Would you put old-man Bronx through major surgery?

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Bronx's dad, Aug 11, 2018.

  1. Bronx's dad

    Bronx's dad Well-Known Member

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    Nov 30, 2016
    Hello all,

    Bronx is scheduled to go in for MRI and Echo on Friday in NYC to see if he is eligible for surgery to remove his pituitary gland and tumor which will be major surgery. He is 12 and has probably had acromegaly a very long time before I caught it. He has trouble walking around due to the excessive bony growth and his organs are still functioning ok, even though all enlarged. Pancreas is not great due to it working overtime so many years. None of this will be reversed from the surgery. Doctor said he will most likely never go OTJ since his pancreas is damaged from fighting for so long. How many more years will he get if he survives the surgery ok, who knows? He will have to be on hormones the rest of his life after the gland is removed and I have no idea how much money that will be or if there are side effects. They say acromegaly causes headaches and that must be awful if true. Folks who had successful surgery in the UK said their cat's personality goes back to the way it was. Bronx basically just eats and sleeps and cries to me all the time for more food. He does not hang with me much at all anymore and never plays around either. These things, and the headaches, could be reversed with the surgery. But he is 12, who knows how playful he would be even if he was a completely healthy cat?

    However, doctor said there is a good chance they won't be able to do the surgery since he had SRT (radiation) which may have caused tissue damage and the surgery could cause excessive bleeding and he would die on the table. Doctor does not know of any kitty getting this surgery after SRT. Tests on Friday will cost me over $2K and are not covered by any donor $. He does not seem miserable and purrs when I pet him & purrs even louder when he's eating :rolleyes:. Do I put him through this? Surgery itself ($18-20K) will be covered by donor funds. But why have old-man Bronx use those funds when there are probably so many younger kitties that can be helped with these funds? And there is a good chance I pay out over $2K to just find out they can't do the surgery. What would you do? Please be completely honest, thanks!!!
     
    Last edited: Aug 11, 2018
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  2. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

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    Had you thought about raising these questions with the group in the UK that has been doing so much research on acro?
     
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  3. Bronx's dad

    Bronx's dad Well-Known Member

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    Nov 30, 2016
    I do belong to the Acro group on FB and many of the folks in the group are from the UK who had the surgery. I will post the same question over there, thanks for the advise.
     
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  4. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    You obviously care a lot about Bronx. You got him the SRT. Most people don't.

    Bronx is only 12. You said he is fairly healthy. But I looked at his spreadsheet. He looks hard to regulate. Leo has been hard to regulate as well. I would coach you to stay the dose for 6 doses. There seems to be a lot of changes there. The reason I'm spending time on this - you could focus a lot more energy into trying to regulate him. It does take a lot of time and testing. And with bouncy cats it is not easy. That might make him feel better. We all know many Acro cats can't afford SRT or pituitary removal. They don't live to be 20, but their owners still love them.

    Would you consider SRT again? That would be less expensive. And probably less potential for mortality.

    Since the doctor mentioned potential mortality on the table, it would be an iffy decision for me. I would rather have a partly sick Leo, than a nice wooden box on the shelf.

    Since he is purring, and still fairly healthy, I probably wouldn't have it done. But I could be wrong, and Bronx could get the surgery and come out a 100% success story. Leo isn't a kitten anymore. He mostly lays around too. Both Leo and Bronx are 12 years old. I play with Leo sometimes and he responds. So it is some of my laziness that he doesn't play much. And some of his too.
     
  5. Olive & Paula

    Olive & Paula Well-Known Member

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    Sep 6, 2015
    I'm sort of in the same boat. Exception is Olive hasn't had SRT. We don't know her age and since she has the other abdominal mass she might not be a candidate anyway. But also find out if they can treat both. She is doing better with the insulin now. And a vet is willing to start cabergoline as long as I release them of all liability. Still the mri is pricey and if nothing can be done do I want to spend that money or use it to pay for insulin and cabergoline.
     
  6. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

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    Dec 28, 2009
    I think @Wendy&Neko has been in touch directly with some of the staff at the RVC. Perhaps she has a name she can pass along.
     
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  7. LizzieInTexas

    LizzieInTexas Well-Known Member

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    Jul 25, 2016
    As my dad used to say... don't put the horse before the cart. See what MRI and echo shows. See how he does with the trip.

