The Emergency Room

I’m stepping back in time a bit to tie up some loose ends. Back on November 17 I started a post by saying that Isabella was sick and I was waiting for the vet to call, but I never reported the outcome.

At the time, I didn’t write about it because I was upset and worried. As days and weeks passed and everything returned to normal, I let it go. So, six weeks late, here’s Isabella’s story from November 17th:

The beginning is actually two days earlier. I took Isabella to her vet for a checkup. I thought she was losing weight in spite of a decent appetite. Her checkup was fine. She had lost about half a pound since her previous visit, but the vet and I decided that it was likely due to opportunistic food thievery by Casey (who was gaining weight as quickly as Isabella lost it.) We assumed that Isabella’s teeth bothered her, so she ate slowly, allowing Casey to steal her food, leading to one fat cat and one skinny cat. I scheduled an appointment for a dental.

Two nights later she threw up twice, then let me sleep late in the morning instead of standing on my head demanding her 6am meal. Unusual, but Isabella enthusiastically gobbled up her breakfast, so I mentally shrugged and went about the day. Until she puked up every bit of the morning meal. And then some water. And sat like a meatloaf with dull eyes. Even a thick-headed dolt like me could tell something was wrong, hence the call to the vet.

That was my first mistake. Not making the call, but waiting for a call back. A call that didn’t come until hours later. By 3pm Isabella looked like death warmed over and the regular vet’s office was closed for the weekend, leaving me no option but to take her to the emergency vet clinic.

The animal ER shares parallels with those in human hospitals: They are slow. Slow. Slow. There are families there who are living through a tragedy. The phone rings incessantly. People are grumpy. These things I understood as soon as I walked in.

I explained the problem to the intake person (inappetant, lethargic, diabetic cat; history of vomiting). She wanted to take Isabella for a blood glucose test, but I had just done one, so the kitty stayed with me, in her carrier. That’s probably the only thing I did right, keeping her with me while we waited.

The wait stretched to an hour, then were escorted to an exam room where we waited another half hour. At last, a tech came in and took Isabella’s vitals and asked the pertinent questions. I should say up front that I was pretty sure that she was having an attack of pancreatitis. The symptoms matched and it’s a common ailment for diabetic cats. So when the vet came in, did his exam and laid out the tests (blood test, pancreatitis test) and therapies (fluids, meds for nausea) he had in mind, I agreed to the plan. I left Isabella in their care for three hours while they did what needed to be done.

When she was ready to come home, I went back … and waited an hour before my credit card was billed and Isabella was brought to me.

That’s when I knew that I would never, ever come back to the emergency vet unless it was life or death. Isabella was completely, utterly freaked out. She was in a state that I’d never seen – not after any trip to the vet, or being spayed, or her cancer surgery. Wild eyes, panting, just this close to going over the edge. I don’t know what went on while I was gone, but it surely upset my little cat, and that upset me.

She did calm down when we got home. And she ate, without throwing up. Over the next couple days she perked up and everything went back to normal, meaning no more late sleeps for me, because Isabella is again on my head every morning begging for breakfast.

Reading back over my blog entries leading up to that day, I can see the trail of warning flags. I mentioned several times that she let me sleep late, or that Isabella had thrown up, or that I felt like things were just not right. Now that I’m more aware of the subtle signs I can watch for them and dose her up with Pepcid. Or get her in to see the regular vet – never again waiting until after hours for a call back.

The ER vet, by the way, did not have a diagnosis. The test for pancreatitis came back negative… but that was probably because he used a test developed for dogs. I got my money back for that one.

Just don’t tell ‘em it’s a cat

I just had my first experience with diabetes customer service.

Isabella’s blood tests have been really flat today. This-can’t-possibly-be-right flat. Her first test this morning was 279.
Followed five hours later with 271.
A couple hours after that? 283.
And just now: 283. Again.

I’ve seen her numbers stay flat before, but really, this was crazy. So out came the control solution to test the meter and the strips … and Bingo! Slightly out of range – the test number was too low. Then I realized that the solution had been opened far, far longer than its 90 day shelf life, so I rummaged around in my supply box and found a new bottle of control. Another test – and the new result was also out of range, this time too high.

Sigh. The control solution was not expired. The strips were not expired. The meter has new batteries. What the heck is going on??

Abbott Diabetes Care, the makers of my beloved Freestyle Flash, promises 24 hour customer service. I decided to call, vowing to answer only the questions asked without volunteering anything extra.

The first surprise is that I’m in their database. When, exactly, did that happen? They knew my phone number, address, even the serial number of my meter. Ohhh-kay. In the back of my mind I’m wondering if I’ve filled something out saying that I use the meter, or would I have said a family member? Don’t ask, don’t tell. Just stick to today’s situation.

I explain about my out-of-range tests. I tell Barbara, the nice gal on the phone, that I just opened a new control. I give her lot numbers for the strips and for the control solution. I answer her questions.

