1/21 Asia PMPS 356 shot half dose

http://www.felinediabetes.com/FDMB/threads/1-20-asia-pmps-203-2-139-back-from-er-all-is-well.189895/

AMPS 81, we are past our normal shot time by 20 minutes already but wanted to check if anybody was around. Asia did what she did last night, she ate about half of her meal, enough to give the impression that she is eating, not unusual for her to eat a bit and come back later, that's how she is typically. Last night, however, she really didn't eat after that. She would go to the bowl and spend a good 5 minutes looking like she was eating and then leave and the amount in the bowl remained unchanged by appearance.

So while she technically ate the amount she would have for me to give insulin, I'm going to assume she can and probably will continue some of the patterns from last night for not eating today. I don't want to entirely skip her shot, I think she will end up in blacks if I do that, 9 out of 10 skips/FS agree (with data to back it up).

Opinions on a dose, cut in half? .6 units ish? I have calipers and can do that.

 

Hi Stacy, I just read the rest of your condo from yesterday.....I'm sorry you had a bad ER vet experience.
Have you given a shot? Sorry, I have no advice as to dosage.
Do you think she's still nauseous?

 

She's still funky in some way, not sure it's nausea at this point, haven't given the shot.

 

I'm always s little iffy with a low-ish BG coupled with an iffy appy...if you stall a bit longer snd see if she'll eat more, would that throw your schedule off too much?

Others may have more solid suggestions. All sorts of vines coming your way.

 

Better a day too high than an hour too low.

Any ketones in the picture?

 

No history of keytones, checked most recently on Friday.

 

Skipping shot, she's not coming up anytime soon it would seem

 

Good.
So at +13.5 BG is 78-basically unchanged.

If it were my cat I would skip.

 

I agree with skipping, too. Appy and feel better vines!

 

If anyone wants to read my ER visit novella, here you go:

Had a horrid ER experience last night. Asia has not been eating well (1/6 of her usual) and I gave her insulin assuming that she was eating well enough (as she had been yesterday until after shot time) and that the new dose of cerenia would be on board to help. She wasn't eating more than bites after eating a decent bit of her preshot meal. This became obvious shortly after her shot when she refused to go back to finish it. So I had two choices: monitor her all night long with only the ability to pump her full of sugar (Karo) as needed or... go to an ER with all the bells and whistles and see if I couldn't get some expensive and fancy tests done (that my vet has to outsource anyway) to figure out why she wasn't eating in the first place. It was a big mistake, but I chose option 2.

I brought with me her monitor, strips, Karo syrup, my notebook with all of her history and previous labs, my SS. Hopped in a cab and we were on our way. Arrived at ER and the receptionist asked my reason for bringing her in and I said she's not eating, she's diabetic and has kidney disease and I'm concerned that she isn't eating.

She came over to make sure I really had a cat in there and then sent me to a room with some paperwork to fill out. I hadn't even finished the paperwork when a vet tech? came in and peeked in the carrier (Asia was hiding her face as per normal when she is really scared, she usually hides her face in to my body if we have contact) and said is a very worried and pleading voice:

"Oh, she looks really 'down', do we have your permission to take her?"

"She's okay right now, she's just scared, why do you want to take her and can I talk to a vet first please?"

"We need to get her bg, she looks really down"

"Can I speak to a vet first please? I just took her bg, she is okay right now"

"Please just let me take her downstairs and get her bg checked and a vet will be right up to talk to you." Complete with sad puppy eyes and upturned eyebrows, clearly implying my cat was obviously in a terrible condition and she knew it, but I was oblivious and they just had to help her in spite of me. I asked could I please go with her while they checked as she is old, deaf, and more scared than most as she's had very little experience going to a vet as opposed to a vet coming to her. No, I could not go with her, it would be really quick and the doctor would be right up.

This, dear readers, is where I should have turned and left with my cat. But I didn't, I thought as soon as I could speak to the vet, maybe we could get somewhere and figure out what is going on. I consented to the bg check as that was the only way they would let me speak to a vet, stupid me. Side note, why do my kids/cats only get seriously ill after hours and on weekends?

A few minutes later a vet? (I suppose, he didn't introduce himself or even say hello), came in and said "Sabrina". Like a statement. I'm sure I had quite the puzzled look on my face as I tried to guess if were calling me Sabrina or thinks I have an animal there named Sabrina. I told him I'm Stacy and my cat is Asia, are you meaning to speak with me? You know, just to make sure he didn't go in the wrong room and I was going to now be making decisions for someone else's animal due to a mix up. His response: "You brought in the hypoglycemic cat. It said Sabrina" ...moving on...

