Post SRT_Follow-up CT Scan? | Feline Diabetes Management Board

Post SRT_Follow-up CT Scan?

M

Madm4444

Member
@Wendy&Neko

The radiation docs indicated that Buster should get a follow-up CT scan after 4 months. We are into the 4th month now. Does that timing sound reasonable to you?
 
Total waste of your money. If for example the tumour size is the same, did it grow for a while before going down to the same size? Did it not change? The good folks at Colorado State University (one of the original places doing SRT) told me that it wasn't something they recommended. I just don't know what a rescan would tell them and more importantly, what they would do differently with that data, In the mean time, Buster would have to undergo anaesthesia, a long one again. With acros, I strongly recommend reducing anaesthesia to those medically necessary. I've seen too many have hidden acro heart conditions found during anaesthesia. 😭

I do see that Buster is responding to the SRT and keeping you busy! In a good way. Look how much his dose has gone down.

I'd buy into blood work to make sure his T4 levels are OK, that should be tested every 3 months for a year after SRT as a small % of SRT kitties go hypothyroid after treatment.
 
Wendy&Neko said:
Total waste of your money. If for example the tumour size is the same, did it grow for a while before going down to the same size? Did it not change? The good folks at Colorado State University (one of the original places doing SRT) told me that it wasn't something they recommended. I just don't know what a rescan would tell them and more importantly, what they would do differently with that data, In the mean time, Buster would have to undergo anaesthesia, a long one again. With acros, I strongly recommend reducing anaesthesia to those medically necessary. I've seen too many have hidden acro heart conditions found during anaesthesia. 😭

I do see that Buster is responding to the SRT and keeping you busy! In a good way. Look how much his dose has gone down.

I'd buy into blood work to make sure his T4 levels are OK, that should be tested every 3 months for a year after SRT as a small % of SRT kitties go hypothyroid after treatment.
Click to expand...
He's hanging in there. Better than me, I think. 🤪
We had the bloodwork done with the IM doc. He's thrilled with how well Buster is doing. But, unfortunately, didn't have anymore insight about the neuropathy. He was not concerned about any of the blood test results.
Here are the highlights:
Total T4: 2.2; Free T4: 1.0. Both within range.
Potassium: a little low at 3.6. (3.7-5.2)
BUN: a little high at 39 (16-37) but Creatinine and SDMA are within range.
AST: a little low at 14 (16-67)
SpecFPL. Ugh. Still higher than normal at 6.4. (0-4.4)
Cardiopet proBNP. Good at 57 (0-100)

I'm a little surprised he didn't suggest a potassium supplement to help with the neuropathy. I'm going to circle back on that one.

Also, I misspoke about the scan. The radiation facility suggested a follow-up MRI. Isn't that even longer under anaesthesia?

I've had some more dosing issues. I lost my patience pants. 🙄
I'll post those on the ProZinc forum.
 
Correct, an MRI is even longer, and more expensive. Again, waste of time and money. Save those anaesthesia sessions for when they are really needed.

Buster is keeping you hopping! Looking really good at this point in time on his insulin needs. Too funny on the patience pants, get a nice comfy pair on.

Is Buster getting Zobaline or other Methyl B12 supplement for the neuropathy? Has arthritis been ruled out? Also agree with you on the potassium recheck.
 
Wendy&Neko said:
Correct, an MRI is even longer, and more expensive. Again, waste of time and money. Save those anaesthesia sessions for when they are really needed.

Buster is keeping you hopping! Looking really good at this point in time on his insulin needs. Too funny on the patience pants, get a nice comfy pair on.

Is Buster getting Zobaline or other Methyl B12 supplement for the neuropathy? Has arthritis been ruled out? Also agree with you on the potassium recheck.
Click to expand...
Thank you for your insight. I don't want any more anaesthesia than is absolutely necessary.

