Monday, June 30, 2008

That Winning Feeling

Yesterday afternoon I was doing some errands and listening to my iPod in the car. I had it on what I call "the big shuffle" and I let it pick out anything from Disturbed to Robert Plant to Barenaked Ladies to Bach. So, I was listening to No Doubt when on came a voice saying "...and there's another point that I'd like to make about language and that is that studies have been done that words spoken at random have an effect on us. So, not only am I very careful to censor my speech but I also deliberately choose words depending on what I want to do. I mentioned in the book, for instance, that sometimes I drive to the barn and depending on whatever spirit moves me, I might say harmony harmony harmony and then I ride my horse and have absolutely the most harmonious ride that day..."

I said to myself, hmmm. I must have forgotten to make the Jane Savoie tape that into an audiobook file (first using Join Together and then Make Bookmarkable). Then I listened to it anyway and thought, good timing.

I first got Choose Your Future and That Winning Feeling when Hannah was starting out in agility. A lot of agility competitors at that time had a background in horses and I'm sure that's where the recommendation came from.

It was very interesting to listen to this segment of Jane's presentation. I think that it would be good to revisit some of her recommendations about language with some of my current goals. I need to float up those climbs on the bike, for instance.

Sunday, June 29, 2008

Rainbow Connection

One day last week, DH and I were driving home after a thunderstorm and we saw a rainbow. As soon as we got home even though it was already starting to fad, I took some pictures.

Wednesday, June 25, 2008

Hannah's progress, week of July 23

This week we have seen few changes in Hannah's health. For the most part Hananh is a good mood and is still, well, Hannah. The main change that I have noted is that Hannah has not wanted to go up and down the half dozen or so steps on the deck so we are having her go out a different door.

She seemed a bit uneven over the weekend so we changed her Tramadol from twice daily to three times daily per previous instructions from her vet. That seemed to even her out some. We talked to her medical team about this ans asked what we could do further even this out. Her vet suggested that we give 2.5 tablets at breakfast time and 2.5 tablets as soon as we get home from work and then 2 tablets at bedtime instead of two pills per dose.

Hannah has had some nausea and vomiting issues at night time -- well early morning is more accurate since it's at about 3:00 a. m. We were advised to hold back some of her dinner and give her a Pepcid A/C (Famotidine) tablet with the remainder of her food at bedtime. Hannah is continuing to eat Purina EN canned .

Finally, we discussed her treatment plan moving forward. We are opting for Lysodren treatment and were again advised that
  • Lysodren is a derivative of DDT and is a very potent drug
  • There is the possibility that treatment will make her worse since each patient may react somewhat differently
  • However not treating Cushings will ultimately lead to her demise
The week of July 7 we will do a blood panel and possibly a liver function test. Depending on those results, we will decide if Lysodren is likely to be beneficial. Additionally, starting Lysodren just before a holiday is not advisable. If we decide to move forward at that time, we will begin the Lysodren the following week. In the meantime, I am to call around and get prices for 25 pills of the 500 mg Lysodren.

Dr. S. feels that Hannah's kidney issues are age related or possibly related to her history of urinary tract infections. While this is not exactly good news, at least Dr. S. doesn't feel that Hannah has a malignant adrenal tumor that is affecting her kidneys. That is not to say that the adrenal tumor is either malignant or benign, just that the kidney issue is more likely age related than Cushings related.

Lysodren 500 mg
Target $120.49 for 25 (4.82 ea)
Costco$146.92 for 30 ($4.90 ea)
WalMart$125.78 for 25 ($5.03 ea)
Rite Aid$140.99 for 25 (5.64 ea)
CVS$152.99 for 25 ($6.12 ea)
Walgreens$145.99 for 25 ($5.94 ea)
Walgreens Prescription Savings Club$135.74 for 30 ($4.52 ea)

Hannah's current medications: osteoarthritis (Tramadol, Zubrin), urinary tract infection (Amoxicillin, FortiFlora probiotic), Denamarin, Actigall, Famotidine (10mg); Purina Veterinary Diets EN GastroENteric Canine Formula dog food

June 30 update: Hannah is in good spirits but she is not eating all of her food. She is currently getting two cans per day. She eats about half of her breakfast and stops. We let her out and she comes back in, eats a few more bites and stops. This means that 2/3 or 3/4 of the food is eaten at that time. I called the vet to see if that is enough nutrition for her. I hesitate to add more pills to her routine since she hates them so.

