Merry Scruffymas!

Another Christmas with The Puffer - I do wish I knew how old he is. He showed up in Baden at Thanksgiving, 2003, so I know he's at least 5 years old. Dr. B thinks that he's about 8 - no more than 10; I don't know, maybe it's the arthritis or something, but he sure seems older than that to me....

Happy Holidays from the Fluffy One!!

Lookin' Good (the slideshow)

Lookin' Good!

(The slideshow above is of today's appointment. I can't figure out how to get it and the narrative together in the same post.)

Today was Scruffy's follow-up appointment with Dr. B. Three weeks after the laser surgery. He seems to be pretty much back to himself, although he's been off alone more than usual - for some reason, he's taken to huddling on the love seat downstairs, despite the cold.

So, Dr. B. was very happy with Scruffy's eye. There is a noticeable area - perhaps 1/4 of the size of the melanosis - of dark brown tissue at about 5:00 on his iris. This, the doctor felt, is most likely burned tissue left from the laser itself; he thinks that it may eventually be sloughed off. There is also - apparently invisible to the naked, non-professional eye - a small area of tan-ish tissue, which is the actual remains of the tumor, I believe he said. He was very happy with the "regression" of the melanosis, and said that it is somewhat likely/possible that it might regress even more over the next few weeks. It was a very good sign that the regression started during the procedure. He is convinced - though there's no way to prove it- that the growth was malignant, but doesn't feel that there is anything that needs to be done about it, unless the area would regrow rapidly or significantly; laser surgery could be done again, presumably. He felt that check-ups using xrays or MRI or whatever to search for more melanomas would be more risky to Puffer than helpful. A concern with iris melanosis is the possible development of glaucoma, and he again checked the pressure in Scruffy's eye(s) - 15 in the right eye, 16 in the left eye (where the melanosis was). Both are good numbers and indicative of no pressure problems. Dr. B did say that, had there been an indication of glaucoma at the previous appointment, he would not have done the surgery, but would have recommended enucleation. (And because of my awful experience with my beloved Black Kitty, I would have agreed, sadly - I would never want another cat to go through what Black did because I didn't understand the treatment options.) Dr. B. feels that Scruffy's procedure was very successful, and that the eye appears to be healing, although there is some inflammation still. "Mild uveitis"? (The directions they gave me only included medicating the eye for two weeks, and, instead of calling and asking if I should continue, I just quit using them. I feel really bad about that.) He has re-prescribed the flurbiprofen drops for 4 more weeks and as needed after that, and the atropine ointment every other day for 10 days. Contrary to their warnings, Scruffy had absolutely NO reaction to the atropine ointment, but he certainly hates the flurbiprofen. (Sounds like a cartoon name, doesn't it?) His pupil is a little distorted, which will probably not change, but isn't likely to cause him much trouble. And he is likely to be sensitive to light, which the atropine is supposed to help with - it will encourage the pupil to change sizes so that adhesions don't develop. He also said to watch for something like brown "glitter" floating around in the eye - it's a sign of something bad, but I don't remember what.

Other general information - the procedure took about 40 minutes. I thought that was a long time; the doctor thought it was pretty quick, considering how many times he had to apply the laser. (Five, I think he said.) And they did check his blood pressure during the surgery- 115, 90, and 80. Dr. B. said anything under 150 they regarded as being acceptable. They checked his glucose level, too, but I don't remember what it was - I think it's in the previous post, anyway. There was some discussion about the fact that he wasn't their most cooperative patient - I don't know what happened to my laid-back kitty who loved everybody and was so pleasant.

We slid him in and out of the carrier in his kitty pi - boy, that makes it so easy. He just sits in it while everybody does whatever to him. And then, after he slid back into the carrier, he hissed and spit three times at the technician standing beside the table. Just to let her know that her efforts were NOT appreciated, I guess.

I had taken my camera along because I wanted a picture of the doctor using this fascinating machine to look into Scruffy's eye. I hadn't said anything to Dr. B about taking a picture, because I was just going to take it without a flash, which wouldn't bother anyone. Only, the stupid camera - I pushed the button with the lightning bolt picture on it, which I believe is the Controller of the Flash, and when I took a picture - after they'd turned off the room lights so they could look at Scruffy's eyes - the stupid flash flashed. Dr. B and Scruffy and the two technicians all jumped. I felt so dumb. Haven't looked at the pictures yet - but I will put his picture here. I don't think I got a very good shot of the interesting eye machine, unfortunately, and it'll be quite a while, probably, before I take a picture of Scruffy's poor eye.

The next appointment, barring complications, is January 13 at 2:00. Now I won't have to worry about the appointment card falling off the fridge and disappearing forever.....

Great improvement!

Scruffy's doing very well. Moving around normally - although he seems to prefer to stay on the bed, eating as usual (like a horse!), peeing okay and has finally pooped (after 6 days and Miralax), and in general, being his old self. Headbutting and a hairball. He is not fussing with the eye, although I do believe that his face must hurt still, because he is cautious about, for example, laying down (without the cone on) on that side of his head, and he still does an odd thing - seems surprised, or something - when he yawns. There seems to be some swelling left around the eye, but it's hard to tell. The fur's been shaved there, and it could be that those bones have ALWAYS stuck out..... He has been incredibly cooperative with the medications - ten times a day, but several of them will be given less often after tomorrow - the 7th day since surgery. I've kept the bedroom blinds closed, which he seems to still need. There's good light from the bathroom window, but he never goes in there, which I interpret to mean that light is still uncomfortable. (`I moved the litter box into the bedroom.) His atropine eye ointment was reduced to every other day, so that may make a difference in his reaction to light. The only difficulty medically at this point seems to be the sinus infection, for which he's taking zithromax, but he's thrown up two days in a row within twenty minutes of taking the pills, so I don't know if he's gotten much benefit from them or not. (Yes, I did sickeningly poke around in the STUFF, which he very thoughtfully placed every single drop of in the food bowl, but I couldn't identify anything that looked like the pills.) He is very snorty and congested, although there does seem to have been minimal improvement.

I'm not sure what to do about letting him out of the bedroom. The last two mornings, he's been sitting at the screen door waiting for his breakfast, and I know he'd like to see what's going on in the living room. But, given Busy's propensity for gnawing on the other cats, and Toot the Brute's chasing habits, I just think he's better off being separated for another week or so. We'll see, I guess.

