feuervogel: photo of the statue of Victory and her chariot on the Brandenburg Gate (Default)
I'm glad we only budgeted a day and a half there. Even with taking a several-hour detour out to Devin castle, we had way more time than we needed to see the city. It is, however, really really cheap.

Getting two phone calls (from a number I didn't recognize) followed by a text message from my vet,letting me know that Isis has ketones in her urine, starting at midnight, then continuing well past 2 am and finally resolving at 6 am (local; midnight EDT) when little Sarah got her all checked in to the vet school.

So, naturally, I got about 3 hours of sleep, if that, which meant I spent half the day feeling sick to my stomach. Then I got all dehydrated and stuff. And I didn't get my morning coffee.

So anyway, we're in Budapest now, and we've had palacinky (crepes, aka palatschinken in Austria), and I got a coffee a bit ago, which did wonders for my headache. My brain no longer feels like it's being squeezed.

I heard from Sarah that internal medicine is taking Isis' case now, which is probably good news, if it's anything like people hospitals. She's out of the ER, anyway, and into general medicine. I don't appear to have made any notes regarding the exact progress the first time at the vet school in my DW. I don't know if she was admitted to the ICU at all; we can't get any info from the vet school. Sarah's kindly being our go-between, but she hasn't heard any further details.

Hopefully since they were checking urine ketones every 12 hours at the vet clinic (where she's being boarded while we're gone), they caught it early enough that it'll be easy to treat and she can go back to the clinic tomorrow afternoon/evening. And not have another sleepless night for us while they play text message tag.
feuervogel: (smiling Zuzu)
When's the last time I wrote about what I've been doing, other than writing? Uh, can't recall. April 10, maybe?

Let's see. Sunday the 11th I went to the park to practice San Shou with my tai chi school, then went to UNC for the anime club's spring picnic/ohanami. That was fun, aside from there being no fucking parking on campus diediedie.

I did the usual weekday stuff during the week, then Friday I went to Charlotte to stay closer to where I was going for a writers conference. The conference itself was OK; it was only $20 so even if the session I went to in the morning was billed as a workshop but was more of a lecture on what to do than how to do and there were so goddamn many Christian-interest writers there, it wasn't a huge waste.

The afternoon session I went to was David Drake talking about how he writes - his process, that sort of thing - and taking questions. It was interesting, and he's really intense. He told me I shouldn't read Hammer's Slammers, because it would disturb me (eh?) because he wrote them after he got back from Vietnam and they were a form of therapy. Now, I like a good, realistic, gritty war story, so I'll see how that goes. I might have time to start reading again soon.

Saturday evening, since I was in the process of flipping out about that volcano in Iceland, after I got home, I texted my ex-coworker and we went out to the bar in Hillsborough. (There's just the one, actually.) Then I tipsy-posted when I got home.

Sunday I went to a Turkish festival out at the fairgrounds. It was OK; there was Turkish coffee, and for an extra $5 I could get it in a Kütahya porcelain cup to take home. I bought some more helva, and Ben got some chocolate-creme-filled cookies that were pretty damn tasty. There were demonstrations of ebru (video) and folk dances (these guys were pretty amazing).

Monday I went out to Greensboro to meet [livejournal.com profile] xjenavivex and J, to talk about starting a regional genre writers group, for things like networking, promotion, support, etc. The coffee machine at the Borders was broken, wtf. It was fun, and we're going to work on how to make it bigger & better. And maybe if we get enough interest, we can do a writers retreat out at the Outer Banks in like January when it's cheap(ish).

Coming up: Saturday I'm going to a conference/CME event on pain, addiction, and the law (from 7:30 am to 5 pm...but I'll get close to 8 hours of CE credit for it.) Sunday we have to run another blood glucose curve on Isis, so I'll be home all day. Then next week, I'll be running around and getting my shit together for Germany (clothes, toiletries, hair cut) and trying to see people before I go. L's having her birthday party Friday the 30th, and I may or may not go. I probably won't decide until Friday, actually. My plane leaves at 12 something (I forget if it's noon or like 12:45), so I'll have to be at the airport at like 10:30. We'll see.

Also, thanks to [livejournal.com profile] av3rnus I have a lot more German industrial & techno. I need to find time to sit down and make note of which bands I liked enough to want more of, now that I've listened to all 3 CDs like 2 or 3 times each. (The only band whose song I skipped was Einstürzende Neubauten. Sometimes music hits certain frequencies or rhythms or something that makes me either cringe or become anxious. I can't reliably describe what exactly it is, either. EN tripped that button, each time I listened to it. Thankfully, I know how to use the 'next track' button.)

Right, then. Time to get the last few scenes on this novel draft edited/written. I only have 4 left. Which means I'll need a few hours tomorrow to finish it, because I'm good for about 3 scenes a day, if they need extensive reworking, and these, uh, do.
feuervogel: (black haru)
Trying to explain to somebody why the method currently in use is resulting in shitty results that aren't useful for the decision-making process and that we may have to turn it over to the pros and having the only response being incoherent grumbling and "I don't think that'll make it any better."

