? BG still erratic, help needed please

Georgiana & Perlutz

Georgiana & Perlutz

Member Since 2019
Creating a new thread as the previous one got too long :p (you can see it here).

Perlutz's numbers are still erratic after nearly 8 months since being diagnosed. At the beginning of July, I thought we were getting somewhere, we were getting yellow, blues and even some greens but that didn't last long and was followed by lots of reds and blacks :( Now he has a bout of better numbers again but I don't know how to make this last this time... Any ideas would be much appreciated!

Tonight's PMPS was 9.7, I stalled 20 minutes and it went up to 10.7 so I fed him and gave him 3.25. Again I changed the dose but I was afraid 3.5 would've been too much on a low number and with a new insulin vial.

@Diana&Tom @MrWorfMen's Mom tagging you in the new thread :cat:
 
Interesting that low PMPS tonight. Wondering if it has anything to do with the new vial of insulin. Your previous vial was only about a month old so it should still be fine but definitely something to keep an eye on. Good idea lowering PM dose as long duration from day cycle could suggest dose too high but again past days readings didn't really give that impression. Hopefully this is a sign that things are turning around a bit. The blues are showing up more often again now. :D
 
Well done on starting a new thread, Georgiana ;)
I can well see your dilemma re dosing of course... uhhhhh... I'll leave it to Linda with her superior experience to make the constructive comments and will just chip in myself if I have anything to add.
Let's hope you'll see a better run again now!
 
Looks like we might have a long night ahead of us Perlutz and I :coffee: +7.7 at +3

We haven't had an easy time with testing and shooting this evening :( We've been testing one ear only for few days (hit right in the vein few days ago and there was a lot of blood coming out and now the ear is badly bruised and we're leaving it alone) and he really didn't want it to be pricked anymore, tried to hide the ear, tried to run, shook his head...poor lil munchkin really wanted to be left alone. Then after I finally managed to test him, he wanted to eat in peace and kept moving when I gave him his shot and about 0.25 might have been a fur shot :facepalm: I didn't see any wetness but 0.25 is such a little drop I don't even know how much wetness there would've been.

Now I'm sitting here regretting yesterday's bad choice of going to bed so late and stressing over pocking his ears even more :( I'd normally test him hourly but I don't think he'll let me tonight so I'll just see how it goes.
 
OH dear! So sorry to hear Perlutz has a sore ear. Have you tried using something like Polysporin with pain relief (not sure what's available in the UK) on his ear? What's the carb level of the Nature's Menu Country Hunter? Right now I'd try to stick with low carb food but if you need to go to bed, you could give Perlutz something with higher carbs to try to slow his drop. Nice to see those blues but their habit of doing this on night cycles is frustrating.
 
MrWorfMen's Mom said:
OH dear! So sorry to hear Perlutz has a sore ear. Have you tried using something like Polysporin with pain relief (not sure what's available in the UK) on his ear? What's the carb level of the Nature's Menu Country Hunter? Right now I'd try to stick with low carb food but if you need to go to bed, you could give Perlutz something with higher carbs to try to slow his drop. Nice to see those blues but their habit of doing this on night cycles is frustrating.
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Nature's Menu is 6% carbs and I will stay up with him to test so I won't bring out the HC unless I really need to. Loving the blues, as always, and in a way I'm glad it's at night so I can watch him and test. Here's to dark circles and being a grump tomorrow :coffee: :smuggrin:

Unfortunately I don't have any Polysporin as it's not OTC in UK and I stupidly forgot to get some when I was back home this summer :facepalm: I only have calendula cream which some UK'ers use but I don't know if it helps much. I'm calling the vet again tomorrow to ask for a prescription cream, we will really need both ears after more testing than usual on only one ear tonight :arghh:
 
Hopefully the vet can prescribe something for those poor ears. I'm actually pleasantly surprised that Polysporin is not available OTC in the UK. I have an issue with the use of antibiotics willy nilly. In the meantime how about some plain old petroleum jelly (Vaseline here in Canada). Might help a bit.
Not familiar with calendula cream at all.
 
I do have some Vaseline but I didn't think it would help so haven't used it. Will give it a shot! And you might know Calendula as Marigold? Supposed to help damaged skin.

