The Jojo Connection

I don't think I mentioned the source of the miraculous Levemir/diabetes improvements here. And I definitely need to express my incredible gratitude to Jojo. Back in February, out of the kindness of her exceptionally large heart (well, not physically large, I hope! ) Jojo took a look at The Puffer's numbers. Which weren't anywhere near as horrific as they have been multiple times in the past, but which weren't good. He was getting 1.25u of Levemir bid. Still a little erratic, and I wasn't seeing the Levemir "hang", for instance. She has a knack - unparalleled! - for interpreting glucose testing. And she said, to my surprise - that she thought that Scruffy was rebounding on that dosage. ( November '07's numbers were shockingly good - and he was functioning - for the first time - on .5u on a fairly regular basis. In December, he had a major herpes attack that threw him off track completely. And I eventually raised his dosage to 1.25. Didn't seem to make much difference one way or another. )

I had already seen many examples of Jojo's ability to discern the solution to these feline diabetes problems. She recommended trying .75u bid and going back to using a smidge of R at the beginning. So, around 2/18/08, the big experiment began. And sure enough, she was right. The last couple weeks of February were definitely better than the beginning. And March! March! Ah, the affection I feel for March!!! And for Jojo.

I had long ago given up any hope of ever getting Scruffy "regulated." Totally. And now, here he is - with lovely numbers in the under-100's for much of the time, and even getting only one shot a day every other day! Who would ever have believed it? Not me, that's for sure. And, on top of all the other delightful outcomes, it turned out that .75u was a smidge too much, and .5u was pretty much JUST FINE!

To say I am grateful to Jojo is way beyond understatement. What an incredible human being she is, and how fortunate we are at FDMB to have her contributions for the benefit of all of our cats.


And for Jojo - a

Averages

Didn't much like last night's numbers, or this morning's, actually. My little furry person sat between 157 and 139 for 11 hours, which is not particularly great news. Things have been so good for the last two months that I have the nerve now to be unhappy with those numbers. Which are, in actuality, below the mystical "Renal Threshold", after all. How quickly we forget, I guess - all those years, not months, when not only did he never get out of the 300's, but I was terrified to give him one unit for fear he'd end up in the hospital again with DKA. That said, now that I've been spoiled by the good Levemir numbers, I feel I must insist to the Universe that they continue.

I'm fascinated by the averages now on my meter. I wish they'd print out here in a neater fashion, though. (They look straight, and then when they're posted, they zig-zag all over the place.) Never really paid any attention to all the extra stuff that this One Touch UltraSmart does, since most of it's for humans, like "#'s after exercise", etc. Scruffy's really not into exercise. There's a graphing function that I never could use before because all of his numbers were so high they wouldn't fit on the graph; now they not only FIT, they're all below the magical line!

Here are the averages for the "last three months" - don't know how precise that time frame is - it says "90 days", so I guess I'll assume that's what it is: (approximately 12/20/07-3/20/08)

# of tests ... Days ...... Average
42 .......... 7 .......... 105
89 .......... 14 .......... 109
180 .......... 30 .......... 135
359 .......... 60 .......... 174
524 .......... 90 .......... 201

Amazing.

The eye situation

Cancelled the appointment in Erie because the ophthalmologist didn't have the diode laser - she would have been willing to give a second opinion, or to refer us to another veterinary ophthalmologist in Syracuse, but that adds another three+ hours to any trip there, and I just don't want to do that long a trip with both Scruffy and Milkshake involved. The good thing is, I did call the doctor's office she would have referred us to, and they were very nice, so I'm keeping the information for emergency purposes. If an emergency that would require a six hour drive is, in fact, doable. Probably not....

After a not-so-brief period of moping and misery about what to do about all this, I called Dr. K and asked the technician - still can't talk to the vet herself - for a little more information about where the "protocol" she thinks she's going to use on Scruffy came from. Someplace in Virginia. I did try to explain that I was not impugning her skills and knowledge, but that I felt strongly that experience in a procedure of this nature was very important to me. Scruffy may be just an old dumpy brown cat, but he's MY old dumpy brown cat, and I want him to have the safest care possible. I don't know exactly how they think the situation has been left - I might as well go ahead and have the bloodwork done. In fact, given the information that I'm about to type below, I will most likely just keep doing what I've done - taking a picture of his eye/s ( - since the other melanosis is growing, too) and having Dr. K continue on a regular basis - 3 months was suggested by Ohio State - to monitor the growth and make sure that it doesn't begin thickening. Apparently, size doesn't matter, but thickness is a very bad sign of melanoma. And it takes her specialized instruments to determine if it's getting thicker.