His pupil is still very enlarged (from the atropine, I assume.) I can't see the edges of his iris, where the melanosis/noma tissue is hopefully shrinking significantly. I am making up a list of questions I want to be sure to remember to ask when we go for his follow-up appointment on the 28th of October.

Forgot to add that his glucose levels have been very good. Highest I found was 102, yesterday was 63, today was 72 (but I had to poke him THREE times - I seem to have lost the knack. Well, it was a little dark to see the blood on his dark ear.....) What a relief.

It's so nice to have him back again. I've been spending a couple hours a day snuggling with him, and it's wonderful. (Okay, we've been napping for much of that time, but it's STILL nice!) He is truly a treasure.

He's feeling better.

Got the little bounce back in his step, his ploofy tail's waving in the air, and - while he didn't eat much this morning after the Metacam-laced "teaser meal" - he enthusiastically gobbled down the treats where his antibiotics were hidden. This ordeal is turning me into a really deceitful person. My whole day is devoted to figuring out innocuous-seeming actions that will result in medication being delivered to his mouth or his eye without his expecting it.

I checked his bg level this morning - 91, after no food or water from 1:30 AM. Given the stress of the cone, the medication, the isolation, the presumed pain and everything else, 91's a pretty good number. I'll take it. The next problem to come up is that he hasn't pooped since Monday, the day before the surgery. I'm NOT accustomed to being interested in who's leaving what in the litter box, so this is a whole new world for me. I did get Miralax yesterday while I was out, but I'm hesitant to use the recommended 1/4 teaspoon because his water intake is restricted. I do squirt a little water in whenever I can, but he's not much interested in water in general, even when he isn't wearing a cone. I add water to his food, but..... He is peeing, so I supposed that's a good sign.

He looks brighter and happier this morning. He rarely gets off the bed, and he's chosen to spend most of his time in the kitty pi (there are two for him to use) that's on the heated cat mat, so I guess he's cold. I've been keeping the room dark and as calm as it can be with five other cats sitting at the door for vast quantities of time - everyone wants in, for a variety of reasons: The Girls think it's THEIR room and they want it back, and please fill up our bowls with Kitten Chow RIGHT NOW; Milk wants to snuggle up with the Puffer, which I considered letting him do, but I don't know if Puffy's up to it. Busy wants in because he's a pain in the neck and there's absolutely no reason he needs to be in there, and Burble would like to get the pi with the heated mat back again - he was using them last week. And Burble and Minnie have perfected a sort of harp duet - they sit at the screen door and pluck, plink with one claw, over and over, endlessly, until I want to scream. Or squirt someone.

Still no sign that Scruffy wants to scratch that eye, even when the cone's off. Yesterday, he groomed himself for almost an hour. (Hairball city is probably coming up.) But he never went anywhere near his eye. I am SO looking forward to taking the cone off on Tuesday, although I don't know if there's a criteria for doing it. The directions from the hospital just said to wear it 1 week and then "as needed." And I just reread the constipation part of the instructions; I guess I'm gonna have to get the miralax into him somehow. (When I gave him his actual "breakfast", he sniffed at it, and then went over, and climbed into his pi with his back to me. Wouldn't touch the stuff. I refilled with Tender Beef FF, and no Miralax, and he ate about 1/4 can.

All in all, feeling better as the days go on. I can't see anything around the edge of his eye yet, because the atropine makes the pupil so huge, so I can't tell if the tissue is "regressing" any more or not. I am going to take my camera to the follow-up appointment just for general purposes.

Getting a grip...

on the medication schedule, and managing to feed him what's getting to be close to a normal amount of food. Unfortunately, through the night, he developed a really stuffy nose - whether it's from the passage of the medications through the eye to the mouth, or if it's leftover from the previous sinus infection before the surgery, or if it's a new herpes attack because of all the stress this week - WHATEVER the cause, the outcome is that he's absolutely miserable. He takes a bite, has to sniff to swallow it. It does not appear to be the customary herpes snorting. I called today and got a prescription for the same antibiotic they had given him prior to the surgery - zithromax. Unfortunately, I had them call it in to Walgreen's, not knowing that they 1) don't deliver and 2) close at 10:00. At 7:00, I went out and got in the car to go pick up the prescription and more Fancy Feast, because we're out of the last of Dian's Homemade Raw - and once again, got no further than the stop sign at the corner when the power steering started to shriek again. I made three right turns and ended up back in the driveway. Rege wasn't home, there was no way to contact him, and no one to go pick up the medicine. I looked in the garage, where there was no visible bottle of anything labeled power steering fluid. I SHOULD have taken the car somewhere on Wednesday. Well, yes, I SHOULD have, but I had other things on my mind and it never occurred to me. So what do I do with it tomorrow? I have to get the pills picked up, and we need milk and bread and light bulbs. Maybe I can borrow some fluid, drive to the drugstore and the grocery store and then to the Dodge dealership, and ask them to bring me and my groceries home? Why didn't it occur to me before Walgreen's closed to transfer the prescription to CVS, which is closer, cheaper, and open 24 hours? Well, WHY???

What I can't stand here is that I try so hard to do stuff right for the cats, and somehow, it never quite works out.

Okay, Mr. Wonderful came home. Had a little more power steering fluid, put it in the car, ranted about why I haven't gotten the stuff fixed in the last two days - SICK CAT! SICK CAT! - and now, the automotive shrieking is stopped, at least for tonight. The human shrieking also, thank goodness, lol. Now, as long as I can get down the road to the stores tomorrow morning, then maybe I can go and fling myself on the mercies of the Dodge dealership and they'll figure out what's wrong. (Is it odd that the oil and the power steering fluid have BOTH disappeared at the same time in a car with only 21,000 miles on it? Got me.)

Have to go and tell Jojo that I don't need her BF's "toe truck."

Over, but not done with.......

The laser surgery's over, and the sad little cat's tucked away in the bedroom with his awful plastic collar. Unfortunately, he's not eating or drinking or peeing or pooping, and the ophthalmologist feels certain that the no-longer-with-us tissue from his left eye was malignant. Not exactly what I'd expected to hear, somehow. And certainly not what I wanted to hear, or think about or see, or know, actually.

These are the medications he came home with: (nothing steroidal, to try to keep the OTJ status)

1) flurbiprofen - antibiotic/painkiller? - 1 drop 4x a day for 1 week, then 3x a day, I guess until the next appointment. I need to call them, I suppose.
2) BNP ointment - Bacitracin-neomycin-polymyxin veterinary ophthalmic ointment - Small amount 2x a day for 1 week, then 1x a day at night.
3) Atropine - Atropine Sulfate Ophthalmic ointment - 1x a day for 4 days, then every other day for 10 days.
4) Metacam - .05ml by mouth once a day for 14 days. Not to start until tomorrow because they gave him a shot of metacam today.
5) lysine - usual stuff to try to keep the herpes under control.

