. I'll give Rocket some head bumps for you as soon as we get him out from under the couch - after three days of this he knows we're leaving in half an hour! :D
     
  41. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Rocket is almost done with SRT. YAY!

    The whole process is pretty taxing, but you guys are almost done now. The anesthesia was tough on Leo too. And the lack of sleep is challenging. I bet your household will be nice and quiet this weekend with everyone sleeping. :bighug::bighug::bighug:
     
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  42. Bronx's dad

    Bronx's dad Well-Known Member

    Joined:
    Nov 30, 2016
    Almost there Rocket...
     
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  43. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Man... I was not prepared for how mentally taxing this would be for me and my husband, as well as Rocket of course. It's hard to see Rocket so worn out. Today they gave him gas anesthesia instead of intravenous, which he recovered more quickly from, but his appetite was less tonight. Maybe it's just the whole week getting to him. I finally got him to eat enough so I was comfortable giving him his shot. Just one more, buddy, and we're done for now. Hang in there. We love you, little Rocket.
     
  44. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    You got this Rocket. One and done.

    Once you both get over this Karen, we will talk about testing, and when you can ease off a bit so you get more sleep. You are a super cat mom, but you need to care for you so you can care for Rocket.

    Total aside, cooking lessons were the best present I ever got my husband.:)
     
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  45. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Thank you Wendy :) That would be great; the next few weeks/months will be "interesting," and we'll definitely welcome advice if/when Rocket's insulin needs start changing. And yes, having to test a bit less often would be fantastic.

    I'm very much looking forward to tomorrow when things are a bit calmer. Rocket will be so much happier once he realizes we're not going to the Dr. AGAIN.

    I agree - husbands who like cooking are the best. Mine came that way (lol) but has only gotten better over the years!
     
  46. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Agreed - YAY! Rocket was feeling a lot better this morning, and his appetite was good. But, he's under the couch again right now - he's no dummy. :cat: Tomorrow will be a much better day, and hopefully much more relaxing. I can't wait!
    :bighug::bighug::bighug:

    edit: hehe, Jeff, I just realized I replied to your post twice. Did I mention I was a bit worn out? :D
     
    Last edited: Aug 16, 2019
  47. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Leo was toast after his SRT sessions. On the final Friday session I drove until midnite to get the first half of the drive back to Austin. You are basically doing a partial drive of that everyday because of the L.A. SRT location.

    Well, it is 5pm Friday. So this is the last SRT day for Rocket. I forecast sleep in your near future, and healing SRT vibes in the next months for Rocket. With luck, he will have a nice steep "down-slope" of insulin usage over the next few months.:bighug::bighug::bighug:
     
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  48. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Well, it’s almost 7 pm here in CA, and we’re home. :) Rocket has pretty much gotten over the anesthesia already, since the last two days they recommended we not give him Gabapentin. So, we’re outside, he’s on his harness, enjoying the sunset and watching some bugs.

    Thank you, Jeff. I hope Rocket has a nice (not toooo steep) slope down too. Just steep enough that it’s not too difficult to adjust his dose to changing numbers. I just hope this treatment helps him, that he feels more like his old self, and that we get to spend some good time with him in the months and hopefully years ahead.

    I’ll definitely keep this thread updated with news on how Rocket is doing. Thank you to all of you who have gone on this short, but emotional journey with us. :bighug::cat::bighug:
     

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  49. Idjit's mom

    Idjit's mom Well-Known Member

    Joined:
    Apr 3, 2018
    Good news Karen! Thank you for the update. I hope all of you get to relax and enjoy the weekend. :):bighug::cat:
     
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  50. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Just one more photo... I’m so proud of my little guy. <3
     

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  51. Idjit's mom

    Idjit's mom Well-Known Member

    Joined:
    Apr 3, 2018
    He's gorgeous, looks like he's enjoying life right now. He's been a good boy and we loves the little fuzzy knickers too!
     
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  52. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Hehe, thanks. Give Idjit another huggle from me. :bighug:
     
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  53. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Love the photos - he is photogenic indeed. And looking very well for a kitteh who just had a week of traumatic driving and vet experiences. Watching bugs outside can be a full time job for most cats.:bighug::bighug::bighug:

    LD is snuggled into bed with his Mom and the little doglets tonight. A nice regular habit that he has continued for the past month.
     
