The past seven days have been a real roller-coaster of a week. The two weeks prior to last weekend weren’t much better.
Throughout the day, Sibylle noticed that Nekko was behaving a bit oddly. As her symptoms became more pronounced, Sibylle took Nekko to the vet. Nekko had experienced hypoglycemia, or insulin shock. There was too much insulin in her bloodstream and not enough sugar. Thanks to Sibylle’s actions, the doctor was able to start a dextrose IV and reverse the effects. Three hours after dropping her off we were able to bring Nekko home. Within a day she was back to her old self. We reduced her insulin dosage from 4 units to 3, every twelve hours, and scheduled a blood glucose curve, to occur in two weeks time.
Another Tuesday, and nearly a second hypoglycemic event. Having seen the warning signs just a week prior, Sibylle recognized them when they started again, and we were able to head it off with syrup and some canned food. This was the day we bought a home testing kit, and started monitoring Nekko blood sugar ourselves. From all the data that we gathered, it appeared as if Nekko had entered some kind of remission. Apparently 20% of all diabetic cats experience this kind of change in the disease. With her body producing insulin once again, the injected insulin was driving her blood sugar dangerously low. Expect for one high BG reading (385+), when we administered a single unit, we halted her insulin. Her appetite was good, her energy level was good, and her BG hovered around 200 unaided.
On Friday we started to notice a bit of lethargy in Nekko, and a lack of interest in eating. She still showed interest in food, and would nibble, but she wasn’t eating. She may have stopped drinking water as much then too. Friday evening we were concerned, but not overly so. When, Saturday morning came and she still showed no interest in eating, we decided to get some new food. Our vet had told us about a boutique pet store that had a good selection of natural foods. On our way there we missed being in an accident only by virtue of being the second car in line, and not the first. We stopped and assisted as much as we could until the emergency responders were there, and then hung around until the police said they didn’t need us any more. On top of our already strained emotions and physical tiredness, the adrenaline surge and subsequent crash, really wiped us out. Being out in the high winds and noon-time heat of a Kansas summer day didn’t help either.
My father and his companion were on their way to spend the weekend visiting with us. We were talking about sites to see or places to visit in addition to trying to figure out what to do about Nekko. After dinner out we returned home to find Nekko almost unresponsive; she was now refusing food and only lapping at water, not really drinking. We finally took her to the emergency hospital around 12:30 am, after she had vomited a sticky, greenish mucus.
The animal hospital, where she had been diagnosed diabetic twenty months earlier, did the usual intake steps, including measuring Nekko’s vital signs. Her temperature was down several degrees, and the doctor indicated she had moderate level ketones, an indication that her blood glucose level was out of whack. Indeed, it was 500, where only a day earlier it had been 200. After waiting while they injected some subcutaneous fluids to help re-hydrate her, we took Nekko home.
Throughout the remainder of Sunday we tried to keep her warm, and comfortable. Sunday evening we called our vet, who graciously met us at his office, and he again injected subcutaneous fluids to help her. He felt that she would be fine overnight, and we arranged to bring her back in the morning so that he and his nurses could try to stabilize her condition. Overnight there would have been no one at his clinic to monitor her.
After making her comfortable at home, with dryer warmed towels and rice, inside pillow cases, warmed in the microwave, we went to see G. and R. at their motel room. They had been very gracious and understanding about our need to stay with Nekko, and had entertained themselves during the day. It was good to see them, even under the circumstances.
We returned home to tend to Nekko. Giving her liquid food, and water, seemed to be working. Her blood sugar was reacting positively to the insulin, and we had warmed the bathroom, where we were keeping her, to nearly 82 degrees. At midnight we injected more fluids subcutaneously, following the doctors directions.
Around 2:45 am she threw up, losing most if not all, of the food we’d given her via syringe. Her breathing was labored, almost panting afterwards. All we could do was keep her warm and stay close by. An hour later, at 3:45 am she died.