I'm hopping, alright! We had a string of low Libre numbers last night but AT checks were above 100. We've decided to use AT 80-90 as a reduction point (just included that info in my reply to @Suzanne and Darcy also).

Regarding the neuropathy, it's taken a bad turn in these last couple of days & it's breaking my heart.
I have been giving him methyl b-12 plus folic acid since March with no improvement - just getting worse. Even though the ingredients are the same, I finally decided to give him the actual Zobaline product. Yesterday was Day 2 of that. I have a call into the IM doc to ask about the potassium. Not sure about arthritis. How would they test for that?

I'm back to wondering if all the bouncing is making the neuropathy worse & Lantus would be better. Except I see spreadsheets with bouncing on Lantus, too, so my head is spinning on this one. Any thoughts?
 
Last edited:
Madm4444 said:
Yes. Hold onto your hat for last night's update.

I did not reduce his dose as both AT values were above 100. I think we've settled on reduction with AT 80-90. Does that sound right?

I hope every verything is going okay with your baby. I know you've had a lot going on.
Click to expand...
I believe that’s the reduction point we may have discussed before (Alpha Trak around 80-ish). I like to see that he got back to work last night with those lower numbers. His bounces seem to clear faster now. Any improvement in the neuropathy symptoms?

Thanks for remembering my cat Grace’s issues (seems I always have cat issues, but these have been particularly challenging.) After diagnostics and surgical explorations at my regular vet yielded no answers (with head radiographs showing something nasty in her sinuses and head) we took her to University of Georgia last week for CT scan, rhinoscopy to obtain biopsies, and some other tests (ultrasound, thoracic radiographs.) The good news is that no neoplastic cells were detected in the histopathology (so no cancer) but the treatment for lymphoplasmacytic rhinitis (which is what they say she has - an inflammatory condition that is autoimmune, I believe) is still radiation — since lymphocytes are very sensitive to radiation. They want to do a ten day course of radiation (Monday- Friday for two weeks) which is the standard treatment if lymphoma or adenocarcinoma are present. Since getting the results on Friday, I have been doing a lot of research and have decided to see if they will agree to a shorter course of radiation treatment that’s been used at Michigan State University and now other places. It’s a lower dose radiation treatment that’s 6Gy of radiation (three fractions of 2 Gy each day for three days.) There’s less chance of side effects and it can be repeated if symptoms return over time. Either way, it’s not curative as there’s no cure, just symptomatic control. They can’t give me any estimates of how long the ten day course of radiation would help either.

That’s more than you ever wanted to know! I’ve been very busy and stressed, but I was encouraged to see Buster’s spreadsheet this morning!
 
Arthritis is sometimes diagnosed with x-rays. With Neko, even I could feel her bony lumps. So just a physical exam.

I presume Buster is eating well? If not, that can make lower potassium worse.

@Suzanne and Darcy Your clowder is teaching you a lot! Sounds like what MSU is offering is much closer to SRT with the 3 days and 2 Gy each day. The other difference with SRT is that the beam of radiation moves around to different angles, so only the affected area gets the full force of the radiation beams.
 
Hi. Thank you for checking in! Buster is really keeping us on our toes. Especially the last couple of days.

I've been trying to be patient to let his pancreas adjust slowly & tell us when it's time to reduce. We got there yesterday. But then, his BG stayed low all night so we reduced again this morning. It looks like he is on the rise to yellows. That might have been too fast but this is unfamiliar (albeit, fantastic) territory. With all these lows, I've really been worrying about hypo. Wow. Did you ever expect to hear that statement from me?

To be honest, I've been afraid to discuss his numbers these past couple of weeks (not just here, with anyone) b/c I didn't want to jinx it. I know, crazy. 🤪

He's in good spirits even though the neuropathy is hindering him. He has been on Zobaline (the actual brand, not my homemade version) for 3 weeks now. He can still do small jumps (ottoman). He can climb his small stairs easily (we have them all over the house). The house stairs are more of a challenge. We use them to 'exercise.' He takes them quickly but then loses momentum & sometimes needs help with the last 1 or 2 steps. But, every once in a while, I will be upstairs & he will appear on his own. It warms my heart. He is such a trooper.

