Dosing adviser clarification

Thanks for the clarification. I'm sure the sheer number of registrations in the short time the new board has been active is confirmation of how much this board and the people that provide assistance are needed.

 

Yes, there is a lawyer in the house...and she is going to tell you what a great job of explaining you were doing, until you got to the part about forming cooperatives or other groups. Rebecca, there isn't a less-than-blunt way to put this, so I'm just going to say it...BAD IDEA! Anytime you sanction the formation of cooperatives or groups that will, by definition, come to be known by certain chracteristics, members, names, etc. (that, by the way, you can't control), you are heading down the same road that "dosing advisor" passed over.

Disclaimers will help, but they are not the best solution (do you have any idea how many times people say 'I didn't read that,' and a court has found it to be an acceptable excuse?). The best solution is for cooperatives and identified groups such as you are proposing to be avoided.

Can't we just all get along?

 

I think this sounds like a wonderful solution. I think I had a small heart attack at the thought of not having d*sing adv*sors ( ;-) ) in Lantus Land anymore.

 

I honestly don't see a reason to make a group of anything officially. As long as consulting happens in the open and is open ended I would think that should cover it. But I suppose now the most experienced people are going to be all gunshy because of the drama. I hope not, but I guess that will be up to them. I think you have been very clear here and it *should* clear up most confusion.

 

I suppose the world would be too boring if we all agreed on everything all the time. At least, that's what I tell myself.

 

Actually I believe the evidence is in...with a few notable exceptions, and as mentioned by Rebecca, everyone was doing pretty well with each other. I am too tired to try and figure out the Cain and Abel reference, but am pleased that something as simple as my post above can bring you perverse amusement.

 

I'm glad you opened this thread, Rebecca. I know you work very hard, and especially lately, on keeping these boards available to us. And I read through the thread that got closed last night, and wanted to make a post, but the thread was closed.

Here's where I, a newbie, stands. I'm a student nurse, and I understand this disease. I just don't understand it in cats; there are huge similarities, but not enough for me to feel confident when my cat goes over 500 unexpectedly, like she did last night. And when I'm on the floor, I can grab a more experienced nurse and/or Dr., and get "advice" from them, even if the patient is not theirs. The patient is mine, and I'm wholly responsible in the treatment I give...good or bad.

Translating that to catworld diabetes, again, I am wholly responsible in what treatment I provide to my cat. No-one else, just me. What she eats, what times I test, what I shoot...all on my shoulders. What has been missing is being able to reach out to those more experienced and getting advice, opinions, thoughts, ideas. In the end, though, it's me that a) has to care for Esse, and b) am totally responsible as to what I do or don't do.

If I had relied solely on my vet, Esse would likely have been quite dead by now. The advice I was given was to shoot 4 units bid of Humulin N, no home testing needed, and leave out dry food if I wanted to. I went round and round with my vet...but only because of my nursing background did I know that something was not right with those directions. I didn't know quite what was wrong, but just that something was wrong. I went ahead and did it, but also decided to home test anyway (you never shoot people blind, why should I shoot a cat blind??). She hypo'd. The vet didn't believe me. I reduced the dose on my own, and still she hypo'd. I asked for a sliding scale, and was told to shoot the whole dose if she was over 300, but nothing if she was under 300. And that did not make any sense to me at all. So I made a fuss, and got bumped to the clinic's directing vet.

I managed to convince her that the insulin was wrong for Esse, and could we please do something else, like Lantus. She switched us, but wanted to go back to 4 units. I flat out told her no, and she said that if I was unwilling to follow her advice, she'd note the chart so she wouldn't get sued. She accused me of giving fur shots when Esse's numbers were high; and she informed me that there was no need to go to an "only wet food" diet. After a time, we negotiated a 3 unit bid dose, but she again said I shouldn't home test, just shoot. I didn't bother telling her that I won't shoot blind...she also said that somogyi effect in cats is very rare, and that some vets do not believe it exists. And she said she'd rather me not shoot anything under 300, and a full dose above 300...and that she'd rather me go for regulation rather than remission.

And still another vet, at the emergency pet hospital that I went to when I caught Esse throwing ketones, informed me that my testing her all the time was "not Munchausen by proxy, but pretty darned close."

I found the Tilly protocol. I found this place. I took Esse off all insulin, and started her back on 1 unit. And with the help of those far more experienced than me, and apparently far more experienced than my vets, I am slowly finding Esse's proper dosage. There have been surprises, there have been scares, but what I find invaluable - literally the reason I stay here - is that I know I can come here and ask for "eyes", and get some good, sound, experienced advice and help from those who've been in my shoes and whose cats have been in Esse's paws. Is the road smooth for Esse? Nope, not in the least. But at least when she throws something unexpected, I can get some help to get her through it, and safely to the other side.