When she had been originally diagnosed in September 2006, the doctor said that in addition to diabetes, she had cardiomyopathy, or an enlarged heart. I think that over the nearly two years of her diabetes, her heart steadily got worse, and that the hormonal roller-coaster she had been on for the last couple of weeks was more than it could survive. Had she been at either the vets’ office or the emergency hospital we would have been unable to be with her at the end.
We stumbled around for a hour or so, until exhaustion caught up with us, and crawled into bed with the alarm set for 7:00 am. Sibylle had an ultrasound appointment at 8:30, and we needed to be up in time. Following the procedure at the hospital we looked at a couple of options and decided to take Nekko to Rolling Acres, just north of Kansas City, on the Missouri side of the river. We had her cremated there.
After lunch at a Panera Bread we find comfortable and welcoming, we headed off to a second doctor’s appointment. The scheduling for this appointment had been botched by the clinic, and we ended up waiting nearly two hours before finally seeing the doctor. He was brusque, and ultimately unhelpful. When doctor’s say, “I don’t want to minimize what you’re feeling…,” then that is exactly what they are doing.
Finally back at home we collapsed into bed for a much needed three-hour nap.
Wednesday evening a EF4 tornado demolished Chapman Kansas, and then cut a path of destruction across southwest side of Manhattan, and the Kansas State University campus. One of Sibylle’s former students lost his home, and several others had theirs damaged in the storm. All day Thursday, Sibylle, kept hearing more about the situation in Manhattan, and the status of her loved ones. Fortunately no one was serious hurt, and the town and nearby Fort Riley military reservation are turning out in droves to help.
In the midst of this week, Sibylle interviewed and accepted a new family of students, bringing her Olathe studio to eight. Next week the ninth student will start. Our kitchen floor was replaced; the new one, laid only a few weeks ago, was torn badly when the construction crew slid the refrigerator into place. The replacement was scheduled to happen Tuesday morning, but was postponed until midday Wednesday when the contractors truck broke down.
Today we are taking it easy. Except for a birthday party later this evening, we have no plans or ambitions. We started to put the kitchen back together following Wednesday’s laying of the floor. We are also preparing to rearrange the piano room a bit, to make room for a new bookcase.
Hopefully the roller-coaster ride is over for now; we need time to catch our breath, sleep, and just be for a while.
Several times since Monday I have started to write something about Nekko, but each time I found the emotion too strong to capture in words. I still feel a sense of emptiness, of being hollow. Nekko was with me for eleven years. She moved from Illinois to Washington, and then to South Carolina, back to Illinois, and finally Kansas. Twenty months ago she was critically ill. Every day since then I have been grateful for deciding to pursue treatment for her diabetes.
Her death is still close enough that I find myself looking for her at the top of the stairs, or listening for her nails clicking on the floor as she drug her favorite string toy towards me to play. Sitting on the futon and watching a movie is poignant now, as she used to share that space with us.
Monday morning we took her to a pet cemetery, where she was cremated. Yesterday afternoon I picked her cremains up, and brought her home. Eventually I know her memory will come without the emptiness I feel now. For now I miss her terribly.
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Nekko (1997 - 2008)
Nekko’s condition, after seeming to stabilize Wednesday and Thursday, started to diminish on Friday. She stopped eating and was more and more listless through out the day. By Saturday morning we were concerned that she wasn’t eating, and had, apparently, not moved her bowels in a couple of days. At the recommendation of our vet we went to a near by pet store and got some natural, grain-free cat food hoping to entice Nekko to eat. She would only sniff the food; she wasn’t interested in eating.
Thinking that the change in her condition, coupled with a change in diet, may have constipated her, we tried giving her some mineral oil. We were out for a couple of hours in the evening and when we returned she had vomited green mucus-y stuff in a couple of places. Some quick research seemed to indicate some problem with her bile system.