    Give him plenty of scritches and kisses from me. :bighug::kiss:
     
  8. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Titan is owned by John and Irene. They live on Jersey Island (near France and Britain), pretty cool. Anyhow.

    I posted a summary of their RVC interaction. They posted the whole letter, and I summarized the letter in the post following theirs. The discussion is hypophysectomy (pituitary removal).
    Pituitary Removal by RVC - info <<<---LINK

    .
     
  9. Bronx's dad

    Bronx's dad Well-Known Member

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    Nov 30, 2016
    But do we even do that? No food for 12hrs & no insulin since they have to administer anesthesia. Stressful for Bronx & his dad & also the $2-3K...
     
    Last edited: Aug 11, 2018
  10. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Silly question, but have you asked Bronx what he thinks? I had to go through a lot of soul searching when Neko's tumour ramped back up. Some people use an animal communicator, but I spent some time observing and "talking" to Neko to see if it was worth going for treatment again. At the time, her CKD was still mild, heart just mildly thickened, the rest of her organs were fine, the worst for her was the arthritis. But between acupuncture and buprenorphine, she still felt good. She played with her toys, whacked the civvie, enjoyed the solarium and purred when we interacted. She liked hanging in her bed by my feet at the computer table.

    I did evaluate the treatment options at the time, including surgery, but it was too risky in 2015. The surgeons did not have a good track record. Options have thankfully changed in 2018.

    BTW, good read on the post Jeff linked, but read the original email too. It described contracindications and risks for surgery. Also described a risk if not all the tumour is removed. Makes me wonder if SRT didn't get all Neko's tumour and that's why it came back,

    I do think it's a good idea to get an echocardiogram, regardless of what you do going forward. So many acrokitties have surprised their beans with heart conditions, sometimes when it's too late. :( Heart conditions can be managed if caught in time. An echo does not need anesthesia, no fasting required.

    Jeff said enough about your dosing, I will mostly stay off that soapbox, you've seen what I have said before. Just one thought, Lev is a depot insulin, look at nadirs, not preshots. Have patience.
     
    Last edited: Aug 13, 2018
  11. Ana & Frosty (GA)

    Ana & Frosty (GA) Member

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    Jan 19, 2018
    Hey, so I did not read any of the other's responses, but I will tell you what I will do for Frosty, and what I would do for your cat. The answer is the same.

    I wouldn't risk it. I wouldn't do the surgery for him if there's a higher risk for him dying on the table, and I wouldn't want him to be the "guinea-pig" either.

    I do (abdominal) surgery for a living. Operating on someone after radiation therapy sucks. It usually takes longer, there is a lot more scar tissue and bleeding. Usually these are done for cancer patients and the chance of cure is worth taking the risk for them, but these are big patients, big bowels and other structures, and not the brain. Having said that, I wouldn't go through with this.

    I have gotten advice from friends, colleagues (human doctors), and family. Everyone tells me to GET THE WORKUP, but wait with the surgery. And I am like, why? Why am I gonna spend $3,000, put Frosty through anesthesia with to get the MRI, and then do nothing? It makes no sense. I would only do brain imaging if he is going to have surgery. Otherwise, I would rather put this money towards Vetoryl, his diabetic supplies, or his workup for his vomiting. It doesn't make sense to throw away this amount of money for information you probably already know.

    In Frosty's case (I need to post more about this in my own post), the vet thinks he has some concurrent GI issues - maybe small cell lymphoma or something else, that needs to be worked up. So I am going to focus on that, since there is no point in putting him through brain surgery if he is having other problems. A cat should be as healthy as possible going into an elective procedure, just like a human.

    I hope his helps. I know in your case for Acro, they could potentially do another SRT treatment. If he didn't have SRT already, I would say surgery would be a good option, but I don't think I would waste money and time, or risk surgery for a cat that is feeling relatively well considering the circumstances. If he was got forbid having neurological symptoms, r was really sick and miserable, and repeat SRT wasn't an option, I would say do it as a last resort. But sometimes in medicine, no matter how much we WANT to do something, less is more...

    Let us know what you decide.
     
