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Trying to manage the bounce

Discussion in 'Prozinc / PZI' started by Camcat, Jan 4, 2020.

  1. Camcat

    Camcat Member

    Joined:
    Jan 4, 2020
    Hi, I think might be dealing with symogyi effect and am panicking. Cam had a hypo last night - 44, no symptoms. Got blood sugar up quickly (about 30 mins) using high cal nutritional gel and dry food. This morning she’s was at 646. Gave her a little bit of food (not supposed to give insulin on empty stomach right?) and 1.5 units of ProZinc. An hour later we are at 711. Is this a vet emergency? I’m going to test her blood sugar again in 20 mins.

    Cam is 10 years old.She has had diabetes for two years. Usual dosage is 1.5. Fructosamine showed poorly controlled so we increased to 2.5 units for the last month. Started monitoring Bs more closely the last 48 hours and noticing some swings, this is by far the worst. Please help.
     
  2. Camcat

    Camcat Member

    Joined:
    Jan 4, 2020
    1/3: 5:50pm 182 bs; gave 1.5 units at 6:30pm
    1/3: 8:50pm 370 bs; gave 0.5 units; 10:50pm 210;
    1/4: 12:50am 44 bs; 1:30am 179 bs; 2:30am 207 bs; 7am 646 bs, gave small amount of food and 1.5 units; 8am 711 bs; 8am 679 gave 0.5 units more.

    Her usual range is 200-400; occasional spikes in the 500s if something goes wrong (she manages to steal food etc). Her blood sugar has never been this high before. She seems okay, quiet, resting, but interested in food.

    I am going to take her to the vet today. I just need to know if this is an emergency situation right now. I am so freaked out.
     
    Last edited: Jan 4, 2020
  3. Sarah&Soph

    Sarah&Soph Member

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    Jun 18, 2019
  4. Sarah&Soph

    Sarah&Soph Member

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    Jun 18, 2019
    Until they weigh in, I will say that the crazy highs you’re seeing are probably a bounce from that 44 reading. Temporarily high numbers are generally not a vet emergency and and are definitely better than low, but the dose is probably too high and it might be a good idea to watch her extra closely if you shot the same dose that brought her down to 44. You also should NOT give more insulin after you’ve already given the injection.
     
  5. Camcat

    Camcat Member

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    Jan 4, 2020
    Thank you so much for the info, this is very helpful and puts my mind a bit more at ease.

    I’m planning on taking her to the vet today, I just want her blood sugar to come down a bit more because she gets stress hyperglycemia and I don’t want it going any higher.

    This morning while frantically researching, I also saw the info that says no additional shots after the first shot. I had no idea. The reason I was doing it was because she’s supposed to be on 2.5 units at the moment (which I am now thinking is too high!). The shot that brought her down to 44 was 1.5+ then 0.5 2 hours later (so 2.0 in total) - the same dose I gave her this morning. After doing some reading on here, I think her pre-shot blood sugar was not high enough last night for the shot.

    This site is wonderful, thank you all so, so much. I can breathe.
     
    Last edited: Jan 5, 2020
  6. Camcat

    Camcat Member

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    Jan 4, 2020
    Her blood sugar is coming down, thank god. It’s 525 as of 10am.
     
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  7. Camcat

    Camcat Member

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    Jan 4, 2020
    I spoke to the vet, and she said as long as she’s stabilizing, and behaving normally (which she is), then it’s okay, and I don’t need to go in. Is this right?

    I don’t currently check for ketones (but have been reading about them on this site) - should I ask the vet to check for them? Sorry for all the questions. Thank you for your help.
     