Here's the problem: most of this stuff travels down inside his little head from his eye through his nose and into his mouth. And most of it tastes really bad. And he won't eat. Also, none of it can be given at the same time as anything else, which pretty much guarantees that he's not gonna be able to eat much of anything the whole time he's using all this medication. Assuming that I can concoct and maintain a schedule of dosing for him, plus coordinate it with Milkshake's already time-consuming pilling schedule. And, please give me pills any day. In the mouth, wrapped in a pill pocket and gone. Ruining his sense of taste - what's the point? I was also warned to be sure to carefully wipe my hands after giving him the atropine because it could end up having a similar effect on me that it does on him, only very long lasting: drastically dilated pupils. I need to look that up, I guess. Whatever, it sounds like a threat for both of us.

They said not to feed him until 6:00 PM. Unfortunately, I hadn't noticed over the past five days that the Flurbiprofen must be one of those nasty tasting eye drops, because the minute I put it in his eyes, he started spitting and dripping and that was the end of eating or drinking anything at that attempt. After the first unfortunate experience, I waited until I could get at least a little food into him before trying one of the ointments. Which was a good thing, because that taste seemed to be the direct cause of the crying-with-whimpery-baby-noises. I did get maybe an ounce of canned EVO - with water and lysine and taurine into him with Milk's baby bottle. And a minimal amount - drops, maybe - of water with another bottle. Then, after I'd left to put the things in the kitchen, I noticed that he had tried to eat the little bit of Fancy Feast I'd left on a little china coaster from Old Economy. The stupid cone must have gotten hooked under the edge of the coaster, though, because it was backed up against the wall and the FF had slid off. I guess it was a good thing that he wanted to eat; too bad he didn't get to. I will make another stab at it again before I go to bed. The directions said that the horrible cone could be taken off if he was supervised, which seemed like the best way to entice him to eat later. Wasn't. And it's a pain. I couldn't figure out which way it needed to go to replace it. The good thing about it is that the directions say that, instead of making him wear it for 3 weeks, which is what the original instructions said, the new paper says "one week, then as needed." Hopefully, one week will be all that's needed.

Scruffy's miserable. I can't comfort him, I can't get him to eat, he can't sit or lay right because of the cone. I am debating trying to sleep in the extra bedroom with him - I hate to have him be alone, and he's slept on me every night for years, but he's not supposed to jump, and I don't think I'd survive the arthritic agony of a night on the floor. His eye is kind of distorted, and it's an odd color - bruised, I suppose, or burned - but it looked like the bottom part of the melanosis/melanoma was still there; a little triangular artifact. I remember that the ophthalmologist said that he was delighted to find that the tissue had started to "regress" while he was still working on it, and that that was good because some eyes take a couple weeks to see the regression. It didn't register that that may mean that the ugly thing is still going to be there in some form, threatening him, for an extended period of time. Actually, if the odds are only 65% of being able to remove the tissue, maybe it'll always be there. I hope not.

This was a horrible day, and a pretty horrible outcome. Not the actual outcome, I guess, of the laser surgery, but the idea that it could even have BEEN a melanoma is horrible. I spent four years trying to repair the damage I did to the poor cat by giving him diabetes, and now - cancer. My old refrain about his walking into the wrong garage springs to mind once again.

Last minute minutia:

- total cost (next follow-up visit is included) - $1051. Plus, $146 for Dr. B. appointment last week, $100 or so for Dr. K appointment the week before, $271 for xrays and bloodwork at Dr. G's. I hope that's enough money for the Universe to say , "Okay, cancer, out of there; Scruffy's covered."

- I have two kitty pi's and a heated electric pad for him to lay on. It's chilly tonight, although that room is usually the warmest place in the house. I want him to be comfortable and pain-free and to have a full-happy stomach. Probably not gonna happen tonight, any of it...

- checked his glucose level just before cramming him in the carrier this morning - 76. And at the hospital, after the surgery, they checked him and he was 80. It would be nice to be able to maintain that; the thought of having to start testing and shooting him again makes me sick. It's about time he gets a break.

-really not crazy about giving him metacam every day for the next two weeks. It's purpose was as an anti-inflammatory, not a painkiller. Still seems like an undesirable plan. I think I'll post and see what others think.

- the litter box was empty - not too suprising, although I would have thought that they'd have given him fluids during the procedure. I gave him the box with the Feline Pine Clumping in it - for a week now, he's been waiting to sneak in and pee in that stuff as soon as I open the door for The Girls to come out in the morning. Now he'll have it all to himself. I do hope he pees soon.

I love you, my sweet Puffer.

Preparations for surgery continue....

Yesterday, Scruffy went to our regular vet for xrays of his lungs (to look for possible metastatic disease) and blood work. I couldn't imagine how they were going to get him to cooperate for the xrays, but was actually spared the agony of knowing - they took him off into the back room - which I don't remember Dr. G. ever doing before, but of course, the xray machine is back there somewhere..... I did hear a huge amount of hissing and spitting, but apparently they were able to do what needed to be done. He got the blood, too, at the same time.

Results were fine for both. He said there were some changes in something about the heart touching the sternum. (? I have no idea.) Blood work was fine. All in all, pretty good, I guess for a cat of uncertain age who was a totally uncontrolled diabetic for three and a half years.

We started the eye drops this morning. Flurbiprofen. (Doesn't that sound like something from a tv cartoon?) Every 8 hours, one drop in the left eye. Scruffy was NOT delighted. I assume he'll have all sorts of drops after the surgery, too, so he might as well give up and get used to it. Useless protest does seem to be a cat's most kneejerk response, though. After biting and scratching.....

I posted on FDMB last night about the cone, and learned, to my relief, that it's not the enormous plastic umbrella-sized thing I had in my mind. I couldn't even figure out how I was gonna get him in the carrier to bring him home with one on his head. But, I saw a picture of a cat cone, and it was small and manageable. Well, manageable for me; I'm sure Scruffy won't be thrilled. Anyway, that was one more thing I'm not going to stew about any more. The significant thing was that he has to have something to prevent him from being able to rub that eye against anything - furniture, the floor, the walls, his foot, whatever - until the tissue has healed. Three weeks. Gonna seem like a looong time, I'm afraid.