I'm gonna test him again in a minute, it's been an hour since the last one. I'll get the stink eye tonight :oops:
 
Well apparently I have to brush up on my "holistic' remedies. Haven't hear of Marigold either and I am a great one for "old wives tales" remedies.

When you get the stink eye, look the other way. They are so good at ignoring us..... maybe a like message will sink in. :woot:
 
Tell me about it :D Marigold was nothing more than a brand of household gloves until I started poking Perlutz's ears :oops:

He was 5.9 at +5.75 so just a tiny, tiny increase from the food. I gave him 1x treat (11% carbs) for letting me poke him again. Should I give him some more food now or wait a bit? Usually he would get some food from the auto feeder in more or less an hour from now.
 
Let the auto feeder guide you and stick to the program. While numbers are nicely down, they are not in any way critical so I'd just let him surf for the moment and give him some food on the schedule you've been using.
 
Ok, he will get his usual autofeeder meal and I will give him 1 more hour after eating until I test again. I'll take advantage and try to take a nap in this hour. Thank you for all your help, as always, Linda :bighug: Will you be around later? This is not our first pyjama party but for some reason I'm a little bit nervous tonight:confused:
 
I have some other kitties I've been monitoring that don't shoot for another hour so yes I'll be around for a bit yet. If you truly do need to hold a PJ party, I'll stay with you or find someone who can. We have a lovely member in Australia I think you'd love who quite often helps when we North American folks are off sawing logs. :D
 
It’s good to have someone to chat to and it gives me a sense of security to know someone is there, but I think we should be fine if you need to go. He is in good numbers and he seems okay, having a little shower atm. I think he is a bit surprised of the sudden blues, but no alarm bells.
 
Crikey, Georgiana, what a rollercoaster! Whatever is Mr P playing at at the moment... he's certainly keeping you on your toes. I take my hat off to you for how you're handling things - you seem to be very cool, calm and collected, and know exactly what you're doing.

I'm glad Linda is giving you good advice, amd I'm sure others would too if you tagged them at any time. I'm sorry I can't offer anything useful - I can do anything you like with letters and words but numbers just scramble my brain! Looking at a spreadsheet nearly gives me a migraine ;)

Keep going and keep smiling :)
 
AMPS was quite high, I guess a bounce? It took me a bit by surprise, I didn't expect such a high number after a 9.2 when I went to bed. PMPS, however, was a nice yellow. I went ahead with 3.5 units again so we might have another long night.

Today he vomited another hairball, a little bigger than yesterday's one and this time mixed with a little food as well. These are the first hairballs in almost 2 months. He doesn't seem to be in pain but I would say he might look a little less like himself? I'm thinking maybe he is just not used to lower numbers and doesn't enjoy all the unwanted attention his ears are getting :blackeye:

Like Diana said, his SS is giving me a migraine more than an idea what to do :banghead: We've been at this for 8 months now and while I definitely learnt a lot, regulating/remission seem like a dream that might never come true :( I know there's no precise recipe to success and that it can take a lot of time and patience... I guess it's just one of those days when it's harder to stay positive....

EDIT: We're seeing the vet this weekend. Mostly because I want the vet to check his teeth properly and give him a general check up as well as discussing Lantus. She did his dental but all the other appointments were with a different vet so I'll try to pick her brain on diabetes in general as well. I don't know if she will recommend any tests but if she doesn't, do you think there's something I should request?
 
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Can you get some tests earlier in the cycle over the weekend? I'm wondering if Perlutz is dropping lower between +3 and +7 and we're just not seeing it on the day cycles. I can't help but wonder if any of what you are seeing is from bouncing and we're just not seeing the lows associated.
 
Georgiana & Perlutz said:
12.7 PMPS and then went all the way up to 24.1 at +3 :eek: What is going on?!:arghh:
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I feel your frustration Georgiana and I know how hard it is to keep plugging away and stay positive. You are doing an amazing job, actually, try to remind yourself of that. A living creature is a very complex thing and sometimes despite all our analyses and efforts, things still don't go to plan... I think all you can do is what you're doing now, ie giving your best guess at doses and see what happens one day at a time. And remember - as long as Perlutz himself is still happy and enjoying his food, play time, etc, that's what's really important right now. There used to be a phrase here on FDMB that I haven't seen for a while - remember to look at the whole cat not just the diabetes. We tend to lose sight of that at times.

