Am I dealing with well intentioned idiots or am I ignorant.

Ok here is the deal.
One of things going on here is that we are trying to get Kittys numbers stable so that he can have his teeth cleaned. He has never had it done before and he is about 13 year old. He also still appears to have a mild gum infection even after a cycle of antibiotics. No further antibiotics have been prescribed as the vet believes the infection will not dissipate until the teeth are cleaned. Which makes a certain amount of sense. If you dont remove the problem you are treating a symptom.

If you check my SS you can see what has been transpiring.
Note the change in the numbers from 12/6 to present.

I had an 8:00 AM appointment with vet this morning.

I tested Kitty about 1/2 and hour prior to the vet drawing blood.
+1 was 165. Ketty tested prior to the vets @159.
The apointment was @ 8:AM. I tested @ 7:42. They drew the blood @ 8:10AM
The vets blood test came out to 165!!
This is almost 14 hours after his last 1.25 units.

I accidentally told them I was giving Kitty 1.75 units. The vet wants to boost to 2.0 units.
However I just called them with the correct information and am waiting to see if there is going to be a change.

They are insisting that they cant move forward until they see how Kitty does at 2.0. The vets have been treating for over 40 years. So I dont doubt the knowledge base. However I dont know why they need the bench mark for Kitty to be at 2 units.
They are also insisting that giving him 2 units even with these numbers will not cause him to go to low.

I could here the vet grumble to the assistant that this was useless when given the information I supplied.

Oh and they dont want me testing kitty.

Am I missing something???
Is there a reason why 2 veterinarians cant work with the numbers I am supplying at the given units?

I am not sure what to think at this point.

 

Re: Am I dealing with well intentioned idiots or am I ignora

Sev, I posted in PZI.

 

Re: Am I dealing with well intentioned idiots or am I ignora

Got it.

Oh and they only want 2 feedings. No midday or evening snacks.

 

Re: Am I dealing with well intentioned idiots or am I ignora

Goodbye old vet - hello new vet, that is my opinion.
The other day you went low on 1.75. What will 2 units do. And for him to want you not to hometest is a sign for me that he thinks you are questioning him to much and he want you to back off. I will never take 40 years of experience for any good if the vet can't use the information I give him from home where my cat is acting normal. Get another vet, get Kittys theeth fixed so he can get better, and then mayby his numbers will have a clearer patteren.

 

Re: Am I dealing with well intentioned idiots or am I ignora

They are worried that the testing is causing him stress.

However they did suggest that the next time I go in I should bring my meter and get a number exactly at the same time.

So they are being helpful. But still... .

 

Re: Am I dealing with well intentioned idiots or am I ignora

Yeah, right! Are you their first client that hometests?

 

Re: Am I dealing with well intentioned idiots or am I ignora

Second what CharlotteDenmark said.........hello new vet, perhaps someone in your area can suggest someone else???

 

Re: Am I dealing with well intentioned idiots or am I ignora

I think I would agree with the testing causing at least some stress. Kitty is getting poked almost every hour. Would you like that? I know all the testing is getting a lot of data points, but honestly, wouldn't you be stressed if someone was poking your ear every hour for a few weeks? Even if he's not showing outward signs of his irritation, it seems logical to assume there is some stress involved with that.

On the other hand, I tend to believe a change is in order from any vet who says they don't want you home testing at all. Clearly, it's not safe to give Kitty shots without knowing what his glucose levels are doing.

 

Re: Am I dealing with well intentioned idiots or am I ignora

No. But they said a week or so a go that they had some home testers and it didnt work out so well.

 

Re: Am I dealing with well intentioned idiots or am I ignora

Oh I here ya.
Kitty has been very good about it and generally ignores me. My little buddy is a very tolerant feline.

 

Re: Am I dealing with well intentioned idiots or am I ignora

I wonder what they mean by that? Did they work with the client, try to help or are they just wanting to be in total control and give you the numbers that they get and blindly shoot at home? Many of us here on FDMB have been contacted by vets to help out and go to the home of one of their clients to work with them and help them learn how to hometest.

 

Re: Am I dealing with well intentioned idiots or am I ignora

Musette gets tested at least every 3 hours if not more often, and if I'm running late she comes looking for me at shot time...she also purrs through the whole thing, and if you also factor in the fact that she has only known me for 6 months and still looks forward to her tests and she and I have become best of friends, I wouldn't say she is stressed at all being tested at home. Now at the vet's office with barking dogs, the smells of medicines and fear in the air, strange people, and animals...that is STRESS!

