1/17 Max Amps 332~+6 125~+7 187~PMPS 453

Good Morning LL
This day is not starting out on the right foot.
Finally had some news from Jill and Cassandra about what was in Jojo's mind.
Consideration should be given to Cushings, IAA and Acromegaly. The good thing is that I did mention them to the vet on Friday since I read their concerns in another condo at 5u as well.
The vet did not seem concerned about those conditions yet. As I have said she thinks his numbers might be high because I am stressing him by testing so much and wants me to stay at this dose for another 3 days, do spot checks and then full curve and fructosamine.
Jill and Cassanadra suggested to bring dose up by .5 although I don't know why not by .25.
Then I started to cry, I didn't know what to do this morning, shot the 5 for now and forgot the Lantus on the counter for 1.5 hours, so now did I ruin it?

If I do what I want, and not follow anything the vet says then honestly, I don't/won't have a vet to go to and will now have to search again and this vet is internal medicine at the only Emergency Hospital we have here. She only treats her patients with Lantus. I guess I should have asked her about her other patients and what they are doing for hometesting.
Then if I don't follow anything she says and it is possible that Max might have any of these conditions, how will I ever save him.
I value everyone and everything I receive form this board but I am at a loss for knowing what to do.
Sorry this was so long. I love my Max so much and just want him to get better. I could not bear the thought of losing him.

Yesterday's Condo

 

Re: 1/17 Max Amps 332

Randi--The last time Moonie was at my new vet, the vet told me that there was a big Vet conference, where they discussed home testing VS. testing in vet's office!! The vets decided that because the cats know the test is coming from the bean, they get stressed & therefore raise their own BG levels :shock: :shock: :shock:
Oh SURE, Moonie is very stressed when she is gobbling those halo treats & I sneak in & test her ear for a split second, versus, going in a cat carrier, trapsing to vet's office, & having cat tested there!!!!!!!!
This is totally irrational & their justification for cats being Less stressed for testing at vets office, is that they know they will be poked & prodded AT the vets, so they get prepared cat(2)_steam
Are They KIDDING????
I know how you feel and do feel for you..This is a trial & error disease, if one dose doesnt work, we try another-Right??--If there is an underlying ilness. we need to know, and you will deal with whatever it is..You love Max & he is top priority..
Let's see how today goes--We are all rooting for you--(((((RANDI)))))

 

Re: 1/17 Max Amps 332

(((Randi))) I think your Lantus will be fine. We refrigerate if for long term use, but it is unlikely to go bad after just 90 minutes out. You are in a very difficult spot with your vet. My vet was very much like yours in the beginning, but we did find a way to agree to disagree with each other. It sucks that you have to pay for a Fructosamine test that you don't need, but I guess if that's what you need to do to get her support, then that's it. Maybe you can bargain a bit and say, OK, I will try what you suggest, but please, if at the end I still want you to send these other tests out, please respect my wishes.

As for your SS and tests: reflect what she wants to see on your SS. Not everyone's SS is always completely up to date. Sometimes some of your spot checks are in your notebook, but you haven't had a chance to update your SS.

I can't suggest to you what to do about the dose, and how to reconcile your vet's wishes and the LL suggestions. I know which one has always worked for me. I hope you sort it out, and that you feel better about things soon.

 

Re: 1/17 Max Amps 332

Randi,
I am so sorry to hear the troubles you are going through. I totally understand your stress.

I don't think you should feel you need to switch vets just because you don't follow their exact instructions. Just stand your ground with the vet. You are the pet owner and really have the last say. I can tell you from a previous experience with another cat who had CRF and the vets told me there was nothing they could do and they were pushing to put him to sleep, but I stood my ground and pushed for more testing and more treatment. In the end I spent a lot of money, didn't find out much more than we knew from the beginning, but was determined to continue to do treatments at home. He pulled out of it, something that the vet was extremely surprised about, and we had him in our lives for another year and a half, before complications from CRF finally took him.

