Introduction - Bishop - Diagnosed 7/22/2020

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Max G

Max G

Member Since 2020
My wife and I are devastated that our Cat Bishop was diagnosed yesterday and we are doing everything in our power to prepare to provide Bishop the best life possible. We also have an infant, a dog as well as another cat to take care of, and I'll be starting graduate school so this is extremely stressful (especially in the CoVID-19 world). We are fortunate enough to work from home in the time being, so we want to tackle this as aggressively as possible to get him to remission on a diet controlled environment *Knock on Wood*.

He is an extremely sweet, but extremely shy DMH Snowshoe Mix, and we have had him for the past 5 years. I always joke that he only likes me when I'm horizontal (lying down or sitting), as he is normally skittish when walking around. (We adopted him from a shelter and we think he was abused in the previous home). I am absolutely mortified about attempting to give him insulin as well as home testing as I really am worried about how to hold him still with out further stressing him out.

I also have questions on the exact cycling of feeding times, and how exact the 12 hour eating and insulin cycle needs to be. We will honestly try our best to be as consistent as possible, but as long as it occurs in the morning and night will we be okay?

We are currently also in process of switching vets just because the current one is quite expensive (they were the only ones with availability to look at him).
 
Also, background: Yesterday Bishop was super lethargic so we took him to the vet. His blood sugar was 233 and had found ketones in urine and vet said and based on blood work the pancreas is working fine and creating insulin, but he is not responding to it. So he started him on 1.5 units twice a day. Does this sound right or should we get a second opinion? His blood sugar doesn't seem to be as high as what other people on this board are reporting. Should we try to find a vet that would entertain a strict diet change before going straight to insulin. *he was kept overnight to rehydrate and they gave him insulin at that time.
 
WELCOME TO FDBM! We are so glad you found us! Welcome Bishop! You are adorable! :bighug:

We are a dedicated group that love our babies and want to help others navigate this disease with ease. It wont always be easy BUT we will be with you 100% of the way. YOU CAN DO THIS!
The art of home testing might seem like a mountain (especially with a skittish kitteth) We can help with that.
But first, may I ask, that you do two things. Both will make life easier and expedite advice. the first is your signature. It will give all your helpers at a glance information on Bishop like insulin type, meter used, food he eats...all those little things that take time to find if not provided. your signature will appear below each of your posts .
The second is a spreadsheet. It tracks daily how the insulin is working in Bishops body. you can find how to do both here:
Suggestions, Tech Support & Testing Area

Again WELCOME we look forward to getting to know you and Bishop! :bighug:
jeanne
 
Welcome. Bishop is gorgeous!

A diet change is not enough if ketones are present.

The ketones in the urine is worrying. They can lead to a life-threatening condition called Diabetic Ketoacidosis requiring a hospital stay. Information here:

Basically DKA is caused by:
not enough insulin + not enough food + something else going on (infection or inflammation)

It is important that Bishop gets fluids. Lots of fluids. It flushes out the ketones. IV fluids like he had last night are the best, but if the cat is not in a DKA state yet, the vet can show you how to give fluids under the skin at home. Add water to his wet food to make it soupy. If he is not eating, an appetite stimulant may be needed. Do not worry about the carb count of the food Bishop will eat. It is important that he eats 1 1/2 times what he usually eats.And just as important is the insulin. The only safe way to tell if a dose is right for Bishop is to home test his glucose levels. A human glucometer will work just fine.

Basic Prozinc information can be found here:
https://www.felinediabetes.com/FDMB...-the-prozinc-basics-please-start-here.164995/

I'll leave it to Prozinc users to respond.

The most important thing is to get the ketone numbers down.

I understand the difficulties of balancing school during the virus. Everything is up in the air at the moment. My son is working on his Ph.D. His university will be online only for the fall term. Universities are scrambling to figure out how to do this effectively, and how to accommodate graduate students' needs.
 
Thank you all for your expedient reply and I can give some additional context as well.

1) Please don't think we are terrible pet parents, but my wife and I went hiking in some national parks on a road trip for a week (we really needed some fresh air away from suburbia since having baby. The baby came with us and was a joy during the hikes. We social distanced well, wore our masks, and got tested when returning home - Got a negative test result today *Small win*.) We had our neighbor as well as our trusted friend check-in on our pets twice a day. The doggo got walked and we had an auto-feeder (filled with dry grain free) for the cats which we normally set up on the table to ensure the dog cannot reach (which we used on previous trips). We also had our friend specifically give wet food twice during the week while we were away to Bishop (and our friend filmed him eating it).