    Last edited: Aug 11, 2018
  12. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

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    Jul 9, 2012
    This is a very personal decision. And a very hard one.
    Shadow had the ball of her left femur sheered off as a 5 month old kitten when my daughter ( age 5) rolled off the bed on top of the cat. She had surgery to go in and clean it all up ( nice straight cut) and my dh at the time didn't want our dd to think she had killed her kitten. But he put a cap of 1000 for that surgery. The price came in at 960 so we did the surgery. At the time we couldn't afford anything much.
    She healed from that surgery....
    then had resportive lesions and several more surgeries removing teeth.... about 2000 at a time. She became diabetic after having her fangs removed, all cracked and I was giving her those crappy treats that I didn't know were super high carb like temptations. I caught it early, and got her to remission quickly luckily. She then started growing a lipoma right on top of her rib cage belly side. We just had had one on our dog that was nothing and then suddenly it was full of cancer. I wanted her lipoma removed asap.
    It turned out to be an infiltrative lipoma which is supposedly very rare in cats. It was hard to remove as it had fingers inserted in muscle. The vet did his best to get it all and even took out muscle tissue. The chance of re-occurrence being pretty high.
    Then while still in remission, IBD started up, severe diarrhea for weeks but we did get past that... tried to change her diet but she wasn't cooperative with that. Vet wanted to do endoscopy to see if it was lymphoma or just ibd but if I couldn't get her on a new diet, I didn't know how I would beat that one. But I would have continued trying happily. Meanwhile, the prednisolone was pushing her back on insulin. She never liked that routine at all.
    Then a lump showed up on her tail base that I quickly had removed and it was a mast cell ... pre-cancer.
    Meanwhile, her hip issue was returning with lots of pain and she was also on adequan ( even tho' she had no joint in that hip) and bupe daily which she had a hard time tolerating and could only take the lowest dose . ( I wish cbd oil had been around then)
    We could see that she was in lots of pain, and she stopped sitting on me, or ever coming to bed .... She had basically moved to under the dining room table and only moved to go to the cat box and then went right back to her hard carpeted floor.

    I had promised her that I would not keep her just because I couldn't let her go.
    And the last picture I took of her, I saw the pain in her eyes. I spent a couple of nights under the table with her, gave her all her favorite foods like raw shrimp and crab legs but i don't think she truly enjoyed them as she previously did.
    I remembered the vet telling me that she wouldn't have a long life and would have difficulties when she got older. She had still been playing at 15 but now
    it wasn't happening. The xray showed severe modeling around the bone and there were fragments everywhere now. She needed the bone cut again and cleaning up all the fragments. There weren't absolutely certain that there wasn't a mass there.
    So she faced another tooth removal surgery, leg/pelvis surgery, endoscopy and she was 15 1/2 with possible lymphoma if we couldn't conquer the ibd question. When I looked hard at the picture of her pain, I knew it was time to set her free from all this .
    She hated the vet ever since that first femur surgery and would fight them tooth and nail. I always had to stay with her until she was knocked out.
    She was such a stressed out patient when she had to do anything at the vet's. She had been thru enough already.

    I look back and think that maybe I was a little quick but all I have to do is look at the picture of her in pain. There was no easy fix for her.

    Over time, we spent almost 30k on her treatments; I'm sure my dh would have balked at that if it had been all at once. He knew she had become my soul kitty after putting her thru the femur surgery. I nursed her back to being happy for so many years.

    The good times we had were precious, and I would happily march thru the diabetes stuff, the ibd stuff, but no one could fix her arthritis and pain from her missing femur and the likelihood of returning cancers. I wasn't going to win for her. And misery had set up a home with constant meds, shots, vet visits and pain.

    So it's a very personal decision of what you feel.... and what you can do to make it better....
    If a cat feels good, it will still play even at an old age...

    But when behaviours change , that is a sign....

    I agonized for years knowing the day would come before things started going badly.... and always told myself to just enjoy every moment we get together because it would end. I loved every day that we were together and I look forward to seeing her again. It's just a temporary thing that we aren't together.
     
  13. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    I just reread your first post. Neko was almost 15 when she had her second SRT, but also part Maine Coon so normally longer lived. 12 is still relatively young. The average age for an acro diagnosis is 11.

    Buprenorphine also helps headaches. Yes it's a opioid, but it made a huge QOL improvement for Neko.

    After a while I stopped having OTJ as my goal, and focussed on regulation or below renal threshold. Regulation should be your goal first for any diabetic cat, acromegaly or not.

    I believe you have the RVC email address already. With over 80 hypophysectomies done, they have way more experience than anyone else and might be able to comment on operating on any cat that has had radiation previously.
     