If I had relied solely on those licensed professionals, I'd probably not have Esse right now. If I didn't have the ability to question drs and 'those in authority', I'd probably have killed my cat by now. Instead, I struggle along, knowing that this road is not smooth, but it is doable...and that I can get help when I encounter some unexpected issue (like a 531), and discuss the options with those with more experience than I.

I want the dosing advisors. I don't care what they're called; to me, they're angels. They've helped me understand things, and learn things, and have given guidance that I've found invaluable. Proof positive of their effectiveness is that Esse is still here...

Does that mean I don't question them? Not at all. In the beginning of this post I said, and I'll say it here, it's up to me what I choose to do with my cat. I'm responsible for what happens to her. But if I blindly did what my vets told me to do, there would be no reason for me to be posting here...Esse'd be gone.

And I don't think I'm alone in that thought.

Thanks for giving me a chance to say that...and I think, if a way could be found to balance the needs of the newbies like me with the legalities, it would be a phenomenal thing. Keep looking for it; it exists somehow...maybe a disclaimer on everyone's account that we have to click (like an end-user licensing agreement) before we can post...I dunno. I just know there is a solution wherein all can be satisfied, and needs met from the newbies standpoint and the pay-it-forward can continue...because FDMB has become something very special, and valuable; and a lot of that is from the posters' contribution to each other.

Best-
Michele and Esse

 

Well, as another newbie here, I also want to report a near-heart-attack last night at the thought of losing this. I am not a medical professional and I know that (almost) no one here is either. But I also know that you can't expect most vets to specialize in diabetes enough to have the information at their fingertips that people here do.

Would any of these things help?

1) Have each user apply for membership to an ISG in a clear "gateway" area. They would need to include in their application an acknowledgment of an FDMB official statement saying that this is a supposrt community, not a medical or veterinary one.

2) I am in another peer review kind of group. We have the ability to rate (anonymously) the advice given and people who give advice have a rating from 1 to 5. I know this is controversial, and invites some gaming, but it's just a thought.

3) Ask people to, in some way, acknowledge that what they are joining here is a sort of informal data-gathering group. That by posting their ss and keeping their condos up to date, they are contributing data and at the same time will receive opinions from people who have done this earlier about what that data means IN LIGHT OF THE OTHER DATA collected over the years.

BTW, here is what I said this morning in my post in LL:
"And I want to add a word or two about the helpful people here. Whatever you call them, I am grateful for their help and fully aware that this is their opinion, only, and not veterinary advice. I am a scientist by training, and I value their experience with the numbers and the insights that the experience gives them. I know that in the end, it is my job to make the decisions about my kitty but I am grateful to have some people willing to put the data into context for me and tell me what they would do--and have done--in the situation."

 

"If I had relied solely on those licensed professionals, I'd probably not have Esse right now. If I didn't have the ability to question drs and 'those in authority', I'd probably have killed my cat by now. Instead, I struggle along, knowing that this road is not smooth, but it is doable...and that I can get help when I encounter some unexpected issue (like a 531), and discuss the options with those with more experience than I.

I want the dosing advisors. I don't care what they're called; to me, they're angels. They've helped me understand things, and learn things, and have given guidance that I've found invaluable. Proof positive of their effectiveness is that Esse is still here..."

Michele, I couldn't have said it better myself....that's why I quoted you. And I love the idea about maybe clicking a box to indicate that we have read, understand and agree to these terms.....disclaimer. Geez, I click one every time I pay a bill online.

And just to clarify, the dosing advisors did not label themselves as "advisors", they are experts:
–noun
1. a person who has special skill or knowledge in some particular field; specialist; authority: a language expert.
–adjective
3. possessing special skill or knowledge; trained by practice; skillful or skilled (often fol. by in or at): an expert driver; to be expert at driving a car.
4. pertaining to, coming from, or characteristic of an expert: expert work; expert advice.
–verb (used with object)
5. to act as an expert for.

I'm fine with the the title of "expert" and I'm also fine with the fact that Punkin is sitting right here, kneading my leg with her sharp, painful claws because of the knowledge and help I've received from said experts.

Sincerely,
Jackie and Punkin.

 

we love Lantus Land and our Team J et al.