He was also eating fine for us when we returned home and he has eaten well when staying at the vet.

**** MY Fear and Theory - Could Ketones have been present in the Urine due to him potentially starving himself or not eating * and not necessarily due to insulin. I think maybe Bishop was scared the entire time we were gone and pretty much hid and he may have only eaten the wet food that our friend laid out for him, which could have caused this? Is this over-wishful thinking that the ketones are not necessarily diabetes and his elevated glucose levels could be stress? Obviously if he is pre-diabetic we will still be making the long-term switch for both of our cats to an all wetfood.

*Obviously we are planning on switching to an all wet food diet and I have an order for Friskies Pate at target being filled today*

2) He has already had his overnight stay with the vet and they have given him plenty of fluids to flush the ketones. but the vet did not mention needing to give extra fluids under the skin and/or further urinary analysis. We are supposed to pick him up later today, and we want to have all of our questions ready when we get to see him again. We can clearly give him more water with foods, but how will we know if the ketones are gone? will he need another urinalysis? or will insulin and glucose testing show this over time?

3) so sounds like we have to have insulin no matter what. I'm assuming we should still go to the Friskies pate diet? Ive read terrible things about the RX dry food and its also pricey but the vet was very pushy on us using it since thats what theyve been giving him for the last 24 hrs and since they are doing their curve and starting insulin amount based on the last 24 hours he wants us to keep using it. advice at all? :)

thank you soooo much from the bottom of our hearts! we are honestly sooo afraid to take on this journey but we love this little dude.
 
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First of all you are NOT bad parents. You need a life with relaxation to give the best care. What good are your babies if you cant think straight.
I could be wrong and I know I will be corrected but it seems to me the vets curve is based on the food he ate and there fore his numbers would be higher. How do they counter that? Insulin. Probably at the wrong dose as you will be switching to a canned diet. Its like wagging the dog.
Your vet also is pushing that food because they get a kick back from the company that makes that food. smh.

I'e never had to deal with keytones so I will let others address that.
 
Max G said:
Ive read terrible things about the RX dry food and its also pricey but the vet was very pushy on us using it since thats what theyve been giving him for the last 24 hrs and since they are doing their curve and starting insulin amount based on the last 24 hours he wants us to keep using it. advice at all?
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Tell him "thank you but no. We can't afford it and are going to try some cheaper low carb options for now. If our situation changes and we decide to try it, we'll let you know"

As for the insulin dose, please ask us before giving it. His numbers are going to be higher just because he's at the vet and under a lot of stress. His numbers at home may be much lower.
 
Red & Rover (GA) said:
In a nutshell, the pancreas is not working fine. It may be producing some insulin but not enough. The long term goal is to get the numbers down by using insulin so that the pancreas gets a chance to heal and reboot itself.
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I wonder if the vet meant that Bishop tested negative for pancreatitis?

And, I agree-- you are not bad pet parents! You made what were at the time reasonable arrangements, how were you to know what was lurking under the surface with your kitty (cats are soooooo good at hiding discomfort!)? And now you're doing everything you can for him.

To answer your questions:

Max G said:
**** MY Fear and Theory - Could Ketones have been present in the Urine due to him potentially starving himself or not eating * and not necessarily due to insulin. I think maybe Bishop was scared the entire time we were gone and pretty much hid and he may have only eaten the wet food that our friend laid out for him, which could have caused this? Is this over-wishful thinking that the ketones are not necessarily diabetes and his elevated glucose levels could be stress? Obviously if he is pre-diabetic we will still be making the long-term switch for both of our cats to an all wetfood.
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Not eating could definitely be a factor in ketone development, but I don't think they would develop to the extent they have in a non-diabetic cat. Perhaps you'd get them in trace amounts, but not enough to make him feel as bad as he did.

Max G said:
We are supposed to pick him up later today, and we want to have all of our questions ready when we get to see him again. We can clearly give him more water with foods, but how will we know if the ketones are gone? will he need another urinalysis? or will insulin and glucose testing show this over time?
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You can test for ketones at home using urine dipsticks (available in human pharmacies with the other diabetic supplies). I would definitely recommend doing so-- anything above "trace" means another trip to the vet.

