<?xml version="1.0" encoding="utf-8"?><feed xmlns="http://www.w3.org/2005/Atom" ><generator uri="https://jekyllrb.com/" version="3.10.0">Jekyll</generator><link href="https://rin.io/feed.xml" rel="self" type="application/atom+xml" /><link href="https://rin.io/" rel="alternate" type="text/html" /><updated>2026-10-01T09:49:58+00:00</updated><id>https://rin.io/feed.xml</id><title type="html">Good Fibrations</title><subtitle>math is art</subtitle><entry><title type="html">The Untested Drug that Saved My Cat’s Life: Neostigmine as a Treatment for Feline Idiopathic Megacolon</title><link href="https://rin.io/megacolon/" rel="alternate" type="text/html" title="The Untested Drug that Saved My Cat’s Life: Neostigmine as a Treatment for Feline Idiopathic Megacolon" /><published>2026-09-22T00:00:00+00:00</published><updated>2026-09-22T00:00:00+00:00</updated><id>https://rin.io/megacolon</id><content type="html" xml:base="https://rin.io/megacolon/"><![CDATA[<p><em>Owner documentation of a life saving treatment that worked for one nine-year-old cat with megacolon, written for owners who have been told euthanasia or surgery are the only sensible options and who may not know that another one exists.</em></p>

<p><code class="language-plaintext highlighter-rouge">Domestic shorthair, neutered male, 9 years</code> · <code class="language-plaintext highlighter-rouge">9 kg → 7 kg</code> · <code class="language-plaintext highlighter-rouge">Status: stable, at home</code></p>

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<hr />

<h2 id="what-this-document-is">What this document is</h2>

<div class="for-pros">

  <p>A case study of off-label neostigmine in a nine-year-old cat with recurrent idiopathic dilated megacolon who was not a candidate for colectomy. It covers the sequence that made it defensible (complete deobstipation and exclusion of mechanical obstruction first), intermittent maintenance guided by abdominal palpation, and adjunct lactulose and frunevetmab for spondylosis-associated pain. It is uncontrolled, owner-reported and referenced throughout. It is not a protocol.</p>

</div>

<p>Cake had megacolon that kept coming back. The standard fix is surgery, and by the time it was needed he was too unwell — and too heavy — to come through it safely. Enemas, a full manual clear-out, laxatives and a wet-food diet all failed to hold. At that point the realistic option given to me was putting him to sleep.</p>

<p>We found another option – my favorite vet suggested we try <strong>neostigmine</strong>, a drug that makes a weak colon push harder. He is still here – eating, grooming, using his litter tray, and happier than he was before this nightmarish adventure began. He just needs an injection every few weeks, and probably always will.</p>

<p><strong>Neostigmine is not an established treatment for megacolon in cats.</strong> There is no trial behind it, no licensed indication, nothing in the standard textbooks. It is a folklore treatment — known to some vets, used quietly, never formally written up. That is exactly why it may not have been offered to you, and it is the first thing section 01 explains.</p>

<p>This is not a claim that it works for every cat, and it is not a protocol to follow at home. It is a written account of one cat’s treatment, detailed enough that you can take it to your own vet and ask whether it is worth considering.</p>

<div class="both donate">

  <p>I am raising money to cover the exorbitant treatment costs involved in saving Cake’s life, and keeping him alive until we found the treatment recorded in this article.</p>

  <p><a class="donate-btn" href="https://www.gofundme.com/f/help-cake-heal-from-megacolon">Help pay for Cake’s treatment: donate →</a></p>

</div>

<table class="both">
  <thead>
    <tr>
      <th> </th>
      <th> </th>
    </tr>
  </thead>
  <tbody>
    <tr>
      <td><strong>Diagnosis</strong></td>
      <td>Dilated megacolon, recurrent obstipation</td>
    </tr>
    <tr>
      <td><strong>Complicating factor</strong></td>
      <td>Spinal spondylosis, painful defecation</td>
    </tr>
    <tr>
      <td><strong>Surgery</strong></td>
      <td>Ruled out — too unwell and too heavy for safe anesthesia</td>
    </tr>
    <tr>
      <td><strong>Current regime</strong></td>
      <td>Neostigmine as needed, daily lactulose, Solensia every 6 weeks</td>
    </tr>
  </tbody>
</table>

<hr />

<h2 id="01--a-folklore-treatment-not-an-established-one">01 · A folklore treatment, not an established one</h2>

<p>When Cake’s vet suggested the neostigmine she used to treat baby horses, she was clear about what she was proposing: <strong>this is not a scientifically established treatment for megacolon in cats.</strong> It is not licensed for it. There is no clinical trial. It does not appear in the textbook chapters or the treatment guidelines on feline constipation.<sup id="fnref:1" role="doc-noteref"><a href="#fn:1" class="footnote" rel="footnote">1</a></sup> A vet who says they have never heard of using it this way is not being careless — there is very little for them to have heard.</p>

<p>What does exist is elsewhere. Neostigmine is well established in horses for large colon impaction, where it is the most commonly chosen drug of its kind.<sup id="fnref:9" role="doc-noteref"><a href="#fn:9" class="footnote" rel="footnote">2</a></sup><sup id="fnref:10" role="doc-noteref"><a href="#fn:10" class="footnote" rel="footnote">3</a></sup> It is used in human medicine for a condition in which the colon dilates and stops moving.<sup id="fnref:12" role="doc-noteref"><a href="#fn:12" class="footnote" rel="footnote">4</a></sup> The principle — restore the push to a bowel that has stopped pushing — is old and well understood. It is the specific application to cats that nobody has written down.</p>

<p>Mathematicians have a name for a result that specialists know, pass around and rely on, but which nobody ever formally published: a <em>folklore theorem</em>. It is true, it is used, and you will not find it by looking it up. Neostigmine for feline megacolon sits in roughly that position. Some vets know of it. Some have used it and seen it work. But because it was never written up, knowledge of it spreads by word of mouth between practitioners rather than through the literature — which means whether it gets offered to your cat depends largely on who you happen to be standing in front of.</p>

<p>That is the gap this document is trying to close, and it cuts both ways. A folklore treatment is not a secret good one that the profession has ignored. It is a treatment nobody has tested properly, which is a real reason for caution and a legitimate reason for a vet to decline. Your vet may have grounds you are not aware of, specific to your cat. The point is only that the conversation should be possible.</p>

<blockquote class="plain-only">
  <h3 id="-an-honest-caveat">⚠ An honest caveat</h3>

  <p>Sometimes euthanasia genuinely is the right decision. A cat in unrelieved pain, with a colon that has stopped responding, or with other serious illness alongside, may be at the end of what medicine can reasonably offer. This document is not an argument that nobody should ever make that choice.</p>

  <p>It is an argument that you should get to make the choice knowing what the alternatives were.</p>
</blockquote>

<div class="for-pros">

  <p>Go looking for feline data on this and you find nothing. No pharmacokinetics, no efficacy trial, no safety series. Not a thin literature — an absent one.</p>

  <p>Everything supporting it comes from other species. In horses, neostigmine is the prokinetic most often reached for in large colon impaction.<sup id="fnref:9:1" role="doc-noteref"><a href="#fn:9" class="footnote" rel="footnote">2</a></sup> A CRI at 0.008 mg/kg/h raises fecal output and makes pelvic flexure smooth muscle contract in the organ bath.<sup id="fnref:8" role="doc-noteref"><a href="#fn:8" class="footnote" rel="footnote">5</a></sup> At 0.044 mg/kg IM it improves caecal and colonic contractility on ultrasound in Arabians — though those authors preferred metoclopramide, which they judged safer and longer-acting in that breed.<sup id="fnref:9:2" role="doc-noteref"><a href="#fn:9" class="footnote" rel="footnote">2</a></sup> Foals with meconium impaction get 0.005–0.01 mg/kg IM or SC.<sup id="fnref:11" role="doc-noteref"><a href="#fn:11" class="footnote" rel="footnote">6</a></sup> Humans get it for acute colonic pseudo-obstruction.<sup id="fnref:12:1" role="doc-noteref"><a href="#fn:12" class="footnote" rel="footnote">4</a></sup></p>

  <p>The same literature contains the awkward finding too: give 0.022 mg/kg four times at half-hour intervals and gastric emptying <em>slows</em>.<sup id="fnref:8:1" role="doc-noteref"><a href="#fn:8" class="footnote" rel="footnote">5</a></sup> Whatever neostigmine does to the horse gut, it doesn’t do it uniformly — useful distally, possibly counterproductive proximally.</p>

  <p>Then there’s the species problem. The classical account of feline megacolon puts the lesion in the smooth muscle rather than the nerves,<sup id="fnref:1:1" role="doc-noteref"><a href="#fn:1" class="footnote" rel="footnote">1</a></sup><sup id="fnref:2" role="doc-noteref"><a href="#fn:2" class="footnote" rel="footnote">7</a></sup> which is uncomfortable, because a drug that works by making neuronal acetylcholine linger needs a myocyte still capable of answering it. That picture has since gotten murkier — section 02.</p>

</div>

<hr />

<h2 id="02--what-megacolon-actually-is">02 · What megacolon actually is</h2>

<p>The colon is the last stretch of bowel. It draws water out of waste and pushes what is left toward the exit in waves of muscular contraction.</p>

<p>In megacolon the colon stretches wide and loses much of its ability to push.<sup id="fnref:1:2" role="doc-noteref"><a href="#fn:1" class="footnote" rel="footnote">1</a></sup> Waste sits there. The longer it sits, the more water is drawn out of it, and the harder it becomes. Harder waste is harder to move, so it sits longer still.</p>

<p>Almost everything that follows in this document is an attempt to break that loop at one point or another. It is worth holding onto, because it explains why single treatments keep failing: an approach that softens the waste but does nothing for the pushing, or improves the pushing while the waste is already concrete, addresses half a problem.</p>

<p>In most cats no cause is ever identified. This is called <strong>idiopathic megacolon</strong>.<sup id="fnref:1:3" role="doc-noteref"><a href="#fn:1" class="footnote" rel="footnote">1</a></sup> When a cat can no longer empty the bowel at all, the word used is <strong>obstipation</strong>.</p>

<blockquote>
  <h3 id="-the-single-most-important-number-in-this-document">⚠ The single most important number in this document</h3>

  <p>In a 2022 study, cats whose signs had lasted <strong>less than six months</strong> responded to medical management in <strong>66.7%</strong> of cases. Cats whose signs had lasted <strong>six months or more</strong> responded in <strong>5.6%</strong> — the rest needed surgery.<sup id="fnref:4" role="doc-noteref"><a href="#fn:4" class="footnote" rel="footnote">8</a></sup></p>

  <p>If your cat is early in this, that is the window. It is the strongest argument in the literature for pushing hard on diagnosis and treatment now rather than managing conservatively and seeing how it goes.</p>
</blockquote>

<div class="for-pros">

  <p>The breakdown of feline obstipation runs roughly 62% idiopathic megacolon, 23% pelvic canal stenosis, 6% nerve injury and 5% Manx sacral cord deformity — those four covering 96% of cases.<sup id="fnref:1:4" role="doc-noteref"><a href="#fn:1" class="footnote" rel="footnote">1</a></sup> Keep dilated megacolon separate from hypertrophic: the first is the end stage of idiopathic colonic dysfunction, diffusely wide and hypomotile; the second is driven by something obstructing. They don’t behave alike and they don’t carry the same prognosis.<sup id="fnref:18" role="doc-noteref"><a href="#fn:18" class="footnote" rel="footnote">9</a></sup> On radiographs, take the widest colonic diameter over the length of L5. <strong>≥1.48 is the feline cutoff</strong>; dogs are ≥1.5.<sup id="fnref:3" role="doc-noteref"><a href="#fn:3" class="footnote" rel="footnote">10</a></sup></p>

  <p>Now the part that actually changed my mind about something. The older literature holds that cats don’t show the enteric neuronal loss seen in human megacolon.<sup id="fnref:18:1" role="doc-noteref"><a href="#fn:18" class="footnote" rel="footnote">9</a></sup> A 2022 histologic study makes that harder to maintain. In cats whose signs had run six months or more, the descending colon had a thickened muscularis mucosa (54.1 μm against 22.33 μm in controls), a fatter inner circular layer (743.65 vs 482.67 μm) and a thicker outer longitudinal layer (570.68 vs 330.33 μm) — but also <strong>fewer ganglion cells</strong>, 0.93 against 2.87, with necrotic myocytes up from 0.07 to 2.25.<sup id="fnref:4:1" role="doc-noteref"><a href="#fn:4" class="footnote" rel="footnote">8</a></sup> Myopathic, then, but neuropathic as well, and apparently more so the longer it goes on.</p>

  <p>I’d rather spell out what that means for the drug in this document than leave it for a reader to spot. An acetylcholinesterase inhibitor doesn’t manufacture acetylcholine; it stops what the neurons release from being cleared. Lose the neurons and you lose the substrate. So ganglion cell attrition predicts a therapeutic window that closes over time — which fits those duration-dependent response rates rather too neatly for comfort.</p>

</div>

<hr />

<h2 id="03--the-part-that-was-missed-pain">03 · The part that was missed: pain</h2>

<p>Cake’s X-rays showed <strong>spondylosis</strong> — small bony spurs growing along the vertebrae of his lower spine. It is common in older cats and often causes no trouble at all, which is exactly why it is easy to dismiss.<sup id="fnref:19" role="doc-noteref"><a href="#fn:19" class="footnote" rel="footnote">11</a></sup></p>

<p>But consider what a cat has to do to pass a stool: crouch, curl the lower back, hold that position, and strain. If that hurts, the cat puts it off. And putting it off is precisely what dries the waste out and hardens it. Pain and constipation feed each other.</p>

<p>This is not merely a plausible story. In a radiographic study of 1,365 cats, those with abnormal lumbosacral vertebrae were significantly more likely to have large bowel problems (p=0.0057, OR 1.73), and for <em>acquired</em> abnormalities specifically — the category spondylosis falls into — the odds ratio was <strong>4.11 (p&lt;0.0001)</strong>.<sup id="fnref:5" role="doc-noteref"><a href="#fn:5" class="footnote" rel="footnote">12</a></sup></p>

<h3 id="how-we-knew-it-was-real">How we knew it was real</h3>

<p>In my entire acquaintance with Cake, he had never washed the back half of his body. His front half was immaculate. This was put down to his size — he was 11 kg when I adopted him, and was around 9 kg by the time the symptoms of megacolon began. Even a 9 kg cat may simply not be able to bend that far.</p>

<p>He started grooming his back end again shortly after beginning pain relief every 6 weeks, <strong>before he had lost any meaningful weight</strong>. That timing is the whole argument. If bulk had been the obstacle, the behavior would have returned gradually as the weight came off. It did not. It returned when the pain was treated.</p>

<blockquote>
  <p><strong>Worth checking on your own cat</strong></p>

  <p>A scruffy or matted coat over the lower back, dandruff you only see behind the ribs, or a dirty bottom on a cat who used to be fastidious. Grooming is one of four validated behavioral domains used to assess musculoskeletal pain in cats — alongside mobility, activity and temperament — and all four improve measurably after analgesia.<sup id="fnref:6" role="doc-noteref"><a href="#fn:6" class="footnote" rel="footnote">13</a></sup> It is easy for everyone in the room to attribute to age or weight. It is worth saying out loud at the appointment.</p>
</blockquote>

<div class="for-pros">

  <p>Spondylosis deformans is a ventral process sitting outside the vertebral canal — new bone laid down where the annulus fibrosus attaches, in response to disc degeneration. It isn’t facet osteoarthrosis and it isn’t degenerative lumbosacral stenosis, and it shouldn’t be discussed as though it were. Absent imaging that shows foraminal encroachment, don’t reach for a neurogenic explanation. What I’m proposing is behavioral avoidance.</p>

  <p>The finding turns up incidentally in older cats often enough<sup id="fnref:19:1" role="doc-noteref"><a href="#fn:19" class="footnote" rel="footnote">11</a></sup> that seeing it on a film proves nothing by itself. You have to build the case. There are two ways in.</p>

  <p>Population level: across 1,365 cats, acquired lumbosacral abnormalities carried an odds ratio of 4.11 for distal GI dysfunction.<sup id="fnref:5:1" role="doc-noteref"><a href="#fn:5" class="footnote" rel="footnote">12</a></sup> That is not a subtle effect.</p>