He informed me that Sabrina's bg was 89 and that it is a really low number. He asked what insulin I was using and how much and when was the last time she ate and how often she ate. I answered his questions telling him how I monitor her and what her numbers have been doing recently, he mansplained to me that "we" don't shoot insulin when a cat isn't eating and "we" only feed diabetics twice a day, and "you" are counteracting the insulin feeding her that often and "we" don't like numbers to be below 200 (or something similar, it was well high is all I recall, even by SLGS standards). I tried to show him labs and my SS so he could get an idea that I was on top of her diabetes and not shooting blind and utterly clueless, he looked away! He asked if I was checking her urine frequently. For keytones? No, for glucose! I again explained I monitor her bg with a glucometer several times a day. To say he was condescending would not only be an epic understatement, but far too kind an adjective to describe him.

I tried, several times, to redirect the conversation to explain why I was there in the first place and I would like to have some diagnostics done on her heart/kidneys/pancreas specifically to try to figure out what's going on and perhaps why she isn't eating. I explained she had CKD and labs pointed to pancreatitis but it was unconfirmed and that her phos was high. He said she really needs to stay overnight they could maybe do a sonogram in the morning, he'd have to check if the right doctor would be there, but we could do all of those things on Monday. Okay...

I asked what would/could they do for her overnight and what would be the reason/benefit for leaving her there vs bringing her back in the morning as I have not left her anywhere and she would be quite frightened. He mansplained some more that "everybody says their animal is frightened" and her bg is really low and she needs to be on fluids overnight and they would implant a continuous glucose monitor and make her "hyperglycemic" to counteract this event. "So you're going to just put sugar and fluids in her, no food?" Yes. And I told you she hasn't been tolerating the fluids well and I'm only giving 50ml at a time, I'm concerned about her heart. Monday.

I said okay, you can bring her up, I can give her fluids and sugar at home. His look could best be described as "you idiot girl" and he left the room without saying a word. They brought Asia back up, I shot her full of Karo right there knowing we wasted precious time and they had done nothing other than open a vein to take blood and stress her out pretty bad. I'm disgusted and out a few hundred dollars with nothing to show for it other than a freshly bloody cat carrier and a sick cat that will have to wait for help until Monday when my vet is open again.

P.S. I had their report sent to me already and for a cat that was looking so "down" they marked her as QAR, quiet, alert and responsive.

 

I hope Asia starts feeling better soon!

Im sorry about that disastrous vet you saw =( I have had that before too with Gordy.

(Vet told me I need to be using u40 syringes because G is a cat... and argued with me when I said insulin drives the syringe, not the being. There was more to that convo, but I ended up packing my upset cat up and leaving.)

 

I'm so sorry this was such a horrible experience....I don't get why people like that actually bother becoming vets. And "Sabrina"???? OMG is all I can say.

I can't remember, is Asia getting any pain meds right now? Since there is possible p-titis, bupe could possibly help. A lot of times they won't eat when they're in pain.

 

There should be a sticky for this "How to navigate ER visits effectively"

 

I am so sorry and shocked at your ER experience. I sure hope there’s another one to go to if you need one. I’d talk to your vet. I bet you saw an intern. This sounds to me like either kidney related or pancreatitis and I’m shocked that they didn’t start by running a blood panel. I hope the cerenia helps with the nausea.

 

Oh my goodness Stacy. I'm so sorry you had to go through that. Have you ever been to this emergency vet before? Not Blue Pearl? My IM vet recommended Blue Pearl in Paramus for cardiology. Dr Andrea Eriksson, here's the link. Or Oradell Animal Hospital to see Donald Schrope, DVM, Diplomate, ACVIM (Cardiology)

 

I can deal with a brusque bedside manner, it's the superiority complex, condescension and refusing to listen to anything I have to say about my cat part I have a huge problem with.

She is getting .75 bupe every 8 hours, he started her out at 1 but it made her a little loopy and "we" don't want that for a regular thing

I gave her 1 last night when we returned instead of her .75, back to .75 this morning though.

 

Unfortunately not, "we" are a senior clinician trained at the Royal Veterinary College that did an internship in cardiology, sure looks good on paper.

https://bluepearlvet.com/new-york-midtown-ny/our-team/jeffrey-s-ganus-dvm/

 

I have no words. It's just such a crap shoot as to the quality of vet you'll get when you have to go to the ER. But you're right, these emergencies always happen after-hours or on holidays.

 

My catupuncturist vet recommended this Blue Pearl, no doctor in particular though. I do not have a car in the city.