  8. Sarah&Soph

    Sarah&Soph Member

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    Jun 18, 2019
    I think whether you decide to go in is totally up to you, but I would definitely recommend monitoring her blood glucose (BG) throughout the day to make sure it doesn’t go too low again. Since you got that 44 she will for sure need a reduced dose tonight, and the experienced users will be able to recommend that to you when they pop in. Your vet can check for ketones if you’d like, but you can also do it at home. They should sell urine ketone sticks at your local pharmacy or Walmart if you’re in the US

    Diabetes can be very confusing and frankly scary, so definitely no judgment! But yes, never double dose. Even if you think you missed or all the insulin didn’t go in, just call it a skip and wait until the next dose
     
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  9. Camcat

    Camcat Member

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    Jan 4, 2020
    Thanks Sarah. Her 11am reading has gone up a bit, from 525 to 541. I am at + 4 hours from her 1.5 unit shots and +2 hours from her 0.5 unit shot. I know we said not to, but if it’s still high at noon, should I give her more? She has had very little food because I’m scared it will increase her blood sugar more. Is this okay?

    I should mention, this is using the alphatrak 2. I am going to be coming up on another common problem I am hoping you can help me with (because I’m still so confused). I have been checking her blood sugar so much over the last 36 hours that I only have 8 alphatrak strips left (more arriving Monday). I have seen posts on here about using human blood sugar monitors. Are they reliable? As far as I can see they are reliable at lower blood glucose levels, but not so much at high blood glucose levels. I’ll keep reading.
     
    Last edited: Jan 4, 2020
  10. Camcat

    Camcat Member

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    Jan 4, 2020
    Update: 10am 525; 11am 541; 12:30pm 540.

    Next will check 2:30pm as it should be right between the nadirs of the 7am (1.5) and 9am (0.5) shots. Seems to be stable, but at this high number.

    I read that the Symogyi effect can take up to three days to clear. Does this mean the blood readings will remain high for three days? Is there a blood sugar level high where it becomes critical to go to the vet? I’m just thinking about dinner time, when it will increase again, and a lower dosage insulin shot (only if her blood sugar is 250 or above). I’m worried about potentially seeing some very high highs (and wondering what is too high for safety).

    Lastly, after reading some more on this blog, I’m thinking that I should have rechecked her low of 44 at 2:30am. Maybe it was a bad reading? What if I just shot her blood sugar up over a faulty reading and this isn’t the Symmogyi effect but just high blood sugar? How does this affect dosing her? I’m just so worried. I’m hoping this isn’t the case because I did double check a low reading (65) the night before last and it was accurate. Anyway, spiraling a bit - sorry about that.

    Appreciate any guidance.
    @FurBabiesMama @MrWorfMen's Mom @Sarah&Soph
     
    Last edited: Jan 4, 2020
  11. Sarah&Soph

    Sarah&Soph Member

    Joined:
    Jun 18, 2019
    No, I would not give her any more insulin until at least her regular PM shot time, and the Prozinc users may even advise against that, we will see. I would also feed her as normal, it’s not usually advised to withhold food to try to keep the BG down. A popular saying here is that it’s better to be too high for a day than to be too low for a minute.

    It’s also perfectly okay to use a human meter! If you have a Walmart nearby, the ReliOn prime is a good option and it’s cheap! The meter is $9 and you can get 50 strips for $9 as well. Really the only difference between and a human and pet meter is the range. For a human meter, normal BG is 50-120 and for a pet meter it’s 68-150
     
    Camcat likes this.
  12. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
    Hi, Linda is away for the day.

    Dosing is based on how low a cat goes during a cycle and not on the preshot numbers. Testing at preshot is to determine whether or not the numbers are high enough to shoot.

    Your cat is bouncing from the low numbers yesterday. It's body sees low numbers that it is not used to as a crisis and reacts accordingly. This is called a bounce.

    Definition of bouncing:
    • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
    The only thing you can do is wait it out. Varying the insulin dose not not work. Insulin is a hormone, not a drug. Giving a second shot is like giving a double dose.

    The 44 on an AlphaTrak was far too low. Even though you are seeing high numbers this morning, the 44 tells us that the current dose is too high and double dosing because of the high preshot numbers is dangerous.

    Test and feed as normal. Hopefully, someone with firsthand Prozinc knowledge will be online before your PMPS shot time.