Our story is quite similar to Michele and Esse's story. I came on the board in March 2007, scared to death. Now, I didn't have to fight my vet like Michele did, I just needed to be proactive. My baby, who I've had practically my entire adult life (adopted him when he was 1 and I was 19, and in 2007, he was 13) had developed hepatic lipidosis, acute/chronic pancreatitis, and DKA. He needed 8 days in critical care in order to be sent home with the instructions to shoot 2U Lantus BID, along with a host of other meds, and no mention of hometesting.

I love the vets I've worked with at the vet hospital. But, when he didn't seem to be responding to 2U, we went up to 3U. A week later, we were up to 4U. That's when I started posting here, and many caring members posted messages to me, urging me to hometest and to lower the dose. I won't lie, those posts scared me. They SHOULD HAVE. I was shooting blindly. I am sure that had I not gone out and bought a testing kit, that I would've kept shooting the same dose of 4U BID. (It turns out it wasn't too much insulin, and thank GOODNESS Jojo came along and explained why he needed all that insulin).

Lantus land quickly welcomed me. Jojo stayed up with me many nights, coaching me through the high numbers, trying to make sure my baby didn't develop ketones again. She even defended me when I was still feeding dry food (gasp!) b/c she understood that Cosmo was recovering from hepatic lipidosis. She helped me learn how to use R with Cosmo when he needed it, then held my hand as I shot it. Then she had to hold my hand some more as he got better and went down the dosing scale in a hurry.

Back then, I guess we didn't call Team J the dosing advisors or dosing team as much, we usually just called them Jill, Jojo or Team J. With life happening, Lantus Land has had to evolve, with long time members helping to shoulder the burden. These members are those who have read and studied the dosing protocols, and been around reading condos, studying spreadsheets, and learning how lantus and levemir work. I am so grateful and so impressed with all of them, and applaud their devotion to the cats and beans who ask for help in Lantus Land.

Now, he's all bcatrun_gif and cat_pet_icon

I guess my question is... if we can't use any kind of group designation, how do we let new people know who has the experience and who doesn't? If I were new to the board now, I would want to know the difference between those who have never treated a diabetic cat, to those who've been around for 2 yrs, 8 yrs, etc.

I sincerely hope that this issue is just a question of semantics. That instead of "dosing advisors" we can instead call them "pieces of eight" or Team HO, or TW3. :lol: and keep on keeping on.

 

I want to add my voice to those of the others who owe the life and well-being of my cat to the volunteers in the Lantus ISG who have supported and advised me over the years I have been dealing with a diabetic/multi health issue cat. I did lurk on the board for many months before being encouraged to post in Lantus, and I have never looked back. There is nothing like the daily support from people who know your cat. My cat would not be alive today without them, period. I also have a very skilled and compassionate vet who works very closely with me. She has deferred the day to day management of Bear's diabetes to me, knowing that I am getting input from an internet group, and because she can see that he is being well taken care of. And yes, I weigh the input I get, and realize that it is my decision to inject insulin, and it is my decision as to how much I inject. Not too long ago, some posters on Lantus were quite insistent, from the behaviour I described, that Bear must be hyperthyroid. I asked my vet about it twice, and she said that he just did not have the symptoms. Finally, I asked her a third time, as the people who know about these things insisted that it didn't sound right, and she agreed to test him. Yep, he's hyperthyroid, very much so. This past week, another poster flagged an interaction between two drugs that Bear is on. My vet posted a question on her board to a veterinary pharmacologist, who confirmed the information. Now, when I ask her about something (perhaps something my Board members have pointed out), she says that she doesn't think that's an issue, but that she has been wrong before, and freely admits that. When discussion of a drug or issue that she is not familiar with comes up, she asks me what people who use it on the Board have said about it (and then researches it herself, of course). She has a lot of respect for what I come away with from here. I have had support on many, many occasions from Lantus Land members through many difficult days and nights with a sick kitty, and times I thought I was going to lose him. I also want to thank those on the general board who have posted replies to questions on Health, Tech, or other places. I had some bad moments last night when I thought that what we have here was being placed in jeopardy. I hope that we can make some changes in terminology, satisfy the legal requirements, but not lose the very valuable resource that we have, thanks to Rebecca and all the regular posters on Lantus and on the Board. I kiss the ground (or whatever it is you kiss for internet boards) for this place. Please let it be O.K.

 

Luna and me and the LL Team

With the support and encouragement from Jojo back in October, Luna and I came along and joined the Lantus forum after a unhealthy, unsafe roller coaster ride on Caninsulin for 2 miserable months.

