Two vets down

It has been just two months since Mia's diagnosis, and I have gone through two vets already. The one who made the diagnosis clearly was not very knowledgeable (she was also really young, so not a lot of experience yet). She made recommendations I was not comfortable with, the final straw being when she recommended against home testing.

The second vet seemed more knowledgeable, she knew about the cat food database and feeding low carb, and she supported home testing. But, she wanted me to always give the full insulin dose regardless of pre-shot BG level. She went so far as to say that even if it was 100, just make sure Mia eats and go ahead with giving her the full dose. It really was not much of an issue until very recently when Mia started actually having some lower PS numbers. I have learned enough to know that giving the full dose would be dangerous. So, I decided to reduce the dose. There is some trial and error involved, but the results tell me that I am doing the right thing. I wrote the vet an email carefully explaining the approach I want to take and why. She is not on board with it at all. She said I am 'not interested in her expertise but am relying on other sources of information as more valuable than her knowledge' and that she 'will not continue to feel professionally responsible for a patient when I am unwilling to follow her advice.' The other day, Mia's PMPS was 134. I gave 1.75 u which proved to be too much and sent her into hypo (56 on AlphaTrak). Just think about what would have happened if I had blindly followed the vet's instructions and had given the full dose of 2.25. Enough said.

So, I find myself once again having to look for another vet. Why is it so hard to find someone who is truly knowledgeable about feline diabetes? I would be happy just to find someone with a reasonable amount of knowledge who is also willing to work with me. It is just so frustrating. We need to start a database of good diabetes vets... on second thought, there probably would not be enough of them to put in it.

 

If you post saying you're looking for a vet in your area someone in that same area may be able to help. I feel for you, it's SO frustrating!!!

 

I think there is a couple of things going on.

1. First is the "I am the professional" attitude. Most vets are generalists (that get limited training), just like our family doctors - when things don't add up we get referred to specialists. Most IM vets don't deal with diabetes. Here we go into a "nobody really knows" loop.
2. Second is the fact that there seems to be a real CYA attitude. I have noticed that lately at my clinic. With the latest hassle to get a pen and being told that I am not giving a "recognized" dose of Lantus for Jones and therefore not giving him any insulin and can harm him. I give 0.1U. Micro dose yes, but a dose. And with some of these kitties a drop means a lot!
3. Third, is the concept that some pet owners are truly engaged in their pet's care. Some vets just don't get it. My previous vet (which I can't wait to come back from maternity leave) made that comment to me several times. For my IMHA dog (that survived!), my cancerous, liver disease dog that lived an additional 4 years and now Jones (which was basically a let us give this 3 months and see where we are at situation) which is still here and kinda stable all things considering. She can not believe how much work, research and time I put in. She always listened to me when we were doing check ups about what I saw. She realized I was on the ground, day-to-day with my pet and was the best source of information in that regard. It was a real give and take scenario, that I believe, gave my pets the best care. She even came around to the methods here when she saw the results. Our current IM vet is working out ok in that regard as well fortunately.

I agree, a list would be nice but not sure how many we would have on the list.

I wish you luck

 

I do think it comes down to ego in a lot of cases. I have been very careful about saying things like "...well the people on my online forums say..." The one time I did come out and say it, I saw the "oh God one of those face". Luckily mine seems willing to at least listen to me. Her boss told me to go up a unit to 6 units (was 5 at the time) and thank goodness I didn't listen. Fast forward 2 months...our optimum dose seems to be 1.25 u of Vetsulin. And this is the woman in charge of the practice who told me to go up. Scary. I thank God for the experienced and kind people here. They got me to where we are now...regulated.

 

Ego/professional arrogance absolutely plays a big part. How dare we not follow their every instruction without questioning it!

That CYA can go both ways. You would think my vet would realize that if I did what she said, and it killed my cat, it would be her fault. I have written proof that she insisted on me giving the full dose even when I questioned the safety of that and told her I was not comfortable with it. On the other hand, if I disobeyed her and killed my own cat, she would not have any liability since she has proof of instructing me to do otherwise.

I NEVER mentioned this forum or any 'online cat people' to either vet. I made sure she knew I was doing extensive research. I try to limit my reference sources to 'legitimate' ones a professional should respect, like the AAHA guidelines or the insulin manufacturer documentation or at least other veterinary professionals.

I am taking my civvie to see an internal medicine specialist soon, and I may see about getting an appointment for Mia, too. The specialist has a lot of experience and endocrinology is one of his areas of interest, so maybe he has more than your average knowledge about diabetes.

 

We are the ultimate ones responsible, so I'm glad you saw fit to follow your gut!

 

In the end, the only living creature I need to answer to is my pet.

I may get some things but I am applying my everything into 1 animal every day - not the 30 animals that they see in a day. And medicine is not an absolute, it is an art.

 

Too bad we cannot get insulin without a prescription.

 

Apparently I am supposed to be able to here in Alberta. My pharmacy won't without a script from the vet, but I was going to go and try Costco this weekend. After the last fiasco at the clinic.

It just seems really whacked that you need to hide stuff from your vet, they are supposed to be your partner in this.

 

I would still keep your wits about you with the internist specialist. I just took Bodie to a internist specialist with valet parking (bah!) and when I mentioned the 'online cat people' he rolled his eyes. I use it as a test. I think if the vet truly has your cat's best interest at heart any information they can get would be welcome.

 

Yeah that's a problem with ProZinc

One of the things I really like about Lantus and buying it from Marks in Canada is that once they have a script, they don't require a new one every year. I've gotten China's script refilled multiple times over the past several years without having to get a new script from the vet

 

I got very lucky with my new vet. She said "well you really only need me for the insulin prescription" after seeing my spreadsheet and the forum. Of course he goes for other health issues and check ups but she doesn't make me bring him in for curves or any of the other money maker tests. I do call and tell them we increased the dose about once a month.
I think posting to see if anyone in your area knows of a good vet is a great idea.
With the new Dr your civvie is seeing... Put feelers out there. Ask them if they support home testing and dose adjustments by you based on those test results? Do they require in house curves and monthly bloodwork? You could be completely honest and say you're looking for a vet to work with you as you treat him at home. Not a vet who is going to get their ego hurt every time you go against their recommendations.