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  54. Idjit's mom

    Idjit's mom Well-Known Member

    Joined:
    Apr 3, 2018
    I need a soft velvety center pic fix Jeff, please. It's been awhile and I miss the family pics very much.
     
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  55. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Thanks. :) He's my little cutie. I love him to pieces. And I agree with Lou - we need some snuggly photos! :bighug::bighug::bighug:
     
  56. Tina Marie and Jan

    Tina Marie and Jan Well-Known Member

    Joined:
    Jul 24, 2019
    Karen - I'm so happy you and Rocket are finished with treatment, and I wish you and that gorgeous boy a wonderful weekend :bighug::bighug: The Acro kitties are super super special in my opinion. It can be heartbreaking to have such a special cat, but I imagine the bonding might be super special too.
     
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  57. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Love those pics! He's such a handsome little man! Scritches to Rocket for being such a trooper! mini-graphics-cats-915307.gif

    Hope you all have a very relaxing weekend!
     
  58. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Glad to hear Rocket is doing well, he's such a beautiful kitty, hope you are feeling better also
     
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  59. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Collecting a few cat-velvety-center pics over next few days. Little Dude is mostly hanging out in the house because it is 100 degrees everyday.

    Now Rocket is done with SRT, and the Acro healing can begin. At the least, Rocket is probably a very happy little man because he doesn't have to go to the vet everyday (for SRT). No more hiding Rocket!
     
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  60. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Thank you all. :bighug: This is a hard thing to go through, and it's wonderful having the support here. I feel better now that the treatment is done, but I'm really good at worrying and "what ifs," and I just wish we had known something sooner. So few vets know anything about acro. I'll feel better once I see Rocket's numbers come down a bit. His numbers have been high all day today, either from getting over the stress of treatments, or maybe bouncing from some of the low numbers he got this week. At any rate I just hope the treatment helps, and doesn't take tooooo long. I just want Rocket to feel better.

    Jeff, tell LD to stay cool, and we're all looking forward to seeing some cat belly! :p
     
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  61. Bronx's dad

    Bronx's dad Well-Known Member

    Joined:
    Nov 30, 2016
    The week is over! Bronx's numbers didn't go down too much at first, it ended up being a more gradual decline that took 2yrs. But ECID, many others drop pretty fast.
     
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  62. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Thank you Paul. Yeah, I know it won't happen right away. I'm just a little concerned, because Rocket seems a little lethargic today. I know last week was hard on him, and hopefully that's all it is. He was snuggly this morning, so there's that. :) Give Bronx a huggle from us.
     
  63. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    How’s he doing today?
     
  64. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    He was snuggly again this morning :) and he seems alert and happy, as much as any cat on a hot day, hehe. His numbers are still high, so I raised his dose to 9U this morning (we didn't make any adjustments during his treatment week). But overall he seems like he feels better, so that's a good thing. Thank you for asking. :bighug:
     
  65. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    So good to hear Rocket is feeling better
     
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  66. Teresa & Cricket

    Teresa & Cricket Member

    Joined:
    Nov 5, 2018
    Sounds like Rocket handled the SRT like a champ!
    Also, he's sooooo pretty!!!!
    All the hugs :bighug:
     
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  67. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    All the hugs to you (and Cricket!) too. Thank you. :bighug::cat::bighug:
     
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  68. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Good idea on the increase, let’s see if we can get a bit more blue back in Rocket’s spreadsheet and give his kidneys a break.

    Do we need an intervention on you using the AT meter? ;)

    Did the vet talk about any follow up plan after SRT? It is suggested to keep an eye on the T4 for a year after SRT. I did once a quarter as per CSU suggestion. A small number of kitties become hypothyroid after SRT treatment, it is easily managed with a pill if that happens,
     
  69. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Ha! Thanks - I have an explanation, I promise! :D I’m not home right now - I’ll post a little later when I have more time.
     