Dr. S. said that Hannah needs to stay on the Denamarin and that the food issue is not so bad that she is concerned about it. She suggests not worrying so much about the food itself but to instead add carbs such as mashed potatoes with butter, rice, bread with flax oil, etc.

Thursday, June 19, 2008

Hannah's progress report

Hannah continues to have some health issues. Her liver status has improved since starting the Denamarin two weeks ago and that is good news. Her kidney values have gotten worse and that is disturbing. Our vet has recommended starting her on Actigall (ursodiol) to give her liver more help so we are doing that, continuing the other medications. Hannah will like that the Actigall needs to be given with a "fatty meal" so she will be getting cheese, peanut butter or 2 teaspoons of flax oil with her evening meal. In three weeks, we will do a liver function test.

Below are all of the high blood chemistry as of June 18
Urea Nitrogen38(6-25)
Creatinine 2.1 (0.5-1.6)
Alkaline Phosphatase 2108(5-131)
ALT (SGPT) 505

Hannah's BUN was normal as of her tests June 4 (25) but was high on June 3 (29). Her creatinine was 1.9 on June 3, 2.0 on June 4 and has increased to 2.1 on her latest test. Both her akaline phosphatase and her ALT have improved. I made a few tables below to show her progression.

June 3
2821 1901
June 4
June 18

June 3
29 1.0
June 4
June 18

We also need to make some decisions about her Cushings (hypoadrenocorticism) . It is important to have her liver and kidneys functioning well before we can move forward on that. I am trying to take the "What Would Hannah Do" approach to this.
  • Hannah does not want to be in pain (who does)
  • Hannah does not want to take pills (but she has to take some regardless because of pain meds)
Treatment options:
  • Keep Hannah comfy (pain meds)
  • Treat the Cushings (Lysodren + pain meds) -- Trilosane is out because it's lots of pills and our vet said that given Hannah's clear desire to not have pills, a twice a day medication would probably not be the best choice. Our vet said repeatedly that Lysodren is chemotherapy and that it is a derivative of DDT. The literature on this is pretty scary too. This treatment option would most likely result in a prednisone prescription.
  • Treat the Cushings aggressively. Surgery (adrenalectomy) might be a good option but she would still have to take pills even with surgery so it does not solve the pill problem and it is a risky undertaking since the adrenal gland is so close to the aorta. The adrenal gland is located between the aorta, the renal artery and vein, which are the sole blood supply to
    the kidney, and the phrenicoabdominal artery. In fact, the more I have looked into this, the less I feel that this is a good option. According to the Textbook of Veterinary Internal Medicine, "Approximately 50% of dogs develop severe postoperative complications, including pancreatitis, pneumonia, pulmonary thromboembolism, acute renal failure, sepsis, and hypoadrenocorticism due to insufficient steroid levels." We know that she has a tumor because it showed up on ultrasound but we don't know if it is malignant or benign because it is not easy to determine if an adrenal mass is malignant or benign before surgical removal and histopathologic evaluation. If the tumor is benign, surgical removal is a cure but if it is malignant, surgery may help for a while but is not a cure. I have read that while only approximately 15% of canine Cushing's syndrome patients have adrenal tumors, half of these patients will have benign tumor and half will have malignant tumors.
Unfortunately, from what I have read, this comment from The Animal Health Clinic is a good summary from: "Dogs with ADH caused by a benign tumor have a good prognosis whereas the prognosis is guarded with the malignant form (adenocarcinoma)."

I will continue to do some research and thinking this weekend, discuss it with DH and meet with our vet sometime in the next week or so to come up with a treatment plan for The Brown One.

Tuesday, June 17, 2008

Emma turns 6!

Yesterday was Emma's sixth birthday. I can still remember when she could fit her whole body under the sofa!

Before Emma joined our family, we had been looking for a Labrador retriever. Our agility instructor pointed us to Emma's breeder and the rest is history. Emma has turned out not to be a great agility dog, which is disappointing in some ways because she has very good structure for it, but she excels at her number one job which is to be a companion and family member in good standing. She is extremely loving and easy to get along with.

Recently someone asked me what actress Emma would be. I said Reese Witherspoon but not really Reese herself but Elle in Legally Blonde -- before she went to Harvard. I have not doubts that Emma has the smarts but she's really busy with her social life and I can picture her as president of a sorority. I also know that if she puts her mind to something, she can make it happen.