Hope you have a good chat with the vet - do let us know.
 
MrWorfMen's Mom said:
Can you get some tests earlier in the cycle over the weekend? I'm wondering if Perlutz is dropping lower between +3 and +7 and we're just not seeing it on the day cycles. I can't help but wonder if any of what you are seeing is from bouncing and we're just not seeing the lows associated.
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Hi Linda,

I’ll try to get some testing between +3 and +7 tomorrow, today we have the vet appointment at +4 and his BG will go through the roof :facepalm:

The same happened this morning, from 12.1 to 24.1 in 2 hours :woot: I don’t think food would almost double his BG, no?
 
No I can't see BG going up by that much from food unless he got into some very high carb food. Every cat's food bump will be different because some cats are more carb sensitive than others, metabolism different etc. but most I would expect to less than 5 or 6mmol at most.
The vet elevation is to be expected and that can elevate 5 or 6 mmol too.

I think a discussion about changing to Lantus is a good idea. While ProZInc is a good insulin for cats, the duration and faster action may be causing some of these ups and down for Perlutz so trying a longer acting insulin might just be the ticket.
 
The conclusion of our appointment today is that we need a new vet.

The vet won’t prescribe Lantus because “there is no evidence it works in cats” and believes we are better off staying on Prozinc or going back to Caninsulin. No ideas on how to proceed with Prozinc either, just “keep doing what you’re doing now”. Didn’t seem to be even remotely aware of the RVC studies, their diabetes remission clinic and the many other studies in support of Lantus.

Had to go through the good old chat about why prescription diets work best for diabetic cats :mad: I was tempted to ask if it’s better for their business or my cat but I just explained why I will stick to low carb, good quality wet food.

There is tiny bit of redness in the upper left side of his mouth, less than it used to be. Right side looked fine. She recommended Stomodine f gel for the redness.

Also wants to do blood tests in a month’s time to check kidney function but want me to give him Gabapentin prior to taking him there so he is “calm” and they don’t have to sedate him. He’s never been sedated before and I don’t think he is feisty enough to require any sort of medication for a blood test. I don’t know anything about this Gabapentin but I generally don’t like the thought of any drugs unless really needed..

Just a moment ago he vomited another hairball, very large one and looks a bit reddish to me but could be the food he is eating? His food is of a similar colour to this. I’ll attach a picture if anyone with a strong stomach can open it...

Last time we saw few days of lower numbers (beginning of July), he was also vomiting hairballs. There have been no hairballs whatsoever between these lower numbers. What could be the connection? Can there be one or it’s just a coincidence?

My only action plan for the moment is to extend my search for a good vet outside our town. I don’t know what else to do at this point... If anyone has any ideas, I’d be grateful for a bit of insight/help.
 
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I'm not even sure what do to in regards to the insulin tonight... His PMPS was 12.9 and he ate a little bit, maybe just slightly less than half. Not sure if I should give him the full dose or reduced... Ideas anyone? I need to make a decision quite quick...
 
Well that seems to have been pretty much a waste of time, energy and money. Now if you are like me and find utter cluelessness difficult to deal with, I'd send the vet copies of the ISFM and AAHA treatment guidelines along with Roomp and Rand and suggest the vet read them. You could soften the message with a " this is why I asked" if you're nicer than me! If you want those docs, just holler, and I'll find the links.

Not sure what to think about the hairball issue. I have an old long haired guy who used to look like death warmed over, vomit several days in a row (projectile fluid or food), produce a hairball or 3 over a few days and then be right as rain for another few months. I have to think that hairballs and the associated attempt to expel them has to make them feel punky but Perlutz appears to be a shorthaired cat (so wouldn't expect hairballs to be as big a problem) and it's odd BG is up when he isn't expelling any.

On dose tonight, if he seems uninterested in food reduce the dose to 3u and retest by +3. to see what he's up to.
 