I'm worried about this whole thing, but hopefully, when it's over, that will be the end of our Iris Melanosis tale. (At least, until the one in the other eye does whatever it's going to do.) I hope that Scruffy's one of the cats who only needs to have the procedure done once.

Another trip to the chiropractor/holistic vet

Scruffy's been increasingly cranky about being touched below his "waist" - or however you would describe the lower regions of his chunky little body. And he seems - although he's still hopping up on the bathroom sink and the table beside my chair and stuff without appearing to have any difficulty - but he seems stiffer and less mobile somehow. I had had an appointment for chiropractic follow-up back in December, which I cancelled because of the weather and then never got around to making another one. So, this morning, we got up early - a lot earlier than planned because Milk had a seizure at 6:30 AM - and got ready - oh, so casually so as not to alert the Cranky One! Who, in that mystical way cats have, apparently was fully aware that I planned to cram him into the carrier again and drag him someplace where he didn't want to go for the 3rd time in a week. And who, immediately, disappeared into the lower reaches of the house. I went downstairs, accompanied by the sea of furry creatures that trails along behind me everywhere I go (except for Milk, who was under the couch upstairs) to try and grab Scruffy and get on the way. No luck. I got out the feather toy - although he did watch Tootle play with it, he wasn't about to come near it himself. And then he started racing around the perimeter of the room, behind all the furniture and Rege's boxes and bags and folders and junk. I opened the sliding door - thinking that he would never be able to resist peeking outside from downstairs, where the door is almost never open, but it wasn't enough to entice him, either. I finally located him behind the recliner. I climbed on it, reached around the back and attempted valiantly to grab him by his scruff. He's bulky, and quite strong, and there's NO loose skin anywhere. Eventually, it was quite clear that I wasn't gonna be able to get hold of anything but one of his front legs and I'd better do THAT fast because he was about to squirt out of my reach. So, apologizing fervently, I dragged him around the corner of the chair by his leg, and plunked him in the carrier. And he hissed and spit and POUTED the entire one-hour trip to Vanport. He actually sat with his back to me in the car - meaning he was looking at the closed end of the cat carrier most of the trip. Even when I stuck my finger in the grill and tried to pet him - no interest.

When we got to the office, they called him in almost right away, but the vet didn't come for about ten minutes. He carried on royally about getting OUT of the carrier. When I slide the kitty pi out, which always works because he just sits curled up in it and ignores everyone - even that wasn't a success - he climbed out of it in the carrier and let it go without him. Expressing his displeasure required quite a lot of hissing and spitting. And in the meantime, the technician said she had to poke around him - for a "required" wellness exam - and that included the ultimate insult, temperature-taking. Needless to say, not a happy camper by the time the vet arrived in the room.

More hissing during the treatment, and personalized glares that include eye squinching so we'd know he MEANT it followed. There was one spot in the middle of his back that provoked the most violent reaction yet. All in all, the whole treatment took only a couple of minutes. I asked about the possibility of his having arthritis in those hips. Dr. K. said - examining what he could of them through the spitting and commotion - that he thought that xrays would be necessary to be sure, and that he could give me a sample tablet of a glucosamine preparation he uses in his practice. I told him about Scruffy's telling the animal communicator that he didn't NEED cosequin any more. (I thought he, of all people, would appreciate that story; didn't appear to...)

Anyway, we left it that I would bring Scruffy back for a follow-up adjustment after the surgery and the cone-wearing-period were over. Which I'm sure would be just fine and dandy for the Puffer.

Additional comments - teeth are a mess. (Yes, I know.) About two pounds overweight, at 12 pounds, 8 ounces. (Well, he's solid, that's for sure.) He's not happy being here. (Duh.)

Oh, and most of the way home, Scruffy was SO happy he spent most of the trip rolling around on his back, with his feet in the air! Rubbing and purring and rolling. It was hysterical. So, I guess we can conclude with some reliability that the treatment worked....

Surgery is scheduled.

We had our appointment yesterday with Dr. B, who was also the ophthalmologist who cared for my Black Kitty when he had glaucoma back in 2000. Dr. B. did say that he has not done the laser surgery for a cat, either, but he has done five or six dog iris melanosis treatments. At this point, I am confident with his ability and skill, and the reality of trying to arrange to have the procedure done elsewhere is too difficult. So.......

Here's the plan:

Surgery is scheduled for 10/7/08, when I'm supposed to appear at the hospital with a starving Scruffy in hand at 7 AM. The surgery will be performed (under general anesthesia - isofluorane) somewhere between 9:00 and 10:00 or so, and is expected to take about an hour and a half. He will recover at the hospital, and I will be able to come and pick him up later in the afternoon. He will have to wear a cone to prevent his rubbing or scratching his eye. He will have eye drops, metacam for the post-surgical inflammation, probably buprinex for pain, and I don't know what else. Oh, Dr. B said that it would be possible to use non-steriod eyedrops afterward, which is a plus. He's gonna be one unhappy little cat. I want to be sure to remember to tell them about not touching his tail or his back legs, particularly the left one, too. I wish I'd thought of it yesterday while we were talking to the doctor.

About a week prior to the surgery (presuming that the new antibiotic prescribed yesterday for what seems like an herpes attack/possible sinus infection is effective) , Scruffy is to have the "met check" xray package - three views of his lungs, intended to ascertain that there has not been any sort of metastases of possible melanoma from his eye. And blood work, to check his kidneys in particular, because of the anesthesia, and because Dr. B feels that the best anti-inflammatory treatment for post-surgery is metacam. This stuff will be done at our regular vet. Who Scruffy is not fond of, to say the least, but I think it's preferable to having them done at the specialty hospital. He's never had xrays, to my knowledge, and how they're going to convince him to let them do it is a total mystery to me. I don't even want to think about it.

Here's the surgical caution we were given:

"Laser surgery is approximately 65% successful to induce regression (in some cases) of the pigmented iris mass (iris melanosis site.) Some patients will need additional laser (and/or other) surgical procedures. There is the potential for post laser-induced ocular lesions such as glaucoma, uveitis (inflammation), cataract, lens luxation, retinal changes, tumor spread, misshapen pupil, others. He may need maintenance ophthalmic medication. He will need to wear the E-collar for ~3 weeks post-op. " There is also an additional warning regarding anesthesia and patients with "metabolic abnormalities (ie. diabetes)."

Not exactly a bright and sparkling prospect, huh? The cost estimate is between $935 and $1057.