  <p>Patient level: run a therapeutic trial against a behavior that pain specifically limits, and caudal grooming is close to ideal for the purpose. It requires flexion and rotation, so it’s mechanically specific. Cranial grooming survives in a cat who is merely sore rather than systemically ill, which hands you an internal control. And it’s a validated pain domain that responds to analgesia in cats with musculoskeletal disease.<sup id="fnref:6:1" role="doc-noteref"><a href="#fn:6" class="footnote" rel="footnote">13</a></sup> Here it returned when the anti-NGF started, not as the weight came off.</p>

  <p>The obvious objection is that all of this is unblinded and owner-reported, and caregiver placebo effect in veterinary analgesia is real and well documented. It’s worth noting that in Bennett and Morton’s cohort the veterinary surgeons’ scores fell significantly as well as the owners’.<sup id="fnref:6:2" role="doc-noteref"><a href="#fn:6" class="footnote" rel="footnote">13</a></sup> That helps. It doesn’t settle it. Supporting evidence, not proof.</p>

</div>

<hr />

<h2 id="04--what-was-tried-in-order">04 · What was tried, in order</h2>

<h3 id="stage-1--failed--a-superficial-enema">Stage 1 — failed · A superficial enema</h3>

<p>It cleared only the waste nearest the exit. Some stool came out, which looked like progress. The bulk of the blockage sat further forward, in the widened part of the colon, and fluid introduced from the rectum never reached it.</p>

<p>This is a common and instructive failure. If your cat has an enema and still seems wrong afterwards, or the belly still feels full, say so — partial output is easily mistaken for resolution.</p>

<div class="for-pros">

  <p>Whatever you infuse ends up in the descending colon and rectum. If the dehydrated mass is sitting in an ascending or transverse colon that has dilated to accommodate it, a conventional enema never gets near — and the stool that does come out reads as success to everyone in the room, which is the part that costs you time. I should be clear that this is me reasoning from where the fluid goes rather than citing a measured endpoint. I haven’t found anyone who has quantified it.</p>

</div>

<h3 id="stage-2--worked-did-not-hold--full-manual-deobstipation-under-anesthetic">Stage 2 — worked, did not hold · Full manual deobstipation under anesthetic</h3>

<p>The vet emptied the entire colon by hand under general anesthetic. At the same time she confirmed that nothing was physically blocking the way — no narrowed pelvis, no growth, nothing swallowed.</p>

<p>That check turns out to be the single most important event in this whole account, for reasons that become clear in section 05.</p>

<div class="for-pros">

  <p>Mechanical GI obstruction is a listed contraindication to neostigmine,<sup id="fnref:13" role="doc-noteref"><a href="#fn:13" class="footnote" rel="footnote">14</a></sup> so the moment someone documents a normal pelvic canal and the absence of stricture, mass or foreign body is the moment everything downstream becomes defensible. Write it down. It’s the difference between a considered off-label decision and a reckless one, and the only thing separating them in the record is whether anybody bothered to note it.</p>

</div>

<h3 id="stage-3--failed--daily-lactulose-and-exclusively-wet-food">Stage 3 — failed · Daily lactulose and exclusively wet food</h3>

<p>Lactulose is a sweet liquid laxative that draws water into the bowel and keeps stool soft. Cake had 5 ml daily in his food, and ate wet food only. Dietary modification and hyperosmotic laxatives are the standard first-line components of multimodal management.<sup id="fnref:1:5" role="doc-noteref"><a href="#fn:1" class="footnote" rel="footnote">1</a></sup></p>

<p>The blockage rebuilt anyway. This is the pivotal observation: his colon had been completely emptied, his stool was softened, his water intake was good, and waste still accumulated. The failure was therefore not one of hydration and not a one-off mechanical event. <strong>His colon was not pushing.</strong></p>

<div class="for-pros">

  <p>When a colon that has been emptied completely refills despite adequate osmotic laxative and good water intake, the failure isn’t consistency — it’s propulsion. That squares with what’s documented about contractile dysfunction in this disease.<sup id="fnref:2:1" role="doc-noteref"><a href="#fn:2" class="footnote" rel="footnote">7</a></sup> It’s also the observation that makes reaching for a prokinetic reasonable rather than speculative, which is a good argument for producing it deliberately rather than stumbling into it after the fact.</p>

</div>

<h3 id="stage-4--unavailable--subtotal-colectomy">Stage 4 — unavailable · Subtotal colectomy</h3>

<p>Where megacolon keeps recurring, the definitive treatment is an operation removing most of the colon. Cats generally do well afterwards — 72.2% favorable outcomes in the 2022 cohort,<sup id="fnref:4:2" role="doc-noteref"><a href="#fn:4" class="footnote" rel="footnote">8</a></sup> and a high rate of owner satisfaction across 18 hospitals in a 2021 series<sup id="fnref:24" role="doc-noteref"><a href="#fn:24" class="footnote" rel="footnote">15</a></sup> — and if it is genuinely available to your cat it is usually the better long-term answer.<sup id="fnref:1:6" role="doc-noteref"><a href="#fn:1" class="footnote" rel="footnote">1</a></sup><sup id="fnref:16" role="doc-noteref"><a href="#fn:16" class="footnote" rel="footnote">16</a></sup></p>

<p>It was not available to Cake. By the time the question was live he was both markedly obese at 9 kg and unwell from the obstipation itself, and the combination made a long abdominal surgery an unacceptable risk. This is worth being precise about, because “not a surgical candidate” covers two very different situations: a cat who is too well to need it yet, and a cat who has become too unwell to survive it. Cake was the second.</p>

<p>There is a bitter logic in that which is worth naming. The disease that makes surgery necessary is the same disease that makes surgery dangerous, and the longer it runs the more true that gets.<sup id="fnref:4:3" role="doc-noteref"><a href="#fn:4" class="footnote" rel="footnote">8</a></sup> Waiting is not neutral.</p>

<h3 id="on-not-having-the-surgery">On not having the surgery</h3>

<p>For most of this document the non-surgical route reads as a consolation prize, and I want to correct that, because it isn’t only one.</p>

<p>Subtotal colectomy is major abdominal surgery, and the recovery is not nothing. Soft stools and sometimes frank diarrhea are expected for the first few months afterwards, stools become firmer with time but <strong>rarely return fully to normal</strong>, and some cats have occasional soft-stool leakage.<sup id="fnref:25" role="doc-noteref"><a href="#fn:25" class="footnote" rel="footnote">17</a></sup> Outcomes are good and most cats end up with an excellent quality of life<sup id="fnref:24:1" role="doc-noteref"><a href="#fn:24" class="footnote" rel="footnote">15</a></sup><sup id="fnref:25:1" role="doc-noteref"><a href="#fn:25" class="footnote" rel="footnote">17</a></sup> — I am not arguing against the operation. But a cat who never has it also never has the anesthetic, never has the laparotomy, never has the months of loose stool, and never carries the small risk of the anastomosis failing.</p>

<p>Cake has none of that. He has a dose every few weeks, a spoonful of syrup in his dinner, and an otherwise ordinary life. Measured against a cat who sailed through colectomy, that is second best. Measured against what was actually on the table for him — which was repeated anesthetics or euthanasia — it is a good outcome by any standard, and it is allowed to be one.</p>

<div class="for-pros">

  <p>Cats with chronic obstipation or megacolon are normally considered colectomy candidates,<sup id="fnref:16:1" role="doc-noteref"><a href="#fn:16" class="footnote" rel="footnote">16</a></sup> so any record ought to say exactly why this one wasn’t — and ought to distinguish a risk-based exclusion from a staging one, because only the first can be undone. Cake’s was both at once: the anesthetic and perioperative risk of marked obesity, compounded by what established obstipation had already done to him systemically.</p>

  <p>Reassessing surgical candidacy after weight reduction belongs in the written plan rather than left to occur to somebody, particularly for a patient facing years of intermittent cholinergic therapy that nobody has safety data for.</p>

  <p>That said, the comparison is less lopsided than it first looks. Median follow-up in the largest recent outcomes series was 64 days, and removing the ileocolic junction was associated with worse outcomes<sup id="fnref:24:2" role="doc-noteref"><a href="#fn:24" class="footnote" rel="footnote">15</a></sup> — so what becomes of these cats years later isn’t well described either. Add the expected morbidity: soft stool or diarrhea through the first months, rarely normalizing completely.<sup id="fnref:25:2" role="doc-noteref"><a href="#fn:25" class="footnote" rel="footnote">17</a></sup></p>

  <p>Which leaves the real choice as one between a surgical option whose long-term course is thinly characterized and a pharmacological one whose long-term course isn’t characterized at all. Neither arm has the data you would want. I’d rather say that plainly than pretend the decision was obvious in either direction.</p>

</div>

<hr />

<h2 id="05--neostigmine-and-why-the-timing-is-everything">05 · Neostigmine, and why the timing is everything</h2>

<p>Nerves in the bowel wall release a chemical messenger that tells the muscle to contract. Neostigmine slows the breakdown of that messenger, so the signal persists and the contraction is stronger.<sup id="fnref:13:1" role="doc-noteref"><a href="#fn:13" class="footnote" rel="footnote">14</a></sup> In plain terms: it helps a weak colon push. It is given by injection, because it is not absorbed if swallowed.<sup id="fnref:17" role="doc-noteref"><a href="#fn:17" class="footnote" rel="footnote">18</a></sup></p>

<blockquote>
  <h3 id="-the-critical-point">⚠ The critical point</h3>

  <p><strong>A drug that makes the bowel contract harder is dangerous if the bowel is genuinely blocked.</strong> Mechanical obstruction of the gastrointestinal tract is a listed contraindication to neostigmine.<sup id="fnref:13:2" role="doc-noteref"><a href="#fn:13" class="footnote" rel="footnote">14</a></sup> Contracting against a hard mass that will not move does not expel it. It raises pressure inside a colon that is already stretched and thin-walled. That is painful, and at worst the bowel can be damaged or perforated. The same objection is made explicitly in the equine literature: a prokinetic given in the presence of a physical obstruction pushes against an impassable point and increases pain.<sup id="fnref:20" role="doc-noteref"><a href="#fn:20" class="footnote" rel="footnote">19</a></sup></p>

  <p>This is why the order of Cake’s treatment matters more than any individual element of it. The same drug is either useful or harmful depending entirely on the state of the colon when it is given.</p>
</blockquote>

<p>Neostigmine was used only:</p>

<ul>
  <li><strong>after</strong> the colon had been completely emptied by hand;</li>
  <li><strong>after</strong> mechanical obstruction had been excluded;</li>
  <li>and thereafter <strong>early</strong>, while the contents were still soft enough to move.</li>
</ul>

<div class="for-pros">

  <p>Neostigmine is a quaternary ammonium reversible acetylcholinesterase inhibitor. It doesn’t stimulate anything directly — it stops acetylcholine being cleared, so whatever the enteric neurons release hangs around and acts on both nicotinic and muscarinic receptors.<sup id="fnref:12:2" role="doc-noteref"><a href="#fn:12" class="footnote" rel="footnote">4</a></sup><sup id="fnref:13:3" role="doc-noteref"><a href="#fn:13" class="footnote" rel="footnote">14</a></sup> The contraction you’re after is the muscarinic one: M2 and M3, G-protein-coupled rather than ion channels, with M3 running PLC → IP₃ → calcium release → myosin light chain phosphorylation. The nicotinic side of it is ganglionic. Being quaternary keeps it largely out of the CNS,<sup id="fnref:13:4" role="doc-noteref"><a href="#fn:13" class="footnote" rel="footnote">14</a></sup> and also means it doesn’t survive the gut — hence the injection.<sup id="fnref:17:1" role="doc-noteref"><a href="#fn:17" class="footnote" rel="footnote">18</a></sup></p>

  <p>Contraindications: mechanical obstruction of the gastrointestinal or urinary tract, and peritonitis. Adverse effects: bradycardia, hypersalivation, bronchoconstriction, and — the irony is not lost on me — increased gastrointestinal motility.<sup id="fnref:13:5" role="doc-noteref"><a href="#fn:13" class="footnote" rel="footnote">14</a></sup> Veterinary sources add asthma, pneumonia, epilepsy, peptic ulceration and arrhythmias.<sup id="fnref:17:2" role="doc-noteref"><a href="#fn:17" class="footnote" rel="footnote">18</a></sup> Overdose gives a cholinergic crisis, at which point you stop immediately;<sup id="fnref:13:6" role="doc-noteref"><a href="#fn:13" class="footnote" rel="footnote">14</a></sup> have atropine and the rest of the anti-shock drawer within reach.<sup id="fnref:21" role="doc-noteref"><a href="#fn:21" class="footnote" rel="footnote">20</a></sup></p>

  <p>The mechanical danger is where I’m reasoning rather than citing, so take it as physics rather than evidence.</p>

  <p>Laplace: wall tension scales with pressure and with radius, and inversely with wall thickness. A colon that has been chronically dilated and thinned is therefore precisely the geometry that turns a given pressure into maximal wall tension — meaning the cats most likely to be handed a prokinetic for impaction are the cats least able to tolerate one. Well short of perforation you get vascular compression within the wall, mucosal ischaemia, and ulceration against something abrasive that isn’t going anywhere, with translocation to follow. And the stimulus isn’t evenly distributed either: the less-affected proximal segments still contract perfectly well, and what they generate is transmitted straight into the segment that is widest, thinnest and least able to push back. I haven’t found anyone who has modeled this for the feline colon specifically.</p>

</div>

<h3 id="why-the-human-comparison-only-partly-holds">Why the human comparison only partly holds</h3>

<p>Neostigmine is used in people for acute colonic pseudo-obstruction, which is defined as marked colonic dilatation <strong>in the absence of mechanical obstruction</strong>.<sup id="fnref:12:3" role="doc-noteref"><a href="#fn:12" class="footnote" rel="footnote">4</a></sup> But in that condition the distended colon is full of <em>gas</em>, which compresses and vents the moment motility returns. A megacolonic cat’s colon contains a solid mass whose deformability decreases by the day. Same drug, same organ, different mechanics — and the difference is the entire reason timing governs the outcome.</p>

<hr />

<h2 id="06--cakes-regime">06 · Cake’s regime</h2>

<h3 id="neostigmine-intermittently">Neostigmine, intermittently</h3>

<ul>
  <li>We started with a small <strong>test dose</strong>, under observation, to check he did not react badly to the drug itself.</li>
  <li>Then, proceeded to an <strong>induction course</strong>: twice daily for three to four days, started after the manual clear-out.</li>
  <li><strong>Ongoing Maintenance</strong>: I feel his abdoment around twice a week to check if waste has built up. If it has built up, he gets a dose. If not, no dose. His current dosing rate is one dose every few weeks (recorded how much and when administered), two at the absolute maximum.</li>
  <li>As his weight fell from 9 kg to 7 kg, the dose was reduced — proportionally more than the weight loss alone would require, and it still works.</li>
</ul>

<blockquote>
  <h3 id="-the-stop-rule">⚠ The stop rule</h3>

  <p>Now that he is in ongoing treatment: If two doses do not produce a bowel movement, <strong>he does not get a third</strong>. He goes in for imaging and manual clearance instead. So far this has not occured. However, failure to respond to dosing is the signal that the contents have already hardened past the point where more contraction helps — and at that point further dosing is pushing against something that will not move. This rule is not a formality. It is what keeps the treatment on the safe side of the contraindication.<sup id="fnref:13:7" role="doc-noteref"><a href="#fn:13" class="footnote" rel="footnote">14</a></sup><sup id="fnref:20:1" role="doc-noteref"><a href="#fn:20" class="footnote" rel="footnote">19</a></sup></p>
</blockquote>

<blockquote>
  <p><strong>No doses are given in this document</strong></p>

  <p>Deliberately. Neostigmine is supplied at several different concentrations, and a volume that is correct for one cat and one product can be a significant overdose with another. Dosing is calculated per kilogram by a vet who knows which vial is in their hand. This document exists to start a conversation, not to replace one.</p>
</blockquote>

<div class="for-pros">

  <p>Call the test dose what it actually is — a screen for idiosyncratic cholinergic sensitivity. It does not establish tolerance of the therapeutic dose, because cholinergic effects are dose-dependent<sup id="fnref:13:8" role="doc-noteref"><a href="#fn:13" class="footnote" rel="footnote">14</a></sup> and an escalation of that size isn’t covered by having survived the smaller one. I’d rather say so than let the sequence imply a safety argument it can’t carry.</p>