I did finally find a new vet, but not because I didn't follow their instructions, it was because I just felt that my cats were not getting the care they deserved. I asked all of my friends with cats where they went and I was so glad when I found my current vet. I still don't always follow what the vet says, but again I am the pet owner and the final decision on what treatment is done and how belongs to me. The vet is just my sounding board and another professional opinion of what is wrong and what should be done, not the end all end all right answer.

I am praying that you see some response to all your efforts.

My heart goes out to you.

 

Re: 1/17 Max Amps 332

((((Randi))))

I second Linda's comment re: your lantus. Put it back into the fridge and it will be ok.
I'm very sorry that you are going thru a lot of stress right now. Your vet doesn't have to totally boss you around. I think you can come to some middle ground however, you will likely have to be strong.
Hang in there... we'll support you!

 

Re: 1/17 Max Amps 332

(((Randi)))

I have left my Lantus out for a couple of hours and it was fine.
It is hard going against a vet that we like and want to stay with. As Linda says sometimes you have to agree to disagree with your vet. I think it would be ok to say to your vet that although the tests may not show anything it would make YOU feel more comfortable treating Max by having them done to rule out some things. She may not agree with how many times you test Max but that is ok. She does not need to know everything.

As far as having a fructosomine test done my vet always tells me that she would not do one on Putty because I test him enough and it would be a waste of time and money. Maybe you could tell your vet you would rather spend your money on the other tests right now and wait to do the fructosomine later.....at least that may sound like a compromise to your vet.

I am sorry things are so tough right now.

 

Re: 1/17 Max Amps 332

I have to agree here with the others
((RANDI))) Max will be ok, u be strong for him and love him like u do. We are here for u no matter what.

Sending prayers that you will find comfort in our words.

Maybe u could post a thread in health about ur vets theory that the testing of BG's is causing him stress, in the hopes Dr Lisa will weigh in and help ease ur mind.

In all honesty, u could just give ur vet a "condensed" version of SS to get her off ur back and to get her to move on to real health issues - cuz honestly, poking the ears should be the least of her concerns, she needs to focus of the important testing, and I know u want to keep her, is that something u might consider?

(((hugs))) to you and (((Max)))

 

Re: 1/17 Max Amps 332

Randi:

Take a breath. First, do you like your vet? If this is someone you like and feel you can work with, great. If not, you'll find another vet. I'm thinking you basically like your vet.

Like Linda suggested, you can have more than one SS. The one you use for yourself and the one you take with you to the vet. That will keep the vet happy. Over time, you can educate your vet about home testing. There is a very good article about home testing by Jacqui Rand who is an expert in FD. I can send you the pdf.

Remember that most vets don't have beans who are as actively involved in their kitties diabetes management as we are. They are used to people who shoot blind and just as blindly do what the doctor says. We don't do that here. We want you to be empowered to do what's best for Max. In most cases, this is consistent with what your vet would recommend. You've been here long enough to know that some vets are not well informed, though. What I would remind you is that most vets are not experts in FD. They have the truly daunting task of being general practitioners who have to know a fair amount about every possible illness and organ system and not just as it relates to one species. They have to have a knowledge base that spans species unless they have a specialty practice. If you put this in human terms, think about the number of times you've sought out specialty care -- you don't go to a cardiologist if you need a UTI treated. Geriatric specialists don't treat children. But, we forget that vets treat lions and tigers and bears and snakes and ferrets and cats and dogs. There is no way they can be experts at everything.

As far as the dose, If you go back through the dosing protocol, there are guidelines regarding when you can increase by 0.5 vs. 0.25 units, the former being when numbers are in the higher ranges. That said, if you are not comfortable being aggressive with a dose, you don't have to be. No one is going to slap your hand if you want to increase by 0.25 if that is more comfortable for you. As far as I know, Max isn't having problems with ketones. If he were, that might be a strong reason to increase the dose by 0.5. Also, it's perfectly reasonable to ask for a clarification if you are unsure what the rationale for an increase or a decrease is. Like I said, you need the power of information on your side and the experienced people here are more than generous at giving you that information so you can be at ease with making decisions on Max's behalf.