I have been thru 3 vets, the 1st couldn't make up his mind about tests and what not, the second one told me repeatedly
"one day you will come home and you're cat will be dead"
not to mention the discouraging phrase
"you do not have my blessing"
- what vet says that?

One who would not let me make my own decisions on the treatment of my cat based on my observations that he couldn't see at home. Hypo.
Found a new vet - and one who encouraged me to try Lantus - although she as most vets - has very limited experience with Lantus much less Feline Diabetes, I chose to stick with her as she was willing to be our vet.
I informed her I was receiving support and educating myself from an internet site called Feline Diabetes Members Board.
She was fine with that as long as I could give her updates on Luna. As we began on Lantus, she was very pleased with the results that she saw on Luna's spreadsheet.

So our journey began on Lantus. Our new vet recommended a 1.5u start, which I opposed due to my initial feelings of Luna's reaction to higher doses. 1.5u isn't much - it isn't considered a high dose by far.
I expressed my concerns in the Lantus forum and it was suggested to me to go with 1u or .75u.
I was urged many times in that first week in the Lantus forum - read the stickies - read about the Tilly Protocol which I did.
I chose to begin at .75u. We took a brief trip to 1u but it was too much for Luna.
Over the last 3 months we are now at what we call "fat zero". A single fat drop of insulin. How often do you see that?

It is is now 6 months as of January 10th, that Luna has been on insulin, first Caninsulin and then Lantus.

With much support, hand-holding and the wise experience of those we call Team J and which I call LL Team, I am proud to say I am forever grateful to this amazing group of experienced, supportive caregivers - who may not be official specialists - but in my heart - they are and will always be Luna's lifeline.

Without this team who steps in daily - taking time out of their own lives to help and support us and our precious kitties, Luna and I would still be on that roller coaster of ups and downs.
Without that talk one day with Jojo, Luna and I would be nowhere near where we stand today.
Without them, Luna would not be the healthy happy kitty he is today - as he once was before this disease took over.

Thank you from the bottom of my heart - and please let them continue what they do best - guiding and supporting us to get our cats back to being the happy pets they once were.

The choices we make are our own and I for one am solely responsible for the well-being of Luna. Edit to add: But - I couldn't of this without the LL Team.

Signed,
Ronnie Majika

 

I must say ditto to all that has been said here--As far as Lantus forum, it's record speaks for itself..
I cannot imagine it without some form of experienced members to help in situations that seem complicated..Knowledge is power! Being in another forum type group, use our experiences to give advice & if we didnt experience it, we dont advise it...

I have been on 2 other forums here on FDMB and there are always one or more members who stand out & give more suggestions than the others-Lantus is just lucky, as we are the largest group & have so many wonderful, experienced members..

Rebecca, you must know the amazing Blessing this site is for FD cats & owners..Your work has saved hundreds of cats' lives..
Let's continue your good work--Maybe have a vet or trained profssional on here to give some ideas, at certain times, or days?? More than has been?
Thanks for all that's being done here--Thanks for helping me & my cat. Ever Grateful...

 

Great posts. Michele, it is especially clear in your post how essential it is for experienced caregivers to continue to advise. It seems like more people than not have the difficult vet experience when it comes to diabetes. It seems from 3 or so years of reading this board, that is almost the "typical" experience. I wish it were not so, but it seems to be the case. In some ways it only makes sense when they are dealing with many other typical ailments and aren't able to focus as is a person who actually has to treat diabetes. I want to point out, as all here often do, my friend has a little girl who was diagnosed as diabetic at 15 months. It was overwhelming. In the beginning, the numbers get fed back to a team of doctors for advisement, but I remember her clearly saying the doctors still told her, you have to learn to make these decisions from the data because no one knows your daughter like you do. It's really the same thing here, but most vets seem to just dole out "give X amount of this insulin", stick them on some prescription food and that's it. The fact is, most vets aren't prepared to actually treat and manage diabetes in cats. They aren't prepared to advise their clients on an ongoing basis based on data retrieved. I understand not all cat owners want to go this route, but at least *find out*. It seems like instead, most (if they have any knowledge of the hometesting studies) assume clients don't want to do this or try and they hand out one vet school answer, pat the client on the head and move on. The other thing is, a human diabetic gets a near 24 hour support in the beginning from their medical team. We all know how overwhelming it is. It's just almost imperative, if for nothing more than venting, but also on decision making. Pet parents don't get that. That is why there is SUCH a dire need for this board and it's cadre of people who have lived with and treated this disease for years.

 

Thank you for the clarification, Rebecca

I can certainly understand why the term itself would be controversial and could even be seen as a legal issue were something like that to ever come up.