    Last edited: Aug 11, 2018
  14. Bronx's dad

    Bronx's dad Well-Known Member

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    Thank you all for taking the time to reply with some great input and stories about how you dealt with your own decisions with your kitties. This really helps a lot.
     
  15. LizzieInTexas

    LizzieInTexas Well-Known Member

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    Jul 25, 2016
    Please keep us posted. There is no judgement here. Only concern and support. Only you and Bronx can decide. :bighug: :kiss:

    Do you give Bronx B12 injections? I do think they help with Gizmo's energy level.
     
  16. Harley Baby & Michele

    Harley Baby & Michele Member

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    Jun 3, 2018
    During a discussion about medical advancements, a wise and dear friend stated: "Just because we Can, does not mean we Should".

    I love my animals to the depths of my soul and I have spent thousands of dollars over the years. I have cried gut busting tears over my animals. It breaks my heart that our pets are with us for such a short period of time. But, several things came into play when deciding how to proceed when my dogs and cats became ill. Finances. Although even if I had unlimited funds I still would not have done or do many treatments. Quality of Life, will they be pain free, happy, enjoying the life of a cat/dog? Or will they just exist? Side effects of treatment. Will there be continued medical issues, cost, surgery, tests. Will my pet suffer because I choose to expose him to a treatment. Delaying the inevitable. Will this treatment definitely provide a long, healthy quality of life.

    If I were in this situation, I would not do any further testing or have surgery. I would work to manage his diabetes. Then every day I would hug and kiss him and tell him how happy he made me by coming into my life. There are no guarantees in this life we have. One Day At A Time.
     
  17. LizzieInTexas

    LizzieInTexas Well-Known Member

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    Jul 25, 2016
    I told the IM vet.. "look, I am not looking for a magic pill or the fountain of youth for Gizmo, i am only looking to provide him with the best quality of life, for the life he has left" I think he finally got it after that.
     
  18. Beth 73

    Beth 73 Well-Known Member

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    Aug 2, 2016
    @Harley Baby & Michele ...” Just because we can doesn’t mean we should “...... that is powerful...thanks for sharing :)
     
  19. Tracey&Jones

    Tracey&Jones Well-Known Member

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    Dec 12, 2016
    That is a very hard and personal question. I have gone both ways. I have gone above and beyond for one of my droolers and the other 2 ...I kept comfortable as long as I could.

    The eyes comment @rhiannon and shadow (GA) , rings very true to me. Pets live in the day and now....1 hour is like a day to them.


    Based upon the information at hand, the likely hood of a better QOL, recovery time. For me, the money wasn't an issue in the sense if I had the means it wasn't a question of spending it.

    It sounds like you need some more input from the RVC.
    So no answer just hugs for you while you ponder your decision.
     
    Last edited: Aug 13, 2018
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  20. Noah & me (GA)

    Noah & me (GA) Well-Known Member

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    Dec 3, 2016
    That's not silly at all Wendy and it goes right to Ana's point.
    I've told the story too many times so this is as short as I can make it. Noah's mom, dad and three brothers all passed before the age of ten. Mostly from cardiomyopathy and it's complications. Noah has never had a hypo episode, hasn't had eating or diarrhea issues in years and with all his problems we've never once had to rush him to emergency. He also has cardiomyopathy and his heart is so enlarged it's actually torn the cardiac sac. About 4 years ago we found out ALL of Noah's teeth needed to come out but he only had a 10% chance of surviving the anesthesia. After losing eight cats, our dog and my mom in four years we just decided to let him live a pain free life and not put another animal through MRI's, needle biopsies and meds that half the time were the result of a misdiagnosis.
    We had no choice and had to board him in May at our secondary vet who has almost all the equipment an emergency clinic would have. We gave the doctor a very simple "End of life" statement. Noah panics when he travels so that was out of the question. He won't survive anesthesia so that was out. He was not to be poked and prodded unless it led somewhere positive where surgery was not needed.
    Noah looks a lot scruffier than his photos and has slowly lost a lot of weight over the years but we've just come to accept that he's a lucky boy and we're thankful that he reacts well to his transdermal BUPE. Cardiomyopathy is a nasty way to go. There will be 24 to 48 hours of labored breathing and that's it. Don't get me wrong, we have spent mortgage payments on our animals but sometimes life just sucks and there is nothing you can do about it.
    Wendy is not nuts, ask Bronx what he wants.
    Ana is in the medical field so she knows what she's talking about.
    Every morning I don't have to search for Noah is a blessing. We haven't given up on him, we just asked him what he thought and he said "Why don't you just let me take my chances".
    It's not about guilt, money or regrets. I know that's not an answer but after a lifetime of "saving" cats this is how we saved Noah and it's worked for us.
    If anyone is sitting near wood could they please knock on it and maybe send Noah some scritches while you're at it. Noah says thank you.
     