To celebrate the event, DH stopped at Three Dog to get treats -- and walked out with a cake. I made frozen pupsicles and of course Emma got some new toys (which means some carcasses can be retired).

Frozen Pupsicles

32 ounces yogurt, plain nonfat
2 bananas, mashed
1/2 cup peanut butter
2 tablespoons honey


Combine all the ingredients in a bowl. Blend well. Fill small paper cups like 3 ounce Dixie cups with the mixture. Freeze at least two hours. To serve, let thaw slightly and pop the pupsicle out of the cup and into a bowl.

Source: You Bake 'em Dog Biscuits by Janine Adams
Serving Size: 12

Father's Day

For Father's Day, my parents invited us over. My dear brother (DB) was on leave between Army schools and he was in Raleigh visiting our parents over the weekend. DH and I were invited for Father's Day dinner along with the Girls.

My father hasn't had a lot of hobbies since giving up golf due to his eye problems. He recently started playing clawhammer banjo. He takes lessons once a week and is signed up for banjo camp at the end of the month. When Dad took up banjo, DH mentioned that he saw a banjo related t-shirt. He sacrificed himself and went to the NOC store last time he was in whitewater kayaking and he got the shirt for Dad and we saved it for Father's Day. The t-shirt says "Paddle Faster (I hear banjo music)" in a reference to Deliverance which was filmed in Western NC. Dad has made it clear that he will never learn Dueling Banjos, much to our disappointment. He did really like the shirt and he said that he plans to bring it to camp.

DB recently graduated from the Defense Language Institute at the Presidio of Monterey where he was learning Arabic. His next set of orders is for interrogation school at Fort Huachuca. No one knows for sure what is after that. He should finish his next school in November. His Guard unit has been activated and it is not clear whether he will finish school before they are deployed or if he will join them or what.

Tuesday, June 10, 2008

Tour de Cure ride report

The Tour de Cure (TdC) is a two day cycling event to raise money for diabetes research. The main route is 75 miles each day and two other routes are offered as well. I participated in the "240k challenge" which is 150 miles.

This was my third TdC and I've enjoyed it each year. I think that this year was probably the best organized of the three years. The volunteers were great, the banquet on Saturday night was pleasantly to the point and the camaraderie was outstanding. I hooked up with a great group of Gyros, Qualcomm, NetApp and unaffiliated riders and on Sunday and we were all pretty good about staying focused at the rest stops and not lingering too long -- figuring that the as the day progressed, it would only get hotter.

The route was pleasant, crossing Falls Lake at about the halfway point, and I enjoyed the minor changes made to the Cary/Apex/Morrisville portion this year. The Masonic Home for Children in Oxford was a great host as well.

It was hot. I tried to ignore it when the weather forecast called for temperatures over 100 degree on Saturday and Sunday. I contacted fellow riders on Friday and they were already changing their plans. A coworker of mine, K1v1n, and I still planned to ride. Our strategy was to minimize our total amount of time outside by riding a steady pace and not lingering at rest stops to socialize. Some groups take a really long time at rest stops and that is never something that I enjoy because the longer I stop, the harder it is for me to get going again.

Both days everything was good until 11:00 or so and then I started to think, "It's hot." By noon both days I started to think, "It's really hot!!!" By 12:30 each day I was thinking, "Dear Lord, is it hot!!" Fortunately, I rolled in between 12:30 and 1:00. Even so, temperture was 97 and the heat index was 102 when I finished on Saturday and even higher when I finished on Sunday.

On Saturday's ride to Oxford I was with a the NetApp group until the middle rest stop and when I was read to leave, the Qualcomm group was leaving so I went with them. Unfortunately, I was dropped going into Creedmoor. I completed the final third of the ride as a solo effort. When I finished, I noticed that a lot of people were coming in alone and I was far from the only solo rider out there. In fact, after taking to K1v1n at dinner, I found that he had much the same experience.

On Sunday morning when we gathered at the starting line, those of us there noticed that we had lost half the riders. This was confirmed by the TdC organizer who also said that the riders alone had raised over $150,000. That's a lot of money.

At the starting area, I found found the Qualcom/Gyros group that I wanted to be with and lined up with them. As we rolled out of Oxford with our police escort, I noticed a girl wearing red shorts with CHE ER on the rear. These were not cycling shorts, just shorts. Wow, that had to hurt. After a few more miles we found out out that her she was a 14 year old high school freshman. The group I was with kind of took care of her and started to call her "Megan the Machine." She made it all the way back to Cary with our group. As someone else in the group said, she didn't know that it was supposed to be hard!