I am guilty of using the term myself, without much (any) thought or regard to legal consequences.

The important thing is that the L team, and the teams on all the other insulin groups (yes, they've been on every insulin group since I first joined whether acknowledged or not) will be allowed to continue their practice of helping owners to save their cats' lives. Thank you, Rebecca.

I have been the recipient of dosing advice and I've given plenty of it. In fact, I learned much of what I know from the dosing advice I received. I consider myself to be above-average with my knowledge of several insulins, but I am not arrogant enough to think I know it all, or that I'm finished learning. I try to make very clear that fact, but that doesn't mean a new or impressionable member might not think that I am saying I am the authority on the subject. I have always been reliant on the strong peer-review aspect of this site. We all get tired, we all read too fast at times and we all miss pertinent information at least once. It stings, but it's not about how we feel. It's about the cats, and if someone hurts my feelings because I was wrong, that's not important. What's important is that an owner is not led down the wrong path.

Can we say it again? It's about the cats.

PS: Michele, Lydia, Cyn, Linda, Jackie and Ronnie, terrific posts Your posts echo through the hearts of all the owners who have thriving cats, due to the excellence of this site and the members who spend hours of their own time selflessly helping others.

 

I had not been posting as much in the last two weeks due to my Dad's illness and his passing on Dec. 23. When I did try to post I realized the old board had crashed and was instructed to register on the new board. The last few days I was only posting Putty's numbers but did not really read much else. On the old board I posted in the Lantus ISG and on health. Yesterday I decided to take a look around the new board and noticed something was not right so I went to Community and started to read the threads on the "disposal" of the "dosing advisors."

Putty was diagnosed with FD August 21, 2008. I had an idea from his symptoms that he had FD so I lurked on the health site before he was officially dx. I was very impressed with the information I was reading and how so many people were so willing to spend their time helping others.
My vet prescribed Lantus and told me to start with 2 units twice a day. I had read enough to know that the dose was too high to start so I started a thread and received great advice. Based on more great advice I learned that I should give Putty low carb wet food and start to home-test.
Putty was very difficult to test and it took myself and DH to test him. I was advised to wrap Putty in a blanket to make it easier which we did. When I was alone with Putty and his bg was a little low I was advised to test him again. By that time my DH had gone to work and I was alone and scared to test him alone. With great advice I was walked through each step and one hour later after a lot of tears and sweat I tested him alone.

I was advised to start posting on the Lantus ISG. Once again I was amazed at the knowledge and support I was given. Because of the great advice I was given Putty went into remission in 24 days.
He did come out of remission 4 months later and we have been regular posters ever since. I could not have taken such good care of him or learned as much as I have without the expertise of many people on this board.

I have confidence that I can take care of Putty because of the great "advisors"that have held my hand when I needed it and gave me the push to figure things out on my own when they knew I could do it. After all Putty is my cat and I know him better than anyone.

Putty has been back on insulin for almost a year...... am I sure that I have learned enough to help others? Yes I am in most instances. Am I confident that I should or could help others with dosing advice? I believe I have learned quite a bit here to "pay it forward" as they say but I have always left the dosing to the experts. I consider them experts because they have been doing this a lot longer than I have.....they have read more, paid more attention to detail, read and reread the protocols and have given much more of their own time than I have ever given reading each and every word on every thread.

Did I ever for one minute think that the "dosing advisors" were in any way taking the place of my vet. Absolutely not. Did they ever imply that they were more knowledgeable than my vet even though in many instances they were. Absolutely not.
Time after time the "dosing advisors stated they were not vets nor could they or did they give medical help to any cat. They always responsibly stated that if there was a medical issue to seek advice of the vet or go to the local ER.

I still rely on the dosing advice that I seek here. After a year and a half of reading, learning and trying to pay attention to "advice" given in other's threads I have become confident that I am just getting comfortable dosing Putty but feel more comfortable with the input from the "dosing advisors."

As you can see I have used the words advice and advisor's many times in my post. The word advice or adviser as much as I can see from the definition below from "Dictionary. com" does not in any way imply that it is nothing more than just that......advice. In the end I have the choice to accept or decline that advice for what it is.

As I said in my opening statement my Dad had been very ill. He was diagnosed with pancreatic cancer in July. I sought out many "medical" websites researching over and over for any and all information I could find to help my Dad and to be more knowledgeable about pancreatic cancer. I found many sites that were contradictory to the actual medical advice we were given by his Dr's. I found many forums for people with pancreatic cancer with all kinds of advice. In the end I had to decide what I wanted to believe given all the information that was out there.