Oh ***! Why oh why don't vets get better training in FD... it is an increasingly common problem amongst the feline population (no doubt largely due to "convenience food" diets) yet so many vets just aren't clued up. Whatever happened to CPD - Continuing Professional Development - which I have to show evidence of in my work and you'd think that medical professionals would have to update their knowledge on a regular basis to keep abreast of research findings and developments... but it doesn't seem that way.

I think you're right - time for a new vet. Did you think about trying a mobile vet who could come to you? There are a few of them around and you could phone and ask what their approach is to treating FD perhaps (actually I am vaguely remembering that you did try this not long ago and the one you looked at wasn't taking new patients, or something)? Maybe go back online and hunt for some others. There is an excellent one called The Cat Doctor which I think may be slightly out of your area, but it might not harm to ring them and say they've been recommended by a friend and do they know a good vet near you...worth a try perhaps. Or just look for others a little outside your usual area perhaps, not ideal but it may have to come to that.
Hairballs and lowet numbers... hmmm. I'd suggest posing this question on Health where it will get more eyes... call the thread "hairballs and lower numbers?" and see what responses you get. I know you're not keen to post too much but it's alesys worth asking and this is what the board is for, after all.

Hopefully Linda will see your query about dosing and help you out there.

Hang in there, Georgiana - give yourself some treats this evening, you deserve something nice!
 
He ate a little bit more and We gave him 3.25 units. We had movie tickets for tonight and we decided to go ahead with it. A bit selfish, I know, but we both really needed it after a long week at work and today’s vet visit really took its toll on me. I’ll reply properly when we get back home in a couple of hours.
 
Go enjoy yourself. That's not selfish. It's called self preservation and you need to do that to keep you in good shape to look after your furry buddy! ;)
 
Very glad you're going out, you do need to get away from it all sometimes! Hope you have a fun evening :)
 
MrWorfMen's Mom said:
Well that seems to have been pretty much a waste of time, energy and money. Now if you are like me and find utter cluelessness difficult to deal with, I'd send the vet copies of the ISFM and AAHA treatment guidelines along with Roomp and Rand and suggest the vet read them. You could soften the message with a " this is why I asked" if you're nicer than me! If you want those docs, just holler, and I'll find the links.

Not sure what to think about the hairball issue. I have an old long haired guy who used to look like death warmed over, vomit several days in a row (projectile fluid or food), produce a hairball or 3 over a few days and then be right as rain for another few months. I have to think that hairballs and the associated attempt to expel them has to make them feel punky but Perlutz appears to be a shorthaired cat (so wouldn't expect hairballs to be as big a problem) and it's odd BG is up when he isn't expelling any.

On dose tonight, if he seems uninterested in food reduce the dose to 3u and retest by +3. to see what he's up to.
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I definitely want those links, please send when you can. I had few print outs with me today, just didn’t have a chance to show them. Because we haven’t seen this vet before, I went with 4 A3 pages of all Perlutz’s spreadsheet to show her how he’s been on Prozinc all these 7 months, how he had bouts of lower numbers occasionally, made some notes of feeding times etc. I barely had a chance to explain what’s the data on it, what all the numbers and colours stand for and she only looked for a split second at the last couple of days and set it aside :mad: The SS is pure gold, gives you such a good insight at what’s happening! You’d think a vet would want to analyze the data? Search for trends? But no, no interest :(

I too struggle with taking this cluelessness (you’re being nice to call it this, I’d use a harsher word lol) but despite feeling my blood boil, I have to stay nice as Perlutz’s health is in their hands :( The only reason I haven’t stormed out of there calling them names...

Perlutz has medium hair let’s say, definitely not long but not short either. But he hasn’t been the hairball kind of cat ever. Last time he had them in July, I thought it was the SEB that’s stopped them. I’ve been sprinkling a little bit on his food once a day every day (except maybe 2-3 days in the past 3 months). I’ll try to do it twice a day, maybe it helps. I am thinking to go with a similar amount to start with, just split over breakfast and dinner. How does that sound?