I contacted the Ophthalmology Department at Ohio State's vet school in Columbus. Very nice and helpful person I spoke with - she actually asked me - when I said that I had a picture of Scruffy's eye - if I wanted to email it to her and she'd show it to the vets there. Which we did. (And she complemented my photography.) I asked about complaints that I'd heard from people who took their cats to Ohio State for treatment - that it took forever to get appointments, student involvement, etc - and she said that if I want to take Scruffy to them - either for a second opinion or for the actual laser treatment, it would take about a month to set up the initial appointment. But that, once an animal is a registered client of theirs, they get immediate appointments whenever they're needed. I also talked to the MedVet office which is outside Columbus - this is where Jennifer and Dylan's IM vet that recommended Dr. Champagne previously worked. They were also very nice - they have the appropriate laser, and have done the procedure many times. There was also a Veterinary Eye Clinic in Akron that I have the number for, but it was the same number as a man named Johnson in a nearby town, and when I called, I got Mr. Johnson instead of the clinic, and I didn't want to risk calling him again.....

All in all, I have a significant amount of information now that was lacking before, and the beginning of a "plan" to deal with this. Despite my concern about the rapid growth that the melanosis has undergone recently, that is apparently not a huge danger to Scruffy. Monitoring is necessary, and can be done by Dr. K, if she's willing. (If she isn't, then I could be stuck doing a whole lot of unnecessary driving....) There are resources out there that can help us, which I didn't know for sure before, and that is good news.

This probably falls under the category of "give it a rest, already".....

but I'm already stewing because Scruffy's numbers have been so good for the last month. Same insulin, same syringes, same food, and there certainly hasn't been any increase in my skill or treatment methods. He could already have cancer brewing in his eye. He could have cancer brewing in that lump on his side, for that matter. As soon as it gets warm enough, I'm shaving the fur around the bump so I can see if it's grown.

Because of my unfortunate need to worry about everything to the greatest extent possible, I'm trying to figure out what to think/say/do - aside from bursting into hysterical tears - if the new ophthalmologist says that laser surgery isn't an option now. Well, I suppose there's really no question - he'd have to have the eye removed. Which I could deal with - it's the OTHER eye that is worrying me. Given how fast this one went from the tiny little brownish pin-prick to this big dark octopus in his eye, I hate to think that I could be doing the exact same thing this time next year. And my cat would be blind. It's not much of an achievement to keep him alive with diabetes if I'm having body parts lopped off/scooped out every couple of years.... He really DID pick the wrong garage to wander into.

I don't know if there's any real relevance to this, but it seems like progress:

Current average glucose test results: (approx. Dec '07-Mar '08)

36 tests .......... 7 days ........... 149
75 tests ........... 14 days ........... 151
175 tests ...........30 days ........... 187
356 tests .......... 60 days ........... 208
511 tests ...........90 days ............ 231

(Stick THAT in your old fructosamine, Dr. K.)

March, 2008 #'s

2/29/08
AM PS (+11) 244 fed .75uLevemir
+1 157
+3 77 fed
+4.5 85
+6.5 86
PM PS (+11) 139 fed .5uLevemir
+1.5 236
+4.5 210


3/1/08
AM PS (+12) 395 fed .75uLevemir
+6 182
+10 150
PM PS (+11) 140 fed .5uLevemir
+4 97

3/2/08
AM PS (+12.5) 317 fed .5uLevemir
+2.5 241
PM PS (+11.5) 267 fed .75uLevemir
+3.5 408

3/3/08
AM PS (+12) 295 fed .75uLevemir
+8 144
PM PS (+11.5) 156 fed fat.5uLevemir
+4 193

3/4/08
AM PS (+12) 232 fed .75uLevemir
+3 164
+7.5 95
+10.5 139 fed
PM PS (+12) .75uLevemir
+2.5 78
+5 62 fed

3/5/08
AM PS (+13) 168 fed .75uLevemir
+3 88
+9 164
PM PS (+9.5) .75uLevemir
+1 fed, threw up, ate again
+3.5 271
+5.5 187

3/6/08
AM PS (+13.5) 135 fed .75uLevemir
+2 101
+5.5 46 fed
+7.5 129
PM PS (+11.5) 117 fat.5uLevemir
+4 119

3/7/08
AM PS (+13) 197 fed .75uLevemir
+2 222
+7 173
PM PS (+11.5) 141 fed fat.5uLevemir
+4.5 53