It's great that he's eating well-- that's more than half the battle with ketones! You might want to ask anyway about getting a prescription for anti-nausea meds and possibly an appetite stimulant, just to have on hand to nip any problems in the bud.

Max G said:
*Obviously we are planning on switching to an all wet food diet and I have an order for Friskies Pate at target being filled today*
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Max G said:
I'm assuming we should still go to the Friskies pate diet? Ive read terrible things about the RX dry food and its also pricey but the vet was very pushy on us using it since thats what theyve been giving him for the last 24 hrs and since they are doing their curve and starting insulin amount based on the last 24 hours he wants us to keep using it. advice at all? :)
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Ditch the Rx food! If the vet insists, buy a few cans, then bring all but one back saying he stopped eating it (it should have a guarantee).

Important: don't switch over to an all-wet-food diet until you are up and running on home testing blood glucose. We still don't know how much insulin Bishop really needs and he's been prescribed a high dose. Adding a diet change, which can reduce insulin needs dramatically, on top of that could be asking for trouble...
 
Nan & Amber (GA) said:
You can test for ketones at home using urine dipsticks (available in human pharmacies with the other diabetic supplies). I would definitely recommend doing so-- anything above "trace" means another trip to the vet.
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1) How do we take a urine sample from him in order to test from ketones, and if they are present do we just tell the vet that we self tested (do they retest there)?



2) We are going to get a 2nd opinion at a different vet tomorrow. Ideally we would like close vet coordination on this effort and we are hoping that they will help us through. He is being prescribed 1.5 units of ProZinc from the first vet, but we are hoping with a 2nd opinion and testing with them that we can do a diet and re-dosing effort. I think eventually we will move to self-testing, but currently we want to work with a veterinary professional that we trust and get as much knowledge as we can in the mean time.
 
Max G said:
1) How do we take a urine sample from him in order to test from ketones, and if they are present do we just tell the vet that we self tested (do they retest there)?



2) We are going to get a 2nd opinion at a different vet tomorrow. Ideally we would like close vet coordination on this effort and we are hoping that they will help us through. He is being prescribed 1.5 units of ProZinc from the first vet, but we are hoping with a 2nd opinion and testing with them that we can do a diet and re-dosing effort. I think eventually we will move to self-testing, but currently we want to work with a veterinary professional that we trust and get as much knowledge as we can in the mean time.
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You can buy keytone strips from any walmart. ts tricky to get a sample some wait till kitty goes to pee then gingerly slide a ladle or large spoon under him. Others put a tiny amount of litter in a clean box and tip it slightly so the pee runs to the bottom then just dip the strip in the collection. Heres a sticky about keytone meters. Personally thats the way I would go. My Zoe is very shy about useing her "box" around us hoomans
Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters
 
Max G said:
1) How do we take a urine sample from him in order to test from ketones, and if they are present do we just tell the vet that we self tested (do they retest there)?
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You can also put a trash bag over the litterbox or wrinkle up some Saran Wrap and place it in the area he usually pee's. You only need a drop of clean urine. If they are over "trace", that's an emergency and he'd need to get to a vet immediately. Make sure you read the strip in a good light and at exactly 15 seconds as the strip will continue to darken as time passes.

Max G said:
I think eventually we will move to self-testing, but currently we want to work with a veterinary professional that we trust and get as much knowledge as we can in the mean time.
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There's no reason you can't start home testing right now, especially if you're going to change his diet Bishop is your cat and if you want to test, you have every right to do it no matter what the vet thinks. If this were a child and their doctor told you to just give them X units of insulin and come back in 2 weeks, they'd be guilty of malpractice....it shouldn't matter if our "kids" have fur!

The tests that are done at the vet's office are going to be unreliable due to vet stress. Just like our blood pressure is higher at the doctor's office, our cats react to stress by having their blood glucose go higher....some up to 200 points higher! The vet see's those artificially inflated numbers and thinks you need more insulin....then you go home, you give the higher dose, kitty relaxes and you have the recipe for a tragedy.

We're really not anti-vet here but the sad truth is that vets get less than a day of "formal" education on diabetes when they're in school and that covers all types of animals. Once they're in practice, they just don't have the time to stay up to date on the latest treatments for every disease in every type of animal they see. If they tried, they'd never have time to see any real patients! Yes, they have to take Continuing Education courses, but since they see more diabetic dogs, most are going to choose a CE course geared towards canines.