 

Re: 1/17 Max Amps 332

Just a few more thoughts:

The more I think about it, the more I like the idea of a separate SS with Canadian numbers for your vet. Easier for her to read. No colors. No dose info. You could even do it on a paper graph that she could stick in your file. I bet she would like that. Don't give her the link to your main SS.

How does Max do during his testing? If he takes it pretty well, you could tape a video to show her that he is not stressed out.

Have you read any threads on the High Dose insulin support group? There is good info about testing and frequency of Acro etc. in the Sticky called "Acromegaly and Other High Dose Conditions: What We Know". There is also another thread there under "$200 to test for acromegaly!" which has some experiences from Canadian members.

 

Re: 1/17 Max Amps 332

Linda (and everyone for your support this morning)
I have no problem in "hiding" the SS. BUT, if she is expecting me to say at 5, how do I show her numbers that are really based on 5.25 or even 5.5. That is my huge dilema. I will test as I see fit, its just whether I leave him a couple of more days at the 5. Especially if I moght need to consider these other tests.
Where do I read about the High Insulin support group? I am not sure I saw that and the Acro sticky.

 

Re: 1/17 Max Amps 332

in here:

viewforum.php?f=5

main page for ISG forums

 

Re: 1/17 Max Amps 332

Maybe 5.25 is a good compromise? I defer to those with more experience on this.

 

Re: 1/17 Max Amps 332

I suspect she might even be told that 0.25U are immesurable and useless.... however we all KNOW that fat and skinny are actual doses.

 

Re: 1/17 Max Amps 332

A good rationale for increasing the dose is to give her a copy of the Tight Regulation Protocol along with the research to back it up AND to point out that you want to do whatever you need to do to keep Max's numbers below renal threshold. If that does not get through to her, she needs to provide you with a cogent and science-based explanation for her treatment recommendation. If she can't, she's shooting from the hip. I've often found that pointing out that in this pile we have the research that points to significantly positive outcomes supporting doing things this way. In this pile, we have no evidence other than what you think may or may not work. Boiling it down to, "If this were your child and your pediatrician said that this is what I personally think you ought to do regardless of what the research indicates is the prudent, evidence-based approach, what, as a parent, would you do?" When put on a personal level, it may get the vet to listen.

 

Re: 1/17 Max Amps 332

I don't think you should feel like you can't tell you vet what you are dosing. Just because they suggested to stay at 5 units doesn't mean you have to do that if you don't feel it is the right thing to do.

On Wednesday, my vet suggested that I keep Sami at 1 unit for another week, but based on protocol and opinions from this board I went ahead and increased to 1.1 unit Thursday morning. When I took Sami into the vet on Friday I was open with the doctor and told her that I went against her recommendation and increased even though she wanted to stay at the same dose. She might not have been happy about it, but it was my decision to make the change. My bigger mistake was following the doctor’s recommendation in increasing from 1.1 to 1.5 only after 4 doses at 1.1. I found that to be a very bad decision as you can see from Sami's SS, and ended up having to skip a dose.

In the end you need to do what you feel is best, and don't feel like you need to hide it from your vet. Like a lot of people on this board have said, if your vet isn't a specialist in FD then they might just be using their own protocol based on past experience, and what they learned from books. Just do what you feel comfortable with and don't worry so much about what they vet might say about it.

 

Re: 1/17 Max Amps 332~+6 125

Well clearly something is happening here today,and not only with the board
barely working.
I skipped the +3 this morning and went for +6 - I tested twice, in both ears and I got
125 and 128. another 200 point drop and he had a couple of snacks in between.

Now what if anything to be worried about? I have not seen blue in 5 weeks.
You see, last time I was worried and concerned he went yellow.
Now blue.