On Sunday morning the most unusual thing happened on my bike ride. I was participating in the Tour de Cure and it was the second day of the tour. I was riding with a group of about 15 cyclists and someone yelled out, "Slowing! Deer!" Then several other riders yelled out, "Deer! Deer!" It was a fawn running on the road in the same direction as we were going. We continued to slow as the fawn continued to run for its life and finally ran into the field to our right. It was still young enough to have spots along its back.

I've seen deer on bike rides before but never had one join the peloton before!

Up next, the Firecracker 100k.

Wednesday, June 4, 2008

Hannah gets a haircut (for her ultrasound)

Hannah continues to test the knowledge of her medical team. This morning she was upset to have to skip breakfast -- yucky pills but not breakfast! -- before having an ultrasound performed. She was shaved for the ultrasound and looks snazzy with her new hairdo.

Short version: Blood work bad, ultrasound good, ATCH stim test today, eating normally now that her tummy not upset (but still on EN)

On Monday, Hannah had a blood panel done. The results came back yesterday and they were not good. In the vets' words ther has been "a dramatic shift in the past two months." The results seem to indicate that it is most likely that Hannah didn't want to eat purely due to nausea. Her four major liver enzymes are off the charts bad. Either she got into something (not likely but possible) or there is a tumor in her liver or blockage in her bowels or something else going on. Yesterday afternoon, we brought her back to the vet to have her clotting factors checked in case they needed to biopsy.

This morning they did an ultrasound. Her liver looked fine (no nodules) but her left adrenal gland was mildly enlarged (2.56 x 0.75 cm). They are doing an ATCH stim test now and results should be back tomorrow. They did not start with the stim test because all of her liver enzymes were so high. She will start on denamarin and actigol (homeopathic milk thistle based supplement) have been added for liver supportive care starting as soon as possible. As of today, the plan is that she will have another blood panel in 1-2 weeks to see if those high liver values have come down. If not, then that will be followed with a liver function test.

Here are the high values from her blood work (with normals in parens). All were normal as of March 15th.
Urea Nitrogen29(6-25)
Creatinine 1.9 (0.5-1.6)
Total bilirubin 0.6 (0.1-0.3)
Alkaline Phosphatase 2821(5-131)
ALT (SGPT) 1901 (12-118)
Cholesterol 900 (15-66)
GGTP85 (1-12)
Platelet Count 431 (170-400)
WBC 4-10 (0-3)

The notes from her ultrasound are as follows
  • The spleen was mildly heterogenous and contained several hypoechoic nodules, up to 6 mm in length (our vet said that this was relatively normal for a dog of her age)
  • The left renal pelvis was mildly dilated (6 mm) (our vet said that this is probably due to her past history of chronic UTI)
  • The left adrenal gland was diffusely, mildly enlarged (2.56 x 0.75 cm)
  • The right adrenal gland was difficult to visualize but appeared normal (1.87 x 0.48 cm)
  • The stomach was moderately distended with ingesta and gas and could not be well evaluated
  • The colon was moderately distended (2.86 cm in diameter) with non-formed feces
The most worrying thing from the notes on the ultrasound is, "left adrenomegaly, likely due to neoplasia." Adrenomegaly, enlargement of the adrenal glands. Neoplasia, an abnormal growth, a group of diseases commonly called tumor or cancer.

With all of this going on, Hannah remains in a very good mood. She is active and has good color both on her lips and gums. She was not bothered by her "veterinary grooming" done for her ultrasound. She is still resisting her pills but is eating the EN dog food as as Labrador should and she wanted more food last night.

UPDATE: Someone asked about her sodium and potassium levels. Sodium is 151 with normal being 139-154 and potassium is 4.8 with normal being 3.6-5.5.

6/6 UPDATE: Hannah's ATCH stim test for Cushings (primary adrenal) was positive. Normal is 15 or less, she is 29.4.

Her current treatment plan is to get her liver healthier. We'll recheck her liver enzymes in about two weeks. Once her liver is healthier, we will discuss lysodren versus trilosane. Our vet said, and we tend to agree, that she is not sure that surgery is appropriate for a dog her age.