The people here deal with nothing but feline diabetes and the complications that tend to come with it. We live it 24/7/365. We have people from the medical field, the research field....you can pretty much name it.....we have the time to research for new treatments that might work for our precious kitty's.

It would be fantastic if you found a vet that's willing to work with you...even if they agree to learn along with you!!....but so many just won't admit they don't know everything or take the time to see if what you're wanting to try might actually be a better, safer or more reasonable treatment.
 
That's why we are getting a second opinion, the first vet is open to self testing, but less so the diet shift.

We completely understand that we have every right to self - test and it is something we plan to do in the future, but we are quite overwhelmed at the moment hence having the support of a veterinary professional is in our interest.

The board support is very helpful, but we have a lot to read and learn before we are comfortable with everything.
 
Hi and welcome to you and Bishop.
Wow you have your SS and signature up and running. Well done!!
The name of the test strips for the ketone testing are Ketostix.
The most important things you can do at the moment for Bishop are
  • Feed Bishop lots of food. It doesn’t have to be low carb in fact I would not swap to low carb until you are home testing because the BGs drop up to 100 points just with the food change
  • Test daily for ketones, these need to be monitored closely to ensure they don’t increase which they can do rapidly
  • Start home testing now. It is so important and will tell you if you are using the right dose. Testing at the vet leads to higher BGs because of stress.
  • After you start home testing the BGs Start the insulin but I would not give 1.5 units with a BG is 233. I’ll tag @Deb & Wink as she used Prozinc
  • Give lots of fluids at home if you can
  • Buy a human glucometer for home testing. They are much cheaper to run than a pet meter and are just as good. Most of us use them here.
Please don’t leave getting started with all these things. If you do, you risk the ketones escalating. The treatment for ketones are food and insulin and fluids.
 
I didn't see you mention how high the ketone level was. More than a trace?
With ketones in the picture, a strict diet change could be dangerous for Bishop, and cause the ketones to rise even higher.
Having Bishop on insulin right now is the better choice, in my opinion. In regards to the starting dose, I can't judge that right now. It's a higher starting dose than some recommendations, but may be the right dose for Bishop with the ketones that he has.

Max G said:
How do you know and become comfortable with self-dosing?
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We have protocols that we use here. Protocols that have been developed with the input of many members, with information from many spreadsheets, and many diabetic cats over the decades this message board has been in existence. They also take into consideration the latest research on what works best in cats, as opposed to dogs.

Those dosing methods or protocols were recently update this year, in February 2020.
Here they are in case you wish to review them. Sticky PROZINC DOSING METHODS

Max G said:
Science Hill Glucose Support m/d
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The Hill's glucose support M/d wet food is a bit higher in carbs at 13% than the AAHA Diabetes Management Guidellines suggest is good for a diabetic cat. Those guidelines suggest 12% carbs and under. We here on the message board have found that many cats do better on foods that are =< 10% carbs. You need to balance protein needs in a cat too. So only focusing on the carb content of a food does not get you the whole picture. It's a balancing act.

ECID Every Cat is Different. It's an expression you will see on here a lot. Some cats do ok on a bit more carb content in their food. Many don't. Let's see how Bishop does.
ECID Every Caregiver is Different. This diabetes diagnosis for your cat is so new to you. You need to find that balance that will work for you and your situation.
ECID Every Cycle is Different. Each 12 hour period is an insulin dosing cycle. Rarely are 2 the same in the results they give. You are looking for ranges in the BG (blood glucose) levels, not absolutes.

Max G said:
We have not shifted his diet because we are currently working in conjuction with the vet.
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Personally, I think that having a good relationship with your vet, a vet that will listen and work with you is very important. Think of the message board as an adjunct resource to your vet, a place where we will bounce ideas off of you, make recommendations, answer questions, and try to help you as much as we can.

Many vets do want their clients to use a pet specific glucose meter for home testing. But they often do not understand that the test strips for those pet meters can run $1 to $2 per strip, and ideally you want to test multiple times each cycle. For sure, at each pre-shot, so you know your cat's BG level is high enough to give insulin in the first place. A good starting point for new members using Prozinc, is a pre-shot test of 200 mg/dL or greater. That changes with time.