 

Re: 1/17 Max Amps 332~+6 125

oh thats neat! something happening indeed!

 

Re: 1/17 Max Amps 332~+6 125

Yeah, and??, lol.
OMG I'm glad I'm home. Like maybe I could see green??
WCR: mostly sleeping on his chair, no doubt from the drop and being so low (for him)
What should I watch out for and when should I test again?

Hey is he bring a drama king?
Maybe feeling left out by some of the Drama Queens residing here. (gabby, shadoe, moonie...love you guys )

 

Re: 1/17 Max Amps 332~+6 125

u know what I'd do if that was my cat? I'd get a +7

 

Re: 1/17 Max Amps 332~+6 125

You mean if you were testing your cat you would test at +7? lol
I gave him a bit of food. But I will go do it in 5 minutes.

 

Re: 1/17 Max Amps 332~+6 125~+7 187

Max looks good in blue!!!!!!

 

Re: 1/17 Max Amps 332~+6 125

Ronnie, that was just TOO funny! :lol:

Randi, here's my 25 cents worth. You have already collected a lot of data and should have a handle on Max's nadir. Give the vet's theory a try for a few days - test ps and nadir. That way you can still ensure that Max is not in any trouble of BG going too low, :mrgreen: and can prove or disprove the "stress of home testing" theory. It won't HURT Max and might ease the vet's mind.

I see that you got a couple blues today. (Yeah!!) Could it be possible that the 5.0 u is finally kicking in and starting to work?

As for the home testing stress theory - MY theory is that it is a bunch of poo poo - in most cases. Sounds to me that Max ENJOYS the testing and the extra time he gets attention and special treatment. ECID and maybe the vet needs to understand that fact. It may be stressful to some cats, but not Max.

Don't beat yourself up so much. You are a GREAT bean and Max is lucky to have a mommy that cares so much. You will find a way to work this out with the vet.

 

Re: 1/17 Max Amps 332~+6 125~+7 187

Thank you so much Jamy.
You sound like you have been reading my thoughts too.
The funny thing is that I work outside of the house all day and if I did not have
my housekeeper who dotes on Max and loves to test him then I would never
have daytime numbers. I will see what tonight's numbers bring and tomorrow
AMPS and although every day is different, I do have some idea how Max's SS goes.
Of course with a few blimps.

BTW, was that totally not the best comment of the day from Ronnie??
I guess she held back from saying: and +8,+9,+10.....lol - 'we heart u Ronnie."

 

Re: 1/17 Max Amps 332~+6 125~+7 187

She sure showed some restrain! :lol:

Nice blues! Am very happy for Mr. Max!!!

 

Re: 1/17 Max Amps 332~+6 125~+7 187

((((Randi)))) you're doing a great job, it's hard to balance the advice you get from everywhere. I like my vet but didn't really want dosing advice from her, so my solution was to "forget" to bring or send the spreadsheet. Once Lucy was well controlled I gladly shared the spreadsheet. Not that honest, but now my vet says that I understand Lantus dosing better than she does.

ps, the reason Jill suggested a 0.5 increase instead of 0.25 is because once cats get to higher doses we can do that, numbers permitting:

Alternatively, if the cat is continuously producing moderately elevated BGs (nadir always >=200 mg/dl), increase the dose every 2-3 days by 0.25 IU ( if the cat is getting a low dose) or 0.5 IU (if the cat is getting a higher dose).

 

Re: 1/17 Max Amps 332~+6 125~+7 187

Nice cycle u got there Randi...Max being a good kitty

 

Re: 1/17 Max Amps 332~+6 125~+7 187

((Randi)) You certainly have gotten great ideas here today....what to do about your vet
and what to say about the dose you want to give Max, etc. It is quite a dilemma when you want to keep this
particular vet cause of her emergency hospital status, etc.

Max showed some blues today...he must be reading your condo too! LOL It will be great if he doesn't need the increase...
on the other hand, maybe a little nudge will be needed one of these days. But he did show you some blue and that is soooo great!