I believe we can all do the same here. Take the advice given and make a choice on whether or not we want to take it.
I do understand the legal aspects of deeming people "experts" but deeming them "advisors" is exactly what the term implies.....giving advice.

I can only hope for the sake of us "oldies" and especially the "newbies" you rethink your position to reinstate the "team" or whatever you want to call them so we know that our cats are getting the best possible care when it comes to dosing. I worry that the consequences without those "advisors" will be more harmful.

ad⋅vis⋅or  /ædˈvaɪzər/ Show Spelled Pronunciation [ad-vahy-zer] Show IPA
–noun 1. one who gives advice.

Thank you for reading this very long post.

Miriam and Putty

 

Thank you Janet. It is much appreciated.

I hope my intention on my previous post was to get my point across about my feelings on the "dosing advisors" and not hijack this thread to be about the loss of my Dad.

 

Jackie, Miriam, Linda and the other LL'ers have already said what I would have.

I hope we can find a solution to this issue.

Oreo was DX'd in March of '08. We started on Glipizide as I had no knowledge of FD. I did switch all of our cats to a wet food diet as I had found Dr Lisa's site. Was terrified of giving her a shot and it sounded like a win/win solution. The vet told us it could stimulate her pancreas and she could go into remission. Then I found FDMB. Read about how Glip tends to burn out the pancreas. Oh, what did I do??? I joined in July of '08 and started reading the information on Lantus. I was already home testing so that I had down pat. Then on 8/30 she looked so horrible we took her in sure she was going to need to be PTS. The next morning our vet called and said it was still the FD and we should try injectable insulin. I had been reading FDMB and was confident I could do it. He offered PZI or Lantus. He had mentioned a human insulin that was working well in cats. I had read here it was Lantus. I asked him for Lantus and began posting. He suggested 2U and that's where we started. Thanks to the angels in LL we started decreasing, got 1/2U syringes and monitored her regularly. She is still on a sk 1.25U right now, but she is happy, looks like a non-FD kitty and is getting back to her old self. The last vet who saw her as mine was on vacation remarked that she doesn't look like a diabetic kitty - thank you FDMB and LL!

It's all about the kitties. The one phrase I always keep in mind from Janet's "Suggestions for adivse givers" is "Do no harm". I believe the LL team always keeps that in mind.

Thank you Rebecca for creating this place. It has saved and helped so many!

 

It looks like further clarification of what I posted is in order; however, please understand I do not speak for Rebecca and am posting only to clarify my previous post.

I said before that any cooperative or group was bad and would be heading down the same road that "dosing advisor" had just travelled, and it would. With that said, there is nothing I have posted here or in the previous thread that should be interpreted to mean that the same people who have assisted you before cannot continue to assist you. The only differences will be : (1) There are no more "dosing advisors" as that term is currently used; and, (2) There will be no more off the board discussions relating to a specific situation. I simply cannot imagine that people who have given so generously of their time and knowledge to all of us (including me) would withhold their support because of these two changes. The same person(s) who have helped people in the ISG's will still be there and they will still continue to respond to member's posts.

I hope this clarifies the situation for everyone and no one will lose sleep thinking that their support system has suddenly gone away.

 

Re: Dosing adviser clarification -- RANT

Quoted post above:
"It looks like further clarification of what I posted is in order; however, please understand I do not speak for Rebecca and am posting only to clarify my previous post.

I said before that any cooperative or group was bad and would be heading down the same road that "dosing advisor" had just travelled, and it would. With that said, there is nothing I have posted here or in the previous thread that should be interpreted to mean that the same people who have assisted you before cannot continue to assist you. The only differences will be : (1) There are no more "dosing advisors" as that term is currently used; and, (2) There will be no more off the board discussions relating to a specific situation. I simply cannot imagine that people who have given so generously of their time and knowledge to all of us (including me) would withhold their support because of these two changes. The same person(s) who have helped people in the ISG's will still be there and they will still continue to respond to member's posts."

SERIOUSLY??? What is it with your hunt against advisors and knowledgeable people discussing among themselves the best advice to give on LL???? I've been fairly quiet through this debate and I understand the perceived legal issues but this is freakin' ridiculous. Things have been working splendidly for a very long time and countless people have been helped. I DON'T RECALL AN ISSUE WHERE THIS HAS NOT WORKED.

As a long time member of this board I am just sad. Report me, ban me, I don't care. I just don't understand why this has suddneny become an issue.

 

Awesome post Miriam.