 

Ugh, Stacy, I am so sorry you had that awful experience! If you were in Arizona; I'd have sworn you saw the same doctor my friend saw at our nearby ER vet! Luckily, I went with her and her dog, and the doctor was nothing if not extremely rude and condescending - I encouraged my friend to leave and go somewhere else. I work with three vets, and they may not have all the answers, but they would never get away with such disgusting bedside manner and condescension!

It's such a shame when you end up with a doctor like that - we have one at both of our nearby ER vets, and that's why I recently opted to go to the bit further one that I had heard was much better. We're fortunate to have many in our surrounding area, however. Maybe your regular vet can refer you to a better specialist for additional diagnostics for Asia?

What makes me so angry with this, is that at our clinic, we constantly have to explain to people why certain diagnostics are so important, but many pet owners don't want to run "tests" and only want medicine. That ER vet had a person in their office that was ASKING for good diagnostics, and he chose to be a jerk instead...makes me so upset! It's really people like that who give veterinarians a bad name.

Hugs

 

You are so right about that, he chose to be a jerk!

Thanks Tasha. Fortunately? This has been my only awful vet ER experience, the few I’ve had previous to this were wonderful and compassionate and most of all, helpful experiences. They were not in the city though. This awful place is nationwide and almost has a monopoly here, several locations in all the boroughs. Sigh.

I 100% agree with you, my vet may not have all of the answers, but he’s kind and gentle and willing to work with me to find the best solutions for Asia, that’s more important to me. I think the place my vet uses is the other ER we have here and their reviews are also abysmal, it’s hard to know what to believe.

I’m fine with running all the tests, my problem is I don’t understand why I can’t be there so she will be calm and less stressed. They wouldn’t dare take a human child away to do things like that, I don’t understand why it’s any different for animals.

 

Good for you standing up for Asia and walking out when it became apparent they were only there to talk at you instead of listen to you and work with you to maximize the chances of having a successful visit and treatment plan.

Continued well wishes for Asia.

 

Good grief....he is interested in cardiac and endocrine disease and he was so incompetent!

Vines for Asia to eat today and maybe a good yoga class at home and some meditation will help your BP. Mine rose just reading this.

 

I'm so sorry you had to go through that. How horrible for you and Asia. I hope she starts eating more for you today and you can get some answers soon. Sending prayers.

 

I think a lot more clinics are adopting an open treatment area policy. It's a tough one though on both sides, for me.

Being on the other side of that as a vet tech - we do tend to see more pets stressed by their pet parent's presence than calm. It tends to be more the case with dogs than cats, I think. The problem we often run into when we allow clients to stay with their pets is that they will either 1) ask to restrain themselves - which is, unfortunately, a huge liability or 2) tell us we are doing something wrong/hurting their pet/not doing it right, etc. Now, that is not ALL people, obviously, but it happens more than you'd think. We're typically happy to allow clients to accompany their pets for diagnostics (other than those involving radiation), but we have had some problems with the above situations, and that makes the diagnostics take much longer and actually become much more stressful for everyone involved. MOST of us are not going to do anything to hurt or scare the pet, but we do still need them to be quite still for most diagnostics, and that involves safe, calm restraint which some owners misinterpret as cruel. That being said, every situation is different, and we always give people the benefit of the doubt if they want to accompany their pet.

Also on that note, I wanted nothing more than to be in the treatment area with Darwin when they ran diagnostics at the ER vet we recently went to, and was not allowed; so I can certainly feel it from both sides.

I think it comes down to communication though. When clients accompany their pets for diagnostics (especially blood draws); I explain exactly what we are going to do, and how we are going to safely restrain their pet and they are usually not quite so nervous about what they are witnessing.

 

That's just what had to be done! They weren't planning on doing a single thing overnight that I couldn't do with less stress on her, less equipment (CGM, can we say infection opportunity), and for less money.

It was a teaching moment, DD was with me and on the walk to find a cab I said "Asia is very sick and still needs care, why did I leave with her?" She's clever, she knew. And I reinforced you always have a say in your care, even if someone with authority insists they know better, and you have to stand up for yourself.

 

RIGHT?!?!?!

 

I do understand the flip side and exactly why many are hesitant to allow it. I think it helps to actually pay attention to people, or to know people if you have an established relationship like a long term vet should. I also think it's a big tell if they want to be there in the first place as so many people are the "I can't watch" type.

I know how Asia will react me being there vs not and it's even worse now that she is deaf because vets still try to smooth her with words (I don't fault them, I talk and sing to her all the time anyway) but they often don't listen when I give them tips on how not to startle her. If she is looking at me, she remains terrified but calm, and may grumble a little bit, no growing or hissing. My vet was able to do a cysto and blood draw without a peep from her simply because she was looking at me.