    It would help tremendously if you could set up a spreadsheet and a signature. We are pretty data oriented here. In a crisis like last night, it helps if all the information is on the spreadsheet and the signature. The forum can be a busy place sometimes and it uses up precious time trying to find the history. If you need help setting these up, just holler. There are a number of people who can do it quickly.

    As regards to the Somogyi Effect - the research for it just isn't there.
    Start reading at post #17:
    http://www.felinediabetes.com/FDMB/threads/5-30-tiggy-prelim-vet-report.96470/#p1032814

    I'm on my way out the door and will be out for the rest of the afternoon.
     
    Camcat likes this.
  13. Camcat

    Camcat Member

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    Jan 4, 2020
    Thank you so much, this is all very helpful. I've created a spreadsheet and posted it in my footer.
     
    Last edited: Jan 4, 2020
  14. Camcat

    Camcat Member

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    Jan 4, 2020
    Thank you for all your help Sarah!
     
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  15. Camcat

    Camcat Member

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    Jan 4, 2020
    Good news, Cam's PMPS reading is 366! Much, much better. Do you guys have any advice on dosing? She's ravenous, and it's about dinner time, so I gave her a small amount of wet food (about 1/2 of what she usually gets). I'm nervous to give her a shot and it was mentioned that some ProZinc users recommend avoiding doing the next shot, so I'm going to hold off for now. Really appreciate any insight or advice.
     
  16. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
    Well, that's a bit of a problem because the 0.5 given at +2 could still be in effect.

    Also, as you can see, Cam is breaking the bounce and her numbers may continue to drop. Is there any history of DKA or ketones?

    How much room do you have without getting completely off track with your shot times? Can you get a test at +13 (in 45 minutes) and see what the number is? It will be food influenced but it may also help tell if Cam is on her way up or still on her way down.
    Tagging
    @Bron and Sheba (GA)
    who has not used Prozinc but is very knowledgable.
     
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  17. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
  18. Camcat

    Camcat Member

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    Jan 4, 2020
    Thanks so, so much Red & Rover!

    There is no history of DKA or ketones, thankfully. The last test was done at the end of Nov, and I don't test at home (I will start tomorrow!). She has seemed her normal self today (I'm the one going nuts!) - so I think if there have been any ketones as a result of her highs today, hopefully they can be managed with insulin.

    I can test at +13 -- I can even wait a bit longer and get to +14 (I think at that 0.5 unit the +2 should have worn off by then). I think what I might do is retest at +14 and then give her 1.0 unit and the other half of her food (if she's still above 250). This is sort of half the dosage that gave her that low of 44 last night (2.0 units -- technically 1.5 units and then 0.5 units 2 hours later -- double dosing, which I am never, ever going to do again!!!).
     
  19. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    May 18, 2016
    Retesting at +14 is a good idea. Because of the low numbers last night, being overly cautiously is a good idea right now. Some cats are more sensitive to insulin after low numbers.
     
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  20. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Hi,
    I am not a Prozinc user but will help if I can.
    As you gave the extra insulin at +2 I would hold off giving any insulin until +14 and as @Red & Rover (GA) said above, Cam is breaking the bounce and the numbers tend to drop lower and quicker in the breaking bounce cycles.
    As to dose, providing Cam is high enough, I would probably err on the side of caution and give the 1 unit. It can always be increased but can't be taken back.

    I think you can takedown the 911 now please.
     
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  21. Camcat

    Camcat Member

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    Jan 4, 2020
    Th
    Thank you so much Bron & Sheba. If she's above 250 at +14, then I'll give her either 0.5 or 1.0 depending on where her #'s are. I might just start with 0.5 to be extra cautious and then do 1.0 tomorrow morning, assuming an uneventful night (fingers x'd!!).

    I have removed the 911 and changed the title. Thank you all so much for your guidance.
     
  22. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    You are welcome.
    Thanks for removing the 911
    You give the dose of Prozinc you are comfortable giving as you know your cat best and will know more about Prozinc than I do.
     