 

Re: Dosing adviser clarification -- RANT

Patty, Jana is not hunting anyone. She was giving her take on the legal repercussions of classing specific people as advisors, the same legal worries that caused Rebecca to post to begin with. I believe she's a lawyer so she should know. We all believe discussing off board is probably not a great idea. There is no reason the people with the most experience can't discuss within a thread anyway. The idea of the board, and how it has been operating as an open peer reviewed advisory. No one would want to report or ban you. I understand your frustration. I share it.

 

Re: Dosing adviser clarification -- RANT

As far as I know, it's an issue because Rebecca wasn't aware that term was being used on the board. Rebecca's just worried about legal repercussions if someone takes that phrase the wrong way.. it can come back on her, and the board. I'd hate to see something as simple as a phrase shut the board down due to legal problems. :cry: I don't see her telling the same people can't give dosing advice to anyone.. it's just the phrase being used concerns her. Why not call them 'Team L' or something? Or even in one of the stickies, just point out the members with the most dosing experience?

 

Re: Dosing adviser clarification -- RANT

"We all believe discussing off board is probably not a great idea. There is no reason the people with the most experience can't discuss within a thread anyway.[/quote]

This is where I disagree. The world is not black and white and though I think in general it is a good idea to post advice publicly, I have NO problem advice-givers discussing a certain instance and making sure they are giving what they think is the safest advice before they post. This is not about sending the advice privately, it's about collbarating between experts (and yes they are experts in that area) before publicly advising.

Let's face it, LL is different than the other ISGs where there are a few dedicated people that spend HOURS a day helping a large number of people understand and apply a protocol to the use on Lantus. I'm not saying there are dedicated members on the other ISGs but anyone who visits LL knows it is different.

 

Re: Dosing adviser clarification -- RANT

Oh, well, I guess I have to disagree and that is something Rebecca was worried about. I don't see anything they could say that could not be said on a thread. Why would it be any different?

 

Re: Dosing adviser clarification -- RANT

My understanding is that Rebecca did not know about "dosing advisors" until yesterday when a poster mentioned them in the previous thread. As soon as she saw it, she made her original post setting forth the reasons why that practice had to stop. You can see her original post here (although she modified it later last night to include a posting of mine): http://felinediabetes.com/FDMB/viewtopic.php?f=4&t=926. As for myself, and contrary to your accusation, I'm not on a "hunt." Rebecca's analysis of the pitfalls of having individuals holding themselves out as "dosing advisors" is correct. Moreover, that analysis applies to any cooperative or designated group. I understand you may not like that and, clearly, do not agree with it - but that is the way it works in legal land. As for off-the-board discussions, that has not been a practice that was favored for as long as I know. In fact, if you look at this post (which was also on the old board) you will see that off-the-board discussions is not encouraged: http://felinediabetes.com/FDMB/viewtopic.php?f=3&t=949.

One last point...you mention "perceived legal issues," and I can assure you there is nothing about Rebecca's concerns that should be viewed as anything less than very real and very serious. All it would take is one person (not two, not three, not dozens), to abruptly end this community, the FDMB, and the LLC, and place Rebecca (and perhaps others) in a position of financial ruin for most if not all the rest of her life. So, I suppose the question is this: If you were Rebecca and just yesterday discovered a situation that placed this board, the FDMB, the LLC, and your personal financial well-being at risk, would you choose to continue the situation unchanged? Or, would you choose to make what are in reality minor changes to the situation that would diminish the risk? I suspect most people, if they stepped back from the emotion of these circumstances, would choose the latter over the former.

 

Exactly, not just the ability to review is important but the sharing of ideas/experiences that were considered to get to that recommendation should be open and available to EVERYONE, there will be NO experienced users or advisors in the future if they are not given the informationwhich to learn from. I think the recipient of the "teams" advice should also have an explanation of why that is being recommended. People need to LEARN to manage this disease not be led by the nose dependant on others for every move. We all need a little hand-holding through this process of dealing with FD, but hand-holding is one thing, we should not encourage people to blindly follow or become overly dependant on a few individuals. We need to teach people not do it for them, there may come a time when no one is around and they need to think for themselves.

In medical school we had a saying....watch one, do one, teach one...anyone ever heard this?

I take 99% of the credit for getting my cat OTJ, I read, I learned, I put it to practice. I had people holding my hand when I needed it. I stated my intentions and didn't ask for approval, but rather waited to see if anyone could give me a good reason to think I was being an idiot. I asked questions and just enjoyed a place to vent or kick and scream when I was at my wits end (I had food issues angry(2)_cat ).