I also noticed he’s been scratching himself a bit more lately (past week, week and a half) so I checked him for fleas but couldn’t see any. He is strictly indoors but maybe we brought some fleas in, who knows. So I bought some Advantage today and will give it to him tomorrow. He’s been through enough today, only want to give him cuddles tonight!
 
Diana&Tom said:
Oh ***! Why oh why don't vets get better training in FD... it is an increasingly common problem amongst the feline population (no doubt largely due to "convenience food" diets) yet so many vets just aren't clued up. Whatever happened to CPD - Continuing Professional Development - which I have to show evidence of in my work and you'd think that medical professionals would have to update their knowledge on a regular basis to keep abreast of research findings and developments... but it doesn't seem that way.

I think you're right - time for a new vet. Did you think about trying a mobile vet who could come to you? There are a few of them around and you could phone and ask what their approach is to treating FD perhaps (actually I am vaguely remembering that you did try this not long ago and the one you looked at wasn't taking new patients, or something)? Maybe go back online and hunt for some others. There is an excellent one called The Cat Doctor which I think may be slightly out of your area, but it might not harm to ring them and say they've been recommended by a friend and do they know a good vet near you...worth a try perhaps. Or just look for others a little outside your usual area perhaps, not ideal but it may have to come to that.
Hairballs and lowet numbers... hmmm. I'd suggest posing this question on Health where it will get more eyes... call the thread "hairballs and lower numbers?" and see what responses you get. I know you're not keen to post too much but it's alesys worth asking and this is what the board is for, after all.

Hopefully Linda will see your query about dosing and help you out there.

Hang in there, Georgiana - give yourself some treats this evening, you deserve something nice!
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I know, right? If there’s any profession out there that really needs CPD, that’s doctors and vets! There’s always a new drug, a new study, a new protocol etc. All 3 vets Perlutz has seen here are in their late 20’s or early 30’s, they have 20-30 more years to profess and you’d think they’d take advantage of a case that doesn’t go according to the 2-3 pages in the book to learn more? Not to mention they should probably be aware of recent studies and research.

I was looking for mobile vets a while back and shortlisted a couple but I didn’t get in touch. I’ve been “stalking” them online trying to find their qualifications and something to reassure the paranoid in me than not every Tom, Dick and Harry can become a mobile vet. Sounds stupid when I write it down but seemed like a genuine reason of concern when it occurred to me :oops:

It’s not that I don’t like posting, I just don’t want to sound like a broken record and become annoying posting too much...
 
Sorry it wasn't a good movie but at least you got out for some "me" time. I remember reading IT long ago. I was too chicken to watch the movie. And now I know I don't need to bother with IT chapter 2 either. Thank you. Love Stephen King but some of his stuff just doesn't translate well to the big screen.

Saw the fluffy chest in your avatar but thought it was just "bed head" hair! :woot: Has Perlutz been licking/preening/bathing more? I have no idea if SEB helps hairballs or not but don't think it can hurt and if it seemed to work last time, give it a go!

Georgiana & Perlutz said:
I too struggle with taking this cluelessness (you’re being nice to call it this, I’d use a harsher word lol)
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My unedited post used a little stronger term than "clueless" but I thought better of it in mixed company! :p

I will get find those links for you tonight. :)
 
As promised here are links to the docs I mentioned.

AAHA Guidelines
http://www.felinediabetes.com/FDMB/...nagement-guidelines-for-dogs-and-cats.195960/

ISFM
http://www.felinediabetes.com/FDMB/...is-management-of-hypertension-in-cats.177121/

This one is a paper on using Levemir (Detemir) in Cats. Might not be in the realm of possibility for you in the UK but it would show you've done YOUR homework thoroughly! :D
http://www.felinediabetes.com/FDMB/...l-for-intensive-blood-glucose-control.195964/

Still trying to find the Roomp and Rand protocols. Have to search my hard drive. Don't see it here.
 
Georgiana & Perlutz said:
I know, right? If there’s any profession out there that really needs CPD, that’s doctors and vets! There’s always a new drug, a new study, a new protocol etc. All 3 vets Perlutz has seen here are in their late 20’s or early 30’s, they have 20-30 more years to profess and you’d think they’d take advantage of a case that doesn’t go according to the 2-3 pages in the book to learn more? Not to mention they should probably be aware of recent studies and research.

