Cole Vet Says Too Much Testing?!

Discussion in 'Feline Health - (The Main Forum)' started by beene5052, Oct 2, 2017.

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  1. beene5052

    beene5052 Member

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    Cole saw his Cat Vet today. Immediately told us micromanaging is "not good." When we asked why she said, " because Sticking 4x day is traumatic to the cat and makes his ears sore! " We told her we were
    switching insulins from Humulin to Lantus and she said fine. Lantus was her first choice.
    She also said if we must test to test PMPS only on Lantus - no need for more unless he is acting sick, etc.
    Cole's test was negative for pancreatitis but test only about 40-60 percent accurate she said?! Now going to do liver test/diagnostics in 2 weeks because she's afraid something may be going on with his liver. Cole used to be a ravenous eater (thus his 20lbs - tried numerous diets to no avail) but hardly can get him to eat 1 full can of wet a day now.

    She started him on an appetite stimulator Metro something (will put in sig) and staying on 16 mg of Cerenia for his IBS. Also going back to Blue Buffalo h/f (hydrolized protien) diet for IBS (Dry) for right now - anything he will eat.

    We are so conflicted now! We went in the office loaded with all our charted numbers feeling we were working hard to get our cat healthy and she gets annoyed! Now mind you this Cat Hospital was recommended to us by Dr Norsworthy, a renowned Cat Vet here in the SW US. We used to take Cole to him because we had a 2nd home close to San Antonio, Texas where he is located.

    Anyway, we are a bit miffed by the whole visit! We just love our cat and do not want to traumatize him in any way but keep him safe and healthy. This is also what I told the Dr.
    Thoughts would be appreciated?!
     
    Last edited: Oct 2, 2017
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  2. Squalliesmom

    Squalliesmom Well-Known Member

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    I had a vet who told me I tested too much, and should only test once a week, if at all. She is no longer my vet. At a very minimum you need to test twice a day before administering insulin! An additional test or two during the cycle also helps you see how kitty is reacting to the insulin. Ask your vet if she would shoot blind if she had a child who needed insulin - it's no different for our fur babies. I doubt you are making his ears sore, and your vet should know this, too; the outer part of cats' ears have very few nerve endings. Nature designed them this way because ears are so frequently damaged in fights or skirmishes, which, as predators, cats are prone to. As for the appetite, well-regulated cats have less appetite than ones who are starving because of high glucose levels. Is Cole losing weight? The appy stimulants I am familiar with are cyproheptadine and mirtazapine, do either of those sound like what she gave you for Cole? Metro is usually metronidazole, which is not an appetite stimulant but is frequently used in cats with IBD/S as an antibiotic/anti-irritant.
     
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  3. Lisa and Witn (GA)

    Lisa and Witn (GA) Well-Known Member

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    You should always test before you give a shot or you risk hypoglycemia. This means you will test in the morning and evening. When switching to a new insulin, I would also recommend testing between shots, at least until you know how Cole responds to the dose. Do you know what your starting dose with Lantus will be? With any insulin, it is better to start with a low dose and gradually raise it until you find the optimal dose that works best for your cat.
     
  4. beene5052

    beene5052 Member

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    Thank you for your replys! Yes, Cole has lost about 1 lb. in the last 2 weeks. It is the mirtazapine he is on. The dosage of Lantus is supposed to be 1 unit 2x day.
     
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  5. FurBabiesMama

    FurBabiesMama Well-Known Member

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    As has been mentioned, you want to test pre-shot to make sure the number is high enough to warrant insulin. And, the point of testing mid-cycle is to see the impact the insulin is having. Your spreadsheet certainly does not show excessive testing! Did the vet discuss a 'no shot' number with you? They should have.

    It took me three vets to get to one who actually has enough knowledge/experience with this that everything he said was in harmony with what I have learned in my own research. The first vet - who was at a very reputable clinic - said they recommend strongly against home testing because it 'damages the animal/human bond'. To put it bluntly, that is a bunch of crap. I have been testing Mia since 7/26 and she still adores me. If anything, she has gotten more spoiled due to all the added time and attention she gets now. She jumps right up into her tower at testing time and sits there waiting for me to finish with her little ear so she can eat her chicken. Obviously, you want to change the spot along the edge of the ear where you test each time and alternate between the two ears, but it is FINE. She still lets me rub on her ears when I pet on her without acting like there is any discomfort. When I have had to do a lot of tests, say with a curve, I do put a little Neosporin on her ear.