  70. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Ok, I finally have some time to sit and write a bit. Dr. Bommarito (the Dr. who did Rocket's SRT) had set up a consult appt. for us with an internal medicine specialist (and endocrinologist, I believe) who he has sent acro kitties to in the past. I figured she might not like the human meter numbers, so I got some spot checks with my AT over the last couple days, just in case. And boy, was I right. She really tried to discourage using the human meter, trying to explain that the numbers aren't going to be the same (I KNOW that; duh?). I tried (nicely) explaining about being more concerned with nadir than high numbers, and overall trends up or down, etc., but it's really hard to not come off the wrong way and either sound like I'm being combative and/or just stupid when talking to a "specialist." Oh! And she suggested only checking BG at shot times, and doing a curve once a week or so "if" his clinical signs aren't good. So, strike two. Strike three was when she tried selling us on prescription food. :banghead: I almost couldn't believe it. It was almost as bad as when we first went to our regular vet (who in his defense, is a lot better now).

    So, I guess I'm just going to continue what we've been doing, and I'm sure I'll have some questions for all the wonderful folks here if/when Rocket's needs start changing. I was hoping to get some input from her about lowering doses on a depot insulin, but nope. And whether we should consider switching back to Prozinc at some point. Anyway it was a frustrating and basically useless meeting. Have any of you seen specialists to help post-SRT?

    Thank you Wendy, for the advice on T4. I've heard about the (small) risk of going hypothyroid after SRT, but I didn't know what exactly to check for. Hopefully this is something that can be done at his regular vet.
     
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  71. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Oh boy on the specialist you saw! That was a “smile and nod” moment for sure.:rolleyes:

    The “specialists” I “saw” post SRT were folks here, plus I kept in email contact with the IM vet at CSU who was in charge of Neko. When you get to lower numbers, I can give you ideas on how to handle the depot. For now, I would stick with Levemir. I think it’s a better insulin overall for cats. To be fair, I did see an IM vet locally when Neko added lymphoma/heart issued to the acro and kidney list. I liked him, trained in Europe and seemed more knowledgeable, though I still debated with him. But he was willing to research for me so we worked together. Until I needed the IM expertise, I worked with my regular vet.
     
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  72. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Seriously. :facepalm:

    Thank you Wendy. It's too bad this meeting didn't work out. It was also a busy specialist/emergency vet and was very impersonal (very different from our experience at Dr. Bommarito's place). I'm so grateful to have the help here. Hopefully Rocket's numbers will start to get a little better, and I can bug you for some more advice. :cat:
     
  73. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Feel free to make another appointment with that specialist and flick them on the ear for me too!

    I got lucky. Our primary cat-only vet had personal diabetic cats, and experience with a lot of diabetic patient cats. Then an internal-only specialist we consulted with, pre-SRT, immediately recognized that Leo had Acro from his features. The specialist also gave us good advice. So we got lucky with 2 vets in Austin.

    I am glad to see those nice blue nadirs for Rocket, after months of struggling to get there. And meters - it seems like most of the FDMB members are using human meters. I used AT for Leo, but got the Freestyle strips from Ebay. The human meters are fine too.

    Did you know JanetNJ did a informal study of AT2 with Alphatrak strips vs Insulinx strips? It's on CC's spreadsheet under the Insulinx tab. (CC link here) (Hi Janet!)

    You know what is missing from your posts - there are no big issues from Rocket after SRT yet! I hope it stays that way too!:bighug::bighug::bighug:
     
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  74. JL and Chip

    JL and Chip Member

    Joined:
    Dec 28, 2009
    Ditto that. I worked with the IM specialists here and we even sent blood to MI State several times for a comprehensive thyroid panel to determine whether Tubby had become hypoT. His results were questionable and even the experts didn't agree on the interpretation.

    I'd also monitor kidney values closely (including a baseline SDMA).

    I've been following along quietly, btw. Good luck!
     
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  75. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Me too!!! Thanks :cat: And I had seen Janet's chart before, but I was looking for it a couple days ago and couldn't find it. Thanks for the link. :)
     
  76. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    This helps too. I'm making a list of things to follow up on. Thank you. :bighug:
     
  77. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    A67E48BC-624B-460F-9364-32E6D38DB922.png
    Yeah the chart is part of my spreadsheet. Here's a a screenshot. I wish screenshot posted clearer. Anyway it's in ccs spreadsheet link under the insulinx tab. The insulinx strips are usually very good... I even use ones that are expired by less then six months and they have worked fine. I get them on eBay. I wait for a good deal. I haven't had to buy any in about 6 months because I still have about 20 50 strip vials. When I get down to 10 I'll start looking again.
     