In the meantime, I am happy to report that Hannah is in an excellent mood and is eating well and wanting treats, etc. She is even taking the denamarin well (must be given 1 hour before meal without food).

Tuesday, June 3, 2008

Snappy Porcine Goodness

I'd like to welcome DH as a guest blogger. DH drove the SAG wagon for me in 3MM. His support on these adventures is greatly appreciated.

Recently I was in Mount Airy, North Carolina, which was the inspiration for TV's "Mayberry". Apparently the only real business mentioned in the show was the Snappy Lunch, which is now famous for a breaded pork chop sandwich.

I arrived in town around 10:30 am, which was much too early for lunch. So I decided to explore Main Street. There was an amazing assortment of kitsch. Many shops were blaring the "Mayberry" TV show theme (It's in my head. Get it OUT!), and the shops contained all things Mayberry. Andy Griffith's eighty-something birthday was coming up, so one shop had a big birthday card to sign. Whew.

It was a big mistake to loiter. When I went over to Snappy Lunch at 11:30, the line went down the street, and the day was getting warm. Apparently a bus load of tourists was just dropped off. Luckily I bought a book from a local shop, which I could read while in line.

As the line shuffled slowly forward, you could see that there was a window at the front of the restaurant. Through the window you could see the cook cooking one and only one thing: the pork chops. Employees would bring piles of the raw, breaded pork in pans from the back of the restaurant to the front. The cook would throw them on the grill, flip them, then toss them into another pan. The cooked porcine goodness was taken to the back where the sandwiches were assembled. Toss. Toss. Flip. Flip. Toss. Toss. At least the sandwiches aren't deep fried.

When I finally got into the door, I was able to find one open chair at the counter. The menu is spartan. There are really only three lunch choices: the famous pork chop sandwich, a cheeseburger, and some breaded hamburger concoction that's apparently a holdover from the Great Depression. The official menu lists a couple more items (bologna anyone?), but I only ever saw people order the pork chop sandwich.The available side items? A bag of potato chips.

Snappy Lunch did have fountain sodas. But, is that LIPTON tea I see on the fountain?! I never learned to like syrupy, teeth chattering sweet sweet tea (I would rather use those calories for beer or a great dessert and I DO like pecan pie), but I've heard that Lipton is the bottom of the barrel in the tea world. And from a FOUNTAIN? Seems so wrong since good tea is brewed. Diet Coke for me, thank you.

I ordered the pork chop sandwich, loaded of course. A couple short minutes later, it was plopped in front of me. There it was. And it was something to behold. A big honking pork chop sandwich all wrapped in wax paper which also came with a plastic fork. I took the top bun off, and saw that it was loaded with cole slaw, a sweet chili, onions, mustard, and tomato all on a white bread bun.

While munching away, I noticed an elderly gentleman pacing back and forth behind the counter, obviously keeping an eye on things. He must be the owner. Much to my shock, someone at the counter waves their empty soda glass and shouts "DIET. I HAD DIET". The poor man could hardly hold the glass. They only needed to wait a minute for one of the other employees to take care of them.

The verdict: the sandwich was very good, but not worth a special trip. If you are in the area, give it a try. But don't get behind a bus load of tourists.

Monday, June 2, 2008

3 Mountain Madness

On Saturday I rode in a cycling event called 3 Mountain Madness. The ride is 75 miles long and involves 9280 feed of ascent according to their websites GPS statics. At the start, they announced that 550 riders had registered. The event was extremely well supported with people at every major road crossing and left turn, well stocked rest areas and showers and lunch afterwards.Riders can sign up for one of three routes: yellow, orange and green. Yellow for now climbs, orange for the 75 milers and green for the folks that thought 75 miles and three climbs was too easy.

The ride started out pretty well. I averaged about 19 mph approaching the first climb. At mile 17, things changed. Someone in the group behind me said, "It's a sharp uphill at the beginning and then it levels out some." The yellow arrows went straight. I made the right turn onto Sauratown Mountain Road and saw what the other rider was talking about. The climbing seemed to go on and on and on. Then there was a sign that said, "Road Ends 500 Feet" and I knew that I had made it. I saw my riding friend Jim at the turnaround and stopped to get a drink and say hello. I took his photo and then braced for the descent. I had been worrying about the descent for several weeks after learning that a fellow rider, Danny Thomas, was seriously injured coming down Sauratown.

One down, two to go.