    The second vet did not believe in a no-shot number. She wanted me to give the full dose regardless, even if Mia was at 100 (that was the example she gave). She also did not believe in 'bouncing'. Again, a bunch of crap. I am having to gather a lot of data with Mia because she is so prone to bouncing and her dose has to be adjusted very slightly and time allowed for her to adjust. Her numbers are not as low as I want, but if I try to rush at all, bouncy, bouncy, bouncy. So, patience is a must. If I did not do home testing, I would never have seen what was going on with her. A dose that is too high can look like a dose that is too low if you do not have the full picture.
     
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  6. Noah & me (GA)

    Noah & me (GA) Well-Known Member

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    You need to shop for a new vet, sorry. The trauma thing is a big IF and it's impossible to test anything in life too much. Trust me on this, a lot of vets have very little education on diabetes. That's not very polite but it's been said here a million times, "If that was your child would you just shoot insulin into him?"
    What to look for in a vet? Ask for a sit down and state your case, it's imperative they believe in your devotion and intelligence.
     
  7. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Dr. Norsworthy is a proponent of "loose control" in managing FD. You can read his articles online.
     
  8. Squeakycats

    Squeakycats Member

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    I'm laughing about "traumatic to the cat"--I have the same experience as @FurBabiesMama . My cat comes running to his testing spot, eager to get a treat and extra love and attention. He purrs and rolls around on his back. And I can sometimes test him without even waking him up. When he *is* in pain from something like an injured claw, he nips me if I try to handle the sore spot--so I really don't think he's in pain. I do use the Neosporin gel with pain relief for times when I'm doing a ton of tests in a single day, though. If anything, I think I have more of a bond with him now--he follows me around and lets me know if he's not feeling well, and he has started sitting on my lap (which he didn't often do previously). I wish I didn't have to poke holes in him all the time, but I think it's critical to have the data, and I don't think it's causing much distress for him!
     
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  9. Noah & me (GA)

    Noah & me (GA) Well-Known Member

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    "Damages the animal/human bond"??? I thump Noah's bed and he jumps in, he trusts me. @beene5052 It's totally do-able, affordable, non-hysterical. Not rocket surgery! Stick with us and we can help. I wonder if you can Super Like a post?
     
  10. FurBabiesMama

    FurBabiesMama Well-Known Member

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    I just read one. I love (said with sarcasm) the fact that that one of the points he lists for why he went to his ultra loose control approach is:
    "Owners frequently expect to report the results of their home testing, get a recommendation over the phone, and pay nothing for the consultation."
    So, the vet getting less money warrants being listed as a reason for 'loose control'. Sorry, but from an 'owner' perspective, that is an argument on the other side of the issue.
     
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  11. beene5052

    beene5052 Member

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    Yes, I read that also. The thing that stuck out to me is that the main reason he started this protocol is because patients were choosing to euthanize their cats because of the rigorous care needed to home test or the cost. I know Dr Norsworthy and he treated Cole up until just recently for about 5 years. I saw only a vet that truly loved cats and has made treating them his life's work. That's not to say that he runs a business as well. I'm not discounting that aspect of it either.
     
    Last edited: Oct 3, 2017
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  12. JanetNJ

    JanetNJ Well-Known Member

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    My cat is far from traumatized. I think most vets think to home test you Pierce the vein. My vet thought that.... Well yeah THAT'S going to hurt. A tiny poke to the edge they barely feel.
     
  13. FurBabiesMama

    FurBabiesMama Well-Known Member

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    I saw that. And, there was also a point about owners not wanting to home test. So, maybe the way I would look at it is, if you are willing and able to put in the work, then your vet should not be against home testing. The same article outlined the tight control approach which included frequent home monitoring, and I believe it said 84% of the cats in the referenced study went into remission. On the other hand, I read that approximately 30% go into remission with his ultra loose approach. So, it sounds to me that owners should be educated and given the choice as to which approach they want to take. Maybe less trips to the vet (which most cats HATE) and a higher chance of remission are enough for some owners to choose more control and a more hands-on approach. A vet certainly should not 'get annoyed' because an owner chooses that option.

    I think the biggest, legitimate concern that some vets have is that the owner is going to focus ONLY on the numbers and forget the importance of clinical symptoms. You cannot do that. Like with Mia, her numbers are pretty high most of the time right now, BUT clinically, there have been improvements. No more weight loss, and in fact, some gain. Her coat is silky soft. She does not drink excessively (really, I never even see her drink at all anymore - she used to live by the water bowl) nor does she pee so much that I wonder if my husband has decided it might be funny to pee in the litter box because surely a cat cannot pee that much. :smuggrin: So, I am patiently working through this ever so slowly in hopes of gradually getting her to go and stay a little lower and a little lower. (Also, some cats just stay naturally higher than others. That is why 'normal' is always given in fairly broad ranges.)