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  78. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Thanks Janet! I checked eBay a while back but there weren’t great deals at the time. I do like having the AT, even as just a backup.
     
  79. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    @Wendy&Neko
    And anyone else who’d like to chime in...

    I’m up early, because Rocket decided to hit a 99 at PM+8.25, and a 73 at PM+9.5. He’s never been this low. I decided to feed him some of his regular food (not high carb) and test again in a bit. PMPS last night was 321. Big bounce incoming, you think? Not sure how much to shoot at 9 am today.
     
  80. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    :D Nice numbers!
     
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  81. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
  82. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Thanks! :) But it's shot time now, and I'm kind of lost. Delaying for now at least.
     
  83. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Delay is good. See if he’s rising or still dropping. This was always the hardest part with Colin and I didn’t have SRT to factor in!
     
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  84. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Acro kitties sure like to keep us on our toes. :bighug::bighug::bighug:
     
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  85. Bronx's dad

    Bronx's dad Well-Known Member

    Joined:
    Nov 30, 2016
    And they are tough cookies for sure!
     
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  86. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    A little update... we're just eight days post-SRT, and Rocket is doing something, but I don't think he knows what yet. :cat:

    He's hit some nice / interesting numbers in the last few days. I'm happy to see those numbers, but... man is he bouncy right now. One hour pre-AM shot on Aug 21st he hit an all-time low of 62. I toyed with the idea of giving a half dose, but ended up skipping to be safe. I mean this was only the second time I've seen green on his chart since we started keeping track. And, of course he ended up in the red by the end of the day. :(

    He went low-ish again pre-shot two days later, and I tried giving a reduced dose. Boom, in the red again at the end of the day.

    This morning started off nice, with a 134... again, 1 hour preshot. This guy's gonna give me a migraine lol. Knowing that he was probably going to bounce back up, I just gave him his full 8.5u dose (and knowing I would be home all day). And now, about 7 hours later, he's in the mid 300s again.

    What do you guys think? Are these just normal bounces; do I just hold the dose until the roller coaster stops? Or is this a result of the SRT treatment already, and I have to get used to the idea of his numbers being wonky for a while? It's hard when his nadirs are at +11 and shot time. Like I said, I'm happy to see greens and blues, but it's scary that he's so unpredictable, and that his daytime / overnight cycles are so completely different. :confused:
     
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  87. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    These are “normal” changes due to the upset in the depot from missed or reduced doses. Looks like Rocket also likes to nadir near preshot like my girl did. Takes some used to shooting low. There is a phenomenon we call New Dose Wonkiness that results in temporary high numbers for a cycle or two soon after an increase, could be seeing NDW today. Plus he still isn’t used to blue, could be a bounce component.
     
  88. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Thanks Wendy. I’m lucky that I’m not working for a few more weeks, so I can keep an eye on him.
     
  89. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Hopefully in those couple weeks you'll see enough good numbers to get a feel for when Rocket needs extra monitoring or food. If not, you can always be extra cautious about reductions until you can monitor more on weekends.
     
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  90. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Ok, I'm really not liking Rocket's spreadsheet last few days. After looking like something good was starting to happen, he's been high and flat-ish since the evening of the 24th. This morning was his 3rd shot at 9.0U - should we increase early, or still hold for 6 cycles before increasing? And at this point, increase to 9.5, or maybe 10?

    Also, something I don't really want to risk, but I'm starting to wonder if we should consider Novilin R if this continues. :(
     
  91. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Continue to hold the dose, at least six cycles. There is a phenomenon called NDW or new dose Wonkiness that gives higher numbers in the first few cycles after an increase. Patience is rewarded. :)
     
  92. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Thank you Wendy. +10 is even worse. Frustrating... he's eating well, so that's good, but it's crazy-making.
     