I did finally get copies of the doctor's notes from the previous visits, but there is really not much of any significance on them. (Aside from the note that there was "slight" (underlined!) progression in the left eye's melanosis between the appointments on 9/28/07 and 2/21/08. The pictures are posted below - it sure didn't seem "slight" to me. And despite Dr. K's overt disinterest in my pictures at each visit, you certainly couldn't have looked at the squiggles she made on the report form and had even the remotest idea what that thing in Scruffy's eye looked like.

Just to make the poor cat really miserable - and in case there's any extra money left in the account (two $150 appointments at the Speciality Hospital in a week!), I'm taking the Puffer back to Dr. Doug on Thursday for a chiropractic appointment. I had cancelled his last one, back in December, because of the weather. But he's gotten increasingly cranky about having his "lower forty" touched, and he seems to have major discomfort/difficulty doing things like standing up now. I would like to know if he's got arthritis or something that can be treated back there. I really don't want him in unnecessary pain. His life is hard enough as it is.

One last thing - Dr. B. estimates that Scruffy's about 8 years old. He said that - I guess judging from the condition of his eyes - he is definitely not 10 or near that. That fits, I guess - when I first got him, back in 2003, the guess was that he was around 2 years old. And I've had him now for 5 years. My sweet boy.

I'm very nervous about all this. The metacam, and diabetes, and the cone, and the cancer possibility, and everything else. Nothing to do but hope, I guess. And try not to embarrass myself by bursting into tears at the least provocation.

It just occurred to me to wonder how you put a cat wearing a cone into a carrier?

Today's appointment

Well, it appears that Scruffy will be getting his melanosis lasered, and in Pittsburgh. Dr. K offered today to ask Dr. B - who was the ophthalmologist for my beloved Black Kitty some years ago - if he would do the surgery. They took Puffy back for him to take a quick look at the eye, and he apparently agreed to do it. (Although, if he was able and had experience with it, which is what Dr. K said today - how come she had to get a protocol from some vet in Virginia?) The initial plan was for me to bring him in early (next Monday, it appeared) to meet with Dr. B, and then for them to do the surgery right afterward. That set up - which I had a little trouble with because I always need time to "prepare" for stuff (to stew and moan and whine and adjust to the potential change) also was troublesome because of Milk's morning medication, which I try very hard not to mess around with. Eventually, we decided to schedule an afternoon appointment for me to meet with Dr. B - I guess I'm supposed to bring Scruffy with me, since he really didn't get to look at the Puffer's eye with his instruments, etc. - and then they will schedule the surgery at that time. I think that's better anyway. I'm nervous enough about the whole thing to begin with.

I took along a bunch of the "diet-controlled diabetic" information today, as well as the eye picture from 8/9/08, but there wasn't any discussion of either. Nor did I get to ask for any sort of summary of the visit again. I did get a bottle of some sort of eye drops that I'm supposed to give Scruffy for several days prior to the surgery. At first, they were going to be steroid drops, but Dr. K said that there was a non-steroid option. Unfortunately, he will probably need steroids after the surgery, though. I'm torn - I feel like I should have enjoyed this last five months without insulin a whole lot more than I have, and despite the fact that I feel much better informed about using Lev, etc, now than I was before, it's still not a happy prospect to think that he might end up insulin-dependent again. For him, I mean - I'm so tied down with Milk's medications that it doesn't make much difference to me if Scruffy needs shots or not. Plus, now I have a spreadsheet...... Whoopee.

I'm scared for my poor sweet old brown kitty. Nothing I've ever tried to do for him that was supposed to be beneficial has worked out that way. It was my fiddling around that made him end up a diabetic in the first place.

Melanosis comparison by date, pt. 1

As we get closer (slowly, oh-so-slowly) to Scruffy's next ophthalmology appointment - 9/9/08 - I was thinking that it might be interesting to try to show the development of what's growing there all in one place. I have never received (or, to be truthful, requested) a copy of the ophthalmologist's report after an appointment. That should be on the list for the September visit, I guess. She doesn't know yet that his diabetes has been diet-controlled since April 9, 2008, either - we had had a mild conflict at the last appointment because she was insistent that he had to have a fructosamine before any procedure, and I had my meter with me, with more than 500 tests in the previous 3 months - much more valuable information than some test that would simply give the average of his levels for two weeks.

This came out somewhat better than I expected, but for some reason, the dates and text are moving all over the place, instead of sitting obediently where I efficiently, and with such great hope, put them. Rats.

** 11/5/05 **

Tiny pinpoint of brown in the left eye. Going on three years ago now, which is hard to believe.


** 5/3/06 **




Although it's a little blurry, there's only the tiniest little dot in his left iris. Pinprick size, almost. And, at this time, there's no indication (to the naked eye) of anything in the right eye.



** 7/21/06 **

Hardly anything in right eye, left eye just slightly darker.


** 12/7/06 *



Slight but noticeable enlargement and darkening of the melanosis in the left eye. (At this point, the ophthalmologist was referring to these things as "iris nevi.") A fairly good-sized darkened area has developed in the right eye also.

Melanosis comparison by date, pt. 2

** 1/29/07 **

The left eye is hard to see, but the tip that's showing is noticeably darker, and presumably larger. The right eye nevis is positioned slightly differently and a little larger.


**9/3/07

Both larger and darker than in January, 07.


** 2/18/08 **

This one is disturbing. I'm not sure where the pictures from 2007 that were between this one and the January, 07 one went, but there has been a very large amount of change in the right eye.


** 8/9/08 **

Some color change, slight change in shape and orientation.

******

I thought that it would be good to have all of these in one place, instead of having to scroll around all over, but it's a little overwhelming.

At last!

What I've been trying to figure out how to show here - the drastic change in Scruffy's numbers at the point where Jojo said she thought he was rebounding on 1.25u BID, and the subsequent insulin activity/numbers from then until he no longer needed insulin. The "rebound test" began on February 18, 2008. I lowered his dose to .75u BID of Levemir, and gave R with each shot, depending on the preshot - around 200 and over, he got .5u R; under that .25uR. This continued until 2/27/08, when I dropped the R. About 3/10/08, I lowered the dose again to .5u of Levemir BID - no R. By the last week of March, he was getting .25u, mostly BID. Between April 6 and April 8, he went 59.5 hours without insulin. (He had a 165 and then a 154 and I panicked and gave him a "shot" - on the "0" marker of the syringe.) I gave him another 0+ shot in the morning of April 9, and that was his last shot, I can only hope FOREVER.