    I think a good vet is one that shares their knowledge and expertise (and opinions.. so much of this is opinions) but is also okay with you educating yourself and having a say in your babies care. It is ultimately up to you, not the vet, whether you see value in home testing and want to do it or not.
     
  14. beene5052

    beene5052 Member

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    I agree wholeheartedly!
     
  15. Squalliesmom

    Squalliesmom Well-Known Member

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    Squallie will paw at his meter case, wanting me to test him so he can have some of the "special" fave treats he only gets at testing time, lol.:joyful: I don't think he'd do that if testing hurt him. I don't have to hold him to test him, either, he just lies down and lets me go about the business. I test several times a cycle.
     
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  16. W.K.

    W.K. Member

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    Saw your kitty was dropping low tonight, but didn't want to post over there since you were getting some great advice and are in good hands. Here's to proving your vet (and husband) wrong. Hope the night goes well.
     
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  17. Noah & me (GA)

    Noah & me (GA) Well-Known Member

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    How many people can you think of that rigorously care for their car or hair and think nothing about the cost of their shoes to the point of absurdity?
     
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  18. Larry and Kitties

    Larry and Kitties Well-Known Member

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    Dec 28, 2009
    I always* do a preshot one each of my three diabetic cats. I only do BG between shots when the PS values are unexpected.

    On a few occasions when I was very late (like 6 hours) at shot time I did not take a BG reading nor did I even give any shots.
     
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  19. beene5052

    beene5052 Member

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    Thank you for all the thoughts and comments!
     
  20. hmclaughlin1973

    hmclaughlin1973 Member

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    I am BRAND new at this and my vet never even mentioned that home testing was an option. I decided after coming across Lisa Pierson, DVM website that I would try out home testing. I tested once the night before PJs first dose of insulin and then in the morning twice before giving him his first dose. Somewhat for practice and somewhat to see what fasting and post meal sugars looked like. I gave him 1 unit of insulin at 10am and tested an hour and half later and got 188 (down from 259 pre injection). Before his evening meal I tested (he wasn't looking too hot at the time, super lethargic and squinty eyes). His BG was 56! If I hadn't been home testing, I would have blindly given him his evening dose of insulin as directed by my vet and I would have gone to bed and potentially woken up to a dead kitty! Any vet that doesn't advocate for home testing ESPECIALLY in the beginning does not have the patient's best interest at heart!
     
  21. Noah & me (GA)

    Noah & me (GA) Well-Known Member

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    This is nothing new, trust me. The general theory is that diabetes in cats is "uncommon" and veterinarian colleges pass very little knowledge on to their students, same with vet techs. If a vet chooses to they will learn from necessity and/or self interest. My vet pours over "What's new" on her own time, as did her Dad who was also a vet. I had a cat who went bonkers if you clipped his nails. Two techs went and got their welding gloves, determined to finish the job. I took Nigel off the table and said "Look, he's mouth breathing (a sign of extreme stress) and his pink nose has turned red (increased blood flow = stress) so this is over." They were shocked and insulted but that was something I learned from my vet, THEIR BOSS!
    You did the right thing my friend, something didn't look/feel/seem right and you took action. When a doctor says "It's doctor, actually" just ask what ethnic background the name Actually comes from and walk out. My vet is my friend, not God. So happy to have a new member that doesn't cower in the face of stupidity.
    :bighug: :banghead: :banghead: :banghead:
     
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  22. beene5052

    beene5052 Member

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    Thank you.
     
  23. JeffJ

    JeffJ Well-Known Member

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    Yeah, your vet is full of crud. We live in a great modern world now with a well understood disease (diabetes). Insulin effectiveness can only be evaluated through regular testing like the others had said above. There have been postings in the past about some vets telling their humans to not test their kittehs at all at home. Bad advice from unknowledgeable vets could potentially lead to some kittehs going hypoglycemic.

    You are doing a good job. I looked at Cole's spreadsheet and Cole is lucky to have you for a kitteh parent! You might consider putting comments into the right column. It makes the spreadsheet more compact and easier to read the BG values.
     
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  24. hmclaughlin1973

    hmclaughlin1973 Member

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    You can also right click on individual cells and choose "add note" to add times and details to each entry! Look at PJs sheet and hover over cells will black in corners!
     
  25. beene5052

    beene5052 Member

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    Thank you all for advice on notes and for the moral support!
     
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