Sunday, August 24, 2008

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 **
scruffyeye-1.jpg picture by olgemac

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 **
100_2024-1.jpg picture by olgemac

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

** 12/7/06 *

100_2752-1.jpg picture by olgemac

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 **

100_3050-1.jpg picture by olgemac

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.


100_4396-1-1-1-1.jpg picture by olgemac

Both larger and darker than in January, 07.

** 2/18/08 **

100_5277-1.jpg picture by olgemac

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 **

100_5875-1.jpg picture by olgemac

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.

Wednesday, August 20, 2008

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?

Tuesday, August 19, 2008

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.

Saturday, August 9, 2008

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: . 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.

Sunday, August 3, 2008

August , 08 #'s

8/01/08 (Day 114)

8/2/08 (Day 115)

8/3/08 (Day 116)

8/6/08 (Day 119)

8/9/08 (Day 122)

8/11/08 (Day 124)

8/17/98 (Day 130)