? 9/16: Oren acromegaly update and a question..

Hi all,
once again, excuse my long absence. So much going on here lately w/ visits, and travels and holidays etc. But in the middle of it all, I came to a decision to try and pursue Oren's acromegaly treatment. To that end, I've also been researching like crazy. After talking w/ NC state university and pretty much figuring that's where I'd end up, I somehow stumbled on a new option, right here in VA, in the DC area. It is called The Oncology Service, and they actually have 4 locations, 3 in DC area and one in Richmond, where I live. Sadly however, the Richmond location doesn't yet do the radiation treatments. So I will need to travel approximately 100 miles , which is comparable or perhaps a bit less than the 2.5 hr out of state to NC. The cost also seems to be comparable, or perhaps just a bit less.

This facility is an oncology practice only, with extensive diagnostic and treatment options, including SRT and other radiation options. I have only been in contact via email so far, but intend to call to make a consultation appointment for within the next month or so, by Oct 16 or the 23rd perhaps.

Oren has been holding his own, but has been upped to 9.5u and still not getting nadirs better than occasional mid 100s lately. Tomorrow is 1 wk. on 9.5u and so I'll likely up him again to 10. He's getting close to the end of his current Lantus vial, and previously many of you had mentioned switching to Levemir might be a good option for him. My question is, if I'm going to switch, do I need to worry about being around to closely monitor him for several days? weeks? From reading other posts I've noted that most kitties don't seem to require too much time to adjust to the switch. I have two periods of travel where I will need to be gone for 5 days during first week of Oct, and 2.5 days near the end of Oct. I'm a little nervous about making a switch and not being around. I'd guestimate I have roughly 1/4 bottle of lantus left; so it's still probably enough for through the first period of travel at least.

am I better off just sticking w/ Lantus until after his consultation appointment? I likely can't pursue the full treatment in Oct, due to my schedule, but would hope to begin in early November. The timing for all this is a bit tricky, of course, as nothing about sugar kitties seems to be easy!

I hope all kitties and their beans are hanging in there, and I apologize for being a bit out of the loop of late. Such a whirlwind lately... (@Wendy&Neko I did see a naughty, ugly black creep into Miss Neko's spreadsheet recently, I sure hope she has settled back down?!).

 

I cannot advise you on the insulin switch but I am a neighbor (in Silver Spring MD) and expect to get Hyde's IAA/IGF test results this week. Springfield VA would be much closer to us than NC or NJ/Yonkers. I am also thinking of switching her insulin when this vial is done.
I'll be watching this thread with anticipation

 

Anne; yes indeed!! They also have a location in Leesburg (ETA; this is the only facility that offers SRT) though the Springfield does full course radiation treatments. I used to live in Silver Spring (Wheaton actually) about 20 years ago! but only for about 9 months...
I'll keep my fingers crossed for your results for Hyde... I suppose you already googled the name, since you knew there is a Springfield location, but for any others who may benefit, here is the link to the facility: http://www.theoncologyservice.com/index.html

 

I'm tagging @julie & punkin (ga) and @Wendy&Neko -- they should be able to give you more information about switching from Lantus to Lev in an acro kitty. @Marje and Gracie also switched over and Marje will have perspective on the timing.

 

I'm also going to leave it to the acro-knowledgable (Wendy and Julie) on whether you should wait until after treatment to switch. Wendy might be most helpful on that as she did switch Neko from Lantus to lev but I don't know the timing in relation to her SRT.

But...when you do decide to switch, you would shoot Lantus one cycle and levemir the next so there's no gap. I would recommend starting levemir on a morning cycle. Normally, we would shoot 70% of the Lantus dose but I'd like Wendy and Julie to discuss dosing with you because it could be different for an acro kitty.

Because you might get some action on the first shot of levemir, than the first cycle or so might be active. That's why we back the dose down just a tad. However, I did not experience this with Gracie and it is not something that happens to every cat. Still, it is very, very smart to be there and monitor closely on the day you switch just in case.

After that, you wouldn't expect to see any huge changes occur quickly. Before I switched Gracie, Jill told me it could take several weeks to a few months to really see her adjusting to lev and she was correct. In fact, I dropped her dose by 30% and then when she didn't drop down the first two cycles, I fast tracked the lev dose up to what the Lantus dose was and actually ended up having to go a little higher per the protocol before we started seeing changes.

I hope that helps...please feel free to ask as many questions as you need to. Wendy and Julie are a wealth of knowledge as is Suzanne but Suzanne just had a sweet baby girl so she's probably not on the board much right now.

 

Hi Megan, good to hear from you and Oren. I am glad to hear you are investigating treatment options for Oren and that there is something close by for you. SRT is so much better than regular radiation therapy for several reasons, not the least is that you can get it all done in four days vs. having to visit every week for a while. I'd be interested in asking the facility how many acrocats they've given SRT to. One of the reasons I went with CSU is the amount of experience they had at the time. You can't get a better expert in the US than Dr. Lunn. Course, I only had about 1400 miles of driving to do.

I switched Neko to Lev about a year after she had SRT. The reason had nothing to do with the size of the dose, I was desperately trying everything I could to switch her pattern of low at night and bounce during the day. However, once I switched, I was glad I had. Her good dose on Lev at the time was just a smidge under what her Lantus dose had been. The only frustrating thing was learning Neko's cycles on Lev. I felt like a newbie again for about a month.

I don't think it makes too much difference when you switch to Lev. A couple things to consider. As mentioned before it'll take a while to figure out what Oren looks like on Lev. Second, SRT can start changing the dose requirements anywhere from 0 to 3 months later. Neko started seeing changes immediately, but that's unusual. Some kitties still have to do increases for a while before SRT changes take effect. I think the most important consideration is picking a time you can monitor a little more closely for a couple of days. Some acro kitties with IAA seem to have a kind of breakthrough when they switch from Lantus to Lev. Suzanne's Cobb did, Suki's Crystal did not. ECID.