  23. Camcat

    Camcat Member

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    Jan 4, 2020
    Just took her +14 reading. It was 450. I gave her the rest of her food (1/4 can) and 1 unit of prozinc. I'll keep my eye on her and do a mid cycle reading. Hope it's an event free night!
     
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  24. Camcat

    Camcat Member

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    Jan 4, 2020
    It was an event free night, her +4 mid-cycle reading was 318. I gave her some more food as I was a bit worried it would drop further, and tested at +6 for 429. I figured it was the food and would come down a bit.

    This morning at +11 is 670. This is even higher than her AMPS reading yesterday, after the hypo event. I gave her a little food and 2 units of insulin. I'm going to keep my eye on her. I was really hoping for better numbers this morning. I hate seeing these high numbers, they scare me so much. Is this just the original bounce still? Or is this a fresh bounce? Or maybe just because I gave her food last night, and the low dosage?

    I ran out of test strips and bought a Freestyle Precision Neo. At +2, her reading is 411.
     
    Last edited: Jan 5, 2020
  25. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Glad to see you had Kel and Bron to help out.

    You don't need to react to individual BG readings. They are but one moment in time and definitely do not require a second dose of insulin a few hours after the previous shot. Giving a second dose is not only dangerous but will only serve to hold up progress. It's the patterns over time that matter. Consistent dosing morning and night methodically adjusted up or down according to BG readings (mid cycle and pre-shot taken into account) in increments of 0.25u will produce the safest results. Your goal right now should be to get Cedric down to about 90 at nadir.

    Right now I think you are likely seeing those high numbers due to bouncing from that low of 44 the other night. Bounces can take up to 6 cycles to clear so I would recommend you stick to 2u as long as pre-shot is over 250. If pre-shot is between 200 and 250, stall without feeding and retest to see if BG is rising on it's own. If it is not rising or BG is below 200, post for assistance.
     
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  26. Camcat

    Camcat Member

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    Jan 4, 2020
    Thank you! I will do this. Do you know if there is a "conversion chart", so to speak, between human monitors and pet monitors?
     
  27. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    There is no way to convert pet meter to human meter numbers or vice versa. On a human meter normal BG is 50 to 120 and your goal for BG is still 90 and dose reductions are taken at 90. Your no shoot number would drop to 200 until you get a lot more data.
     
  28. Camcat

    Camcat Member

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    Jan 4, 2020
    Sorry for so many questions, but I have one more about Ketones. Cam has not had a problem with ketones in the past, and never had a DKA. But, I don't think her numbers have ever been as high as they have now (600s on the alpha trak 2 yesterday and this morning). She seems normal, is eating, drinking, purring just fine. How worried should I be about ketoacidosis?

    I think testing the urine myself is going to be very tough. I have read on a couple of blogs that the new monitor I started using this morning (Freestyle Precision Neo) tests both blood and ketones. However, nothing on the monitor packaging indicates this (except for one small blurb on the back that says to only use the specific glucose control test fluid and ketone control test fluid). I also can't seem to find the ketone strips anywhere except online. Should I take her to the vet to check her ketone levels? Or wait until I can have some strips delivered and try it myself? Not sure how urgent / panicked I should be.

    Thanks for your help.
     
  29. Camcat

    Camcat Member

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    Jan 4, 2020
    *Sorry, that was reading of 411 was +1. Her +2 reading is 281. This is a decrease of 130 in 1 hour. I gave her a little more food. Should I be concerned? I'm testing again in 1 hour to get the +3 reading.
     
  30. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    With no history of ketones or DKA, I don't think you need to panic particularly since Cam (I assume that is your cat's name?) is eating/drinking well and acting normally but I would order the strips and test when they arrive. If there is any change in appetite, lethargy etc. then a trip to the vet to check if strips haven't arrived would be called for if numbers stay high. When you get the strips for ketones, a reading of 2.4 or higher is cause for concern and a vet consult. The reference numbers on the packaging inserts is for humans not kitties.