This is the printout from my OneTouch Ultrasmart meter that shows very clearly the amazing results of using the right dosage. The pinkish band is what the One Touch insisted is the "desirable glucose level range" - for humans, I guess - of 90-140. One other interesting fact - the two spikes in glucose level, on March 14 and March 28, were both reflections of a dosage change. On the 14th, he had an extended duration of 24 hours from his previous shot, and on the 28th, I lowered him to .25u. Amazing - if ONLY I'd realized that Lev was going to be so consistent with that reaction to changing the dosage months before.....



As his spreadsheet shows, once he was off insulin, he had quite a few numbers that seemed to be higher than might be desirable, but he brought himself back down to good numbers easily. He free feeds, so unless there was some reason I wanted to see if food would lower him, he made his own judgments on when he needed to eat. I will freely admit that I had a really hard time adjusting to the fact that his numbers OTJ were not nearly as nice as they had been with Levemir, although spot checks now are usually between the 60's and the 80's.

I don't know why I feel such a sense of relief finally getting this chart posted. It's been making me crazy for months now that I couldn't show the miraculous - well, it WAS miraculous! - difference Levemir was able to make once we removed the things I was doing that caused all that rebound and gave low, steady, appropriate doses. I still think that Scruffy is a prime example of a fortuituous combination of a great insulin, a perceptive advice-giver, a persistent although basically clueless caretaker, and a whole bunch of good luck. And I guess there's nothing wrong with any of that, right?

The spreadsheet

Since I managed to conquer doing Scruffy's spreadsheet for the last four months that he was on insulin + his OTJ tests (even though it never did really demonstrate what I wanted it to - all that work for not-so-much reward!), I figured that I might as well do the entire year he was on Levemir. Always a glutton for punishment, obviously. It's been pretty upsetting, so far, and I've only done two or three more months.

Despite the reading that I did, I clearly missed the point of working with Lev. I READ the Tilly protocol, I truly did, several times. I was too intimidated to try the Insulin Support Group on FDMB. (Not even sure it was in operation when we started on Lev.) But apparently, nothing sank in. I just finished recording the April, 2007, numbers, and I can see that I was still operating on a PZI/TR sort of mode, just using a different insulin. One which didn't work quite right with that kind of usage. There are brief glimpses of the potential that Lev has every now and then in April, but for the most part, I totally missed the point of using it. There are places where I actually noticed that Scruffy was having a good day or two and then a bad day - a pattern that continued right up until I finally managed, with Jojo's help, to get the dosage right months later; the trouble was, I never caught on that I was CAUSING that pattern, changing doses every couple days or even more frequently. Like you could do with PZI, no sweat. And even though I did my little "experiment" - one shot of R the first week, that had wonderful results - I was convinced that I didn't want to use R, that the Lev and Scruffy and I would all do our jobs and it wouldn't be necessary to use a booster of any kind. I have no explanation for that idiotic determination; I just had it in my head that this would work the way it was supposed to. Period. So there are TWO reasons why it took so long to catch onto how Levemir works. (Or, in this case, DIDN'T work.) On the other hand, there were those times when there were stunningly gorgeous numbers - that I'd certainly never seen on PZI - and that was enough incentive to keep me going, despite the rough patches. (At one point, I proudly showed my graph of one month of Scruffy's numbers to someone, and she said, "Well, yeah, but look how it zigzags up and down and up and down here. Do you WANT it to do that?") The sad thing was, I was so thrilled with the LOW numbers - the ones that were under the 300's that I'd been used to for so long - that I just kind of ignored the HIGH ones. In my defense, if there is a defense for excessive stupidity, given the fact that eventually - and despite me - Scruffy no longer needed insulin, I gave him an extended time for his pancreas to heal. (Is that a defense? Well, it's an excuse, anyway.)

Aside from the fact that I've got a ton of work left if I'm going to finish the spreadsheet- because I seem to have disposed of the actual logbook pages by accident, so I have to transfer everything from the blog to a notebook and then to the spreadsheet - it's embarrassing to think that anyone might look at the spreadsheet and know immediately that I had NO idea what I was doing. On the other hand, if the truth hurts, so be it, I guess.

General stuff

I am convinced that a whole bunch of posts have disappeared from here. Surely I've had stuff to say about the Scruffer since May, wouldn't you think? I thought maybe posts were somehow trapped in the "drafts" folder, but nooooooo. I don't know - it just seems PRETTY odd.

So what did I miss during the last three + months that Scruffy's been doing? Well, not all that much. He's still OTJ, which is amazing. I've been able to assert a little more control over myself and my need to test him - I'm substituting testing myself for poking him. (But only if there's a non-violent/non-needle-involved source of blood. Accidental bleeding, I'm right there with my Ultrasmart meter. If I'm a diabetic, I really don't want to know right now. Or ever.... ) And oh, wait - I MADE A SPREADSHEET! Google Docs - template courtesy of someone named cyncyn on FDMB. It only includes the data from Jan. 1, 2008 to the present, though. Because #1 - it took me hours and hours to get all that stuff typed in as it was, and #2 - I seem to have accidentally thrown away all the Levemir information from 2007, apparently. The numbers are recorded here in his blog, so I'd have to copy and transfer them twice, and also, the information about vet visits and ear infections and herpes attacks are pretty much gone. But, the main reason I wanted the spreadsheet was to demonstrate the amazing improvement in his numbers after Jojo said, "He's rebounding," and I started lowering the dose. That was in mid-February, and by the beginning of April, the difference was stunning. It's not easy to see in spreadsheet form after all, to my disappointment, but on a graph, it looks like falling over a cliff! Which, come to think of it, might be possible to show using Google Docs, maybe. I wish I was more computer literate. Oh, and if you want to admire/criticize my first successful spreadsheet work, there's a place to click over on the lower right-hand column.