By midnight her condition hadn’t improved at all and so we took her to the emergency hospital, the same hospital where she was diagnosed with diabetes twenty months ago. They did some basic vitals and agreed with us that something was wrong. Her temperature was down, and her skin tone was off. The cost to stabilize her was far past the amount we could afford. After consulting with the attending doctor we decided to have them inject some fluids subcutaneously, which would help to re-hydrate her. We brought her home and spent the last few hours of the night napping on the futon and getting up to check on Nekko.
This morning she is still very listless. She does respond when you talk to her, opening her eyes, and sometimes lifting her head. She is still capable of moving around; once we spend some time with her in the bathroom, where she tends to gravitate, she’ll move back under the futon. We are both thinking that she is dying, and that even something heroic wouldn’t alter that eventuality.
I don’t know what today will bring. For now we are going to keep her warm, and give her water, and loving attention.
Yesterday around noon, we ran an errand to get some natural cat food at a nearby pet store. On the way we were one car shy of being in an accident.
It was all over so quickly that I really didn’t realize it was happening until afterwards. At a traffic light controlled intersection (a main road with 4 lanes plus left-turn lanes) and a side street (bank on one side, residential and gas station on the other) we had solid green lights. The speed limit is 45 and traffic was moving close to that.
The mini-van in the left lane, directly in front of us, was hit by a car coming from the side street. Both cars stopped rather quickly, and there was an explosion of glass, plastic, and metal on the road. I was able to stop our car, thanks to the ABS braking system. I drove around the accident scene and then stopped to go render aid. Sibylle used her phone to try and call 911. Several other people stopped as well.
The single occupant of the car was unhurt, and after getting over an initial daze at what had happened, seemed okay. The husband and wife in the mini-van were a bit more beat up. He had a large bruise forming on his wrist, and she was shaking and panting in her seat - I think the airbag deploying into her had really shaken her up. One of the first people there was a nurse and she quickly and calmly took over aiding the woman.
After what seemed like a very long time the police showed up, and then an ambulance. The occupants of the mini-van were taken to the hospital, while the driver of the other car waited for friends he had apparently called to arrive. The driver of the car which had been next to the mini-van filled out an accident report for the police; since I had really only seen the ending, and not how it had started, they didn’t request one from me.
In all we where there for 40 minutes or an hour. Long enough that I have a mild sunburn on the back of my neck and the tip of my nose. Even though we came to a extremely rapid halt in our car neither of us was hurt. Although, Sibylle, did experience an ocular migraine after we got home from our errand. She looked it up online and discovered that it was possible to have a migraine in the area of the brain that interprets signals from the optic nerves, and that these could be completely painless but would cause jagged halos or crescents of light in ones vision. After laying down for a few minutes the symptoms went away. We are both thinking that the stress of the accident directly in front of us, and then being a part of its aftermath, on top of an already long week worrying about Nekko, was enough to trigger this migraine.
The driver of the mini-van used Sibylle’s phone to call someone, who came just as the ambulance arrived. Later today, or perhaps tomorrow, we are thinking about calling that same number to find out how they are doing.
For the past week, Sibylle and I have kept a much closer watch on Nekko, her insulin injections, her food intake, litter box usage, and general overall demeanor. For the most part Nekko has seemed to be fine. She still displayed some aggressiveness around our food, but willingly ate her own food. We reduced her insulin dosage to 3 units every twelve hours; a 25% reduction from the 4 units she has been getting twice daily since March 2007.
This morning at about 4:00 am, or about seven hours into her insulin cycle, Nekko let out a very loud, unhappy sounding meow. Sibylle got up immediately to see what was going on. Nekko seemed fine. When offered a plate with syrup on it, she sniffed but didn’t partake. After a few minutes Sibylle came back to bed only to have Nekko meow loudly again. This time I got up and sat in the room with her for a while. Again, she seemed normal.