I hope things are going well with Grace & your other babies. I know you have a lot on your plate. 😻
 
Wendy&Neko said:
Arthritis is sometimes diagnosed with x-rays. With Neko, even I could feel her bony lumps. So just a physical exam.

I presume Buster is eating well? If not, that can make lower potassium worse.
Click to expand...
I just posted an update but I realized I never responded to you regarding Buster's eating.

He is still eating well. Interestingly, these last few days at such low numbers, he has been much less aggressive about eating. We have had to stall several times & he's been 'pretty good' about it. I'm hoping these changes are indicative of a healing pancreas & not something else... 😬

Regarding his potassium for the neuropathy, the IM doc does not want to supplement right now given all the positive changes in his bg numbers & heart issues. We plan to revisit this in the future.

We've had a lot of problems with the Libre sensors over the last few weeks so Buster has been to the clinic a lot. Accordingly, I'm trying to limit any extra vet visits.

Hope all is well with you. 😊
 
Madm4444 said:
I'm hoping these changes are indicative of a healing pancreas & not something else...
Click to expand...
I'd actually vote for the "something else", which would be the acro tumour fading or ebbing. Acros can often have a working pancreas. It's just the extra growth hormone causing the diabetes (with a few steps in between). Reducing the growth hormone output can means a lower dose needed, and less of those side effects like the savage hunger.

I agree that you want to be careful with supplemental potassium with heart issues. I'd explore the arthritis possibility and supplements or medications to help if there. They don't impact the heart. Neko had quite severe arthritis so I tried a laundry list of things for it, including acupuncture.
 
This is such a LONG ROAD! I am really happy to see the decrease to 7.5 and the fab numbers today. I would let this dose sit for a but and not be too hasty to go back up (within reason, of course, but just ride out the bounce if it happens.) I just feel like he’s really getting there. I guess it’s taken over 20 weeks to get to this point!

We are doing okay here in kitty land. Grace had her radiation treatments and we have seen some improvement, it will be two weeks post radiation on Wednesday and they told us it could take 1-2 weeks. She is eating a lot better on her own now so I think she also must be feeling better. Paws crossed. And as if that wasn’t enough, this week another cat was diagnosed as hyperthyroid. T4 over 10. I knew it was either diabetes, CKD or hyperthyroidism. Diabetes wasn’t likely because he just didn’t look or act the part. CKD also didn’t seem likely because he doesn’t even drink water much at all due to being on wet food and also his appetite is quite large. So I was kind of expecting the hyperthyroid diagnosis. Now we are waiting to hear from the facility where I hope to get the I-131 treatment done. It just goes to show you… it’s always somethin’ :) It goes with having senior cats, I guess.
 
Well, Buster went low again for most of last night. The lowest ever with AT3: 77.

Based on the low values, we took another reduction to 7 units. Now, he's all the way up in the high 300s & unhappy.

Was the reduction a mistake? Should we go back to 7.5 tonight?
 
Suzanne and Darcy said:
This is such a LONG ROAD! I am really happy to see the decrease to 7.5 and the fab numbers today. I would let this dose sit for a but and not be too hasty to go back up (within reason, of course, but just ride out the bounce if it happens.) I just feel like he’s really getting there. I guess it’s taken over 20 weeks to get to this point!