Let's see - we've gone to everyone eating about half/half Dian and Wheezer's wonderful raw chicken/Fancy Feast over the last month. Scruffy has been eager to eat it fairly consistently since the beginning. And he's more than willing to polish off his bowl and then move along to the next one. Having seen the improvement that eating the raw chunks has made in Milkshake's teeth, I'm desperately hoping that Scruffy will have similar results, because otherwise, he's gonna need another dental in the very near future. Aside from the unpleasant smell, this afternoon he yawned WIDELY right near my eyes, and what's going on in there does NOT look good. Lots of browns and reds and yellows and other colors I don't want to see again. The most unfortunate aspects of a dental are the fact that he hates the vet, and the risk of screwing up his OTJ status. (I don't know if that really happens or not, it just seems like something worth worrying about.) I don't know what happens to him when I drop him off at the vet's for a dental; I do know that he's highly unlikely to be cooperative. (The last two appointments, he's pooped right on the examining table. And shrieked when they touched him.) He's pretty bulky and strong, and I do worry about whatever's going on with his right rear leg/hip area; I wouldn't want him injured while they're wrassling him out of the carrier.
So CHEW UP, Chunky Boy!



Making an appointment with the ophthalmologist for next week, hopefully. (Well, rats - she's booked up until September 9th.) There has been some change in the shape of his melanosis. And sometimes I think that he's looking out of that eye kind of oddly. Not squinting, exactly, but it just looks different. I took - finally - a fairly decent picture to leave with the doctor; not that she thinks that my pictures are significant, when she's making her little pencil drawing of the growth, but...... The shape of the top of it has changed, and the color seems a little darker. The last picture was so good that this one really suffers by comparison, but I took about a dozen pictures and this was the best of them: (It's clickable.)





This is a link to a very good article/picture collection of iris melanosis/melanomas: http://www.animal-eye-specialists.com/iris.htm . Still quite depressing.


Other than that, he's my same old cranky but sweet ScruffyPumpkin. He's still obsessed with the bathroom. The other day, he actually teetered on the edge of the tub while I was taking a shower; he was absolutely determined not to get down, and there wasn't enough room on the sink for him to sit there and wait for me to finish. He and Milkshake have become my constant companions. Wherever I go, there they are, six inches away. I like to think that they treasure me as much as I treasure them.

On that weepy note, enough's enough, I guess.

August , 08 #'s

8/01/08 (Day 114)
82

8/2/08 (Day 115)
101

8/3/08 (Day 116)
81

8/6/08 (Day 119)
69

8/9/08 (Day 122)
66

8/11/08 (Day 124)
69

8/17/98 (Day 130)
78

July, 08 numbers

7/1/08 (Day 83)
67

7/3/08 (DAY 85)
82

7/6/08 (Day 88)
76

7/10/08 (Day 92)
82
83

7/13/08 (Day 95)
67

7/15/08 (Day 97)
69

7/18/08 (Day 100)
63

7/21/08 (Day 103)
90

7/22/08 (Day 104 )
52

7/24/08 (Day 106)
68

7/25/08 (Day 107 )
72

7/31/08 (Day 113)
89

8/1/08 (Day 114)
82

Numbers for June, '08 OTJ

5/31/08 (Week 8, Day 4)
+1260 76

6/1/08 (Week 8, Day 5)
+1281 69

6/2/08 (Week 8, Day 6)
+1293.5 82

6/3/08 (Week 8, Day 7)
+1309 94

6/5/08 (Week 9, Day 2)
+1356 104
+1363.5 83

6/6/08 (Week 9, Day 3)
+1384 65

6/7/08 (Week 9, Day 4)
+1416 53

6/9/08 (Week 9, Day 6)
+1452 64

6/10/08 (Week 9, Day 7)
+1488 65

6/11/08 (Week 10, Day 1)
+1503 77

6/13/08 (Week 10, Day 3)
+1548 132
+1560 98

6/14/08 (Week 10, Day 4)
88

6/17/08 (Day 70)
85

6/19/08 (Day 72)
84

6/22/08 (DAY 74)
81

6/23/08 (Day 75)
110

6/25/08 (Day 77)
62

6/26/08 (Day 78)
73

6/29/08 (Day 81)
72

7/1/08 (Day 83)
67

Average bg numbers for June, 2008:

# of tests...... # of days...... Average
5 ............... 7 ................. 77
8 ............... 14 ................. 83
23 ............... 30 ................. 86
105 .............. 60 ................. 99

I am obsessed.

With what will happen to my cats if something happens to me. You'd think that Scruffy's being OTJ would be helpful, but.... not really. (Although Rege said to me last night that Scruffy'd come down and napped on his lap three times in the last couple days - now that's real progress. Maybe Scruffy's worried about the future, too.)

I was thinking that other blogs seem to give more of a picture of the cat's personality; mine, not so much. I just ramble on and on about numbers, etc. So here's a capsule of my sweet boy:

From the minute I brought him home (and an hour later when I had to take him to the emergency vet because he'd developed an instant urinary blockage!), I was amazed by what a laid-back cat this was. I plunked him down in the midst of three other cats - one of whom was the famed Picklefritz, one of the world's oddest cats ever - and he was totally unconcerned. (Well, maybe not, since there was that blockage that I assume came from stress. And a second and third blockage that probably also were stress-related.) Anyway, he has never been particularly interested in and/or threatened by other cats. He just seems to take what comes. He's always been friendly and unafraid of strangers. His two main interests in life are eating and trailing around behind me waiting for me to sit down so he can sprawl across my lap and rest his head in the palm of my hand. It's very touching to me, this kind of closeness he wants so badly. Especially when you think that for the last going-on-four-years, I've been poking his ears and sticking needles into him on a regular basis. To say nothing of dentals and ear infections and ear and eye drops. I'm surprised that he even lets me touch him, much less that he's so determinedly "my boy."

I used to have to nudge him with the sweeper to get him to move out of the way. Nothing bothered him. Except that NO ONE touches his tail. He's been like that from the very beginning. There doesn't seem to be anything wrong with it; he just doesn't want anyone going near his tail. And his legs are way too short for the rest of his body, although he doesn't care if you touch them. He's got that awful fur that has the undercoat "reversed" - the stuff that's supposed to be on the bottom is on the top with him - but, oddly enough, it always looks pretty good when it's photographed (see the picture at the top of this blog) - in person, it sort of sticks up in every direction. Not smooth and soft and pretty. Although, since he's been off insulin, his fur does seem softer and smoother.

Lately, he's developed this interest in the bathroom. He insists on being in there when I take a shower. He even sits beside the door for hours on end, just so he doesn't miss my making a trip. A number of times, he's been sitting on the toilet lid when I went out, and when I came back four or five hours later, he's STILL sitting there.

Scruffy's reason-for-being is food. But only cat food - no people food. He literally inhales every meal. He stands in front of his bowl and eats and eats and eats, frequently until he throws up right into the bowl. And then he goes around and empties everyone else's dish. When he was diagnosed with diabetes, he had lost 4 pounds in a week - down to ten pounds. He managed to get back to 12 pounds within six or seven months, despite being an incredibly poorly managed diabetic. He's up to something over 12 pounds now.