  <p>The one thing here that might be worth something to somebody else: per-kilogram exposure ended up <em>below</em> the induction dose and still worked. Several explanations, none exclusive. Induction may simply have overshot — it was arrived at by climbing from a cautious start, not by coming down from a known ceiling. The biomechanics improved as he lost weight. Intervening earlier meant smaller and more deformable masses. And there’s a distribution argument: neostigmine is hydrophilic and quaternary,<sup id="fnref:13:9" role="doc-noteref"><a href="#fn:13" class="footnote" rel="footnote">14</a></sup> so it goes into lean tissue and extracellular fluid rather than fat, which means dosing an obese cat on total body weight delivers more per kilogram of the tissue that actually receives it than the number on the syringe suggests. That last one is inference from physicochemistry, not a feline measurement.</p>

</div>

<h3 id="lactulose-daily">Lactulose, daily</h3>

<p>5 ml once daily, mixed into wet food. This is not an optional extra alongside the neostigmine — the two are co-essential, and this is the mechanistic heart of why the combination works where either alone did not:</p>

<ul>
  <li><strong>Lactulose</strong> keeps the stool soft enough to be moved.</li>
  <li><strong>Neostigmine</strong> supplies the force to move it.</li>
</ul>

<p>Soft stool with no propulsion simply sits there — that is what the months on lactulose alone demonstrated. Strong propulsion against a hardened mass only builds pressure — that is the danger in section 05. Neither element is sufficient. The aim is soft but formed stool; watery diarrhea means the dose needs revisiting with the vet rather than adjusting yourself.</p>

<div class="for-pros">

  <p>Lactulose is a synthetic disaccharide that mammalian intestinal enzymes can’t touch, so it reaches the colon intact, pulls water in osmotically, and is then fermented to short-chain organic acids which drop luminal pH and add further osmotic load. Hyperosmotic laxatives sit squarely in the standard multimodal package for this disease.<sup id="fnref:1:7" role="doc-noteref"><a href="#fn:1" class="footnote" rel="footnote">1</a></sup> 5 ml q24h is on the cautious side for a 7–9 kg cat by conventional titration, and whether giving it more often would stretch the interval between neostigmine episodes is genuinely unknown here. If you do escalate, watch potassium — hypokalaemia worsens colonic motility, which rather defeats the object.</p>

  <p>One wrinkle in the tidy two-factor story above: short-chain fatty acids themselves make feline colonic smooth muscle contract in vitro.<sup id="fnref:22" role="doc-noteref"><a href="#fn:22" class="footnote" rel="footnote">21</a></sup> So the laxative and the prokinetic may be less mechanistically independent than I’ve made them sound.</p>

</div>

<h3 id="solensia-monthly">Solensia, monthly</h3>

<p>An injection for pain every 6 weeks. It is a felinized monoclonal antibody that binds nerve growth factor, a substance that sensitizes nerves to pain.<sup id="fnref:14" role="doc-noteref"><a href="#fn:14" class="footnote" rel="footnote">22</a></sup> It is licensed for osteoarthritis pain in cats;<sup id="fnref:15" role="doc-noteref"><a href="#fn:15" class="footnote" rel="footnote">23</a></sup> using it for spinal pain is a slightly different application.</p>

<p>Its role here is not only comfort. If defecation stops hurting, the cat stops deferring it — which breaks the pain–avoidance loop from section 03 at the other end from the laxative and the prokinetic.</p>

<div class="for-pros">

  <p>Frunevetmab, a felinized anti-NGF monoclonal at 7 mg/ml, dosed by weight band — one 1 ml vial for 2.5–7 kg, two for 7.1–14 kg, aiming at a minimum of 1 mg/kg;<sup id="fnref:15:1" role="doc-noteref"><a href="#fn:15" class="footnote" rel="footnote">23</a></sup> the EU SPC quotes 1–2.8 mg/kg monthly.<sup id="fnref:16:2" role="doc-noteref"><a href="#fn:16" class="footnote" rel="footnote">16</a></sup> Efficacy in osteoarthritis pain came out of a randomized placebo-controlled field study,<sup id="fnref:14:1" role="doc-noteref"><a href="#fn:14" class="footnote" rel="footnote">22</a></sup> and the pharmacokinetics and immunogenicity after IV and SC dosing have been worked out separately.<sup id="fnref:23" role="doc-noteref"><a href="#fn:23" class="footnote" rel="footnote">24</a></sup></p>

  <p>Keep an eye on the vial count when a patient is crossing that band boundary on the way down. Underdose at the heavier end and you have inadequate analgesia quietly sustaining the very pain–avoidance loop the drug was brought in to break — which is a particularly irritating failure mode, because from the outside it looks like the drug simply not working. Clearance is by protein catabolism, not hepatic or renal. Anti-drug antibodies can develop and cost you the effect, and nobody has established whether it’s safe alongside NSAIDs in cats.<sup id="fnref:15:2" role="doc-noteref"><a href="#fn:15" class="footnote" rel="footnote">23</a></sup></p>

</div>

<hr />

<h2 id="07--feeling-the-abdomen">07 · Feeling the abdomen</h2>

<p>Cake’s re-dosing is triggered by palpation — feeling the abdomen for waste building up, and treating before a hard mass has formed rather than after. That is what keeps the drug on the right side of the line described in section 05.</p>

<blockquote>
  <h3 id="-read-this-before-you-try-it">⚠ Read this before you try it</h3>

  <p>Ask your vet to show you on your own cat first, with their hands over yours. A description on a page is not a substitute for being taught, and the two structures you are distinguishing between feel more alike than this illustration suggests.</p>

  <p><strong>Never press hard, and never squeeze.</strong> A distended bladder can be ruptured by firm pressure. If your cat tenses, cries, or resists, stop.</p>
</blockquote>

<p><img src="/wp-content/uploads/2026/09/cake-palpation-diagram.svg" alt="Two-panel anatomical diagram. Panel A, side view of a cat: the colon sits high in the rear abdomen running backwards, the bladder low and further back, and the palpation zone is marked behind the last rib. Panel B, cross-section from behind: spine at the top, colon high on the cat's left, bladder low and central, and flat fingertips pressing gently inward from either side." /></p>

<p><em>The colon sits <strong>high and toward the cat’s left</strong>, running backwards through the rear half of the abdomen. The bladder sits <strong>low, central and further back</strong>. Both can feel firm. Telling them apart is the reason to be taught this in person rather than from a diagram.</em></p>

<h3 id="how-it-is-done">How it is done</h3>

<ul>
  <li>Cat standing, or relaxed on your lap. Never when agitated.</li>
  <li>Fingers <strong>flat</strong>, using the pads rather than the tips. One hand each side, or one hand spanning the belly.</li>
  <li>Start <strong>behind the last rib</strong>, in the rear half of the abdomen, and work gently backwards until you are directly under the spine.</li>
  <li>Press slowly and <strong>lightly</strong> — enough to feel through the body wall, no more. The pressure is closer to resting your hand than to gripping.</li>
</ul>

<h3 id="what-you-are-feeling-for">What you are feeling for</h3>

<ul>
  <li><strong>Normal:</strong> soft and yielding. Nothing firm that holds its shape.</li>
  <li><strong>Filling up:</strong> a firm, sausage-shaped tube high on the cat’s left, running front to back. It may feel lumpy, like a row of hard beads through a sleeve.</li>
  <li><strong>Not what you want:</strong> a hard, round, distinct ball sitting low and well back. That is more likely the bladder. Leave it alone.</li>
</ul>

<blockquote>
  <h3 id="-a-cat-straining-may-not-be-constipated">⚠ A cat straining may not be constipated</h3>

  <p>A cat straining in the litter tray may be unable to <strong>urinate</strong> rather than defecate. From the outside the two look almost identical.</p>

  <p>In a male cat, a urinary blockage is life-threatening within hours, not days. If you feel a tense, firm, round structure low and far back in a cat who is straining, do not press on it — phone the vet immediately and say you cannot tell which it is.</p>
</blockquote>

<div class="for-pros">

  <p>The descending colon runs dorsally and to the left through the caudal abdomen toward the pelvic inlet, and a fecal column palpates as a firm tube, often segmented enough to feel like beads under the fingers. The bladder sits ventral and caudal and goes spherical as it fills. An owner can absolutely confuse the two, which is what makes the differential here more than academic: a straining cat with a tense round caudoventral structure may be urethrally obstructed — and urinary obstruction is itself a contraindication to neostigmine.<sup id="fnref:13:10" role="doc-noteref"><a href="#fn:13" class="footnote" rel="footnote">14</a></sup></p>

  <p>The palpation-triggered, pre-emptive dosing is the part of this I’d actually want someone to take away. It shifts the intervention point from established obstipation to detected early accumulation, and that shift is the whole reason cholinergic stimulation stays on the right side of its own contraindication here. Where an owner is doing the palpating, document what they were taught and where their threshold for escalating sits.</p>

  <p>And track two numbers rather than one: the interval between doses, and the days without defecation preceding each. If the trigger point drifts quietly later over time, the second number shows it and the first doesn’t — and a drifting trigger erodes the entire safety argument with nothing on the surface looking wrong.</p>

</div>

<hr />

<h2 id="08--weight">08 · Weight</h2>

<p>Cake went from 9 kg to 7 kg. For an overweight cat this helps in several directions at once: less load on a painful spine, an easier crouch to pass stool, and better odds if surgery is ever reconsidered.</p>

<blockquote>
  <h3 id="-do-not-do-this-quickly">⚠ Do not do this quickly</h3>

  <p>Overweight cats must lose weight slowly and under veterinary supervision. Obesity and a period of reduced food intake are the classic setup for <strong>hepatic lipidosis</strong>, a serious and potentially fatal liver condition in cats.<sup id="fnref:7" role="doc-noteref"><a href="#fn:7" class="footnote" rel="footnote">25</a></sup> No crash diets. If your cat stops eating, phone your vet. Weight loss that happens without you trying is also a reason to be seen, not reassured.</p>
</blockquote>

<div class="for-pros">

  <p>The classic setup for hepatic lipidosis is an obese cat that stops eating, and the mortality without aggressive nutritional support is not trivial.<sup id="fnref:7:1" role="doc-noteref"><a href="#fn:7" class="footnote" rel="footnote">25</a></sup> That deserves rather more attention than usual in a cat on intermittent cholinergic dosing, where nausea and a day or two of poor intake around each dose are entirely plausible.<sup id="fnref:13:11" role="doc-noteref"><a href="#fn:13" class="footnote" rel="footnote">14</a></sup> It is an unglamorous way to lose a patient you were otherwise managing well.</p>

</div>

<hr />

<h2 id="09--day-to-day-and-what-to-watch">09 · Day to day, and what to watch</h2>

<ul>
  <li>Lactulose in wet food, daily. Aiming for soft but formed.</li>
  <li>Wet food only. Water always available.</li>
  <li>A written note of when he goes, what it looks like, and whether he strained. This is the single most useful thing to bring to an appointment.</li>
  <li>Regular abdominal palpation, to catch accumulation early rather than late.</li>
</ul>

<h3 id="the-number-that-matters-most">The number that matters most</h3>

<p><strong>How often the injection is needed.</strong> If the gaps between doses stay roughly constant, the regime is holding. If they start shortening, the colon is likely deteriorating — and that is the moment for a fresh conversation about what comes next, including whether surgery has become possible again at a lower weight.</p>

<p>Writing that down honestly is uncomfortable, and it is the reason this document is a record rather than a recommendation. A treatment that is working is not the same as a cat that is cured. The duration data in section 02 make clear that this disease has a direction of travel.<sup id="fnref:4:4" role="doc-noteref"><a href="#fn:4" class="footnote" rel="footnote">8</a></sup></p>

<blockquote>
  <h3 id="-phone-the-vet-now-if">⚠ Phone the vet now if</h3>

  <ul>
    <li>Straining in the tray with nothing coming out</li>
    <li>Nothing passed for more than a couple of days</li>
    <li>Vomiting, especially with a tight or swollen belly</li>
    <li>Not eating, or gone quiet and withdrawn</li>
    <li>Crying or yowling in the tray</li>
    <li>After a neostigmine dose: weakness, collapse, or difficulty breathing</li>
  </ul>
</blockquote>

<hr />

<h2 id="10--taking-this-to-your-own-vet">10 · Taking this to your own vet</h2>

<p>If your cat is where Cake was, these are the questions that opened up the useful parts of the conversation:</p>

<ol>
  <li>Has anything physical been ruled out — a narrowed pelvis, a stricture, a growth?</li>
  <li>Could <strong>pain</strong> be part of why my cat avoids the tray? Has the spine, hips and pelvis been assessed, and would a trial of pain relief be reasonable?</li>
  <li>If the colon has been fully emptied and it still rebuilds on laxatives, does that point to a propulsion problem rather than a hydration one?</li>
  <li>Is my cat a surgical candidate — and if not, what specifically rules it out, and could that change?</li>
  <li>If surgery is off the table, are there prokinetic options worth trying, including ones that are not standard?</li>
</ol>

<div class="for-pros">

  <p>Before anyone reaches for neostigmine on the strength of this account, let’s address the established competitors. Cisapride is a feline colonic prokineticthe reference which is illegal in the EU, but used in some other countries; it makes idiopathic megacolonic smooth muscle contract in vitro, and interestingly those contractions are only partly dependent on enteric cholinergic nerves<sup id="fnref:7b" role="doc-noteref"><a href="#fn:7b" class="footnote" rel="footnote">26</a></sup> — which is a point in its favor, given the ganglion cell attrition in section 02.<sup id="fnref:18:2" role="doc-noteref"><a href="#fn:18" class="footnote" rel="footnote">9</a></sup></p>

  <p>Next, let’s consider ranitidine (1–2 mg/kg PO q12h) and nizatidine (2.5–5.0 mg/kg PO q12h). Both stimulate feline colonic smooth muscle, apparently by inhibiting acetylcholinesterase — the same mechanism as neostigmine, orally available, and already described in this disease. Cimetidine and famotidine don’t do it.<sup id="fnref:16:3" role="doc-noteref"><a href="#fn:16" class="footnote" rel="footnote">16</a></sup><sup id="fnref:18:3" role="doc-noteref"><a href="#fn:18" class="footnote" rel="footnote">9</a></sup> Prucalopride at 0.64 mg/kg has cats defecating within the hour without changing consistency; misoprostol contracts feline colonic smooth muscle in vitro. Metoclopramide, domperidone and erythromycin act too far proximally to help here, and bethanechol’s side effects have kept it out of use.<sup id="fnref:16:4" role="doc-noteref"><a href="#fn:16" class="footnote" rel="footnote">16</a></sup><sup id="fnref:19:2" role="doc-noteref"><a href="#fn:19" class="footnote" rel="footnote">11</a></sup></p>