Human meters were used for pets for decades, before the meter manufacturers saw a market and created meters with algorithms specifically for animals. Depending where you live in the world, there are human meters that many of us have used. If you are interested, let us know.

There are also blood ketone test meters, that can test for ketones in the blood. The ketone levels show up in the blood hours before they show up in the urine. Most of these blood ketone test meters, can also test the glucose levels in the blood. Different strips are used, depending on which type of test you are doing with the meter at the time that you test.

My apologies, I've already gone on too long, and probably overwhelmed you again.
 
Paperwork from check up (one page or urinalysis and one page of hematology)

There are a couple more pages but I do not know if they're relevant
 

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We got a follow-up from our regular vet, and they semi-disagreed with the recommendation and diagnosis from the first vet. He was concerned with ketones in the urine, but he disagreed with the diagnosis of diabetes (at least until we can clear his fever and rule out an infection causing crazy things) mainly because his blood sugar never went above 214 per all the paperwork we received and that was the day we brought him in for being sick. However, he does want us to drop the dosage of insulin to about 0.5 units (prozinc twice a day) since we already started and doesn't want a cold turkey stoppage and stated that can help with the ketones as whole.

He also agreed that the original blood work was fine, but thinks it may be a UTI or some other infection that hes fighting (due to the fever), and we are going to run the course of the anti-biotics, and the vet will see us in a week and a half to retest urine and blood. Obviously we would go back if something happens in the meantime but he said barring any further complications thats our plan. He did a spot check glucose at 93 which was ~2 hours after giving him the 1.5 units of ProZinc this morning so we are bit concerned about him dipping too low today; he told us to closely monitor him (we are keeping a close eye on him now that we are home and have given him a Sheba Perfect Portion with Broth which he is eating/ate).

Overall, this vet actually perfers we do our own curve testing at home IF we get to that point and is amenable to discussing a new diet once we can fight the fever and ketones. So we are super hopeful!

We appreciate your support through this trying time. We are doing a walmart pick-up order for some of the ketostick measures to do some monitoring there in the meantime!


(Edit: Just posted the curve conducted by the the first vet.)
 

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That all sounds very positive!

Yes, please do keep a close eye on him today. Getting that 93 2hrs post-shot is concerning-- that's about when the ProZinc should start to work, and 93 is already close to our "take action" (give high carb food) number of 68 on a pet meter. Good thing he's happy to eat right now! I'd go ahead and let him have the higher carb stuff you have available to you-- better too high than too low at this point, until you can get all this sorted out. The second vet sounds very on-the-ball!
 
There is a tab on the spreadsheet for labwork results. You have to enter the reference ranges for the lab your vet uses (Idexx, Antech, etc.) in a new column you add. Then you add a column for the test results and enter the values that you got. You won't have every bit of lab work done, but most everything that can be done can be tracked on the spreadsheet (SS).

Yes, the second vet sounds encouraging. I like their SLGS (Start Low, Go Slow) approach. A dose of 0.5U of Prozinc is a better starting dose. It's what our SLGS protocol suggests, for a cat on a wet food diet.

Do keep a close eye on the ketones, as they can increase to dangerous levels quickly. So keep making sure that Bishop is eating enough food. Since ketones form when the body is burning fat and muscle for energy, giving him plenty of food will help to prevent that cataboliization of body mass to provide energy for his body.

Here is the Catching and Testing Urine Tips link, in case you have not already found it.
 
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*Labs Sheet in Spreadsheet has been Updated*

Just want to get some people's opinions further based upon what we've gone through today. Bishop has quiet the healthy appetite and we gave him about 2 trays of the Sheba in broth wet food (spread out in the day) as well as his morning and night time Rx 0.25 cup. He drank a pretty good amount of water as well. We are doing 0.5 doses of ProZinc now, and we haven't done a full diet shift yet to completely wet.

I guess based upon the numbers from first vet and the opinion of second vet, I'm just afraid to be optimistic because we obviously hope our little man will not be diabetic. But I don't want to disregard what the first vet found (ketones in urine) just because the second vet gave us better news. He did have a fever when we brought him in, and could a potential infection (which was not directly found) be what caused ketones? How long do the ketones take to go away? (15mg/dL is what was found originally). What about the BG in his urine being so high?