    That is a major drop in BG over a short period of time which will likely set off yet another bounce but hopefully not to the same levels. I'd check Cam again at +4 and if BG is still dropping, keep monitoring and offer small snacks of low carb food to try to slow drop down. If you need assistance, post.
     
  31. Camcat

    Camcat Member

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    Jan 4, 2020
    Cam, yes my cat, just had another big drop for +3. She went from 281 to 188 (drop of 93) in the last hour. Better than the previous hours drop, but if it happens again it could put her below 100. I'm also worried that this is only the +3, not even the +5-+7 range. I gave her some more wet food, along with some dry food. I'll post again at +4.

    Thank you so much for the info about the Ketones, and all the help and guidance.

    UPDATE: +4 is 158. Slowed the drop, thank god! (only 30!). Testing again in 20.

    I'm thinking that maybe last night she had a bounce -- her blood sugar dropped pretty quickly between +2 and +4 (from 450 to 318, a difference of 132). End of cycle blood was very high. This morning she must have been coming down from the bounce + had the insulin shot (2 units). She will come out of this, right? :(
     
    Last edited: Jan 5, 2020
    Reason for edit: Update
  32. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Cam is fine. ProZinc onsets around 2 -3 hours post shot and some kitties hit nadir (lowest point) by +4. No need for the dry food when you see a drop like that unless the resulting BG is low. Stick to Low carb wet food to try to extend the time Cam stays in those lower range numbers. Only by staying in those lower numbers for longer periods do they get reacquainted with them and relearn that they are safe so the bouncing decreases.
     
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  33. Camcat

    Camcat Member

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    Jan 4, 2020
    Sorry, I just saw this now -- thank you so much! Good to know about the Prozinc 2-3 hour onset. I feel like a major doofus. At +4 (after another -30 drop) I gave her a little high calorie nutritional gel because I was so worried that her levels were still dropping. Gonna put her in the other direction now.
     
  34. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Those lower numbers are scary at first and many if not all of us tend to overreact a bit. You'll figure her out and she'll be fine.
     
  35. Camcat

    Camcat Member

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    Jan 4, 2020
    Thank you so much Linda.

    Good (although expected) news, that +5 is 238 (not falling anymore!). Looking back at the past three cycles, I think you're right -- Cam's nadir is +4! So great to know. I will not be quite so alarmed when I see this going forward, and I'll try to slow any fast drops around +2, and +3 with wet food. Since she's a +4 nadir, what does this mean for her later hours? Does the ProZinc wear off more quickly? In the future when the bounce is under control, should I be giving Cam her next shot at +10 or +11 if her levels are high?
     
  36. Camcat

    Camcat Member

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    Jan 4, 2020
    +6 is 425 on the human meter (+ increase of 187 since her +5). That's really pretty high. I'm worried again -- what is +7 and +8 going to look like if the numbers keep rising this much? :( Should I give a tiny bit more insulin? 0.25? Is there an upper number or limit that will send her to the ER? Or will she be okay as long as she's just her usual self (no ketoacidosis)? I'm just as worried about the highs as the lows -- should I be? I know it's "better to be high for a day than low for a minute", but is that accurate even in very high glucose levels?
     
  37. Camcat

    Camcat Member

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    Jan 4, 2020
    +7 is 463 on human meter. Should I give next dose of insulin at +10 bc of early nadir?
     
  38. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    May 18, 2016
    What time did you shoot?
    It would be a good idea to put the times you shot on your spreadsheet. Create 2 new columns beside the units columns.

    I am on a laptop missing some keys. Also, I am working with a stack of paper and will not be able to respond quickly.
     
  39. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    May 18, 2016
  40. Camcat

    Camcat Member

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    Jan 4, 2020
    Hi! I shot at +11 (7:30pm) when I saw that 'HI' reading. She's doing good actually -- her +2 was 391, and her +3 was 381 (I am so relieved). Going to check her +4 in a few. Hopefully not any massive drops tonight.

    I added in the times to my spreadsheet -- this is a great idea!

    Thanks for being so responsive. You have helped me hold onto my sanity this weekend.
     

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