</div>

<hr />

<h2 id="references">References</h2>

<div class="footnotes" role="doc-endnotes">
  <ol>
    <li id="fn:1" role="doc-endnote">
      <p>Washabau RJ, Holt D. Pathogenesis, diagnosis, and therapy of feline idiopathic megacolon. <em>Veterinary Clinics of North America: Small Animal Practice.</em> 1999;29(2):589–603. <a href="https://www.sciencedirect.com/science/article/pii/S0195561699500363">Link</a> <a href="#fnref:1" class="reversefootnote" role="doc-backlink">&#8617;</a> <a href="#fnref:1:1" class="reversefootnote" role="doc-backlink">&#8617;<sup>2</sup></a> <a href="#fnref:1:2" class="reversefootnote" role="doc-backlink">&#8617;<sup>3</sup></a> <a href="#fnref:1:3" class="reversefootnote" role="doc-backlink">&#8617;<sup>4</sup></a> <a href="#fnref:1:4" class="reversefootnote" role="doc-backlink">&#8617;<sup>5</sup></a> <a href="#fnref:1:5" class="reversefootnote" role="doc-backlink">&#8617;<sup>6</sup></a> <a href="#fnref:1:6" class="reversefootnote" role="doc-backlink">&#8617;<sup>7</sup></a> <a href="#fnref:1:7" class="reversefootnote" role="doc-backlink">&#8617;<sup>8</sup></a></p>
    </li>
    <li id="fn:9" role="doc-endnote">
      <p>Ultrasonographic evaluation of the effects of the administration of neostigmine and metoclopramide on duodenal, cecal, and colonic contractility in Arabian horses: a comparative study. <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC7750228/">Link</a> — <em>author list and journal details to be completed before print</em> <a href="#fnref:9" class="reversefootnote" role="doc-backlink">&#8617;</a> <a href="#fnref:9:1" class="reversefootnote" role="doc-backlink">&#8617;<sup>2</sup></a> <a href="#fnref:9:2" class="reversefootnote" role="doc-backlink">&#8617;<sup>3</sup></a></p>
    </li>
    <li id="fn:10" role="doc-endnote">
      <p>Drugs coordinating and restoring gastrointestinal motility and their effect on selected hypodynamic gastrointestinal disorders in horses and cattle. PMID 8822186. <a href="https://pubmed.ncbi.nlm.nih.gov/8822186/">Link</a> <a href="#fnref:10" class="reversefootnote" role="doc-backlink">&#8617;</a></p>
    </li>
    <li id="fn:12" role="doc-endnote">
      <p>Kasi PM. The use of intravenous neostigmine in palliation of severe ileus. <em>Case Reports in Gastrointestinal Medicine.</em> 2013;2013:796739. doi:10.1155/2013/796739 <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586442/">Link</a> <a href="#fnref:12" class="reversefootnote" role="doc-backlink">&#8617;</a> <a href="#fnref:12:1" class="reversefootnote" role="doc-backlink">&#8617;<sup>2</sup></a> <a href="#fnref:12:2" class="reversefootnote" role="doc-backlink">&#8617;<sup>3</sup></a> <a href="#fnref:12:3" class="reversefootnote" role="doc-backlink">&#8617;<sup>4</sup></a></p>
    </li>
    <li id="fn:8" role="doc-endnote">
      <p>Nieto JE, et al. In vivo and in vitro effects of neostigmine on gastrointestinal tract motility of horses. <em>American Journal of Veterinary Research.</em> 2013;74(4):579–586. <a href="https://pubmed.ncbi.nlm.nih.gov/23531066/">Link</a> <a href="#fnref:8" class="reversefootnote" role="doc-backlink">&#8617;</a> <a href="#fnref:8:1" class="reversefootnote" role="doc-backlink">&#8617;<sup>2</sup></a></p>
    </li>
    <li id="fn:11" role="doc-endnote">
      <p>Field triage of the neonatal foal. <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC7135403/">Link</a> — neostigmine 0.005–0.01 mg/kg IM or SC for meconium impaction <a href="#fnref:11" class="reversefootnote" role="doc-backlink">&#8617;</a></p>
    </li>
    <li id="fn:2" role="doc-endnote">
      <p>Washabau RJ, Stalis IH. Alterations in colonic smooth muscle function in cats with idiopathic megacolon. <em>American Journal of Veterinary Research.</em> 1996;57(4):580–587. <a href="#fnref:2" class="reversefootnote" role="doc-backlink">&#8617;</a> <a href="#fnref:2:1" class="reversefootnote" role="doc-backlink">&#8617;<sup>2</sup></a></p>
    </li>
    <li id="fn:4" role="doc-endnote">
      <p>Use of radiographic and histologic scores to evaluate cats with idiopathic megacolon grouped based on the duration of their clinical signs. <em>Frontiers in Veterinary Science.</em> 2022;9:1033090. <a href="https://www.frontiersin.org/journals/veterinary-science/articles/10.3389/fvets.2022.1033090/full">Link</a> — <em>author list to be completed before print</em> <a href="#fnref:4" class="reversefootnote" role="doc-backlink">&#8617;</a> <a href="#fnref:4:1" class="reversefootnote" role="doc-backlink">&#8617;<sup>2</sup></a> <a href="#fnref:4:2" class="reversefootnote" role="doc-backlink">&#8617;<sup>3</sup></a> <a href="#fnref:4:3" class="reversefootnote" role="doc-backlink">&#8617;<sup>4</sup></a> <a href="#fnref:4:4" class="reversefootnote" role="doc-backlink">&#8617;<sup>5</sup></a></p>
    </li>
    <li id="fn:18" role="doc-endnote">
      <p>Feline megacolon. WSAVA Congress Proceedings, 2003. <em>Conference proceeding.</em> <a href="https://www.vin.com/apputil/content/defaultadv1.aspx?pId=8768&amp;id=3850188">Link</a> <a href="#fnref:18" class="reversefootnote" role="doc-backlink">&#8617;</a> <a href="#fnref:18:1" class="reversefootnote" role="doc-backlink">&#8617;<sup>2</sup></a> <a href="#fnref:18:2" class="reversefootnote" role="doc-backlink">&#8617;<sup>3</sup></a> <a href="#fnref:18:3" class="reversefootnote" role="doc-backlink">&#8617;<sup>4</sup></a></p>
    </li>
    <li id="fn:3" role="doc-endnote">
      <p>Trevail T, Gunn-Moore D, Carrera I, et al. Radiographic diameter of the colon in normal and constipated cats and in cats with megacolon. <em>Veterinary Radiology &amp; Ultrasound.</em> 2011;52(5). <a href="https://www.research.ed.ac.uk/en/publications/radiographic-diameter-of-the-colon-in-normal-and-constipated-cats/">Link</a> <a href="#fnref:3" class="reversefootnote" role="doc-backlink">&#8617;</a></p>
    </li>
    <li id="fn:19" role="doc-endnote">
      <p>Washabau RJ. Feline megacolon: the hard facts / GI motility disorders. Conference proceedings. <em>Conference proceeding — reports signalment data (mean age 5.8 y, 70% male, 46% DSH), nizatidine and ranitidine AChE findings, prucalopride and bethanechol.</em> <a href="https://www.dvm360.com/view/feline-megacolon-hard-facts-proceedings">Link</a> <a href="#fnref:19" class="reversefootnote" role="doc-backlink">&#8617;</a> <a href="#fnref:19:1" class="reversefootnote" role="doc-backlink">&#8617;<sup>2</sup></a> <a href="#fnref:19:2" class="reversefootnote" role="doc-backlink">&#8617;<sup>3</sup></a></p>
    </li>
    <li id="fn:5" role="doc-endnote">
      <p>Thanaboonnipat C, Kumjumroon K, Boonkwang K, Tangsutthichai N, Sukserm W, Choisunirachon N. Radiographic lumbosacral vertebral abnormalities and constipation in cats. <em>Veterinary World.</em> 2021;14(2):492–498. <a href="https://www.veterinaryworld.org/Vol.14/February-2021/22.html">Link</a> <a href="#fnref:5" class="reversefootnote" role="doc-backlink">&#8617;</a> <a href="#fnref:5:1" class="reversefootnote" role="doc-backlink">&#8617;<sup>2</sup></a></p>
    </li>
    <li id="fn:6" role="doc-endnote">
      <p>Bennett D, Morton C. A study of owner observed behavioral and lifestyle changes in cats with musculoskeletal disease before and after analgesic therapy. <em>Journal of Feline Medicine and Surgery.</em> 2009;11(12):997–1004. doi:10.1016/j.jfms.2009.09.016 <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC11318772/">Link</a> <a href="#fnref:6" class="reversefootnote" role="doc-backlink">&#8617;</a> <a href="#fnref:6:1" class="reversefootnote" role="doc-backlink">&#8617;<sup>2</sup></a> <a href="#fnref:6:2" class="reversefootnote" role="doc-backlink">&#8617;<sup>3</sup></a></p>
    </li>
    <li id="fn:13" role="doc-endnote">
      <p>Neostigmine. In: <em>StatPearls.</em> Treasure Island (FL): StatPearls Publishing. <a href="https://www.ncbi.nlm.nih.gov/books/NBK470596/">Link</a> <a href="#fnref:13" class="reversefootnote" role="doc-backlink">&#8617;</a> <a href="#fnref:13:1" class="reversefootnote" role="doc-backlink">&#8617;<sup>2</sup></a> <a href="#fnref:13:2" class="reversefootnote" role="doc-backlink">&#8617;<sup>3</sup></a> <a href="#fnref:13:3" class="reversefootnote" role="doc-backlink">&#8617;<sup>4</sup></a> <a href="#fnref:13:4" class="reversefootnote" role="doc-backlink">&#8617;<sup>5</sup></a> <a href="#fnref:13:5" class="reversefootnote" role="doc-backlink">&#8617;<sup>6</sup></a> <a href="#fnref:13:6" class="reversefootnote" role="doc-backlink">&#8617;<sup>7</sup></a> <a href="#fnref:13:7" class="reversefootnote" role="doc-backlink">&#8617;<sup>8</sup></a> <a href="#fnref:13:8" class="reversefootnote" role="doc-backlink">&#8617;<sup>9</sup></a> <a href="#fnref:13:9" class="reversefootnote" role="doc-backlink">&#8617;<sup>10</sup></a> <a href="#fnref:13:10" class="reversefootnote" role="doc-backlink">&#8617;<sup>11</sup></a> <a href="#fnref:13:11" class="reversefootnote" role="doc-backlink">&#8617;<sup>12</sup></a></p>
    </li>
    <li id="fn:24" role="doc-endnote">
      <p>Grossman RM, Sumner JP, Lopez DJ, et al. Evaluation of outcomes following subtotal colectomy for the treatment of idiopathic megacolon in cats. <em>Journal of the American Veterinary Medical Association.</em> 2021. doi:10.2460/JAVMA.20.07.0418 — <em>18 hospitals, 2000–2018; high owner satisfaction; removal of the ileocolic junction associated with worse outcome; median follow-up 64 days.</em> <a href="https://everycat.org/cat-health/evaluation-of-outcomes-following-subtotal-colectomy-for-the-treatment-of-idiopathic-megacolon-in-cats/">Link</a> <a href="#fnref:24" class="reversefootnote" role="doc-backlink">&#8617;</a> <a href="#fnref:24:1" class="reversefootnote" role="doc-backlink">&#8617;<sup>2</sup></a> <a href="#fnref:24:2" class="reversefootnote" role="doc-backlink">&#8617;<sup>3</sup></a></p>
    </li>
    <li id="fn:16" role="doc-endnote">
      <p>Solensia summary of product characteristics. European Medicines Agency. <a href="https://ec.europa.eu/health/documents/community-register/2021/20210217150435/anx_150435_en.pdf">Link</a> <a href="#fnref:16" class="reversefootnote" role="doc-backlink">&#8617;</a> <a href="#fnref:16:1" class="reversefootnote" role="doc-backlink">&#8617;<sup>2</sup></a> <a href="#fnref:16:2" class="reversefootnote" role="doc-backlink">&#8617;<sup>3</sup></a> <a href="#fnref:16:3" class="reversefootnote" role="doc-backlink">&#8617;<sup>4</sup></a> <a href="#fnref:16:4" class="reversefootnote" role="doc-backlink">&#8617;<sup>5</sup></a></p>
    </li>
    <li id="fn:25" role="doc-endnote">
      <p>Megacolon. American College of Veterinary Surgeons, owner education resource. <em>Post-colectomy course: soft stools and occasional diarrhea for the first few months, progressively firmer but rarely fully normal; occasional soft-stool leakage; postoperative constipation rare; continence preserved.</em> <a href="https://www.acvs.org/small-animal/megacolon/">Link</a> <a href="#fnref:25" class="reversefootnote" role="doc-backlink">&#8617;</a> <a href="#fnref:25:1" class="reversefootnote" role="doc-backlink">&#8617;<sup>2</sup></a> <a href="#fnref:25:2" class="reversefootnote" role="doc-backlink">&#8617;<sup>3</sup></a></p>
    </li>
    <li id="fn:17" role="doc-endnote">
      <p>Neostigmine for animals: pharmacology and contraindications. <em>Trade source</em> — replace with a veterinary formulary (e.g. Plumb’s) before print. <a href="https://www.vetscraft.com/neostigmine-for-animals/">Link</a> <a href="#fnref:17" class="reversefootnote" role="doc-backlink">&#8617;</a> <a href="#fnref:17:1" class="reversefootnote" role="doc-backlink">&#8617;<sup>2</sup></a> <a href="#fnref:17:2" class="reversefootnote" role="doc-backlink">&#8617;<sup>3</sup></a></p>
    </li>
    <li id="fn:20" role="doc-endnote">
      <p>Medical management of the colicky foal. <em>Trade source quoting clinician opinion on prokinetic use in the presence of obstruction — replace with a peer-reviewed source if one exists.</em> <a href="https://www.bloodhorse.com/horse-racing/articles/134471/medical-management-of-the-colicky-foal">Link</a> <a href="#fnref:20" class="reversefootnote" role="doc-backlink">&#8617;</a> <a href="#fnref:20:1" class="reversefootnote" role="doc-backlink">&#8617;<sup>2</sup></a></p>
    </li>
    <li id="fn:21" role="doc-endnote">
      <p>Neostigmine injection data sheet. Medsafe, New Zealand. <a href="https://www.medsafe.govt.nz/profs/datasheet/n/Neostigmineinj.pdf">Link</a> <a href="#fnref:21" class="reversefootnote" role="doc-backlink">&#8617;</a></p>
    </li>
    <li id="fn:22" role="doc-endnote">
      <p>Rondeau MP, Meltzer K, Michel KE, et al. Short chain fatty acids stimulate feline colonic smooth muscle contraction. <em>Journal of Feline Medicine and Surgery.</em> 2003;5:167–173. <a href="#fnref:22" class="reversefootnote" role="doc-backlink">&#8617;</a></p>
    </li>
    <li id="fn:14" role="doc-endnote">
      <p>Gruen ME, et al. Frunevetmab, a felinized anti-nerve growth factor monoclonal antibody, for the treatment of pain from osteoarthritis in cats. <em>Journal of Veterinary Internal Medicine.</em> 2021;35(6):2752–2762. <a href="https://onlinelibrary.wiley.com/doi/10.1111/jvim.16291">Link</a> <a href="#fnref:14" class="reversefootnote" role="doc-backlink">&#8617;</a> <a href="#fnref:14:1" class="reversefootnote" role="doc-backlink">&#8617;<sup>2</sup></a></p>
    </li>
    <li id="fn:15" role="doc-endnote">
      <p>Solensia (frunevetmab injection) package insert. Zoetis Inc., Kalamazoo, MI. <a href="https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a73b79c4-3623-4b52-81ea-6180528a031e">Link</a> <a href="#fnref:15" class="reversefootnote" role="doc-backlink">&#8617;</a> <a href="#fnref:15:1" class="reversefootnote" role="doc-backlink">&#8617;<sup>2</sup></a> <a href="#fnref:15:2" class="reversefootnote" role="doc-backlink">&#8617;<sup>3</sup></a></p>
    </li>
    <li id="fn:23" role="doc-endnote">
      <p>Pharmacokinetics and immunogenicity of frunevetmab in osteoarthritic cats following intravenous and subcutaneous administration. <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC8222533/">Link</a> — <em>author list to be completed before print</em> <a href="#fnref:23" class="reversefootnote" role="doc-backlink">&#8617;</a></p>
    </li>
    <li id="fn:7" role="doc-endnote">
      <p>Webb CB. Hepatic lipidosis: clinical review drawn from collective effort. <em>Journal of Feline Medicine and Surgery.</em> 2018;20(3):217–227. <a href="https://journals.sagepub.com/doi/10.1177/1098612X18758591">Link</a> <a href="#fnref:7" class="reversefootnote" role="doc-backlink">&#8617;</a> <a href="#fnref:7:1" class="reversefootnote" role="doc-backlink">&#8617;<sup>2</sup></a></p>
    </li>
    <li id="fn:7b" role="doc-endnote">
      <p>Hasler AH, Washabau RJ. Cisapride stimulates contraction of idiopathic megacolonic smooth muscle in cats. <em>Journal of Veterinary Internal Medicine.</em> 1997;11(6):313–318. <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1939-1676.1997.tb00472.x">Link</a> <a href="#fnref:7b" class="reversefootnote" role="doc-backlink">&#8617;</a></p>
    </li>
  </ol>
</div>]]></content><author><name></name></author><category term="medicine" /><category term="veterinary medicine" /><category term="bio" /><category term="feline-megacolon" /><category term="neostigmine" /><category term="prokinetic-agents" /><category term="veterinary-medicine" /><category term="obstipation" /><category term="acetylcholinesterase-inhibitors" /><summary type="html"><![CDATA[A record of what worked for one nine-year-old cat with megacolon, written for owners who have been told euthanasia is the sensible option and who may not know that another one exists. Referenced throughout.]]></summary></entry><entry><title type="html">Impaction (My First Play)</title><link href="https://rin.io/impaction/" rel="alternate" type="text/html" title="Impaction (My First Play)" /><published>2026-04-19T00:00:00+00:00</published><updated>2026-04-19T00:00:00+00:00</updated><id>https://rin.io/impaction</id><content type="html" xml:base="https://rin.io/impaction/"><![CDATA[<p><img src="/images/nothingtoseehere.jpeg" alt="" /></p>