Around 7:00 am, while I was eating my breakfast, Nekko start meowing loudly and continuously. Sibylle immediately recognized that this was the same meowing Nekko had displayed last week prior to going into insulin shock. She showed Nekko the plate of syrup, which was lapped up immediately. We moved on to a small can of wet cat food, which was also consumed rapidly. After eating and consuming some more syrup Nekko again seemed fine. Within minutes however, she threw up. Obviously her system wasn’t prepared for large amounts of food. Worried that she might not have absorbed or retained enough glucose from the syrup, we decided that we needed a home test kit.
I was able to get an Accu-Check blood glucose monitoring kit and some test strips at the local Wal-Mart. Nekko was surprisingly obliging as we fumbled around with the lancet trying to find a setting that would sufficiently prick her ear. When we finally got enough blood for a reading it was 84.
Felines are a bit different than people, in how they express diabetes. The “normal” range for a cat is something like 70-160. However, for a diabetic cat the danger is getting too much insulin and dropping the BG below 70. The optimal range for Nekko is more like 100 - 200, with 100 being the absolute lowest reading we’d like to see. The safe human range extends to nearly 350, so a high reading isn’t going to bother us at this stage of her disease.
Two hours, and a little bit of food later, Nekko’s reading was 90. Two more hours later it was 204. Throughout the day she has had some diarrhea and has thrown up again. Sibylle mixed some rice (bland) with canned cat food, and Nekko has thus far kept that down. At that time her BG was 202. Once she manages an hour without incident we’ll give her another portion.
We are going to test her glucose level every couple, three hours for the next day or two. Hopefully that will give us a baseline of where she is now. We are going to discontinue insulin for the time being. As the doctor said, too high is better right now than too low.
As for the cause of her sudden hypoglycemia, the Diabetes Mellitus in Cats site, offers this information:
The first signs of spontaneous remission is hypoglycemia. At the peak time (determined by the glucose curve), the cat is very unresponsive; however, a few minutes to a few hours later he appears normal. The cat has the ability to respond to hypoglycemia by converting glycogen (stored in the liver) to glucose. However, after a few days of this response, glycogen stores are depleted and the cat becomes seriously hypoglycemic. He may die without immediate intravenous glucose. The episode last week certainly sounds like it could be the onset of remission. That she has continued on for another week, with insulin injections, seems to fit with the use of stored glycogen. It is based on this information that we are taking the steps to monitor her BG and suspend insulin injections for the time being.
We are hopeful that Nekko’s episode with insulin shock was an isolated event. Since Tuesday we have closely monitored her eating and insulin, and haven’t seen any evidence of another bottoming out like Sibylle caught that day.
For her part, Nekko, seems to be normal again. She still displays some aggressiveness around our food, needing to be shooed away from an unattended plate, but nothing that causes any concern. If anything she is more approachable in the aftermath of Tuesday’s episode.
In a little less than two weeks we’ll have another day long glucose curve performed, and hopefully learn more about the current state of her diabetes. Until then, we’ll be watchful and cautiously optimistic.
For the past twenty months Nekko’s diabetes has been under control. Sibylle and I have eased into a pattern where she administers the AM shot, and I take care of the PM shot. The last several spot checks of her blood glucose levels have been good, and the blood glucose curve we had performed in March was excellent.
This afternoon, for no immediately apparent reason, Nekko went into insulin shock or hypoglycemia. Fortunately, since this is the week between her spring lessons and the start of the summer program, Sibylle was home today. She noticed that Nekko was behaving oddly, and was being very vocal. At one point Nekko tried to throw up, and then Sibylle saw that she was arching her back and she noticed a tremor in Nekko’s paws. Cats mask their pain and illness; showing weakness in the wild invites predators. Sibylle’s instinct that something wasn’t quite right was well founded. We had been told that should Nekko ever have too much insulin in her system, for any reason, to give her some syrup, as the glucose will be absorbed by the mucous membranes in her mouth immediately. Sibylle did smear some syrup in Nekko’s mouth before rushing her to the vet’s.
