June 14, 2008
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.