If I am not there, I know how she is because I can read it in the dr notes.

Here's just last nights example, mind you, she was "so down" according to whomever that was, I don't know how she managed to do any of this: "growling, hissing and fractious"

I don't even know what her hissing sounds like because I've never heard it before! And believe me, my come to your house vet has needed to restrain her, several times, in front of me, it didn't look like a good time and Asia wasn't happy about it, but there was zero hissing involved.

I would think it could be as simple as some ground rules, "we need to do x,y,z and if you interrupt or get in the way we will have to ask you to leave or have to quit the procedure and still charge you for it." It's easy to establish boundaries, you can't control what people do, but you can enforce the boundary regardless. If it's not that simple, figure out what human doctors do re: children and copy their SOPs!

I know it must have been extra hard for you with Darwin, considering you do work on the other side (shouldn't that be a healthcare professional courtesy that they would make an exception for you)? Sounds like you work at a forward thinking practice. I like it!

 

Carla, I know you feel me! I'm pretty sure this guy and the person at the pharmacy you no longer visit could be the best of friends!

 

Oh Stacy, reading your account of the ER vetty visit made my blood pressure go up!

 

Looked for update all morning and couldn't find it. Old tired eyes I guess. There isn't anything that can be added except to say that I'm so sorry you and Asia had to go through that and we are sending you tons of love and positivity and healing energy. Myagi hearts his girl!

 

Was chatting about that with "ultrasound-vet" when she did Quintus's last. She was commenting on how relaxed Quintus was, and that my presence was clearly calming him (I was giving him lovely head scritches and chin rubs during the whole thing, helps!). She said it wasn't always the case that the owner's presence calmed the pet, and I suggested that maybe hyperanxious or freaking-out owners probably didn't, and she said "oh, indeed, good point". Seems so obvious to me and was surprised it didn't seem to her.

I've only rarely been "forbidden" to go with my cat. At the teaching hospital, indeed, they whisk away the animal for a first exam while a team of vet students get all the info they can on the case out of you. Other than that, surgeries, of course, and sometimes ultrasounds. I've actually watched on during a minor tooth extraction.

Yeah, with you on this one. Seems to me that it comes down to not being that good at handling humans -- IMHO an absolutely necessary skill as a vet.

Your horror story makes for compelling reading, but so so sorry you had to go through it!

 

Hope Asia is doing better today after that horrible experience.
My vet actually insisted that I be in the tiny ultrasound room with Yum when she had her last Ultrasound. I held her paw. :^)

 

Asia's appetite is much improved from last night, it's far from normal and she's still in the thick of whatever crisis is going on, but she's well in to pinks at this point and I have no interest in making this whole situation a lot worse with horrible kidney numbers. I think I'm going to shoot half of 1.25 in about 30 minutes. I can do the Karo all night thing again if need be, but a) I doubt she's going to zoom out of those high numbers and b) it's such a tiny dose and following a skipped shot, I'm skeptical that she would get very far with it anyway.

If anyone thinks this is an asinine decision, please speak up.

 

{{ Hug }} Stacy.

 

Hugs from us too

 

I'm glad to see her appy is improving...kitten steps. I agree that, given her BG and improved appy, shooting something was a good idea. Prayers continue from us!

 

The depot is probably somewhat drained from the skipped shot, so if you are confident she will continue to eat, I would go ahead with a BCS, since you will monitor.

 

You can always syringe if necessary. I’d shoot too.

 

YAY for better appy!

 

WOW on that ER visit! Stacy, I'm so glad you got Asia out of there.

I'm glad that her appetite is OK and that you shot a half dose.
Sending lots of vines for Asia and for you.

Thanks so much for Rusty' vines.

 

I would probably shoot a BCS tonight as the depot has drained . I am so sorry you had such a horrid ER experience. ! Vines for her appy!

 

I hope you never have need to visit an ER in the city, but I can at least tell you which one not to go to!

Thank you, she needs them and yay for a good day for Rusty!

 

Mini report, Asia is eating a lot better. I don't think she's actually doing much better, but at least the cerenia seems to be working today? Will be to vet as soon as possible, if possible, tomorrow.

 

So glad she's eating. Continued prayers and vines.

 

Will be thinking good thoughts for Asia's vetty visit tomorrow. Glad she's eating.

 

Glad sweet Asia is eating better tonight. Sending continued vines for Asia, and comfort to you as I can imagine how you must be feeling!

 

Eating is better than not eating and I hope it makes her feel better in herself.

All the best for the vet visit.

 

Late to the game but I think the half-measure was a good call! Good balance between stress and high BG.

 

Glad she's eating better...vetty vines for today!