3/8/08
AM PS (+12) 156 fed, threw up, ate again fat.5uLevemir
+5 113
+8.5 90
+10 93
+12 102
PM PS (+14) 129 fed .5uLevemir
+2.5 116

3/9/08
+10 126 fed
AM PS (+11) 175 .75uLevemir
+4 122
+6 103
+9 88 fed, threw up, ate again
+10.5 103
+12 115
PM PS (+13.5) 137 .5uLevemir
+3 114

3/10/08
+8.5 121 fed, threw up, ate again
+12.5 81
AM PS (+16) 122 .5uLevemir
+3 81 fed
+7.5 184

3/11/08
AM PS (+16.5) 173 fed .5uLevemir
+3 105 fed ( because I had to go out)
+9.5 101
+12 87 fed
+14 107
PM PS (+16) 126 .75uLevemir

3/12/08
+7.5 132 fed
+10 89
+13.5 86
+15 91
+18.5 89 fed
PM PS (+20) 139 .75uLevemir
+3.5 45 fed a ton
+4.5 68

3/13/08
AM PS (+12) 239 .5uLevemir
+2 180
+7 80
PM PS (+11) 136 fed .5uLevemir
+3.5 88 fed

3/14/08
+12.5 100 fed
+15 97
+16.5 92
+21 94
PM PS (+24) 120 .5uLevemir
+4.5 90 fed

3/15/08
+12.5 97 fed
AM PS (+15.5) 126 .5uLevemir
+4.5 106
+7.5 83 fed
PM PS (+12) 127 .5uLevemir

3/16/08
+8.5 79 fed
+12 93
+14.5 91
+18.5 84
+20 72 fed, threw up, ate again
PM PS (+22) 140 .5uLevemir

3/17/08
AM PS (+10.5) 155 fed .5uLevemir
+4.5 85
+11 103 fed
PM PS (+14) 135 .5uLevemir
+1.5 88 fed

3/18/08
AM PS (+10.5) 175 fed, threw up, ate again .75uLevemir
+2.5 57 fed
+3.5 56
+7 106
+11 97 fed
+15.5 113
+16.5 98

3/19/08
+23 110 fed
+24.5 125
AM PS (+27) 145 .5uLevemir (fur shot? - reeked of insulin)
+3 94
+6.5 108
+8.5 100 fed
+10.5 110
PM PS (+13) 127 fed .5uLevemir

3/20/08
+7.5 111 fed
+10.5 61
+11.5 66
+13.5 60
16.5 84
PM PS (+19.5) 153 fed .5uLevemir
+4 97

3/21/08
+12 65 fed
+14 75
+19 106
+21 117
+23.5 121 fed
PM PS (+26) 157 .5uLevemir
+3 146

3/22/08
AM PS (+11) 139 fed .5uLevemir
+5 66
+8.5 60 fed, threw up, ate again
+14 61 fed, threw up, ate again
PM PS (+16.5) 119 .5uLevemir

3/23/08
+7 52 fed
+10.5 47 fed
+11.5 60
+16 71
+17.5 59 fed
+19 94
PS (+22) 123 .5uLevemir
+2 72 fed

3/24/08
+8 108 fed
+11.5 67
+15 72
+19 95 fed
+23 83
+25 128 fed

3/25/08
AM PS (+33) 144 fed, threw up, ate again .5uLevemir
+4 45 fed
+5 64
+8 94
PM PS (+12) 118 fed .25uLevemir
+1.5 99
+3.5 73

3/26/08
AM PS (+12) 141 fed .25uLevemir
+3 62
+4.5 41 fed
+6 51
+7 93
+9 92
+10.5 89 fed
+13 86
+16 75

3/27/08
+21 101
AM PS (+24.5) 219 fed skinny .5uLevemir
+1.5 220
+4.5 42
+5.5 56
+9 91
+10 fed
+10.5 87
+14 78
+15.5 70

3/28/08
AM PS (+23.5) 192 fed skinny .25uLevemir
+1.5 145 fed
+5 60
+10.5 99 fed
PM PS (+13.5) 128 .25uLevemir
+2 120
+3 134

3/29/08
AM PS (+10.5) 116 fed .25uLevemir
+3 120
+6 68
+11 fed
PM PS (+13.5) 106 .25uLevemir
+2 103

3/30/08
AM PS (+10) 126 fed .25uLevemir
+5 100
+10 91
PM PS (+12) 127 fed .25uLevemir
+3.5 72

3/31/08
AM PS (+11.5) 89 fed .25uLevemir