We are afraid to do a strict transition to an all wet because if the insulin is helping fight the ketones and he is not diabetic, then he may need the higher calories. Also, we normally have a hidey cat who lazes around, so we are also super afraid if him being hypo (we hope giving him 0.5 ProZinc twice daily instead of 1.5 twice daily will definitely prevent that).
 
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Hi Max :) Don't feel overwhelmed by the diagnosis and with all the information. I've been there 3 months ago and trust me, it will become easier :) I am sure someone already told you about Ketones? Your vet will give you antibiotics to treat it. Took Bee 3 weeks of it but dont worry, its a small pill that you put in the food. The insulin injection is the easy part. the blood sugar testing is tricky but you can do it !
 
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Agree with Deb. Keytones are serious business. Keep on top of them.

You have a lot going on. I dont know if I could do as good a job as you have so far. Keep asking questions!
jeanne
 
Max G said:
I guess based upon the numbers from first vet and the opinion of second vet, I'm just afraid to be optimistic because we obviously hope our little man will not be diabetic.
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A positive attitude and keeping your hopes up is extremely important. There is a small chance that Bishop is not diabetic, but even if he is, you are treating him and working with your vet and learning more about feline diabetes here.

Max G said:
But I don't want to disregard what the first vet found (ketones in urine) just because the second vet gave us better news.
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Insulin given via insulin syringe helps to fight the ketones because it allows the food that Bishop does eat to be processed by his body better.

I'm not sure that 1/2 cup a day of the Hill's M/d dry food plus 2 portions of the Sheba wet food are enough for Bishop.
The labs tab on the SS shows that Bishop weighs around 10 pounds. But is that a good weight for him? Does he need to gain some weight back?

At this point, with ketones in the picture, even if Bishop needs to lose weight, or is at his ideal weight, extra food can help to combat the ketones, by providing energy from a more external source. A food source that does not involve him burning off his own fat and muscle tissue.

Diabetic cats can need 2 to 2.5 times the normal amount of food. You might want to increase the amount of food you are giving Bishop.

Cats also do not need to only eat twice a day. Free feeding is fine, or scheduled meal feeding (or using a pet feeder) work also. Most cats want to eat multiple times a day, not just every 12 hours. When you do get around to trying the home testing of the glucose, you will want to withhold food for 2 hours before the pre-shot test. Other tests in the cycle are expected to have some food influence. But that pre-shot test is the one you do not want to be inflated by food, and then have the insulin onset and take the BG levels too low.

Max G said:
He did have a fever when we brought him in, and could a potential infection (which was not directly found) be what caused ketones?
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Yes, infection/inflammation in combination with not eating enough food and not enough insulin is the classic setup for ketones to form.

Max G said:
How long do the ketones take to go away? (15mg/dL is what was found originally).
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I don't know. Every Cat is Different. Every Situation is Different.

It depends on how quickly the infection resolves in combination with enough food being eaten in combination with enough insulin being available to process the food.

A cat that has had ketones in the past is prone to get them again. Because of the same causes, the lack of appetite, the infection/inflammation.

Max G said:
What about the BG in his urine being so high?
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That is concerning. Have you been able to do any home testing of Bishop's urine?
Or did you get a glucometer, so you can try home testing?

These are my 2 favorite links from the home testing thread. Hometesting Links and Tips - includes numerous links, instructions, pictures, & videos

Marje and Gracie's Testing and Shooting Tips
•Ear Testing Psychology•

If you need to sit on the floor with Bishop, then go for it.

p.s. When we read a thread that we are following, it takes us to the first unread section. If you go back and edit your thread, we won't necessarily know that you did that. It's better to create another reply, than to edit a previous reply.

p.p.s. Not sure that all your questions were answered. Did the best I could.
 
Good News and for those interested! Bishop went to the vet this evening and he tested a BG of 120 on half a unit of ProZinc at 8AM, and he literally ate half a packet of Sheba Wet Food in Gravy 30 minutes prior to arriving at the vet office (and this is an extremely skittish kitty so stress factor too!).

This vet pretty much said that the first vet and initial diagnosis was completely off base. The vet said to stop giving insulin completely and come back in a week (and he didn't even charge us).

I appreciate all the support and knowledge given by this community and I am overwhelmed by everyone who took time to help us through the extreme stress we experienced. We truly hope we are out of the woods, so we hope next week is just as good as today was.
 
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