  21. Phoebes

    Phoebes Well-Known Member

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    Jan 16, 2017
    So in touch with that. Beautifully written. Something not only Paul needed to hear. Thank you for sharing your pain.
     
  22. Bronx's dad

    Bronx's dad Well-Known Member

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    Nov 30, 2016
    After much thought and the great input from all of you, I decided to call and cancel the appt. I weighed all the pros and cons and the unknowns and everything points to not doing the surgery. Some great posts in this thread, hopefully it also helps other beans in similar situations with their kitties.

    Thank you all so much for making me feel like I made the right decision :)
     
  23. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    This has sparked an amazing discussion. It helped Bronx's dad but everyone else too. :bighug:
     
  24. Noah & me (GA)

    Noah & me (GA) Well-Known Member

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    Dec 3, 2016
    You are absolutely right Kris. My sister once told me how much surgeons love to operate. "It's what they do". I have an honest doctor who urged me NOT to have surgery for something simple because the truth was it would be incredibly painful and probably wouldn't solve anything.
    I trust vets much more than human doctors but there's still this desire to fix everything without asking anyone if they want to be "fixed".
    I have Trigeminal neuralgia, Chiari malformation, cluster headaches and some other whacky neurological stuff. It's basically like winning the health lottery in reverse. It cannot be "fixed" and I'm fine with that. It's why I write in short sentences, get off track and why I get so emotional but it just is what it is. I don't need fixing and since this happened to me I've become much more dedicated and aware of the health of our animals and my family.
    There is a fantastic book (and a documentary on PBS Frontline) called Being Mortal by Doctor Atul Gawande. He was absolutely determined to save a woman from terminal cancer to the point where only the numbers and results mattered. In the end he deeply regretted the steps he took (all ethical) because he forgot there was a human being at the other end of all the radiation, chemo therapy and never-ending trials. She just got sicker and sicker and never had a single day to just enjoy a sunset or hold a laughing baby. In the book he talks with the husband about balancing the will to live against accepting fate and learning to live with that.
    It's not about giving up, letting nature take it's course or putting your faith in the hands of God. I don't know what "it" is, I don't think anyone does.
    I didn't want that to be about me but the story would have no meaning otherwise.
     
  25. Amanda & Shmee

    Amanda & Shmee Well-Known Member

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    Feb 18, 2018
    Awh Bronxy baby... I know you love him so much. In this situation I think surgery would sound way too scary for me too. I think you are making the right decision. :bighug::bighug::bighug:
     
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  26. LizzieInTexas

    LizzieInTexas Well-Known Member

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    Jul 25, 2016
    :bighug:
     
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  27. Phoebes

    Phoebes Well-Known Member

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    Jan 16, 2017
    :bighug::bighug::bighug::bighug::bighug: extra scritches for furbaby.
     
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  28. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Now that you have a future for Bronx, you can possibly devote more time to testing and dose stability.

    I see he is basically 15.0 units - 16.0 units since 8/6. Jeez what a challenge. He is bouncing all over the place. Maybe strict feedings will help. Just a suggestion.

    I always felt bad that Bronx didn't have a good response to the SRT. That is such a large commitment, and it should have worked out better.
     
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  29. Bronx's dad

    Bronx's dad Well-Known Member

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    Nov 30, 2016
    Thanks Jeff. And I had a bad feeling he wouldn't have had a good response to the surgery either. He was at 37u at his worst before the SRT, so it hasn't been a total failure. I think I just caught the acro too late and the tumor had taken too strong of a hold on him.
     
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  30. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    That is a really good point - the Acro for Bronx was well developed. As soon as Leo started ramping, I reached out here real fast, then acted on it.

    I'm glad that Bronx is now using less than 50% of his pre-SRT dose. You might get lucky and maybe he could decrease again back to 8.0 or 9.0.

    You actually had him pretty well regulated in April 2017 leading into the SRT. Maybe he will settle down and become a little easier to regulate again. At least I hope so.
     
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