<p>My first play, <em>Impaction</em>, was performed in LA as part of <em>Nothing to See Here</em>, directed by my amazing friend <a href="https://jacquesmanjarrez.com/">Jacques Manjarrez</a>. The last night was recorded and can be seen <a href="https://youtu.be/YNYGaUns5wY?si=r--t-V_5jJw9tXTR&amp;t=3602">here</a>.</p>

<h2 id="impaction">Impaction</h2>
<p><em>by Rin Ray</em></p>

<h3 id="cast">Cast</h3>
<ul>
  <li><strong>Main Character (MC)</strong></li>
  <li><strong>Sick Creature</strong> — a human wrapped in blankets to look vaguely unidentifiable, but certainly alive</li>
  <li><strong>Doctor</strong> — wearing a rhinoceros mask and a pink lab coat</li>
  <li><strong>Creatures</strong> — a crowd in costumes</li>
</ul>

<h3 id="props">Props</h3>
<ul>
  <li>Lots of yellow and pink ribbon</li>
  <li>Two chairs</li>
  <li>Two phones</li>
  <li>A banana</li>
</ul>

<hr />

<h3 id="scene-one">Scene One</h3>

<p><em>MC and Sick Creature on stage. A phone near the back of the stage.</em></p>

<p><strong>MC:</strong> <em>(Standing, staring out into space at the mostly lifeless body.)</em></p>

<p><strong>Sick Creature:</strong> <em>(Lying on their side, crying slightly, breathing labored.)</em></p>

<p><strong>MC:</strong> <em>(Backs up slowly and sinks down next to the phone without looking at it, still staring at Sick Creature. Tension slowly builds. Through shaky breaths, holding back tears, dials.)</em> “Hi, does your clinic offer the procedure?”</p>

<p><strong>Voice on the phone:</strong> <em>(Disappointed)</em> “Ah, I see. Okay, thank you.”</p>

<p><em>(MC crosses a name off a list. Approaches the creature and strokes its hair while calling once more. Increasingly agitated, MC throws the phone down.)</em></p>

<p><strong>Sick Creature:</strong> <em>(Flinches and curls in on itself, breathing faster and shallower, building toward panic.)</em></p>

<p><em>(MC picks the phone back up and calls the Doctor.)</em></p>

<p><strong>MC:</strong> “Doctor, I can’t reach anyone who does the procedure. Do you know someone?”</p>

<p><em>(MC gets up to go outside. A flash of different styles and genres of music begins to play.)</em></p>

<p><em>(A parade emerges from behind the audience and weaves through the seats: minions, clowns, demons, nuns, a flamingo — all shitfaced drunk. Each holds a pink or yellow ribbon trailing behind them. The music keeps switching rapidly as they float by. Strings and ribbons flow through the space.)</em></p>

<p><em>(The characters pull to the side and play rock paper scissors in an uncanny, chittering clown language. The next batch comes out with ribbons in the same way, in front of MC, freestyling mischievously in their mayhem.)</em></p>

<p><em>(Suddenly MC is caught in a web of ribbons, dodging side to side, running their hands through them. They “trip” and grab one. The being holding that ribbon — the flamingo — stops, walks up to MC, and hugs them. MC holds on tight, then looks at the ribbon in their hand, then back at the flamingo. MC lets go of the ribbon, and the flamingo immediately turns around and rejoins the parade.)</em></p>

<hr />

<h3 id="scene-two">Scene Two</h3>

<p><em>(The parade mostly clears the stage as MC exits. A small parade keeps passing parallel to the stage, ribbons leading offstage. Upbeat, quickly shifting music continues.)</em></p>

<p><em>(Two chairs. The Doctor, in a pink coat, sits on one next to a phone. Hidden behind them: another phone and a banana.)</em></p>

<p><em>(MC opens a door, arriving.)</em></p>

<p><strong>MC:</strong> “Help me.”</p>

<p><strong>Doctor:</strong> “What? Okay.”</p>

<p><em>(MC and Doctor both start calling frantically while the parade continues, alternating the same line.)</em></p>

<p><strong>MC &amp; Doctor:</strong> “Hi, do you offer the procedure?”</p>

<p><em>(More characters join the parade in the background. MC and Doctor keep calling, now in different languages, building to a frantic pace.)</em></p>

<p><strong>Doctor:</strong> “Hi, do you offer the procedure?”</p>

<p><strong>MC:</strong> “Hallo, bieten Sie die Operation an?”</p>

<p><em>(More characters enter.)</em></p>

<p><strong>Doctor:</strong> “Bonjour, proposez-vous l’OPÉRATION ?”</p>

<p><strong>MC:</strong> “Hola, ¿ofrecen la OPERACIÓN?”</p>

<p><em>(The Doctor raises the banana to their other ear, as if on two phones at once.)</em></p>

<p><strong>Doctor:</strong> “Salve, operationem offersne?”</p>

<p><strong>Doctor:</strong> “They have always abandoned us. We must do it ourselves.”</p>

<p><em>(The parade grows louder and closer until it is walking in front of and around them, club music pounding. MC and Doctor are obscured.)</em></p>

<hr />

<h3 id="scene-three">Scene Three</h3>

<p><em>(While covered, the Doctor exits with their chair and phone. Sick Creature enters and lies on the floor, two ribbons already tied around its throat, each held by a costumed person.)</em></p>

<p><strong>Sound:</strong> <em>(The upbeat music continues, but slowed down, as if playing in another room.)</em></p>

<p><em>(The costumed people in front of MC part down the middle and move left and right behind them, revealing Sick Creature on the floor. MC sits blindfolded on a chair. Behind MC, the costumed people split the ribbons into two paths — yellow and pink — like a fork in the road.)</em></p>

<p><strong>Doctor:</strong> <em>(Walks out to stand behind MC.)</em> “Here are the options.”</p>

<p><strong>Doctor:</strong> “You can end its suffering — kill it.” <em>(Points to the pink ribbon.)</em> “Or you can try the procedure yourself, but act as its tormentor as you try.” <em>(Points to the yellow ribbon.)</em></p>

<p><strong>MC:</strong> “What will they lead to?”</p>

<p><strong>Doctor:</strong> “You cannot know the future.”</p>

<p><em>(The two ribbons around Sick Creature’s neck feed into the two paths behind MC, so that MC sits inside a triangle of ribbon. The people holding the neck ribbons begin to pull.)</em></p>

<p><strong>Sick Creature:</strong> <em>(Fights the ribbons at its neck, clawing wildly and whimpering, in clear agony, growing more intense by the second.)</em></p>

<p><strong>MC:</strong> <em>(Breathing heavily, still blindfolded, gets up and crawls on hands and knees to stroke the creature’s face as it whimpers. The ribbon-holders move closer; the triangle shrinks and forces MC back into the chair.)</em></p>

<p><strong>Sick Creature:</strong> <em>(Screaming and seizing in pain, still clawing at the ribbons.)</em></p>

<p><em>(MC turns to the audience.)</em></p>

<p><strong>MC:</strong> “Fuck! What do I do? Fuck!”</p>

<p><strong>Offstage Narrator:</strong> “Those who want yellow, raise your hand. Those who want pink, raise your hand.”</p>

<p><em>(A TV in the background shows yellow on one side, pink on the other. The audience votes.)</em></p>

<link href="https://fonts.googleapis.com/css2?family=Archivo+Black&amp;display=swap" rel="stylesheet" />

<style>
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    <p><strong>MC:</strong> "So that's what you choose?"</p>
    <p><em>(MC takes a deep breath, swivels, and grabs the yellow ribbon running to Sick Creature's throat. Falls from the chair to their knees.)</em></p>
    <p><em>(Everyone holding pink runs offstage with their ribbon. Once they are gone, the people holding yellow release Sick Creature — limp, screaming, crying. The parade takes the chair with them.)</em></p>
    <p><strong>Sound:</strong> <em>(The music cuts out the moment the last creature leaves the stage.)</em></p>
    <p><em>(MC collapses onto their knees and rips off the blindfold.)</em></p>
    <p><strong>MC:</strong> "We must try ourselves."</p>
    <p><em>(MC mimes using syringes and making incisions and getting tangled in the yellow ribbon.)</em></p>
    <p><em>(MC scoots remaining seated on the floor to the back of the middle stage, face facing forward, and waits with a 1000 yard stare.)</em></p>
    <p><strong>Sick Creature:</strong> <em>(Gets up — walking, but limping and still unwell, holding parts of itself together. Approaches MC along the same path it was dragged down. Crouches, hugs MC, and starts crying.)</em></p>
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    <h4>The audience chose pink</h4>
    <p><strong>MC:</strong> "So that's what you choose?"</p>
    <p><em>(MC takes a deep breath, swivels, and grabs the pink ribbon running to Sick Creature's throat. Falls from the chair to their knees.)</em></p>
    <p><em>(Everyone holding yellow runs offstage with their ribbon. Once they are gone, the people holding pink take hold of Sick Creature — limp, screaming, crying — and drag it off along the pink path. The parade takes the chair with them.)</em></p>
    <p><strong>Sound:</strong> <em>(The music cuts out the moment the last creature leaves the stage.)</em></p>
    <p><em>(MC collapses onto their knees and rips off the blindfold.)</em></p>
    <p><em>(MC goes over to the creature and chokes it to death, saying:)</em> "I love you. I love you. I love you."</p>
    <p><em>(MC looks accusingly at the audience. The TV behind them is covered in eyes, staring out at the audience.)</em></p>
    <p><strong>MC:</strong> "How could you? How could I?"</p>
    <p><em>(MC collapses. The screen behind them reads: "I forgive you.")</em></p>
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</script>]]></content><author><name></name></author><category term="art" /><category term="playwriting" /><category term="theater" /><category term="script" /><category term="experimental-theater" /><summary type="html"><![CDATA[]]></summary></entry><entry><title type="html">Using Automorphism Groups of Curves to Control the Slopes of their Jacobians</title><link href="https://rin.io/gausssums/" rel="alternate" type="text/html" title="Using Automorphism Groups of Curves to Control the Slopes of their Jacobians" /><published>2025-05-23T00:00:00+00:00</published><updated>2025-05-23T00:00:00+00:00</updated><id>https://rin.io/gausssums</id><content type="html" xml:base="https://rin.io/gausssums/"><![CDATA[<p>I’ve felt for a long time that automorphisms of curves should control or at least exert serious force on the slopes on their Jacobians. Symmetry forces height, as I’ve written about previously in <a href="https://rin.io/every-height/">Models of Formal Groups Laws of Every Height</a>, and <a href="https://rin.io/height-is-symmetry/">Endomorphisms Directly Control Slope</a>.</p>

<p>In this post, I conjecture that the Frobenius eigenvalues of Artin-Schreier-Witt Curves (\( \mathbb{Z}/p^k \)-covers) are Gauss sums, generalizing an old and classic theorem of Davenport and Hasse (fuck nazis though). I explain and expand (i.e., make the paper type check and fill in details) a gorgeous reproof of this theorem using local systems by Robert Coleman.</p>

<p>This playful note is toward exploring this force, and outlining a conjectural approach for further exploiting it. Enjoy and click. <a href="/pdfs/Gauss_sums.pdf">Read about my Gauss Sums :P</a></p>

<figure class="pdf-embed">
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<p class="repo-link"><span class="repo-label">Code</span> <a href="https://github.com/catherineray/newton">newton (Newton polygons of Artin–Schreier–Witt curves)</a></p>]]></content><author><name></name></author><category term="math" /><category term="code" /><category term="gauss-sums" /><category term="artin-schreier-witt-curves" /><category term="newton-polygons" /><category term="davenport-hasse-theorem" /><category term="automorphism-groups" /><category term="arithmetic-geometry" /><summary type="html"><![CDATA[I’ve felt for a long time that automorphisms of curves should control or at least exert serious force on the slopes on their Jacobians. Symmetry forces height, as I’ve written about previously in Models of Formal Groups Laws of Every Height, and Endomorphisms Directly Control Slope.]]></summary></entry><entry><title type="html">Cut and Paste Invariants and Duality: A Motivating Example Via zeta(-1), zeta(2) and SL_2Z</title><link href="https://rin.io/SL2Z/" rel="alternate" type="text/html" title="Cut and Paste Invariants and Duality: A Motivating Example Via zeta(-1), zeta(2) and SL_2Z" /><published>2025-02-14T00:00:00+00:00</published><updated>2025-02-14T00:00:00+00:00</updated><id>https://rin.io/SL2Z</id><content type="html" xml:base="https://rin.io/SL2Z/"><![CDATA[<p>Here’s something enticing and strange: there are two “cut and paste” invariants of the same group which are equal to dual zeta values!</p>
<ul>
  <li>the euler characteristic \( \chi(SL_2(\mathbb{Z})) = \zeta(-1), \) and</li>
  <li>the tamagawa measure of \( \mu(SL_2(\mathbb{Z})\backslash SL_2(\mathbb{R}) = \zeta(2)\).</li>
</ul>

<p>I repeat, these apriori unrelated invariants of our beloved example case \( SL_2(\mathbb{Z}), \) are dual zeta values! Is it a general pattern? Let’s define and explain these results to spiritually prepare ourselves for the general picture!</p>

<h1 id="euler-characteristics-of-arithmetic-groups--star-of-the-show--chisl_2mathbbz--zeta-1-">Euler Characteristics of Arithmetic Groups – star of the show: \( \chi(SL_2(\mathbb{Z})) = \zeta(-1) \)</h1>

<p>An arithmetic group is the integer points of an algebraic group (i.e. a group object in abelian varieties). For example, \( SL_2(\mathbb{Z}) \) is the arithmetic group associated to the algebraic group \( \mathbb{SL}_2 \). In general, \( \chi(G) \) for arithmetic groups <em>is related to L-functions and zeta functions.</em></p>

<p>The euler characteristic is defined for a torsion free group \( G’ \) as follows:  \(\chi(G') = \sum_i (-1)^i H^i(G', \mathbb{Z}).\)  This is supposed to generalize the notion of euler characteristic for surfaces of polyhedra where \( \chi(P) = V - F + E \), the analogy is to consider \( \dim H^0(P, \mathbb{Z}) = V \), \( \dim H^1(P, \mathbb{Z}) = E \), and \( \dim H^2(P, \mathbb{Z}) = F\).</p>

<p>For example:</p>
<ul>
  <li>if we consider \( F_n \) the free group of rank \( n \geq 0 \) then \( BF_n \) has one vertex and n \( 1 \)-cells, therefore, \( \chi(F_n) = 1-n \)</li>
  <li>free abelian group of rank \( n \geq 1 \) then \(n\)-torus \( (S^1)^n \) has euler characteristic \( \chi(S^1), …, \chi(S^1)=0.\)</li>
</ul>

<p>The euler characteristic is defined for any group \( G \), in terms of \( G’ \) a torsion free group, 
\(\chi(G) = [G: G']^{-1}\chi(G')\)</p>

<p>Note: This doesn’t depend on choice of \( G \), consider a two different torsion free subgroups \( \Gamma’ \) and \( \Gamma’’\), and define \( \Gamma_0 := \Gamma’ \cap \Gamma’’ \) , then</p>

\[\frac{\chi(\Gamma')}{[\Gamma: \Gamma']} = \frac{\chi(\Gamma_0)/[\Gamma': \Gamma]}{[\Gamma: \Gamma']} = \frac{\chi(\Gamma_0)}{[\Gamma : \Gamma_0]} = \frac{\chi(\Gamma'')}{[\Gamma:\Gamma'']}\]