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  93. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    You are being impatient and increasing after five cycles. Give it six so the depot has time to fill. Rocket will find his good numbers soon enough. :bighug:
     
  94. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    :oops: Yeah, I guess we are getting a little impatient... my husband said to blame him (lol!). Just yesterday we noticed what might be the start of neuropathy in his left front leg too, so that ups the stakes a bit. I hear you though... he's just been high and flat for so long. Hopefully this dose will be ok. I'm monitoring very closely. Thank you. :bighug:
     
  95. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Ok, so Rocket has been on 11u for 8 cycles now. Yesterday we finally had a breakthrough - he was in blues from the early morning thru the afternoon. Yay! And then... the inevitable bounce. Last night he hit 426 at his PMPS, and is at 378 right now. His AM shot is in 2.5 hrs... do I hold the dose and wait for the bounce to clear? Or increase today? If we hold at 11u and he stays high, how many days til increasing? Still unsure how to handle bounces (obviously). Rocket just loves those high numbers. I’m assuming the acro makes this much more complicated. :banghead:

    Edit: I’m not looking to get perfect cycles right this minute; I would be happy to see if we could get those blues back for now, and not be so darn bouncy.

    We had a good follow up appointment yesterday with the Dr. that did his SRT. I’ll update a little later. For now I’m going to get a bit more sleep. :)
     
    Last edited: Sep 4, 2019
  96. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Mostly ignore the bounces. Just try to avoid the increase on a cycle they are breaking the bounce because there can be extra downward momentum. You are fine to increase today. You have seen what 11 units can do, and it’s better, but not quite enough.

    Those blues were lovely, maybe a little more juice will bring down the highs and make the blues last longer. That’s the only way he’ll get used to them and stop bouncing as much. Being acro doesn’t make much difference to bouncing, just can take a higher dose to get to the point where they get used to normal numbers again.

    Looking forward to the vet visit report.
     
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  97. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Thank you Wendy. I saw your post right before shot time, so he's now at 12u. Fingers crossed for a good couple of days. Should I post these kinds of questions in a separate post, and not in Rocket's general SRT thread?

    I'll write about the vet visit this afternoon when I have a bit more time. No major news, just some info.
     
  98. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Dosing questions should be a separate thread, otherwise the thread on SRT gets kind of busy. My suggestion is posting dosing quesitons in the Lantus/Levemir forum, to get more eyes on you. Not may of the people comfortable with aswering dosing questions monitor this forum. And I'm not always around. The flip side to the L/B/L forum is that you might get answers from those not familiar with high dose cats. Read their signature and spreadsheet to see if it's someone you want to listen to. There are a couple of senior members who can still provide good advice, in spite of not having acros themselves.
     
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  99. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    So the week got away from me, and I forgot to post about our follow up appt. last Tuesday. :cat:

    Not much to report really; Dr. Bommarito took a look at Rocket, and asked how he was doing. We let him know that Rocket was pretty much the same; appetite good, etc., but his BG numbers are still high and flat, and that we are still increasing insulin doses. He said that it could take 4-6 weeks or more to start seeing improvement (which we knew already, of course). He said we shouldn't expect to see any negative side effects (hair loss, vision changes, etc.). He knew we were not happy with the IM Dr. he had referred us to, and we talked about that for a bit, as well as the state of veterinary medicine in general (mainly independent vs. corporate-owned hospitals), and he gave us a couple more names in case we decide we need an endocrine specialist in the future.

    We talked again about his past experience with acro kitties (which we had done in our consult appt. too) -- I don't have exact numbers unfortunately, but he's had a few go into remission after SRT, and a few that had insulin needs reduce markedly. I asked if any had come back to re-do the procedure -- he said only one had ever come back for re-imaging, but that cat had a larger tumor to begin with, and ended up passing from other causes.

    Overall it was a good visit; we like the Dr. and I would recommend him to anyone in the area. Now we just have to wait to see if Rocket will start responding... we keep increasing his dose, and I'm getting a little nervous about what that big depot we're building will mean if Rocket does start dropping. Have any of the SRT kitties gone back to an in-and-out insulin like ProZinc once they started responding to treatment?
     
  100. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    You could be the first!

    I'm glad to hear that Rocket is doing well. And particularly that there have been no SRT bad side effects (yet). They listed some of them at CSU, and none of them happened to Leoberry either.
     
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