We are doing okay here in kitty land. Grace had her radiation treatments and we have seen some improvement, it will be two weeks post radiation on Wednesday and they told us it could take 1-2 weeks. She is eating a lot better on her own now so I think she also must be feeling better. Paws crossed. And as if that wasn’t enough, this week another cat was diagnosed as hyperthyroid. T4 over 10. I knew it was either diabetes, CKD or hyperthyroidism. Diabetes wasn’t likely because he just didn’t look or act the part. CKD also didn’t seem likely because he doesn’t even drink water much at all due to being on wet food and also his appetite is quite large. So I was kind of expecting the hyperthyroid diagnosis. Now we are waiting to hear from the facility where I hope to get the I-131 treatment done. It just goes to show you… it’s always somethin’ :) It goes with having senior cats, I guess.
Click to expand...
 
I think he likes it. He has been so much more social lately. He's not a touchy-feely boy but he likes to be wherever we are again. He seems brighter & there is a lot less peeing & drinking.
I am so very grateful to you guys for all your help. I never thought we would see blue, let alone green!
Now if we could only get those darn legs feeling better so he could enjoy this time a bit more...
 
@Suzanne and Darcy
@Wendy&Neko

So, here we are again. Buster's Libre failed this afternoon (2 days early). It looks like he was clearing his latest high numbers/ bounce(?).
I suspect he is still in lower numbers but won't be able to check him with the AlphaTrak for another 2 hours - which will coincide with PMPS.

I don't want to bother anyone with an urgent post so could I get your general dosing advice in advance?

He is currently on Day 6 at 7 units.

Decrease or hold dose if:

1 - Bg <100?
2 - Bg <150?

I presume anything over 150 would be full dose, is that correct?
 
What times after PMPS would be best to check him? Pls remember that he is not a great patient...

Thank you!
 
And his reduction point is 80 on the AT? That’s what he hit today? Edit: I looked above in this thread and you said reduce if between 80-90 on the AT. And he just hit 80 on the AT today.
 
So in light of this earned reduction to 6.5 units. I would say that most numbers you will likely see in 2 hours should be shootable at his new dose (seeing as how you shot 7 units with a PMPS of 82 three nights ago and 8 units with a PMPS of 75 one week ago.) Does this make sense?
 
Suzanne and Darcy said:
So in light of this earned reduction to 6.5 units. I would say that most numbers you will likely see in 2 hours should be shootable at his new dose (seeing as how you shot 7 units with a PMPS of 82 three nights ago and 8 units with a PMPS of 75 one week ago.) Does this make sense?
Click to expand...
Yes. It's just nerve-wracking without the Libre when he has these drops.

Don't get me wrong, it's still great!

When should we be testing overnight?
 
Well, it kind of depends on how low he is. If he’s in the green at PMPS you will probably want to try to het a +2 for starters to see if he’s gone up, is steady or what. It’s interesting to see how Buster doesn’t have a consistent pattern for when his numbers start to drop in a cycle. Sometimes he stays pretty stable for the first several hours, sometimes he goes up for the first two hours, and sometimes he drops. In light of that, I would get an early test at around +2 or +3 (depending upon how low that PMPS is) and just go from there using my judgment as to when to test next. I know you are used to having the Libre, but you also have a very good feel for his numbers, and I think you will be able to let his numbers guide you as to when to get the next test.
 
Suzanne and Darcy said:
So he has at least earned a reduction down to 6.5 (which is a very good thing!)
Click to expand...
Well, not sure 6.5 is his dose. Only a few AT tests but pink & red. Starting to see a slight increase in ketones. It is clear from his behavior that he is in high numbers.
We get the new Libre later today so we will have a better idea where things stand. He has not been a fan of the ear pricks...😾
If he is still high at PMPS, what are your thoughts about going back up to 7 units?
 
It's possible. He has been clearing his bounces a lot quicker these days so I'm not sure. I'll keep you posted.

How's Grace doing post-radiation? Did you connect with the I-131 facility for your hyperT kitty? How's the rest of your gang?
 
Madm4444 said:
It's possible. He has been clearing his bounces a lot quicker these days so I'm not sure. I'll keep you posted.