<p>It’s time to stare at the Gauss Bonnet Thm: Let \( Y \) be closed Riemannian manfiold, then there’s a canonical measure \( \mu \) in \( Y \) such that \(\chi(Y) = \mu(Y).\)</p>

<p>There’s a version for orbifolds, \( Y = BG\) and let \( X \) be its universal cover, there’s a canonical measure such that</p>

\[\chi(Y)= \mu(Y)\]

<p>Further, \( \chi(BG) = \chi(G). \)</p>

<p>Let’s look at \( SL_2(\mathbb{Z}) \). The free group \( F_2 \) is a torsion free group living inside of \( SL_2(\mathbb{Z}) \) via the ping pong lemma. It has index 12, not sure why tbh.</p>

<p>Thus, \(\chi(SL_2(\mathbb{Z})) = [F_2: SL_2(\mathbb{Z})]^{-1} \chi(F_2) = \frac{1}{12} (1-2) = -\frac{1}{12} = \zeta(-1).\)</p>

<h1 id="the-tamagawa-number-of-arithmetic-groups--star-of-the-show--mu_inftysl_2mathbbzbackslash-sl_2mathbbq--zeta2-">The Tamagawa Number of Arithmetic Groups – star of the show: \( \mu_\infty(SL_2(\mathbb{Z})\backslash SL_2(\mathbb{Q})) = \zeta(2) \)</h1>

<p>Given an arithmetic group \( G \), it comes equipped with a canonical measure on its adelic points \( G(\mathbb{A}) \). All other measures are a constant times this measure. It is defined by considering the measure associated to a differential form.</p>

<p>Given an algebraic group \( G \), pick any \( \omega \) which is a top degree invariant differential form of \( G \) defined over \( \mathbb{Q}. \) Then, define the measure \( \mu \) place-wise (a la the adelic perspective of Tate) for each \( G (K_v) \) by \(\mu_v := |\omega|_v \) on \((\mathbb{Q}, +)\). We then renormalize such that:</p>
<ul>
  <li>for finite places \(v \), \( \mu_v(\mathbb{Z}_v)=1 \),</li>
  <li>and at infinite places \(\mu_\infty([0,1]) = 1.\)</li>
</ul>

<p>You might be like – we chose \( \omega \) there, seems noncanonical to me. Well it is noncanonical, if we consider it individually over each place, but all together, no matter which choice of \( \omega \) we take, we will get the same answer because for any number \( f \), the product of its valuation over global fields will always be one: \( \prod |f|_v = 1. \)</p>

<h2 id="non-archimedian-case-family-friendly--prod_p-mu_psl_2mathbbz_p--zeta2-1-">Non-archimedian case (family friendly) \( \prod_p \mu_p(SL_2(\mathbb{Z}_p)) = \zeta(2)^{-1} \)</h2>

<p>In this section we wish to show that \(\prod_p \mu_p(SL_2(\mathbb{Z}\_p)) = \prod_{p} (1-p^{-2})^{-1} = \zeta(2)^{-1}.\)</p>

<p>We may compute the Tamagawa measure for \( SL_2(\mathbb{R}) \) using Iwasawa decomposition. We get that the Haar measure on \( SL_2(\mathbb{Q}_p) \) is \( |x^{-1}|_pdxdydz, \) where \( |x^{-1}|_p = p^{-v_p(x)} \). A nice reference on this is the <a href="https://www-users.cse.umn.edu/~garrett/m/v/volumes.pdf">notes of Paul Garrett</a>.</p>

<p>Now consider the reduction map:</p>

\[f: SL_2(\mathbb{Z}) \to SL_2(\mathbb{F}_p)\]

<p>\(\mu\_p(SL_2(\mathbb{Z}\_p))= \# SL_2(\mathbb{F}\_p)\mu\_p(\text{ker } f)\)  and \(\mu_p(\text{ker } f) = \int_{x,y,z} \|x^{-1}\|_p dxdydz = p^{-3}.\)</p>

<p>Lemma: \( \# GL_2(\mathbb{F}_p) = (p^2-1)(p^2-p), \),</p>

<p>Proof: This because when forming a matrix in \( GL_2 \), the first column \( r_1 \) of the matrix can be anything but the 0 vector (giving us \( p^2 - 1\) choices), and second column of the matrix can be anything other than a multiple of the first vector (it can’t be \( r_2 = cr_1 \) ).</p>

<p>Lemma: \( \# SL_2(\mathbb{F}_p) = 1-p^2, \)</p>

<p>Thus, we have proven: \( \mu(SL_2(\mathbb{Z}_p)) = \frac{1}{1-p^{-2}}, \) and we may conclude:</p>

\[\prod_{p} \mu_p(SL_2(\mathbb{Z}\_p)) = \prod\_{p} (1-p^{-2})^{-1} = \zeta(2)^{-1}.\]

<h1 id="lets-get-archimedian--mu_inftysl_2mathbbzbackslash-sl_2mathbbq--zeta2---to-be-continued">Let’s get Archimedian \( \mu_\infty(SL_2(\mathbb{Z})\backslash SL_2(\mathbb{Q})) = \zeta(2) \)  (to be continued…)</h1>]]></content><author><name></name></author><category term="math" /><category term="arithmetic-groups" /><category term="euler-characteristic" /><category term="tamagawa-numbers" /><category term="special-values-of-zeta-functions" /><category term="sl2z" /><category term="number-theory" /><summary type="html"><![CDATA[Here’s something enticing and strange: there are two “cut and paste” invariants of the same group which are equal to dual zeta values! the euler characteristic \( \chi(SL_2(\mathbb{Z})) = \zeta(-1), \) and the tamagawa measure of \( \mu(SL_2(\mathbb{Z})\backslash SL_2(\mathbb{R}) = \zeta(2)\).]]></summary></entry><entry><title type="html">The Bernoulli Numbers Come from a Shift Operator</title><link href="https://rin.io/faulhaber-shift/" rel="alternate" type="text/html" title="The Bernoulli Numbers Come from a Shift Operator" /><published>2025-01-28T00:00:00+00:00</published><updated>2025-01-28T00:00:00+00:00</updated><id>https://rin.io/faulhaber-shift</id><content type="html" xml:base="https://rin.io/faulhaber-shift/"><![CDATA[<p><img src="/images/german-tales.jpg" alt="" /></p>

<p>The Bernoulli numbers were defined by Faulhaber in terms of the following generating series.</p>

\[\frac{x}{e^x-1} = \sum_{k \geq 0} B_k \frac{x^k}{m!}\]

<p>But why? Where did this come from? Well, the mathematicians of the time were contemplating the following sorts of patterns:</p>

\[\begin{aligned}  1+2+\cdots+n &amp;= \frac{n(n+1)}{2}  \\ 1^2+2^2+\cdots+n^2 &amp; = \frac{n(n+1)(2n+1)}{6}  \\ 1^3+2^3+\cdots+n^3 &amp; = \frac{n^2(n+1)^2}{4}  \\  1^s + 2^s +  \cdots + n^s &amp; = \text{ }?? \end{aligned}\]

<p>The general formula requires \( B_k \) :)</p>

<p>To give you an idea of how hard this is, I don’t even know of a proof of the \( s = 2 \) case that that doesn’t involve guessing the formula then showing inductively (other than the Bernoulli version I’m about to show).</p>

<p>Today I’m giving a modern explanation of Faulhaber’s trick. This is based on <a href="https://math.ucr.edu/home/baez/qg-winter2004/bernoulli.pdf">notes of John Baez</a>.</p>

<p>Consider \( \mathcal{E} \) to be the space of entire functions on \( \mathbb{C} \). We can consider \( \mathcal{E} \subset \mathbb{C}[[z]] \)</p>

<p>Next, consider the finite difference operator</p>

\[\Delta(f(z)) = f(z+1) - f(z) .\]

<p>Discrete Fundamental Theorem of Calculus: If \( \Delta F = f \), then \(\sum_{i = 0}^{n-1} f(i) = F(n) - F(0)\)</p>

<p>For example, here’s a <em>big clue</em>: If \( f(z) = z^s \), then if \( \exists F \) such that \( \Delta F = f \), then 
\(\sum^{n-1}_{i=0} i^s = F(n) - F(0).\)</p>

<p>Let’s set some groundwork before proceeding, we consider an operator (called the ‘‘annihilation operator” in conformal field theory):</p>

\[\begin{aligned} a: \mathcal{E} &amp; \to \mathcal{E} \\ f(z) &amp;\mapsto \frac{d}{dz}f(z) \end{aligned}\]

<p>Let us further define our friend the exponential</p>

\[\begin{aligned} e^{ta}: \mathcal{E} &amp; \to \mathcal{E} \\ f(z) &amp;\mapsto e^{ta}f(z) := \sum_{k \geq 0} \frac{(ta)^k }{k!}(f(z)) \end{aligned}\]

<p>Lemma: \(e^{ta}f(z) = f(z+t)\)</p>

<p>Proof: I can’t help myself, I just love power series. We prove this by expanding both sides and observing that they are the same. Take \( f(z) := \sum_i c_iz^n) \), then</p>

<p>\(\begin{aligned} e^{ta}f(z) &amp;= f(z) \\&amp; + (t\frac{d}{dz})f(z) \\ &amp; +  (t\frac{d}{dz})^nf(z)  \\ &amp; + \cdots \end{aligned}\)
i.e., 
\(\begin{aligned} e^{ta}f(z) &amp;= c_0 + c_1z + c_2z^2 + \cdots + c_nz^n + \cdots \\&amp; + c_1t + 2c_2tz + \cdots + tnc_nz^{n-1} + \cdots \\ &amp;  + n!\frac{c_nt^n}{n!} + (n+1)!\frac{c_{n+1}t^nz}{n!} + \cdots  \\ &amp; + \cdots \end{aligned}\)</p>

<p>Let’s expand the other guy, 
\(\begin{aligned} f(z+t) &amp;= c_0 + c_1(z+t) + c_2(z+t)^2 + \cdots + c_n(z+t)^n + \cdots,  \\ &amp;= (c_0 + c_1t+ c_nt^n +  \cdots) + (c_1t + 2c_2t + \cdots + nc_nt^{n-1} + \cdots)z + \cdots \end{aligned}.\)</p>

<p>It’s the same yay. That means we can write \(\Delta = e^{a} - 1.\)</p>

<p>So, given our big clue above, if we can find \( \Delta^{-1} \), we can solve our addition problem.</p>

<h1 id="lets-playguess-that-inverse">Let’s play…GUESS THAT INVERSE!!</h1>

<p>If we consider \( e^x - 1 \) as a function, we want to find another function \( f(x)g(x) = 1 \), then:</p>

<p>GUESS #1: \( \frac{1}{e^x-1} \) <em>beeping noise</em> nope this is not entire, has a pole when \( x= 0 \).</p>

<p>GUESS #2: \( \frac{x}{e^x-1}) \) we can plug that pole, and get an entire function!! However, we have this extra \( x \) factor floating around (since we want to compose to 1, i.e., the identity operator).</p>

<p>If we were working non-commutatively, then, we’d want to look at either</p>

<p>NON-COMMUTATIVE GUESS #3 : \( x^{-1} \frac{x}{e^x - 1} \) or \( \frac{x}{e^x - 1} x^{-1} \)</p>

<p>Alright, we have some candidates. Let’s get back to operators to make this into real math. We define</p>

\[\begin{aligned} a^{-1}: \mathcal{E} &amp; \to \mathcal{E} \\ f(z) &amp;\mapsto \int_0^z f(u) du \end{aligned}\]

<p>Note, \( a a^{-1} f = f \), but  the other order is not always true \( a^{-1} a f \neq f \)  (because of the icky \( + c \) ).</p>

<p>That means our noncommutative guess  \( \frac{x}{e^x - 1} x^{-1} \) is a good bet! In fact, we define the following operator:</p>

\[\begin{aligned}  \frac{a}{e^a-1} \colon \mathcal{E} &amp;\to \mathcal{E} \\ f(z) &amp;\mapsto \sum_{k \geq 0} B_k \frac{a^k}{k!}f(z)\end{aligned}\]

<p>and finally, we claim \(\Delta^{-1} = \frac{a}{e^a-1}a^{-1}.\)</p>

<h1 id="tying-it-all-together-to-finish-the-job">Tying it all together to finish the job</h1>

<p>We take: \( f(z) = z^s \),  we need to calculate \( \Delta^{-1}f := \frac{a}{e^a-1}a^{-1} \).</p>

\[\begin{aligned} \Delta^{-1}f(z) &amp;= \frac{a}{e^a-1}(a^{-1}z^s) \\ &amp;= \frac{a}{e^a-1}(\frac{z^{s+1}}{s+1}) \\ &amp;= \sum_k B_k (\frac{d}{dz})^kt^k(\frac{z^{s+1}}{s+1}) \\ &amp;= \sum_{k = 0}^{s+1} B_kt^k(s+1)(s)\cdots(s+1-k) \frac{z^{s+1-k}}{s+1}  \\ &amp;= \frac{1}{s+1}\sum_{k = 0}^{s+1} B_kt^k { s+1 \choose k} z^{s+1-k}  \end{aligned}\]

<p>Note in particular that \( \Delta^{-1}f(0) = 0 \). Using our discrete fundamental theorem of calculus, we see the following:</p>

<p>Since \( \Delta(\Delta^{-1}f) = f\), let \( f = z^s \), then</p>

\[\begin{aligned} \sum_{i=0}^{n-1} i^s &amp;= (\Delta^{-1}f)(n) -  (\Delta^{-1}f)(0)  \\  &amp;= \frac{1}{s+1}\sum_{k = 0}^{s+1} B_kt^k { s+1 \choose k} n^{s+1-k} \end{aligned}\]

<p>Tada! We did it!</p>

<p>There is also the following fabulous quick derivation trick of the Bernoulli numbers, which we discussed several years ago in <a href="https://rin.io/derivation-of-the-bernoulli-numbers/">Umbral Calculus Derivation of the Bernoulli Numbers</a>.</p>

<p>A quick way to remember the sum formula is to set \( B^i \) equal to the Bernoulli number \( B_i \). This can be earnestly done if one uses umbral methods.</p>

\[1^s + \cdots + n^s = \frac{(B + n + 1)^{s+1}-B^{s+1}}{s+1}\]

<h1 id="graph-laplacians-in-more-generality">Graph Laplacians in More Generality</h1>

<p>The definition of the graph Laplacian for a graph \( G \) is the following. Let \( v \in V \) be the vertices in the graph, and let \( N(v) \) be the set of vertices neighboring the vertex \( v \).</p>

\[\nabla_G f(v) = \frac{1}{|N(v)|} \sum_{w \in N(v)} f(v) - f(w)\]

<p>The directed graph Laplacian rather looks at \( N^+(v) \), the set of vertices the vertex \( v \) maps to with edge length 1:</p>

\[\nabla_G f(v) = \frac{1}{|N^+(v)|} \sum_{w \in N^+(v)} f(v) - f(w)\]

<p>We can define the graph Laplacian to act on entire functions on \( \mathbb{C} \):</p>

\[\nabla_{G, v} f(z) = \frac{1}{|N(v)|} \sum_{w \in N(v)} f(z+v) - f(z+w)\]

<p>Notice that if we consider the lattice of \( \mathbb{Z} \) in \( \mathbb{R} \) to be directed (going toward positive numbers), we must make a slight type change.</p>

\[\nabla_{\mathbb{Z}, 0} f(z) = f(z) - f(z+1) .\]

<p>This is quite interesting because the <em>left inverse</em> of a graph Laplacian is the Green’s function associated to the uniform random walk on the graph where you hop to each of your neighbors of distance one away with probability one. The Bernoulli numbers are derived from the <em>right inverse</em> of \( \Delta = -\nabla_{\mathbb{Z}, 0} \). That’s a big difference in description of the inverses on both sides!</p>

<p>Let’s use this language to boogie. Take the lattice \( \Lambda := \mathbb{Z} + \tau\mathbb{Z} \subset \mathbb{C} \) ,  with the directions pointing toward the positive imaginary and positive real directions. The neighbors of the vertex</p>

\[\begin{aligned} \nabla_{\lambda, (0, 0)} f(z) &amp; = \frac12 (f(z) - f(z+1)) + \frac{1}{2}(f(z) - f(z+\tau))  \\ &amp;= f(z) - \frac12(f(z+1) + f(z+\tau)) \\ &amp; = \big( \mathrm{id} - \frac{\mathrm{id}}{2}(e^a + e^{\tau a})\big) f(z) \end{aligned}\]