I made it down Sauratown fine and ran into some friends at the rest stop shortly after Sauratown. I went on to the second climb of the day. A short 15 minutes later I was at the bottom of Hanging Rock. Wow, 15 minutes was not a lot of time to recover for this flatlander. Hanging Rock was the shortest peak of the three climbs but only a short time after Sauratown, it was not easy. There was an event photographer on the climb. That could be a scary photo! On my way down Hanging Rock, I could see the expressions of the climbers. People were really working.

At this point, it became kind of interesting. For some reason, I was under the impression that it would be flat to rolling between Hanging Rock and Pilot Mountain. This is not the case. Climbing Climbing Climbing. I spent a lot of time under 10 mph during that time. I felt like it was slow more than difficult.

I made it to the rest stop at about mile 60., the final "big" rest stop before Pilot Mountain. One person that I ride with frequently said to me, "Pilot still intimidates" when I asked him if he was doing the 75 mile route. I stopped and chatted with some riders and refilled my water bottles. I was told that there was a rest stop at the bottom of Pilot but it was pretty much a water only stop. Someone else had advised me that Pilot is 2.4 miles. She said, "Remember Pilot's only 2.4 miles long. Yes, the longest 2.4 miles you will ever experience, but still only 2.4 miles."
At the ranger station I checked my odometer and did the appropriate math. I had been advised that the first 1.6 miles were the worst. I began to pedal up the mountain. I was going very slowly -- often 4 mph or less. Pedaling. Pedaling. One mile, gone. Nearly halfway. Another switchback and another. Oh now. This is the part that people talk about. The riders in front of me have gotten off their bikes and are walking. Pedaling. Pedaling. I pass the walkers and they are encouraging. I know that if I can make it around the next corner, the grade will ease up some, and it does. It is just as I was told. The tree canopy opens above me and the grade eases somewhat. I pedaled up Pilot Mountain. I did it. I rode to the overlook but there was no view. It was too hazy. I asked a rider who was resting to take my picture. Yes, it may look like a picture of me in a parking lot but it's me in a parking lot at the top of Pilot Mountain.

From there it was "just" the descent and about 10 more miles. It was on the descent that I saw the warning sign for trucks -- 10% grade. I knew that I was in business when I rejoined with the yellow route.

The event was really fun! I've already added it to my calendar for next year -- May 30, for those keeping score.

Now I'm worried...

Now I feel bad for saying that Hannah was saving money by not eating her pills. She has been off her food since last week. Even when we removed the pills, she was picking at her dry dog food. We have been using wet foods -- canned food, oatmeal, yogurt, ricotta, etc. -- as a stopgap measure since Friday night when she refused her dry food altogether. She is at the vet today, Monday, while they take a look at her. We are hoping that she broke a tooth but we are fearing worse.

4 pm update:
Hannah does not have a dental issue and radiographs show nothing wrong with the esophagus or abdomen. Our vet's recommendation at this time is to treat Hannah as if she has an upset stomach. Hannah's bloodwork should be back tomorrow and if the bloodwork shows nothing, ultrasound on Wednesday. But that's as far as she'd take it for a 13-14 year old patient. The risks on anesthesia for an MRI are too high considering they may not be much benefit.

7 pm update:
I know that some of my friends will want to know some details including exactly what medications that Hannah is on with her current treatment plan:
  • continue on tramadol and zubrin for arthritis
  • continue on amoxicillin for UTI
  • metronidazole, generic Flagyl (500 mg per tablet) every 12 hours for inflammation of intestinal tract
  • Famotidine tablets (pepcid ac) (20 mg daily) given concurrently with metronidazole
  • metoclopramide, generic Reglan (10 mg) given by mouth every 12 hours 20-30 minutes prior to meal for nausea and intestinal motility
  • Purina Veterinary Diets EN GastroENteric Canine Formula dog food
  • FortiFlora probiotic (30 packs) given with food.
If no improvement within 24 hours and the bloodwork does not show anything, an ultrasound is recommended for Wednesday after a 12 hour fast.

Two radiographs were taken. The films were read by the head of radiology of the vet school and showed no abnormalities. Hannah's lymph nodes and tonsils appeared normal. Her teeth and mouth appeared normal.

10 pm update
  • dinner stayed down fine
  • gums and lips appear to have better color. odd since I had not noticed that the color was pale before
  • mood is excellent but breathing appears to be fairly rapid or at least more rapid that is normal