I know I work part-time in a vet's office, since this is also my vet and they have seen both Musette and Maxwell ( Maxwell taught them home-testing) they encourage their patients to test at home. And discount any test they get that isn't 300 or above as it can be influenced by stress and will order further testing before even mentioning diabetes to the owner.

Knowing what I know after having 2 diabetic cats any vet that tells me not to test at home and won't work with the numbers that I have gathered at home and still wants me to raise my dose ...well that would be the last conversation we would be having, except for the one when I call and ask them to transfer my animals records to the new vet...That is just my 2 cents.

The other thing is a vet could have 40 years of experience and maybe only seen a handful of diabetic cats, and out of those it is a good chance that many of those owners didn't decide to treat and opted for euthansia.

Mel, Maxwell, Musette & The Fur Gang

 

Re: Am I dealing with well intentioned idiots or am I ignora

Dont know. Got a speal about home testing not being accurate due to the differences between human testers and feline calibrated.

 

Re: Am I dealing with well intentioned idiots or am I ignora

Well, the numbers I gave you yesterday had the AlphaTrak test there. Same drop of blood and you saw the numbers in relation to the other meters I listed.

 

Re: Am I dealing with well intentioned idiots or am I ignora

On my phone, can't be eloquent. Look at the SS. In the past four days, 2u may have been fatal.
Find a new vet?
Carl

 

Re: Am I dealing with well intentioned idiots or am I ignora

Here's an argument to help you:

If you had a child, would you ever give insulin without knowing it is safe?

Then why on earth would you expect me to do that with my cat?

Also, perhaps this article might be helpful, although it deals with a different insulin. Dr Rand worked with the Diabetes Katzen online community to develop the protocol used with Lantus, including the use of home glucometers, with reference ranges using home glucometers. See Table 3A

Roomp & Rand 2008 dosing testing protocol

 

Re: Am I dealing with well intentioned idiots or am I ignora

Hey, BJ....I said that to one ER vet couple years back, young vet and very smart too, and her response to me was "cats are different than humans" ohmygod_smile

 

Re: Am I dealing with well intentioned idiots or am I ignora

Not that different. They can die from an insulin overdose just like us. Their "normal" glucose range is just like ours. And they can get diabetic ketoacidosis, just like us.

 

Re: Am I dealing with well intentioned idiots or am I ignora

Ok guys I'm back. Spent about 2 hours talking with the new vet (Dr Hinkle).
Came armed with the original blood work and my colorful SS chart.
I fully explained the situation and all the physiological changes I have seen in kitty since starting the therapy. Also outlined in detail what I was dealing with at the other clinic.
Told her point blank that I am not here to be told what I want to hear but rather what is correct and that there were to many unanswered questions with the other vet.

It went very well. She was very impressed with the data and the research I have done. I pointed out my position that when the data does not support the conclusion I become wary.
She said I am the only individual that has ever showed up with this type a data.
You should have seen the look on her face when I said the chart is comprised or hourly test.
We went over the chart for a little while so she could familiarize herself with the layout and I explained the various stages of units I had been administering.
They have several board certified people there. Unfortunately none for dental. However I was quick to get a recommendation for one if I so wanted.

Over all the clinic is welcoming. The people are relaxed and there appeared to be no tension in the air. Its clean and well laid out and the staff I interacted with were professional and had good attitudes.

I have invited her to the board and am sending links to this site, Doctor Piersons site and Binky's page. The data break down on Binky's page was of particular interest after I explained what it was.

So bottom line. They have a new client. I was exceedingly pleased with my first experience.
Kitty is getting full spectrum blood work (Total Body Function: SuperChem/CBC/T4) that will be posted on Wed. It will be interesting to compare the old and the new.
We discussed the changes I made in Kitty's diet and went over the numbers on the original blood work. Like was pointed out here she said that some of the elevated numbers may have been due to dehydration and that due to the restructuring of Kitty's diet I should not be surprise to see his elevated numbers come into line.
She also concurred that with the current numbers that remission was not out of the question and that I should stay with the 1.25 units. She had no explanation why the other vet would consider my data useless and that it was very informative and would be very helpful on determining how to approach Kitty's condition.
She stated that I am on the right track.

Dr Hinkle said that with Kitty's current numbers there is no reason not to have his teeth cleaned. Total cost for the cleaning will be $175.00 which includes all the peripheral charges as well.