Did I shake the control vigorously before each test? I say: yes. I think: gosh, I don’t know, and shake the bottle vigorously (better late than never).

Would I run another test, please?

Of course. I laugh and say, it’s been high, it’s been low, do you want to bet that this one is in range?? (Ahem, now that the bottle is shaken.) Test number three was in range.

Wee!

It could be just about anything, Barbara says. Did you discard the first drop of control before you ran the tests?

I say: yes. I think: uh, probably not.

Shoot, says Barbara. We can’t tell if your meter is messed up, or the strips, or the solution. (I think: or it could be operator error…) I can send you a new meter and more strips. And replace your control. How many strips do you have?

I’ve prepared for this question. I tell her there are about 25 left in the vial I’m using, plus I have an unopened box of 50 from the same lot number. (Cha ching! New strips! For free!)

Barbara tells me that a meter, 100 strips, and new control solution will be sent out FedEx overnight. Except that with tomorrow being Sunday, and Tuesday being Christmas, I won’t see my bounty until Wednesday. I assure her that I’ll survive, and start to rise from my chair for the happy dance.

Her next words slap me right back down on my butt.

We’ll include a prepaid envelope for you to return that possibly-wonky meter and the possibly-wonky strips.

I say: OK, great. (Dang, I still woulda used those unopened 50… ) We wish each other the merriest of holidays and hang up.

So I’m not hitting the test strip Lotto after all. Odds are that Isabella’s numbers really are just as flat as the pre-Columbus earth, but I guess it’s better safe than sorry. I’ll crack open a new vial of strips from a different lot and send the probably-not-wonky strips back to Abbott, along with the meter. I’ll be sort of sad to see the meter go, since it’s the one we started this crazy trip with. It’s just a little piece of electronics, but I feel rather attached to it.

I now also know some of the questions customer service asks when there is a possible problem. It’s good that they don’t question the species using the meter, because somehow I don’t think Barbara would have ordered an overnight shipment of new supplies if she knew it was for my cat.

The Cat and the Christmas Party: a Limerick

I had a holiday party for some friends last Sunday. It went down something like this:

My cat, who likes things her own way
Watched my gathering friends with dismay
The hell with good cheer
I don't want you here
So she blocked the route to the buffet

Alright, the poem might be a slight exaggeration, but it’s pretty close. Isabella employed a several Mean Cat battle tactics during my holiday shindig. She started with some impressive stealth attacks from beneath the tablecloth-draped buffet. When that failed to deter my guests, she retreated to the laundry room and pulled few more weapons from her kitty armament: Mean Looks, Scary Growls, and Menacing Hisses. No one needed to go into the laundry room anyway, so this battle station served her well for quite a while.

After a time though, battle weary and overwhelmed by the increasing numbers of the enemy, Isabella was granted an armed escort (my arms) to Headquarters (the bedroom) where she was able to rest, watch the movements of the enemy, and hide under the bed as needed.

Isabella waited patiently until she sensed that the enemy was growing tired and perhaps a little drunk. Then, a second assault was staged from the back of the house. Some guests were challenged as they approached the bathroom (a tricky tactic indeed), others were verbally assaulted in the kitchen itself. As the evening grew long, Mean Kitty became bolder, to the point of smacking at anyone who dared cross her path.

In the end, Isabella triumphantly saw the last guest retreat from the battlefield and the house was once again, under her complete control.

None of this behavior has any direct relation to diabetes, she’s always been unwelcoming to guests. I do admit she has gotten somewhat worse in the past few years – more directly confrontational (ask my sister about that!). In the end, the party had very little effect on her blood sugar. Sometimes I think that terrorizing people is Isabella’s idea of a good time.

What’s on??

In my blog index, a section only I, as the blog owner, can see, are several “draft” posts. Most are just a title, something to remind me of an idea for a possible entry. Place holders of sorts. One of these draft entries says just “TV Guide.” It’s been sitting there for months, taunting me, challenging me to flesh it out. The idea – which seemed so fruitful when I saved it into the index – is to take the bits and pieces of my cat-related activities and distill them resemble television listings.

Today, for some reason, the post finally took shape. Somehow I managed to transform my mundane life into talk shows, comedy, drama, and even a little education. Cable channels, broadcast channels and community access – my “TV life” has it all. So sit down, grab your remote, and choose a show.


6am (NBC) Today: Segments include: using a cat as a substitute alarm clock and scheduling your morning routine to include pet care. Guest Dr. Phil gives tips on shaking off early morning surprises and moving on with your day.

10am (Animal Planet) Cats! Cats! Cats!: Blending up a healthful raw diet for felines and a review of species-appropriate canned food options.

11am (Community College Channel) Accounting 12A: Saving for unexpected expenses.

1pm (Community College Channel): English 4B: Creative writing for bloggers.

2pm (FOX) Montel: Therapists stage an intervention to help a guest with double addictions: repeatedly testing her diabetic cat’s blood sugar levels and drinking Irish Cream.