Right, because having a huge spike due to stress at the time the NADIR is supposed to be happening is going to be really fucking useful in evaluating the current insulin regimen's efficacy.
feuervogel: (writing)
607 words, in a day spent doing other things (like getting groceries, cleaning the bathroom, dealing with email I haven't responded to since the beginning of the month, and fooling around on facebook.)

Which brings my total up to 47544 words and puts me firmly into the ho-shi-politics part. Which means I need to spend some time sketching that shit out. For all the time I spend in political stuff, you'd think that'd be right up my alley. Apparently it's hard! Who knew??

I'm apparently working this week. I'm glad I looked at my calendar! Though I'm listed as 10-7 every day, which ... isn't what I asked for. I emailed my 'agent' and asked what was up. We're working on the 3-day compromise thing.

Having bad luck with the Isis-ear-poking thing today. We only have like 3 readings. :P
feuervogel: (isis)
It sounds like a cool band name or some sort of SFnal plot twist, yeah? Not really, but it is pretty cool.

We did a glucose curve on Isis yesterday. Her fasting reading was 307, then we fed her and gave her insulin, and 2 hours later it was 347. That's not incredibly unusual, to see a sustained increase in blood sugar after eating. In a non-diabetic, the BG will approximate normal at 2 hours. I considered, upon seeing her high fasting sugar, whether there was any Somogyi effect going on, and I kept that in mind throughout the day.

We continued to check her sugar every two hours, and over the course of the day, it continued trending downward. Before dinner, it was 160, then at 8 pm it was 140, then before bed it was 93.

Normal range in humans is 80-110; in cats it's similar. In diabetic cats, they want it between 130 and 200.

I didn't like the look of that, so we gave her a few Wildside Salmon treats (freeze-dried salmon; the cats LOVE it) and some dry food before bed. We checked her sugar before breakfast today: 143. To me, that indicates yesterday's morning reading was likely due to Somogyi.

So what the hell is this Somogyi I keep talking about? First, a little biochemistry. When you sleep, you're not consuming any sugars, though you're not really exerting yourself, either. Your body is still metabolically active, keeping your heart going and your brain going and your breathing going, doing cellular repairs, that sort of thing. This requires energy. The liver stores glycogen, which are basically long-chain sugar molecules, and it releases glycogen when your body signals "hey, we could use a little sugar here" at 3 am. (Glycogen also plays a role in distance running and other endurance events.)

In diabetes, when the BG drops too low overnight, the liver can overreact and dump more glycogen stores than it needs to, leading to a spike in BG in the morning. This is the Somogyi effect.

Ben is sending the spreadsheet I made of Isis' BG readings yesterday to our vet, and hopefully there'll be discussion of how to manage this. We can't really go down further on her nighttime insulin - she only gets 1 unit, so skipping it entirely or giving her kibble before bed are likely to be good options. We'll see what our vet says.

I really would prefer not having to stick her ear and get a BG reading every night, though. She's none too thrilled about it, and we're crap at making the kitty burrito.

I also haven't heard back on the additional testing from the spleen aspirate to see if she has cancer. I asked Ben to ask if they'd heard anything on that yet.
feuervogel: photo of the statue of Victory and her chariot on the Brandenburg Gate (Default)
So, we picked her up Tuesday night, as I mentioned. We're giving her insulin, which she seems to tolerate, and Clavamox tablets, which she doesn't. (If we could Pill Pocket her, trust me, we would. However, they're made with wheat, which she absolutely cannot has. She's allergic to it, pretty severely.)

We're trying to get her to eat, because they found evidence of fatty liver, which happens when cats mobilize their glycogen stores when they're not eating. If she continues not to eat, it could become fatal. But she is interested in her food, and she'll eat all of it with encouragement, so it's good. She's catching on to us, though, because this morning she ate some food, then slinked off upstairs. I brought her back downstairs, and she ate more. Then after a while, we poked her and shoved a pill down her throat. We're bribing her with salmon treats, and she goes for those after we pill her. I got her to finish her breakfast after the treats.

The spleen aspirate showed some leukogenesis, which isn't too surprising, because they gave her iron IM and she was a bit anemic, but the cytologist said, "if you have any question of lymphoma, do this other test." So they're running another test that involves staining the slides and looking at them again, to find out if she's got lymphoma. (The differential diagnosis is irritable bowel disease, which, with her history of food allergies, seems slightly more likely, but I'd rather definitively rule out cancer (or rule in) than keep fretting over it. Definitive yes or no is better than inconclusiveness.)

We need to get her back to our vet for a blood draw tomorrow morning, to check her liver function and see if it's getting better. She won't like that at all, and she'll be pretty cranky about being stuck for insulin, pilled, *and* shoved into a box, then poked some more. Hopefully she'll forgive us quickly.