I guess many vets may never understand us here and the way we test our kitties. . BUT, I doubt you would refrain from testing just cause of what she said to you, would you?
So, the only other thing to do is to not mention it so much to her. Different SS to bring to her if you want to....
Duh...just thought of something...I bet Max will be getting lower numbers now so she will have to admit that he is NOT stressed...so just forget about her.

The Focus is on your MAX and test almost as much as Ronnie suggests to you... :lol:
BTW, if you hadn't gotten those 2 tests today, you would have missed the blue numbers!!!!!!

MAX is the important one here...certainly not your vet. And if the experienced people here on this board see things that the vet might have missed or not focused on, I would not hesitate to explore the things they suggest. Her feelings or her opinion of you have nothing to do with anything....it would be nice if she respected your thoughts, but if she won't, oh well. She might not be "concerned' about things, but if you have a concern about your MAX, then she should listen to YOU......
Remember, YOU are paying HER...she works for YOU!!!

Now, give Max a big hug from me and tell him that Raja & Shadow want to know what time he is going to Luna's party.....they
can't WAIT...so excited....Raja's planning Shadow's party and she even said something about Max's too...she likes to plan ahead....
waaaaay ahead.... :RAHCAT

 

Yup, what a cycyle. Here is the bounce. Ouch. I was holding my breath as the meter counted down. Mr. Max was Mr. sleepy today. I guess he had no idea what to do with these numbers.

.

I know, can you believe it. Still on the fence for the next few days. Of course I will continue my testing, not tell her, show her the numbers and move on from there. I also plan on calling my old vet again, and ask her opinion if she will follow Max medically but respect my dosing choices. She is not familiar with Lantus so maybe that's a good thing? She definiately understands Diabetes so maybe this match up might work. She was very devoted to Max's care when this first started, she would call me on weekends from home and I had her private number as well.

What do you think of that plan?

 

Max, nice numbers buddy; keep up the nice colors.

Randi,
Do what feels right to you. By now, you know enough to be able to stand your ground with whichever vet you choose. You have been testing and know what you are seeing from following this protocol. It works and that's that. I would think that the vet who cares so much about Max is also going to be more receptive to accepting your choice of treatment. You could do something similar to what I have been doing.

There are a handful of vets at the animal hospital around the corner from me and it's the place I have always gone in Toronto. Each vet there is diff and each has his/her own levels of knowledge. The one I like the best, overall, does not know as much about diabetes, but she was informed enough to know that Shadoe's numbers required more than trying a change of diet! as suggested by the other vet who had more knowledge on diabetes.

I am the boss. Always. My cat, and you, the vet, serve me. That's right up front. I always take my ss with me, and a copy of the protocol and other info related to any particular visit. I demand copies of everything and want explanations which I do write down. Don't talk fast please; I am writing.

I know my daughter would disagree with my bull in a china shop approach, but for the most part it works. When I had waited all Sat and then Sun with no call back from the vet to discuss Shadoe's results, I stormed in there with my printouts and demanded to talk to a vet, and yes, I would wait.
I am afraid I tend to get loud and cause scenes when angry and when you mess with treating my cat, I get real angry. And I demand attention and resolutions.

You don't like the dosing I use? Tough. You got something to back your advice? Show me and we will compare it to what I got, OK? Here is my cat's ss and this is how I am doing things. I am not here to discuss what methods I am using, ok? I want you to run this list of tests, and don't tell me we don't need to run this one or that, just run what I want.

Randi, honest, when it comes to health, yours or Max's, you need to be firm, do your own research and then demand service. We can't expect all the vets to be experts, just like human drs. For special
stuff, we are sent to specialists, but it's a bit tougher with vets, so we need to help the vets out with info. I never hide what I am doing from my vet; the vet is to serve us, and it must be a partnership. Make it a good partnership. A good vet will welcome a partnership.

Max, let's see some more nice numbers tomorrow OK?