3pm (NBC) Ellen: How to choose a pet sitter for special-needs animals. Special guests: the Broadway cast of Cats!

8pm (NBC): The Office: The office is thrown into turmoil when internet access crashes due to Angela’s excessive posting to an online bulletin board for diabetic cat owners.

8:30 (CBS): Survivor: China: Survivors are challenged to restrain and test a hungry, grumpy diabetic cat. Winners receive dried tuna flakes.

9pm (ABC) ER: A pancreatitis attack threatens the health of a cranky middle-aged patient. A family member holds ER staff hostage after receiving a shocking bill for services.

10pm (FOX) 24: The drama continues as Jack runs an overnight blood glucose curve.

11:30pm (NBC) Tonight Show: In his monologue, Jay pokes fun at the lengths some cat owners are willing to go to for their pets. Guests include feline diabetes specialist, veterinarian Lisa Pierson.

Hometesting Lesson

A couple days ago, I met Mike, Jennifer, and their newly-diagnosed diabetic kitty Max. Max had a very rough introduction to diabetes – swinging from ketoacidosis (a life-threatening side-effect of uncontrolled high blood sugar) to hypoglycemia (complete with seizures) in the course of one week. If anyone needed to learn how to test their cat’s blood sugar – and pronto – it was these guys.

When Mike first posted on FDMB, members asked, as they usually do, where he lived. That turned out to be about 10 miles from me, so I got in touch with him and offered to come to his house with a meter kit and teach him how to perforate his cat. I still have a robust collection of meters at the ready, and I’ve poked thousands of holes in my own cat, apparently all the qualifications needed for this educational project.

We scheduled a time, I gathered the supplies, and set out. I did ask about Max’s personality – if he was anything like Isabella, I’d bring protective gear – but Mike assured me he was a sweetie.

And he was. A cute black & white long-haired model, Max was skinny, but seemed none the worse for wear after his ordeal. I introduced him to bonito flakes (on the advice of others on FDMB: make friends with cat before poking) and chatted with Mike and Jennifer about the general routine that I use to test Isabella. After we practiced using the meter on Mike (blood glucose: 99) we assembled supplies in the kitchen and got ready.

I held the wee Max in my lap and poked. Three heads bent close to inspect his ear. Nothing. (Max was completely cooperative.) Mike suggested testing the inner, un-furry side of the ear, and lifted the cat into his own lap.

Poke. Inspect. Ah! A little blood appeared and was sucked up into the test strip, but it wasn’t enough. Quick! Poke again! A bigger bead this time, enough to start the meter on its countdown.

The results of Max’s first test? Blood glucose: 59

OK then! Good thing I stopped by. Jennifer was set to give Max another dose of insulin in about an hour. With a glucose of 59, more insulin probably would have landed Max in the emergency room with his third hypo of the week. I talked to them about the importance of testing before every shot and having a “don’t shoot below” threshold. For instance, if Isabella’s blood sugar tests below 150 or so (a rare event, indeed), I don’t give her insulin. I wait until it’s high enough to justify an injection. They needed a similar plan to give themselves a cushion. They also probably needed to reduce Max’s dose, since he was still pretty low many hours past his last dose.

It’s a lot to take in when you’re new at the diabetes game. It’s even harder when the only message you’ve gotten from the vet is about the importance of sticking to a 12-hour injection schedule and always giving a consistent dose. Here I was, a total stranger, telling them that the meter trumped the vet, and they should listen to me. I think they understood. I hope so.

After I left, I remembered lots of things I forgot to tell them:
~ to give Max a treat after the test (the 59 completely distracted me!)
~ to apply pressure to Max’s ear for a few seconds to reduce bruising
~ that one day, sooner or later, they’d hit the vein and be wiping blood off the walls, cabinets, and floor. (They’ll figure out the importance of applying pressure when the cat is bleeding all over, that’s for sure!)

Then there was the stuff I deliberately didn’t mention:
~how my cat used to scream when I tested, I was so bad at it
~that I wore long pants, long sleeves, and leather gloves to avoid being maimed
~that I used to have to encase my cat in a blanket to get the deed done at all
That’s not the sort of information that builds confidence in the teacher, you know what I mean?

I haven’t heard from Mike or Jennifer since the lesson. Hopefully they’re using the new tools and Max is going great. Hopefully their vet agreed with a lower dose when they reported the 59. Hopefully, hopefully.

I just have to accept that I did the best I could.

Apologies

I want to apologize to all the spouses, roommates, brothers, sisters, and children of anyone who reads this blog and who has had to endure the singing of O Pancreas, over and over and over, for the past week.

Apparently, once the song gets in your head, it stays. And it has to be sung. Repeatedly.

Just ask my cats. Or poor Wally, in Minnesota who has listened to Dan.

I'm sorry. Really. But the damage is done and I can't take it back now.