<p>If we allow ourselves full license to fuck around, let’s set \( \tau = i \) and play GUESS THAT INVERSE. We consider the function 
\(1-\frac{1}{2}(e^x + e^{\tau x})\)
And look at it’s inverse: 
\(\begin{aligned} \frac{1}{1-\frac{1}{2}(e^x + e^{\tau x})} &amp;= \frac{2}{e^x + e^{\tau x}-2} \\ &amp;= \frac{2}{\sum_n \frac{(1+\tau^n)x^n}{n!}-2}\end{aligned}\)</p>

<p>This function has a pole of order 3 at 0, and for the simplest case \( \tau = i \), the remaining poles are of order one at roots of \( i \). We can plug those poles, no problem:</p>

\[\frac{2a^3(a+1)(a-1)(a+i)(a-i)}{e^a + e^{ia} - 2}\]

<p>I’m not sure where to go from here, I’d love for this to in some way compare to the Kronecker-Eisenstein series 
(which tantalizingly involves the character \( \phi(z) = e^{\frac{z-\overline{z}}{A}} \)). Here, \( A = \frac{\text{im } \tau}{\pi} \) is the area of the fundamental domain of the lattice \( \Lambda \) divided by \( \pi \). The Kronecker-Eisenstein series is defined as follows, (typically the role of the letter \( b \) is played by \( a \), but we are already using \( a \) to stand for annihilation operator).</p>

\[\kappa_{b}(z, w, s, \tau) = \sum_{\lambda \in \Lambda}^*\frac{(\overline{z}+\overline{\lambda})^b}{|z+\lambda|^s}\phi(z \overline{w}),\]

<p>where the \( * \) means that the summation excludes \( \lambda = -z \) if \( z \in \Lambda \).</p>

<p>A good reference on these is <a href="https://webusers.imj-prg.fr/~pierre.charollois/Charollois-Sczech_5.pdf">Elliptic Functions according to Eisenstein and
Kronecker : An Update</a>. See in particular the elliptic analogs of Bernoulli numbers discussed on page 8.</p>

<p>This is a nostalgic topic for me which feels like home to step back to. I previously contemplated the analogs of such shifts in 2015 while I was still a robotics inventor sitting in the back of lectures at Berkeley <a href="https://rin.io/euler-maclaurin-slipper/">On Detiling Polynomials: A Generalization of the Euler MacLaurin Formula</a>.</p>]]></content><author><name></name></author><category term="math" /><category term="bernoulli-numbers" /><category term="faulhaber-formula" /><category term="finite-differences" /><category term="shift-operator" /><category term="generating-functions" /><summary type="html"><![CDATA[]]></summary></entry><entry><title type="html">A Song About Computing Sheaf Cohomology with Cech Covers</title><link href="https://rin.io/cech-covers/" rel="alternate" type="text/html" title="A Song About Computing Sheaf Cohomology with Cech Covers" /><published>2025-01-17T00:00:00+00:00</published><updated>2025-01-17T00:00:00+00:00</updated><id>https://rin.io/cech-covers</id><content type="html" xml:base="https://rin.io/cech-covers/"><![CDATA[<p><a href="/images/Cech cover.m4a">Cech Covers</a> (click the link to listen to us). I wrote this song with my beloved old room mate Christian Gorski in my last year of grad school while I was wrapping up my thesis. For weeks, I was doing nothing but computing etale sheaf cohomologies of ramified covers of the projective plane. I would decompose sheaves on these curves by cutting around the neighborhood of ramification point (the stomach), and capturing the properties of the ramification group from the ramification point (the heart). The gluing back datum was the punctured neighborhood of the sheaf.</p>

<p>Let \(X\) be a curve over a complete local ring, and let us decompose it into two affine pieces \(X = A \cup B.\)</p>

<p>Given a sheaf \(\mathcal{F}\) over \(X\), we have the following Mayer-Vietoris sequence.</p>

\[0 \to H^0(X, \mathcal{F}) \hookrightarrow  \mathcal{F}(A) \times \mathcal{F}(B) \to \mathcal{F}(A) \cap \mathcal{F}(B) \to H^1(X, \mathcal{F}) \to 0.\]

<p>In particular, if take the decomposition of \(X\) into the point at infinity and its complement \(X = U \cup {\infty}\), we get the following sequence, let \(T\) be a divisor at \(\infty\).</p>

\[0 \to H^0(X, \mathcal{F}) \hookrightarrow  \mathcal{F}(U) \times \mathcal{F}^\wedge_\infty \to \mathcal{F}^\wedge_\infty[\frac{1}{T}] \to H^1(X, \mathcal{F}) \to 0.\]

<p>A global section \(H^0(X, \Omega^1_X)\) can be specified by either a basis in terms of \(\mathcal{F}(U)\), in terms of \(\mathcal{F}^\wedge_\infty.\) This is because we are considering \(H^0(X, \mathcal{F})\) as a subset of \(\mathcal{F}(U) \times \mathcal{F}^\wedge_\infty\).</p>

<h1 id="lyrics">Lyrics:</h1>
<p>I’ll cut you into manageable pieces<br /> 
I hope you’re not too hard to glue back together<br /> 
There’s so many ways to form an affine cover<br /> 
Yet I keep slicing open your stomach<br /> 
And I pull out your heart<br /> 
I don’t know why<br /> 
that’s where I like to start<br /> 
<br /> 
It’s an easy thing to fall in love with a hand<br /> 
When its lifeless and the fingers are missing<br /> 
I can trace the truth<br />
As it sits motionless<br /> 
beneath my glass, slowly twitching<br /> 
<br /> 
And when I stitch it back together<br /> 
It jumps and motions toward the sky<br /> 
There’s a hanging sequence of all of your pieces<br /> 
And your other hand is waving hi<br /> 
<br /> 
I’ll cut you into manageable pieces<br /> 
I hope you’re not too hard to glue back together<br /> 
There’s so many ways to form an affine cover<br /> 
Yet I keep slicing open your stomach<br /> 
And I pull out your heart<br /> 
I don’t know why<br /> 
that’s where I like to start<br /> 
<br /> 
Those intersections between your skin<br /> 
Reveal raw flesh that I’m kissing<br /> 
There’s so many ways to stitch you back<br /> 
I GIVE YOU MORE EYES MORE EYES MORE EYES MORE EYES<br />
YOUR DICK IS MISSING, i needed it to make more eyes<br /> 
<br /> 
I love to cut you apart to find the ways you combine<br /> 
How many times can I do this before you fall apart forever?<br /></p>]]></content><author><name></name></author><category term="art" /><category term="math" /><category term="music" /><category term="songwriting" /><category term="sheaf-cohomology" /><category term="cech-cohomology" /><category term="mayer-vietoris-sequence" /><category term="math-songs" /><summary type="html"><![CDATA[Cech Covers (click the link to listen to us). I wrote this song with my beloved old room mate Christian Gorski in my last year of grad school while I was wrapping up my thesis. For weeks, I was doing nothing but computing etale sheaf cohomologies of ramified covers of the projective plane. I would decompose sheaves on these curves by cutting around the neighborhood of ramification point (the stomach), and capturing the properties of the ramification group from the ramification point (the heart). The gluing back datum was the punctured neighborhood of the sheaf.]]></summary></entry><entry><title type="html">The Crystalline Period Map</title><link href="https://rin.io/crystalline-period/" rel="alternate" type="text/html" title="The Crystalline Period Map" /><published>2025-01-17T00:00:00+00:00</published><updated>2025-01-17T00:00:00+00:00</updated><id>https://rin.io/crystalline-period</id><content type="html" xml:base="https://rin.io/crystalline-period/"><![CDATA[<p><img src="/images/lubin-tate.jpg" alt="" />  This drawing is an old drawing I made when I was preparing for my qualifying exam in my second year of grad school at Northwestern. It is the crystalline period map. The tower to the left is the “Lubin-Tate” tower, the deeper it goes the more level structure. In the upper right corner there is projective space, and the “cat like” creatures below are moduli stacks of curves. I always draw the moduli stack of elliptic curves as a cat because it has 2 stacky points (its ears) and a third stacky point if you compactify “the sock” of the fundamental domain (its tail). At the time I was working on what became my PhD thesis: using moduli stacks of curves with marked points to understand moduli stacks of formal groups with level structure.</p>

<p>If I was braver then, I would have added this drawing to the paper which I wrote at an Arizona Winter School. I still think that paper is good resource for learning quickly about the Fargue Fontaine curve. <a href="https://arxiv.org/pdf/1911.08615">A Global Crystalline Period Map</a></p>

<p>All of this is on my mind because I have had the great privledge and joy of returning to this topic after years away.</p>

<p>While we are sharing old things, in 2018 or 2019, Artem, Kolya and I made an outline of an approach to rational Chromatic Vanishing  \(H^*(J_h, W(k)) \times \mathbb{Q} \simeq H^*(J_h, W(k)[[u_1, ..., u_{h-1}]][u^{\pm}]) \otimes \mathbb{Q}\) using the two tower isomorphism which reduces the problem to directly calculating the \( GL_h(\mathbb{Q}_p) \) action on constant functions on the Drinfeld projective space <a href="/pdfs/chromaticvanishingapproach.pdf">Chromatic Vanishing Approach</a>.</p>

<figure class="pdf-embed">
  <object data="/pdfs/chromaticvanishingapproach.pdf#navpanes=0&amp;view=FitH" type="application/pdf" aria-label="Chromatic Vanishing Approach (PDF)">
    <p class="pdf-fallback">This browser can't show the PDF here. <a href="/pdfs/chromaticvanishingapproach.pdf">Open “Chromatic Vanishing Approach” (PDF)</a></p>
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  <figcaption><a href="/pdfs/chromaticvanishingapproach.pdf" target="_blank" rel="noopener">PDF not showing? Open “Chromatic Vanishing Approach” ↗</a></figcaption>
</figure>

<p>At the time, the tools to compute the p-adic cohomology of the Drinfeld projective plane were not available to us so we ulitmately were scooped.  I was initially sad about this because I felt then I could not prioritize thinking about these awesome and gorgeous concepts. However, recently I have begun with many others a spin-off project, which I am delighted and healed by. :)</p>]]></content><author><name></name></author><category term="art" /><category term="math" /><category term="drawing" /><category term="illustration" /><category term="crystalline-period-map" /><category term="lubin-tate-tower" /><category term="moduli-stacks" /><category term="chromatic-homotopy-theory" /><summary type="html"><![CDATA[This drawing is an old drawing I made when I was preparing for my qualifying exam in my second year of grad school at Northwestern. It is the crystalline period map. The tower to the left is the “Lubin-Tate” tower, the deeper it goes the more level structure. In the upper right corner there is projective space, and the “cat like” creatures below are moduli stacks of curves. I always draw the moduli stack of elliptic curves as a cat because it has 2 stacky points (its ears) and a third stacky point if you compactify “the sock” of the fundamental domain (its tail). At the time I was working on what became my PhD thesis: using moduli stacks of curves with marked points to understand moduli stacks of formal groups with level structure.]]></summary></entry><entry><title type="html">Fuck Perfectionism</title><link href="https://rin.io/fuck-perfectionism/" rel="alternate" type="text/html" title="Fuck Perfectionism" /><published>2025-01-16T00:00:00+00:00</published><updated>2025-01-16T00:00:00+00:00</updated><id>https://rin.io/fuck-perfectionism</id><content type="html" xml:base="https://rin.io/fuck-perfectionism/"><![CDATA[<p>I have been working recently to counter the writers block that has formed insidiously from an unhealthy creeping perfectionism. In order to do this, I will post some old art and music which at the time I felt was “not good enough to share” or “inappropriate for a professional mathematician to have associated to them.” But all of these labels and caring too much about what other people think – I am sick of them. I don’t want them in my value system. I just want to be my full authentic self. So I will be. Enjoy!</p>]]></content><author><name></name></author><category term="psych" /><category term="perfectionism" /><category term="writers-block" /><category term="authenticity" /><summary type="html"><![CDATA[I have been working recently to counter the writers block that has formed insidiously from an unhealthy creeping perfectionism. In order to do this, I will post some old art and music which at the time I felt was “not good enough to share” or “inappropriate for a professional mathematician to have associated to them.” But all of these labels and caring too much about what other people think – I am sick of them. I don’t want them in my value system. I just want to be my full authentic self. So I will be. Enjoy!]]></summary></entry><entry><title type="html">Designing the Young Topologists Meeting 2024</title><link href="https://rin.io/ytm-2024-design/" rel="alternate" type="text/html" title="Designing the Young Topologists Meeting 2024" /><published>2024-08-05T00:00:00+00:00</published><updated>2024-08-05T00:00:00+00:00</updated><id>https://rin.io/ytm-2024-design</id><content type="html" xml:base="https://rin.io/ytm-2024-design/"><![CDATA[<p><img src="/images/ytm-2024/ytm-2024-cover.jpeg" alt="The YTM 2024 banner: &quot;YTM 2024 UNI-MÜNSTER&quot; in pink next to the logo, on a teal background" /></p>

<p>From 5 to 9 August 2024, the <a href="https://www.uni-muenster.de/MathematicsMuenster/events/2024/YTM.shtml">Young Topologists Meeting</a> came to the University of Münster. YTM is a conference run by and for early-career topologists: PhD students and postdocs give most of the talks, and two lecture series anchor the week. This year they were Ishan Levy (Copenhagen) on <em>Telescopic computations in algebraic K-theory</em> and Arunima Ray (MPI Bonn) on <em>From knots and links to 4-manifolds</em>.</p>

<p>I was on the organizing committee, together with Konrad Bals, Etienne Batelier, Edith Hübner, Marin Janssen, Alexander Kutzim, Lukas Stöveken, Maximilian Tönies and Thomas Tony. I also drew the logo, and Natalia Pacheco-Tallaj did the graphic design around it.</p>

<h2 id="the-logo">The logo</h2>

<p><img src="/images/ytm-2024/ytm-2024-logo.png" alt="The YTM 2024 logo: the letters Y, T and M drawn as pink and cyan flames around a lightning bolt, inside a yellow scalloped seal" style="max-width: 320px;" /></p>

<p>The letters Y, T and M are drawn as flames, hot pink with cyan shadows, and the T in the middle is split by a lightning bolt. They sit inside a yellow seal with a scalloped edge, somewhere between a sun and a sticker. Everything has a heavy black outline, so the logo reads both large on the banner and small in the corner of each day of the schedule.</p>

<h2 id="the-schedule">The schedule</h2>

<p><img src="/images/ytm-2024/ytm-2024-schedule.jpeg" alt="The YTM 2024 schedule: one lime-green card per day, with talk times, speakers and titles, smiley-face stickers, and a &quot;Where things are&quot; panel" /></p>

<p>Natalia and I made the schedule together. Each day is its own lime-green card with the logo in the corner, speakers in cyan, and titles in black; the coffee breaks, lunches and the poster session (“with finger food!”) get their own bands. Yellow smiley stickers and pink and cyan bursts are scattered across the page, and a last panel says where things are: talks in M1 and M2, coffee breaks and the poster session in the Cluster Lounge, and a silent room in the SRZ. Here is the full schedule, page by page:</p>

<figure class="pdf-embed">
  <object data="/pdfs/ytm-2024-schedule.pdf#navpanes=0&amp;view=FitH" type="application/pdf" aria-label="YTM 2024 schedule (PDF)">
    <p class="pdf-fallback">This browser can't show the PDF here. <a href="/pdfs/ytm-2024-schedule.pdf">Open “YTM 2024 schedule” (PDF)</a></p>
  </object>
  <figcaption><a href="/pdfs/ytm-2024-schedule.pdf" target="_blank" rel="noopener">PDF not showing? Open “YTM 2024 schedule” ↗</a></figcaption>
</figure>

<p>The palette is the same everywhere: hot pink, cyan, lemon yellow and lime on teal and lilac.</p>