Every vet who's ever examined him has thought that there was something wrong with his abdomen. During his first hospitalization, they announced that he had FIP and we should take him home to be isolated until he died. (That was five years ago, and he's STILL HERE!) When he was in the hospital with DKA, they wanted to xray him because they thought he had vital organs in the wrong place. (Or else, as I discovered when I got the copies of his records - the vet had personally given him way too much fluids and she was afraid that his lungs were full....) At some point, we'll probably have an ultrasound done, and that'll hopefully put to rest the speculation about what parts are where inside him.

Right now, he's got what's supposedly a lipoma on his right side - (gonna shave him again this summer so I can keep my eye on it) - and a horrible creepy sickening iris melanosis in his left eye that I can't decide what to do about. Dr. G says just ignore it - that lots of cats have them and they don't turn into melanomas. Dr. K wants to laser it out of there, even though she's never done the procedure before. I have the name of a clinic in Ohio that I think I'm going to take him to for a second opinion.

Despite his unknown age, at least a couple times a week, Scruffy will come thundering and thumping across the living room floor and bounce up four or five levels of the cat trees like he thinks he's a kitten. I guess as long as he's able to do that, he'll keep on truckin'. He is such a sweet, affectionate cat, and what a fortunate thing it was for both of us that he showed up when and where he did. (Of course, he wouldn't have gotten diabetes if someone else would have taken him in; it was my insistence on treatment for the "sinus infection" that got him the shot of depomedrol that did him in.) Anyway, he's a very special cat and brother, do I love him.

May, 2008 glucose #'s OTJ

4/30/08 (Day 21 ends at +504 and start of Week 4)
+501.5 86
+512.5 86

5/1/ 08 (Day 22 ends at +528)
+525 88
+536 82

5/2/08 (Day 23 ends at +552)
+550 119
+555.5 81
+564 67

5/3/08 (Day 24 ends at +526)
+523 81
+589.5 114

5/4/08 (Day 25 ends at +600.)
+547 102
+604.5 98
+613 95

5/5/08 (Day 26 ends at +624)
+621 141
+624 146
+627 67
+632.5 88

5/6/08 (Day 27 ends at +648)
+645 102
+655 96
+660.5 95

5/7/08 (Day 28 ends at +672 and Start of Week 5)
+669 149
+672 68
+676 107
+680 91
+ 686 64

5/8/08 (Day 29 ends at +696)
+694.5 88
+704.5 102
+709 87

5/9/08 (Day 30 ends at +720)
+718.5 109
+726 112
+731.5 90

5/10/08 (Day 31 ends at +744)
+741 125
+743.5 107
+749 133
+755 64

5/11/08 (Day 32 ends at +768)
+765.5 207
+767 154
+769 59
+771 73
+776 89

5/12/08 (Day 33 ends at +792)
+784.5 117
+789 161
+793 81
+805 101

5/13/08 (Day 34 ends at +816)
+810 106
+813.5 112
+818 85

5/14/08 (Week 6, Day 1)
+833.5 161
+837 125
+845.5 101
+848 120
+853 70

5/15/08 (Week 6, Day 2)
+861.5 105
+865.5 77

5/16/08 (Week 6, Day 3)
+886 146
+892.5 169
+895.5 133
+899.5 74
+903 85

5/17/08 (Week 6, Day 4)
+909.5 124
+914 65
+920.5 104
+923 106

5/18/08 (Week 6, Day 5)
+933.5 73
+941 103
+948.5 78


5/19/08 (Week 6, Day 6)
+957.5 110
+965.5 65

5/20/08 (Week 6, Day 7)
+982 115
+989 86
+994.5 96

5/21/08 (Week 7, Day 1)
+1005 112
+1017 88

5/22/08 (Week 7, Day 2)
+1045 91

5/23/08 (Week 7, Day 3)
+1058.5 87
+1067 124

5/24/08 (Week 7, Day 4)


5/25/08 (Week 7, Day 5)
+1100 127
+1103 117
+1117 85

5/26/08 (Week 7, Day 6)
+1131 53 (ate dry kitten food.)
+1136.5 91

5/27/08 (Week 7, Day 7)
+1148.5 77
+1159 137

5/28/08 (Week 8, Day 1)
+1176.5 102
+1182 91
+1189 76

5/29/08 (Week 8, Day 2)
+1198 114

5/30/08 (Week 8, Day 3)
+1221 108

5/31/08 (Week 8, Day 4)
+1260 76

No purpose for this

I just think the expression on Scruffy's face is priceless. How much more pleasure can an old diabetic cat have than this?

After all the anticipation and nervousness.....

today was supposed to be Scruffy's official OTJ day. Only, I got sick in the middle of the night, and what with the wandering around that was going on, no one got much sleep. And when Rege left for work, he apparently gave Scruffy more than the approved ONE Temptations treat, which, even at this stage, seems to be a recipe for glucose level disaster. Then I was awakened for the day by the sound of Scruffy heaving up a healthy hairball. I can't remember for sure, but I don't recall him having ever had a hairball, which is odd and hard to believe, given how long and fluffy his fur is. Anyway, when I tested him, he was at 150. Which made me want to cry. He didn't want anything to eat, so maybe his stomach was upset, too.... And a couple hours later, I tested him again and he had only come down to 105. So, I officially cancelled the "celebration" - not that there was going to be any fussing anyway, since it was all only in my head. But I feel sad. By 6:00, he was back down to 69, which was a relief, but it left me feeling sufficiently uncertain that I'm just going to wait and not say anything about his OTJ.

I went to vote yesterday afternoon, and Dr. C was standing, as usual, at the bottom of the steps in the town hall. And I couldn't resist - we hugged, and then I said, "Do you ever see Jay anymore?" (because I know, even though I haven't been to their hospital for four years, that he sold the practice to Dr. O'L.) And he said that he does, so I said that I'd left their practice because I just wasn't able to do what they wanted when Scruffy was diagnosed, but that he had been on this wonderful new human insulin for a year, and now he was OTJ. And Dr. C was very nice about it, and congratulated me, and acted like he may have had some clue what I was talking about. I was wishing afterwards that I'd offered to teach any of their diabetic patients' families to hometest. I always had this fantasy of telling Jay all the stuff I couldn't accept and why - not nastily, because I always considered him a friend as well as a vet. Oh, well.