I suddenly have a contract, so I'm working 1-7. Which means I'm foisting my writing into the morning. In about 45 minutes, I wrote 648 words, most of which were rewriting an entire scene (because this way makes so much more sense.) They want me to do 40 hours, but I hesitate, because I'd be gone from 9:15 until 7:45, and that cuts heavily into my doing anything other than work time. I'm contemplating asking if I can bring my laptop and write during the 1-hr lunch break, but ... I'm still undecided.

On that topic, I need to go eat lunch and put some real clothes on before heading out. Isis is squawking on the stairs. Last I checked, she was sleeping in a sunbeam. She's so cute :)
feuervogel: photo of the statue of Victory and her chariot on the Brandenburg Gate (Default)
A bit dopey from the sedation, but home. And she ate most of the food Ben gave her for dinner, with some encouragement. Hopefully she won't need a feeding tube.

I'm gonna go sit with my dopey fuzzbutt until it's time for bed.
feuervogel: (isis)
So, this morning, we were supposed to go in for a simple urinalysis and some how-to on the insulin shots, then go home.

Best laid schemes, as they say.

There were ketones in Isis' urine, so they ran a serum sample (separated blood) and found moderate to high ketones. What does that mean, you ask? It means she's spending the next 24-48 hours at the NCSU vet hospital, getting hydration and IV insulin.

So, in diabetes, the body doesn't process sugar properly, usually because there isn't enough insulin available. Insulin acts as a key to open the door that lets sugars into the cells. When insulin isn't doing its job, either because there isn't any (type 1) or because the cells aren't as sensitive to it (type 2), the cells aren't getting the sugar they need to do their jobs, and the body looks for other ways to get energy. (Sugar is the basic fuel source for every cell in your body.)

Ketones are a breakdown product of fat and fatty acids, which the body can also use for fuel. However, this is not a good state of affairs for the body in general. Ketosis and diabetic ketoacidosis can occur.

Isis is being treated for ketosis, as opposed to DKA, I believe. Neither of the vets said she had a low blood pH, which is the distinction between ketosis (presence of ketones) and ketoacidosis (ketones + acid). DKA has a third component: elevated blood sugar.

So I'm waiting for the vets to call with an update on her blood chemistries and her condition in general. She was feisty and surly this morning, but sick enough that she had to go to the hospital.

Also, a local friend had some syringes and a glucometer from her late diabetic cat, and now we have them. It'll save us a bit of the initial outlay, which is nice, considering I paid $300 at the vet, then a deposit of $1500 at the vet school, and we haven't even bought the Lantus yet.
feuervogel: (isis)
So, Señora Crankypants has diabetes. Her cleaning for Monday is off until we get her under control, but we have to take her in for a urine sample Monday, as well as some instructional stuff and getting the prescription.

- This is where my training in diabetes education and management will come in handy. Thanks, UNC SOP! I'm a little out of date as far as what meters are available, but we don't need anything fancy like Ascensia Breeze. Luckily for me, some kind soul at Walgreens put together a comparison table.

- Our vet likes to use Lantus pens. Except not as pens: they want us to draw insulin into regular U-100 syringes. It's more cost-effective: one box of 5 3-mL cartridges costs $185 at Harris Teeter (and we can get a VIC discount), and one 10-mL vial costs about that. Once you open a bottle of insulin, you're supposed to pitch it after a month. If you're good about aseptic technique, and you're vigilant about checking for precipitate in the cartridge, you can use it longer. I personally wouldn't use it more than 2 months. (In humans, this typically isn't an issue.) So even if the pen cartridges cost more, it's really saving money in the long run.

- Isis should eat food that's <7% carbohydrates. The Evo she's eating is 7% max, which is the lowest carb content in dry cat food. We'll try a few other types of canned Evo, to see what she likes. The one she's eating at the moment (turkey & chicken) is really mushy, and I think she may have trouble eating it. We know she likes Luna's food, which is Innova canned (not Evo), and that has 3% carbs. A trip to Phydeaux is in our future.

- We also need to have Karo syrup on hand in the event of hypoglycemia. Smear it onto her gums, apparently.

- The vet said I can do a glucose curve at home, because she's comfortable with me doing it, since I'm a pharmacist. It's about $170 each time they do it in clinic, and it may require several times to figure everything out, so it'll be another cost saver. Because I feel more comfortable having a glucometer available when giving insulin, I'm going to acquire one.

- Boarding at the vet clinic is $22/day, plus $2.50 if the cat needs medication. They also do a flea treatment on admission for $5. So not too much gloom and doom for vacation travel (there's no way I'm asking a pet sitter to deal with this. Isis hates everybody except me & Ben. Vet staff can deal with it, and if anything goes poorly, they'll be able to take care of it.)

Things to buy:
- glucometer (AccuChek Aviva ($20 at Walgreens) or Active)
- test strips (AccuChek Active $30/50 at Walgreens; Comfort Curve $20/50 at Amazon)
- alcohol wipes
- lancets
- Karo
- Lantus SoloStar

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feuervogel: photo of the statue of Victory and her chariot on the Brandenburg Gate (Default)
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