How's Grace doing post-radiation? Did you connect with the I-131 facility for your hyperT kitty? How's the rest of your gang?
Click to expand...
He gets the Libre put on today? Hopefully you will have a better idea after that. I would test him at home before taking him to get the Libre installed.

Grace is doing better but is by no means “cured”. Wednesday will be three weeks since the last radiation treatment. I don’t really know if this is as good as it’s going to get or if she will need more radiation.

My hyperthyroid kitty… Richard…. I don’t have an appointment yet, but if everything checks out it will be a couple of weeks before he can have the I-131. I am not looking forward to keeping him isolated for two weeks at home, but I will do what I have to do.

And since then my cat Marcus (my FIV+ boy who has had ear surgery and nose radiation for squamous cell carcinoma and has had surgical biopsy for IBD) now has elevated liver enzymes. All three enzymes were elevated with ALT of 363. We have started him on Baytril and are hoping it’s just an infection and not something worse! It’s always something. I think the ideal number of cats is two (maybe one?) Anyway, Marcus has perked up a lot since last week and is eating quite a bit of food. He’s very underweight.
 
Suzanne and Darcy said:
I can’t see anything except the 408 AMPS
Click to expand...
I only just updated the SS. Still in high numbers (HI on reader).

Please keep in mind that, unlike the app, I have to upload the reader data onto a computer manually so I only do it a few times a day...

I was thinking that I would give him today to see if he gets a decent drop. If not, increase back to 7u tomorrow. What do you think?
 
Madm4444 said:
I only just updated the SS. Still in high numbers (HI on reader).

Please keep in mind that, unlike the app, I have to upload the reader data onto a computer manually so I only do it a few times a day...

I was thinking that I would give him today to see if he gets a decent drop. If not, increase back to 7u tomorrow. What do you think?
Click to expand...
Sorry for the delay. Today is my son’s birthday and I took him out to lunch.
I don’t know about that. Seeing him in that string of black and now pink — I don’t trust that he isn’t coming down more. I would probably wait and see what happens thos evening. Of he goes back up into black at PMPS, I might increase. If he’s still in pink or lower, I would hold.
 
Suzanne and Darcy said:
Tell me how Buster is doing? Is he still having trouble getting around?
Click to expand...
He's doing okay. He gets around alright but can't really jump anymore. Still handling the stairs okay but doesn't go upstairs much anymore. His back legs aren't strong enough to let him sit for very long so he has to lie down pretty quickly. It's hard to watch. But despite everything, he's mostly been in good spirits.

Suzanne and Darcy said:
Sorry for the delay. Today is my son’s birthday and I took him out to lunch.
I don’t know about that. Seeing him in that string of black and now pink — I don’t trust that he isn’t coming down more. I would probably wait and see what happens thos evening. Of he goes back up into black at PMPS, I might increase. If he’s still in pink or lower, I would hold.
Click to expand...
Birthday lunch - fun! I hope you guys had a nice time.

He was pink at PMPS so I held his dose last night. However, his numbers never went down last night & his AMPS was black so I increased his dose to 7u this morning. Hopefully, it will be enough to get things moving again...
 
Madm4444 said:
He's doing okay. He gets around alright but can't really jump anymore. Still handling the stairs okay but doesn't go upstairs much anymore. His back legs aren't strong enough to let him sit for very long so he has to lie down pretty quickly. It's hard to watch. But despite everything, he's mostly been in good spirits.


Birthday lunch - fun! I hope you guys had a nice time.

He was pink at PMPS so I held his dose last night. However, his numbers never went down last night & his AMPS was black so I increased his dose to 7u this morning. Hopefully, it will be enough to get things moving again...
Click to expand...
You gave him enough time to come down. I would have done the same! Hugs. I am sad that his back legs are weak. Poor boy jas had enough to cope with and the back legs too 🥲 It’s nice to hear that his spirits are positive— is he still enjoying his food?
 
You must log in or register to reply here.
Back
Top