I was looking for mobile vets a while back and shortlisted a couple but I didn’t get in touch. I’ve been “stalking” them online trying to find their qualifications and something to reassure the paranoid in me than not every Tom, Dick and Harry can become a mobile vet. Sounds stupid when I write it down but seemed like a genuine reason of concern when it occurred to me :oops:

It’s not that I don’t like posting, I just don’t want to sound like a broken record and become annoying posting too much...
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Cluelessness, incompetence, laziness, call it what you will... it starts to verge on "lacking due care" if the vets don't see that there is a mystery here to be solved, a case where an animal is not responding as expected to the treatment they prescribe. I'm actually starting to feel beyond frustrated and more angry on your behalf. There must be vets out there within a reasonable distance of your town that would take a real interest in Perlutz. I'd definitely be looking around now for someone who has the gumption to put in a bit of effort to help you guys. We here on this board seem to care more about Perlutz than your vets!

Georgiana, you don't sound like a broken record and you're not remotely annoying! You're a genuine, nice, level-headed person who wants to make your cat better. Everyone can see that. Please do post whenever you want to - as I said, that's what the board is for. All and any questions you have are valid and if you post and get few or no responses, it's not because people are ignoring you, it's because they have nothing to say. (If you want help with thread titles ;) just shout and I'll come up with some suggestions! :) )
 
MrWorfMen's Mom said:
Saw the fluffy chest in your avatar but thought it was just "bed head" hair! :woot: Has Perlutz been licking/preening/bathing more? I have no idea if SEB helps hairballs or not but don't think it can hurt and if it seemed to work last time, give it a go!
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I haven’t noticed him bathing more than usual but I’ll step up the brushing, just in case.
Here’s a little fluffy belly <3
59A6AAF8-7889-4D80-81DB-2DCBC39E54AF.jpeg
 
Diana&Tom said:
Cluelessness, incompetence, laziness, call it what you will... it starts to verge on "lacking due care" if the vets don't see that there is a mystery here to be solved, a case where an animal is not responding as expected to the treatment they prescribe. I'm actually starting to feel beyond frustrated and more angry on your behalf. There must be vets out there within a reasonable distance of your town that would take a real interest in Perlutz. I'd definitely be looking around now for someone who has the gumption to put in a bit of effort to help you guys. We here on this board seem to care more about Perlutz than your vets!

Georgiana, you don't sound like a broken record and you're not remotely annoying! You're a genuine, nice, level-headed person who wants to make your cat better. Everyone can see that. Please do post whenever you want to - as I said, that's what the board is for. All and any questions you have are valid and if you post and get few or no responses, it's not because people are ignoring you, it's because they have nothing to say. (If you want help with thread titles ;) just shout and I'll come up with some suggestions! :) )
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I’ve said it before, you guys here DO care about Perlutz more than our vets, there’s no doubt!

Frustrating and angry is exactly how I feel. It drives me insane that they don’t want to do anything for Perlutz. Not only they don’t want to try something new, they don’t even try to see if there is something that could maybe make Prozinc work better. Zero interest :(

I will start calling other vets in Berkshire, there has to be someone willing to take a bit more interest in Perlutz!
 
Georgiana & Perlutz said:
I’ve said it before, you guys here DO care about Perlutz more than our vets, there’s no doubt!

Frustrating and angry is exactly how I feel. It drives me insane that they don’t want to do anything for Perlutz. Not only they don’t want to try something new, they don’t even try to see if there is something that could maybe make Prozinc work better. Zero interest :(

I will start calling other vets in Berkshire, there has to be someone willing to take a bit more interest in Perlutz!
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Yes do it! If I come across any ideas I will let you know.
 
MrWorfMen's Mom said:
Yep...that fluff could lead to hairballs. That pic is adorable. I just want to rub that chest and tummy and give him scritches! So cute!
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Oh he would love that! He’s so cuddly today, he’s been glued to me since we woke up :p

I took some readings at +3 (20.7) and +6.5 (13) but AMPS was a bit higher today. I’ll test him again later on, maybe +9?
 
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