By the time she reached the vet’s office, Nekko had started to convulse, stiffening and arching in the carrier. The doctor immediately started a dextrose IV. The initial blood sugar reading was below the lowest detectible level. There was no sugar in her blood stream. Nekko was hypoglycemic. Fortunately, thanks to Sibylle’s quick action and thinking, Nekko will be okay. We will return to pick her up for the night in a couple of hours, and then tomorrow take her in for a new glucose curve.
While we’ve been waiting Sibylle has done some research into insulin shock, both in people and in felines. Everything we’ve read indicates that the course of action our doctor is suggesting is the right one. That for some reason she suddenly had too much sugar in her blood stream. Either her pancreas has started producing insulin again (not unheard of in felines), or she didn’t eat sufficiently following her last shot. We have noticed an increased aggressiveness towards our food in the last several days. Last evening, as she was trying to eat a piece of cheesecake, Sibylle had to fend Nekko off several times. Not at all Nekko’s usual behavior. In light of this afternoon’s episode, it appears that Nekko’s system may have been changing for several days now.
We’ll know more tomorrow evening.
iTunes allows you to back up your purchased media, in fact you can make a back up of your entire library. However, since most of my non-iTunes purchased media is already on CD, I don’t see a need to back up the iTunes version. My iTunes purchases include the introductory mini-series and first three seasons of Battlestar Galactica (BSG), a whopping 18 GB of material, that, quite frankly, has to go. Even with an after-market 100 GB drive installed in the Powerbook, I’m regularly below 8 or 9 GB of free disk space these days.
My Powerebook only has the Combo-drive, capable of reading DVDs, and burning CDs. Backing up the BSG shows to CD would take some 26 or 27 CDs, and who knows how long for each CD. Not really looking forward to feeding the laptop CD after CD for an entire day, I’ve been putting this chore off for a while. With rain in the forecast for our Memorial Day weekend I decided to start the process Friday night, and just feed the slot drive as needed. Clicking on File | Back Up to Disc… option started the process. After inserting a blank CD I was informed that one of the purchased items was larger than the 700 MB capacity, and that I should insert a DVD instead.
Huh? Larger than 700MB? Something purchased from iTunes?
Turns out that one of the Battlestar Galactica episodes I was trying to back up was in fact a two-hour episode, and weighed in at a whopping 900 MB. Since the Powerbook hasn’t got a DVD burner it appeared, at first, like I was out of luck.
I do have the original 40 GB hard drive, in a USB/Firewire enclosure, however. And iTunes will allow you to transfer purchased content to a different computer. So. The 18 GB of BSG stuff was copied to the portable drive, so that it could be imported to the ThinkPad, which does sport a DVD burner. Of course what it didn’t have was 18 GB of free space. It too suffers from creeping drive usage disease and has only about 5 GB free out of an 80 GB drive. Triaging the drive in the ThinkPad, I found some old Java/HTML/Ruby archives that could be moved off the machine, and so I copied them to the portable drive, giving me about 10 GB of free space to work with. Not enough for the entire 18 GB, but just barely enough to import and backup a season at a time.
After importing season 1 (and activating the computer on my iTunes account), I was able to start the backup process. While I didn’t keep track of the time, it seemed to produce the completed DVD in fairly short order. With season 1 on DVD, I deleted the episodes from the ThinkPad and imported season 2, and back them up as well. Season 3, with the two-part episode, weighed in at nearly 10 GB all by itself. Apparently NBC or the SciFi Channel or Apple, increased the video quality and consequently the individual episode size. iTunes informed me that it would have to create data disks and that the back up would span 3 DVDs total. Fine. Again, each disk took a relatively short period of time to be completed.
After testing each of the disks to make sure they weren’t coasters, I returned to the Powerbook and deleted the three seasons from my hard drive. Now, instead of 8 or 9 GB of free space I have 26 GB. Much better. As a bonus, I now have a backup of my iTunes purchased television programs.
UPDATE: October 24, 2009 - I’ve now successfully restored the backed up material to my new computer. You can read about that in Restoring iTunes Backups.