<p>YTM 2024 was supported by the Cluster of Excellence Mathematics Münster, the K-theory Foundation and the Foundation Compositio Mathematica. Banner: © Natalia Pacheco-Tallaj (graphic design) &amp; Rin Ray (logo). Schedule: © Natalia Pacheco-Tallaj &amp; Rin Ray. Photos of the week, by Arye Deutsch, are on the <a href="https://www.uni-muenster.de/MathematicsMuenster/events/2024/YTM.shtml">conference page</a>.</p>]]></content><author><name></name></author><category term="art" /><category term="math" /><category term="logo-design" /><category term="graphic-design" /><category term="young-topologists-meeting" /><category term="topology" /><category term="conferences" /><category term="munster" /><summary type="html"><![CDATA[]]></summary></entry><entry><title type="html">The Biome</title><link href="https://rin.io/biome/" rel="alternate" type="text/html" title="The Biome" /><published>2024-05-06T00:00:00+00:00</published><updated>2024-05-06T00:00:00+00:00</updated><id>https://rin.io/biome</id><content type="html" xml:base="https://rin.io/biome/"><![CDATA[<p>We outline connections between the gut microbiome, autoimmune conditions, neuropathic pain, eye pain, chemical intolerance, and a specific set of “overactive” mental illnesses. All seem to be connected to a sensory processing disorder. This is joint work with Luca Estinto.</p>

<p>We propose there is collection of disorders characterized by sensory processing issues. This collection of symptoms affects many and is rarely viewed holistically. We propose to view them holistically and approach their treatment as such – keeping in mind that autoimmune disorders usually are best detected genetically, and medication-wise sensory processing is best treated using tricylic antidepressants, GABA analogues, and glasses prescribed by a behavioral optometrist.</p>

<h2 id="sensory-processing-disorders-and-connectivity">Sensory processing disorders and connectivity</h2>

<p>People who react strongly to perfumes and strong smells (chemical intolerance) are such that they perceive a smell at a constant level of intensity, the signal is processed at the same intensity over time. Normal people perceive the signal intensity to decrease over time, they “get used to it”. Signal intensity is monitored via brain blood flow (measured using EEG and fMRI). The same blood flow pattern as those with chemical intolerance is found in those with chronic pain. [(2012)<a href="https://www.sciencedaily.com/releases/2012/01/120120182914.htm">Summary of Linuss Andersson (Sick of Smells: Empirical Findings and a Theoretical Framework for Chemical Intolerance)</a>] [(2018) <a href="https://journals.lww.com/joem/Fulltext/2018/02000/Multiple_Chemical_Sensitivity__Review_of_the_State.5.aspx">Multiple Chemical Sensitivity Review of the State of the Art in Epidemiology, Diagnosis, and Future Perspectives</a>].</p>

<h2 id="sensory-processing-disorders-and-glutamate">Sensory processing disorders and glutamate</h2>

<p>If you want to imagine what life is like as a highly sensitive person recall what it is like to have a hangover — when you have a hangover you have an excess of free glutamate which causes overexcitability of sensory processing.</p>

<p>Children with sensory processing disorders have disconnected white matter (measured using DTI) [(2016)<a href="https://www.ucsf.edu/news/2016/01/401461/brains-wiring-connected-sensory-processing-disorder">Brain’s Wiring Connected to Sensory Processing Disorder</a>].</p>

<p>It is worth nothing that Gabapentin (600mg) seems quite effective in cases of patients who tend toward alcohol to calm overexcitability and anxiety.  Gabapentin is structurally similar to the neurotransmitter glutamate and competitively inhibits branched-chain amino acid aminotransferase (BCAT), slowing down the synthesis of glutamate.</p>

<h2 id="excitable-mental-illness-and-the-role-of-glutamate">Excitable Mental Illness and the role of Glutamate</h2>

<p>A sensory processing disorder makes excitable mental illnesses more likely. Mental illness wise, adhd, aspergers, bipolar, anxiety and autism have “ring of fire” blood flow patterns in the brain. Too much glutamate causes overexcitability of the brain (measured using SPECT). [<a href="https://pubmed.ncbi.nlm.nih.gov/?term=AMEN+DG+OUTCOMES">Amen Clinics Articles</a>] Their clinic uses SPECT imaging as a diagnostic tool for psychiatric treatment [<a href="https://pubmed.ncbi.nlm.nih.gov/23709407/">Amen Clinics: Multi-site six month outcome study of complex psychiatric patients evaluated with addition of brain SPECT imaging</a>]. Some examples (all photos are from the Amen Clinic):</p>

<p><img src="/images/bipolar_amen.png" alt="image" /></p>

<p><img src="/images/ocd-amen.png" alt="image" /></p>

<p><img src="/images/asd_amen.png" alt="image" /></p>

<h2 id="spd-causing-visual-tunneling-and-autoimmune-conditions-affecting-eyesight">SPD causing Visual Tunneling and Autoimmune conditions affecting Eyesight</h2>

<p>Visual tunneling is a particularly pervasive issue that affects all senses, it results from an overload of visual sensation in the brain. Tunneling is a subconscious spatial adaptation to reduce the information the individual handles. The individual is either overwhelmed with informatio or has trouble sorting out the significant area for attention.[(2014)<a href="https://www.ovpjournal.org/uploads/2/3/8/9/23898265/ovp2-1_viewpoint_getzell_web.pdf">Visual Tunneling: A Pervasive Vision disorder</a>]</p>

<p>“Cognitively speaking, for these individuals to succeed, they subconsciously fragment space or tunnel, i.e. reduce the amount of information processed in order not to be overwhelmed in dealing with abstract or conceptual activities. In the physiological aspect, the complications of this adaptation for the hyperopic patient include moving the pelvis backward and the forehead forward, and the eyes feel like they are turned out.”  This visual tunnelling affects their ability to control their attention, as well as motor and postural changes. For example, one might walk with smaller steps, round their shoulders, lock their knees when standing, and develop upper back, shoulder, or neck tension.</p>

<p>Nutrient deficiences such as low vitamin D as well as being sensorily overwhelmed cause eyesight issues (autoimmune diseases of the eye and visual tunneling respectively) [source?].</p>

<h2 id="sensory-processing-disorders-and-autoimmune-disease">Sensory processing disorders and Autoimmune Disease</h2>

<p>People who are highly sensitive (a genetic trait) are more likely to have autoimmune diseases such as diabetes, and I would postulate, celiac. [(2018)<a href="https://www.sciencedirect.com/science/article/abs/pii/S0882596317302397">Sensory Processing Sensitivity and Type 1 Diabetes</a>] [Celiac and Diabetes are often comorbid]</p>

<p>This study does not show causalty, it shows that 50% of children with autism also suffer gastrointestinal symptoms, such as celiac disease or constipation, comorbidly. Children with ASD have altered gut microbial composition, with decreased gut bacterial variety and underestimation of potentially helpful bacteria such as Bifidobacterium, Prevotella, and Desulfovibrio, as well as a decrease in short-chain fatty acids. <a href="https://ejo.springeropen.com/articles/10.1186/s43163-022-00270-6">Screening of gastrointestinal symptoms and celiac disease in children with autism spectrum disorder</a></p>

<h2 id="enteric-nervous-system-and-excitable-mental-illness">Enteric Nervous System and Excitable Mental Illness</h2>

<p>Our guts produce 90% of serotonin, if you are low on folic acid or any other basic vitamins/nutrients you literally cannot create serotonin, dopamine, and other neurotransmitters. [add] Would a severe serotonin deficiency show up in a SPECT scan?</p>

<p>There is ongoing work to directly detect and monitor this for diagnostic and treatment purposes. [<a href="https://ece.umd.edu/release/symptoms-all-in-your-heador-in-your-gut-maybe-a-little-of-both">UMD: building an ingestible capsule that can monitor and model gut microbiome serotonin activity</a>]</p>

<p><a href="https://www.nature.com/articles/s41398-019-0389-6">Altered composition and function of intestinal microbiota in autism spectrum disorders: a systematic review</a>. The overall changing of gut bacterial community in terms of β-diversity was consistently observed in ASD patients compared with HCs. Furthermore, Bifidobacterium, Blautia, Dialister, Prevotella, Veillonella, and Turicibacter were consistently decreased, while Lactobacillus, Bacteroides, Desulfovibrio, and Clostridium were increased in patients with ASD relative to HCs in certain studies.</p>

<p><a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC7661167/">A cross-sectional study of gastrointestinal symptoms, depressive symptoms and trait anxiety in young adults</a></p>

<p>There has been some recent research on fecal transplants curing some forms of mental illness. The inverse is also true “with the transmission of depressive and anxiety-like symptoms and behaviors resulting from the transplantation of microbiota from psychiatrically ill donors to healthy recipients”. We collect some examples here:</p>

<p><a href="https://pubmed.ncbi.nlm.nih.gov/32539741/">Effect of fecal microbiota transplant on symptoms of psychiatric disorders: a systematic review</a>.</p>

<p><a href="https://clinicaltrials.gov/ct2/show/NCT03281044">Fecal Microbiota Transplantation in Depression</a></p>

<p><a href="https://journals.physiology.org/doi/full/10.1152/ajpgi.00194.2019">Posttraumatic stress disorder is associated with altered gut microbiota that modulates cognitive performance in veterans with cirrhosis</a>.</p>

<p><a href="https://clinicaltrials.gov/ct2/show/NCT04109196">Examining Changes in Microbiota Over the Course of PTSD Treatment</a>.</p>

<p><a href="https://www.statnews.com/wp-content/uploads/2022/02/OLP-vs-DBP-PAIN-2021.pdf">Open-label placebo vs double-blind placebo for irritable bowel syndrome: a randomized clinical trial</a></p>

<h2 id="enteric-nervous-systemspd-causing-lowered-immune-system-causing-autoimmune-disease">Enteric Nervous system/SPD causing Lowered Immune System causing Autoimmune Disease</h2>

<p>If you have a lower immune system (low igA or igG or igM) you are more likely to have an autoimmune disease.</p>

<p><em>Remark: As a note, you are also more likely than average to have an autoimmune disease with an abnormally strong immune system. This is not the case we are discussing here.</em></p>

<p>The enteric nervous system generates igA and igG in our body. There is a link between igA and levels with a person’s perception of stress, implying the nervous system has the ability to control igA levels. <a href="www.sciencedirect.com/science/article/abs/pii/S0306453097000425?via%3Dihub">EFFECTS OF PSYCHOLOGICAL STRESS ON SERUM IMMUNOGLOBULIN, COMPLEMENT AND ACUTE PHASE PROTEIN CONCENTRATIONS IN NORMAL VOLUNTEERS.</a></p>

<p>People with IgA deficiency should be tested for celiac disease because they are 10 to 20 times likely to develop an autoimmune response to gluten than the general population. <a href="https://www.beyondceliac.org/celiac-disease/related-conditions/iga-deficiency/"></a>]</p>

<p>Using tests of raised igA and igG to detect for celiac disease is harmful and ineffective, as having naturally lowered igA and igG is usually comorbid with celiac disease. Thus, the rasied igA and igG register as normal levels on tests, giving many patients false negatives. The most effective test is a DNA test for the celiac markers. 
[(2017)<a href="https://pubmed.ncbi.nlm.nih.gov/28437323/">Lack of Utility of Anti-tTG IgG to Diagnose Celiac Disease When Anti-tTG IgA Is Negative</a>].</p>

<p>Immunosenescence or the aging of the immune system is linked to the increase of autoantibody frequency while the antibodies decline [(2004) <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/immunosenescence">The Neuroendocrine Immune Network in Aging</a> ].  One way to frame the connection between SPD and being immunocompromised is that higher sensitivity leads to greater stress / perceived stress, which leads to a decrease in immunity which then naturally causes an increase in autoantibodies that would otherwise have occured during someones natural immunosenescence. [(2004) <a href="https://www.sciencedirect.com/science/article/abs/pii/S1568997204000424">Inflamm-aging: autoimmunity, and the immune-risk phenotype</a> ]</p>

<h2 id="mechanisms-of-functional-dyspepsia-and-treatment-with-tricyclic-antidepressent">Mechanisms of Functional Dyspepsia and Treatment with Tricyclic Antidepressent</h2>

<p>A proposed mechanism is that there is original inflammation, and then continued faulty pain signaling when input is gone. That is, a central sensitization model. [(2002) <a href="https://pubmed.ncbi.nlm.nih.gov/12089851/">Functional dyspepsia–a psychosomatic disease</a> ][<a href="https://www.gastroenterologyandhepatology.net/archives/february-2020/functional-dyspepsia-a-review-of-the-symptoms-evaluation-and-treatment-options/">Functional Dyspepsia: A Review of the Symptoms, Evaluation, and Treatment Options</a> ] [(2005-2015) <a href="https://mayoclinic.pure.elsevier.com/en/projects/antidepressant-therapy-for-functional-dyspepsia">Antidepressent Therapy for Function Dyspepsia</a> ] [(2018) <a href="https://www.healio.com/news/gastroenterology/20180108/antidepressants-improve-functional-dyspepsia-symptoms-but-how-remains-unclear">Antidepressants improve functional dyspepsia symptoms, but how remains unclear</a> ]</p>

<h2 id="autoimmune-disease-is-under-direct-enteric-neural-control">Autoimmune Disease is Under Direct Enteric Neural Control</h2>

<p>The following are quotes from this paper:
<a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC1727729/pdf/v045p00679.pdf">Fast acting nervous regulation of immunoglobulin A secretion from isolated perfused porcine ileum</a></p>

<p>“As in the salivary gland, sIgA is rapidly secreted in mucosal explants from porcine distal colon in response to both cholinergic and adrenergic receptor agonists, but remains unaltered by acute exposure to an enteroadherent microbial pathogen. The enteric neurotransmitters acetylcholine and NE appear to act on muscarinic cholinergic and alpha-adrenergic receptors expressed by crypt epithelial cells to promote transcytosis of the polymeric Ig receptor and enhance vectorial secretion of both sIgA and free SC toward the mucosal surface. In its early stages, this action appears to be temporally coincident with, but mechanistically independent of active ion transport. The precise receptor types and associated signal transduction mechanisms mediating sIgA secretion by these and possibly other enteric neurotransmitters at this mucosal immune effector site remain to be characterized.”</p>

<p>“In a more complex, vascularly-perfused porcine ileum preparation however, electrical stimulation of extrinsic nerves innervating the intestine increases sIgA secretion only after atropine and phentolamine pretreatment; this effect is inhibited by hexamethonium, a blocker of ganglionic neurotransmission. This result suggests that there may exist important inhibitory reflex circuits containing muscarinic cholinergic and alpha-adrenergic receptors which modulate the enteric neural control of sIgA output. Additional investigations will be necessary to establish how basal sIgA secretion onto the mucosal surface in vivo is modulated by the release of acetylcholine from enteric nerves.”</p>

<h2 id="virome-mediates-stress-and-memory-responses">Virome Mediates Stress and Memory Responses</h2>
<p>This will be a topic of a future post, it is critical to note that in fact the virome controls the gut biome entirely. Bacteriophages maintain biodiversity of a healthy gut.</p>

<p><img src="/images/virome.png" alt="image" /></p>

<p><a href="https://archive.is/20240713074246/https://www.newscientist.com/article/mg26334991-200-the-vital-viruses-that-shape-your-microbiome-and-your-health/">The vital viruses that shape your microbiome and your health</a></p>

<h2 id="keyword-summary">Keyword summary:</h2>
<ul>
  <li>visual tunneling</li>
  <li>chemical intolerance</li>
  <li>chronic pain</li>
  <li>excess free glutamate</li>
  <li>high sensitivity</li>
  <li>autism/ocd/add/ptsd/bipolar</li>
  <li>functional dyspepsia</li>
  <li>sensory processing disorder.</li>
  <li>low autoimmune system</li>
  <li>likelihood to have autoimmune disease</li>
  <li>enteric nervous system</li>
  <li>lowered ability to create serotonin</li>
  <li>joint hyperflexibility</li>
</ul>]]></content><author><name></name></author><category term="bio" /><category term="sensory-processing-disorder" /><category term="gut-microbiome" /><category term="enteric-nervous-system" /><category term="autoimmune-diseases" /><category term="glutamate" /><category term="chemical-intolerance" /><summary type="html"><![CDATA[We outline connections between the gut microbiome, autoimmune conditions, neuropathic pain, eye pain, chemical intolerance, and a specific set of “overactive” mental illnesses. All seem to be connected to a sensory processing disorder. This is joint work with Luca Estinto.]]></summary></entry></feed>