So that is how it stands folks. I am feeling a bit more comfortable and reassured.

 

Re: Am I dealing with well intentioned idiots or am I ignora

:dizcat :RAHCAT dancing_cat

GOOD FOR YOU AND KITTY

 

Re: Am I dealing with well intentioned idiots or am I ignora

Yay!!!!! A happy ending. And a very smart owner. Love it! Congrats to you for pushing through the BS and not caving in. There are some crazy-ass vets out there. Same thing was told to my mom - raise the dose and do NOT test! Her cat would have died because he hypo'd on the first dose. Testing is essential.

 

Re: Am I dealing with well intentioned idiots or am I ignora

Sev

175.00 for a dental, dang that is cheap. I never got out of the vets office with a dental for under about 500.00 or more. Sounds like you finally have a decent vet on board as well.
I went through the exact same thing with my vet, they told me give her this much insulin, do not test her at home we will test her. It does not seem like you have any problem testing kitty at home so why on earth would they tell you not to test?
You know whats best for kitty and that requires testing at home for sure.

Terri

 

Re: Am I dealing with well intentioned idiots or am I ignora

She is also checking on ordering the human grade insulin I am using. She thought I might be paying to much. It would be nice to see a discount.
Well todays exam and blood work totaled about 180.00 so I am not getting out unscathed. :smile:

 

Re: Am I dealing with well intentioned idiots or am I ignora

Sev

Thats still not a bad price. I am paid 500.00 for dental plus bloodwork and other exam fees. The 500.00 was just for the darn dental. This sounds like a decent vet you may have. Mine did nothing to help me with my cats diabetes I am not sure is she did not know or what. There are good vets out there but I am not so sure they know a lot about feline diabetes. Mine had treated my cats for 10 years but when my cat became diabetic I think she was at a loss.

Terri

 

Re: Am I dealing with well intentioned idiots or am I ignora

I have my fingers crossed. Our friend that recommended this clinic has a ton of cats.
Also that they have a person that is board certified for herbal treatment tells me they have an open minded approach. I believe the doctor was impressed with my commitment thus far.
Her assessment that Kitty's number may come in line after the teeth cleaning was good to hear.
She also pointed that the initial 2 weeks of wild numbers may have been part of Kitty settling into his new diet. God only knows what was happening the 2 weeks I was not testing.

 

Re: Am I dealing with well intentioned idiots or am I ignora

dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat

 

Re: Am I dealing with well intentioned idiots or am I ignora

I think you're dealing with vets that haven't done any continuing education in quite a while. You might want to read this article and print it out for your vet. It's the American Animal Hospital Association's guidelines for treating diabetes. See page 218 for their recommendation re. home testing. They also support everything you're doing and the vet is telling you not to do. What BJ pointed you to is specific to Lantus. It will be easy for your vet to dismiss. These guidelines encourage the use of both Prozinc and Lantus and discuss more than just home testing.

If your vet won't work with you, if it were me, I'd vote with my feet.

 

Re: Am I dealing with well intentioned idiots or am I ignora

Sev,

Congratulations on working through all of this! I had to leave Kitty's first vet also. It was hard, but it was the right thing to do.

Dental cleaning: here are some tips posted by Sienne in the Lantus RT ISG. This was for a cat likely to have extractions, which may not apply to you, but the information on post-anesthesia care is excellent. http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=58079

You may find this helpful for your kitty's dental:

 

Re: Am I dealing with well intentioned idiots or am I ignora

Sev,

That price seems low to me as well. I wonder if you could verify that this is an anesthesia procedure. There are some vets who try a non-anesthesia cleaning, but my understanding is that this is a bad option.

I'm about to take my kitty for a dental as well. Here are some of the notes I'm making to talk with my vet about:

1. NO METACAM.

2. Existing condition to watch: Discuss with them how they'll monitor BG during anesthesia.

4. Pre-anesthesia sedation/induction: propofol, valium. (Note that some ketamine has been recalled.) Induction should be with an IV drug vs. a gas.

5. Anesthesia: Sevo or Isoflurane (these should not be used for induction, however, only for general anesthesia)

6. Monitoring: Blood pressure monitoring (Doppler or Cardell monitor): blood pressure, oxygen, EKG, carbon dioxide.

7. Monitoring: Cardiac monitor: pulse oximeter or cardiac monitor

8. IV catheter for fluid access

9. Warming: make sure there is a means of circulating warmth vs. one warm spot. The latter can cause burns.

11. X-rays: Pre-procedure: full digital jaw x-ray is recommended.

12. Pain meds: administered post-procedure and to take home: Buprenex. Again NO METACAM due to the potential for renal failure.

 

Re: Am I dealing with well intentioned idiots or am I ignora

Thanks everybody.
Looks like I am going to be getting eyes strain with all the reading.

I really think the Doc enjoyed talking with someone that is being proactive and has at least a basic understanding of what is going on.

 

Re: Am I dealing with well intentioned idiots or am I ignora

Here is the list in the quote
1. Dental prophy.
2. Examination Pre-Anesth N/C
3. Pre-Anesthetic Medication
4. Torbugesic
5. IV Barh(1)/line(1)/fluids for procedure
6. Teeth Cleaning/Polish
7. ECG during surgery
8. Dental prophy Paste Cups
9. Clindamycin 25mg
10 Midazolan 5mg/ml

Total. 179.75

 

Re: Am I dealing with well intentioned idiots or am I ignora

I don't know about the specific meds, but looks good!

You might want to find out what the pre-anesthesia medication is.

A vet who welcomes involvement is a KEEPER.

 

Re: Am I dealing with well intentioned idiots or am I ignora

The doctor is also the anesthesiologist.
I didnt know it and ask how good their anesthesiologist was. ohmygod_smile :lol:

 

Re: Am I dealing with well intentioned idiots or am I ignora

I hope the answer was... "EXCELLENT! Also very humble." :lol: :lol:

 

Re: Am I dealing with well intentioned idiots or am I ignora

Yah it was something like that.

 

Re: Am I dealing with well intentioned idiots or am I ignora

I didn't see any x-rays on that quote; better check unless some were already taken.

 

Re: Am I dealing with well intentioned idiots or am I ignora

I will.
We didnt discuss x-rays.
Need to see what that new blood work looks at.
Really hoping there are some positive moves from the last one.

 

Re: Am I dealing with well intentioned idiots or am I ignora

Good point!

And I guess the discussion of the infection is ongoing.

 

Re: Am I dealing with well intentioned idiots or am I ignora

Yup.
A week of antibiotics following the cleaning of the teeth. The infection is not that bad but still there.

 

Re: Am I dealing with well intentioned idiots or am I ignora

Hey guys.
Just got a phone call from the new vet.
Apparently most if not all of Kitty's number are now in the normal range.

WOOOOO WHOOOOOOOOOO!!!

Def looking forward to tomorrows consultation.

 

Re: Am I dealing with well intentioned idiots or am I ignora

:RAHCAT Now....what's with the consultation tomorrow? I thought you had a long visit with her yesterday? Is the dental scheduled yet?

 

Re: Am I dealing with well intentioned idiots or am I ignora

Yes we had a long visit yesterday where I predominately doing the talking.
Tomorrow I am going in to pick up a copy of the blood word and go over the changes.
I am going to try to schedule the dental as soon as possible. Unfortunately There are some budgetary restrictions at the moment that I have to iron out.
Going to the other vet and now retracing my footsteps has basically double my expenses.
Plus the extra medical expenses on Blue were not counted on.

 

Re: Am I dealing with well intentioned idiots or am I ignora

Heading in this morning to get the results of the blood.
Had to sit on kitty yesterday due to his numbers plummeting @ 1.25u
He hit 44 and was still dropping.
It was a fun morning.

I'll post up the new and old blood work for comparison later on today.

 

Re: Am I dealing with well intentioned idiots or am I ignora

Good luck! I love how informative this vet is. Let us know how it goes.

 

Re: Am I dealing with well intentioned idiots or am I ignora

Will do.
Teeth cleaning is scheduled for the 21.
Unfortunately they are not equipped for x-rays. The specialist for that is over 2hrs away.
So for now we are going for the cleaning and mapping of the teeth.

So far the new vet has been great and very complimentary of my efforts. She is very interested in Binky's page and the updated nutritional values.

 

Re: Am I dealing with well intentioned idiots or am I ignora

I have not read this whole thread but whenever prices are discussed remember that you 'get what you pay for'.

No xray capability.....no mention of blood pressure monitoring which is a major deal breaker for me - I would never put my own cats or any patient under anesthesia without VERY careful BP monitoring...... Torbugesic and not butorphenol....(torb is not a great pain med for cats).

Also keep in mind that you can't do two things at once - you can't be doing surgery/dental work and also monitor the anesthesia.

I do not understand how anyone can do a properly monitored dental procedure for such a low cost given the cost of anesthetics/adequate pain meds....proper monitoring equipment....and technician time.

One of the key questions that should be asked when shopping for a vet to do dental work is....do they have the capability to take dental x-rays. Many non-boarded colleagues have dental xray units and it shows a certain level of care and concern to practice optimal medicine.

I want to reiterate - I would never allow my cats to go under general anesthesia without careful BP monitoring. There are additional monitoring devices but that one is a must. I also did not see where a pulseoximeter is being used. I think only an EKG was referred to which is not very useful.

Again, you get what you pay for.

 

Re: Am I dealing with well intentioned idiots or am I ignora

Kathy - add to your list NO CONVENIA.

I just had to deal with another death from that drug.

Keep in mind that it stays in the body for over 2 MONTHS, not 2 weeks.

 

Re: Am I dealing with well intentioned idiots or am I ignora

Good afternoon Lisa.

Unfortunately it appears I am in an area where the nearest specialist is several hours away. I have done a search in 4 states and it appears that board certified dentist for felines are not common either.
Unfortunately I am also stuck with what my region offers.
On another note the previous vet quoted me 104 for the teeth cleaning.
I am finding most prices where I am are less expensive than other areas of the county.

 

Re: Am I dealing with well intentioned idiots or am I ignora

Hi Sev,

Yep, I do very much understand the limited resources in certain areas but there still needs to be minimum standards and BP monitoring is one of them.

Please ask your vet if the BP will be constantly monitored by a tech. BP machines cost as little at $900 (Doppler) and there is simply no excuse for any practitioner to not at least monitor the BP of any patient under anesthesia.

Dental x-rays can be overlooked but not BP monitoring.

 

Re: Am I dealing with well intentioned idiots or am I ignora

Make that BP monitoring AND a way to monitor the oxygen saturation of the blood (pulseoximeter).

That is part of the minimum standards, in my opinion.

 

Re: Am I dealing with well intentioned idiots or am I ignora

That's what the use. A pulseoximeter. Just got off the phone with them.

I posted Kitty's blood work in another thread from when I first found out he was diabetic and the one from the new vet several days ago.
Its pretty impressive what a change of diet can do. From what I understand all his stats have come back into the normal ranges.

 

Re: Am I dealing with well intentioned idiots or am I ignora

Dr. Lisa,

I posted in the Lantus group a question about this. Before I came to this site and heard about Convenia warnings, Kitty had received the drug. He had no adverse reaction to it. If a cat is known to tolerate it, is the drug okay, or do you feel it should be avoided under all circumstances?

Thanks!

 

Re: Am I dealing with well intentioned idiots or am I ignora

2 Kitty's in the same state.

 

Re: Am I dealing with well intentioned idiots or am I ignora

Pulse ox does not measure BP. Did you ask them about blood pressure and what they use to measure it? Doppler? Oscillometric?

 

Re: Am I dealing with well intentioned idiots or am I ignora

Just because they "tolerated" it once, does not guarantee that they will "tolerate" it again.

I say "tolerate" because you have no idea if/what damage was done at the cellular level. By the time adverse effects show up, the body is severely injured....but there are plenty of adverse reactions that fly under the radar.

You would have to hold a gun to my head to make me inject Convenia into any of my cats. There are very few instances when this drug should ever be used.

 

Re: Am I dealing with well intentioned idiots or am I ignora

They said they measured BP. However I am unfamiliar with the medical equipment needed to ask the appropriate questions.

 

Re: Am I dealing with well intentioned idiots or am I ignora

I figured I would add this.
I was just looking at the oral pain killer the other vet prescribed for Blue after getting spade. It was Metacam. Glad I decided not to use it all on her.

 

Re: Am I dealing with well intentioned idiots or am I ignora

oh no - not metacam - here is an old discussion on that topic:

http://www.felinediabetes.com/phorum5/r ... ?8,1867651

 

Re: Am I dealing with well intentioned idiots or am I ignora

Hmmmm.
Good move on my part.

 

Re: Am I dealing with well intentioned idiots or am I ignora

I love it when a "Do it my way" vet gets dumped for a "Lets work together on this" vet.... That's how I found my wonderful clinic.... and Dr. McCabe... then.... I interact with the other vets in the clinic... and they are ALL wonderful..... One only needs to locate them and then spread the word...