Everyone has something to offer, and those that give so much of thier time are appreciated , it's not nessasary to bestow a honorary title upon them to show our gratefulness.

I'm glad this board is here I enjoy the interaction here and consider many people here friends (maybe not after I hit Submit :roll: )
Thanks Rebecca for creating such a lively place to hang out! bcatrun_gif

 

Re: Dosing adviser clarification -- RANT

I don't think it's about whether what they're saying could or couldn't be said on the thread, it's about taking the information and data as it stands and analysing it, weighing up the pros and cons of different possibilities and coming up with the best advice, opinion, whatever the hell you want to call it, then giving that to the person, explaining how the conclusion has been reached so they can learn. The person seeking the advice isn't losing out in this process, in fact it can be a hell of a lot more efficient and less confusing than having all that back and forth on the board.

It's been going on for years, long before LL. It works.

 

Re: Dosing adviser clarification -- RANT

Yes, MORE EFFICIENT especially when there is the sheer volume of posts going on in a group like LL. And if legally it is better to call the experts (that's what they are) in LL something like Team L or Lantus opinion givers, then so be it. But I'm not at all seeing how it is possible to tell them they can't brainstorm in private in order to give the safest advice publicly.

Clearly I have had WAY too much caffeine today.

 

Re: Dosing adviser clarification -- RANT

No, off board advice is not encouraged, in fact it's highly frowned upon as it should be. Off board discussion of what advice to give is an entirely different thing. The advice itself still ends up on the board.

 

very good point Yolanda!

 

Re: Dosing adviser clarification -- RANT

And is, apparently, legally dangerous. That should be justification enough if anyone wants the board to continue unfettered.

 

Re: Dosing adviser clarification -- RANT

Thank you Yolanda, for clarifying. AFAIK, there is no "off board advice" being given in LL, at least not by our "team." The off board discussion is done so as to not overwhelm with sheer number of posts.

 

Just adding my 2 cents...I had missed this whole discussion. Had no idea this was going on. Just trying to adjust to the new board logistically, and not reading every post, etc.

Now that I see this, I echo Miriam's' and Cyn and Cosmo's and so many other's input about this. I also lurked for a long time, and then when I started posted and getting advice...or input....or suggestions based upon people with far more experience...whatever you want to call it, it was scary to me, because I had such a big learning curve ahead of me. But no one else gave me the structure, the suggestions, that really made the difference between having an out of control diabetic cat and one with a prayer of becoming regulated.

I was shooting blind. I did not test. My vets told me to just keep upping the dose. Thomas was a very sick boy and all over the place until I came to this board and was introduced to home testing. Who had ever heard of that? My vet certainly never mentioned it, and when I mentioned it to them, one of the vet techs told me it 'would be hard to impossible'...no supportive heartfelt concern like I got here.

Because of this board, I was given a FREE testing kit to get me started and tons of moral support, and we were on our way. I also did keep in touch with my vet, who had heard great things about this board and wholeheartedly approved of me communicating with folks here...it was the balance between the two, but I have to say, without the input from this board, the week that Thomas went OTJ might not every have happened. My vets wouldn't have suggested the protocol that ended up getting Thomas OTJ...where he remains today, despite, his many and increasingly serious health concerns.

Most cats with his issues would never be where he is today, or even given the faintest hope of surviving all the various things he has been through, on TOP of diabetes...given the way we started out, he would have most likely not survived his diabetes without this board. In part due to his other complications making him a more fragile and complex kitty to treat. The folks who were helping us here took all of these things into account when making suggestions to us...not viewing them as impossible complications, but minor hurdles and issues to consider as part of the whole cat. Now, instead, he has had almost 2 extra years, and it won't be the diabetes that will take him from me. I would have lost him 2 years ago.

We owe his well being to the caring input from so many people on this board. I hope that will not change for others seeking the kind of help and support that we got. This place is a community of caring people, and caring for the cats is the prime focus, and I hope can remain so.

This is heartbreaking to me. I hope that some resolution can be reached so that the board can remain the magnificently informative and supportive and caring place it has always been to kitties and beans like Thomas and me.

Judith and Thomas

 

Yolanda and Patti... I agree that collaboration to come to a positive next step in treatment is a good idea. And anyone can do that. For someone to say, "I've talked to Patti, Yolanda and Janet about this and we think this is the right way to go and here's why and how we came to this conclusion... " is, in my opinion, a fair and open way to go.

As as much as the people that rely on and have relied on Team J and other in LL are freaking out that they might lose that support - even though that was not at all what was said - many more of us understand the ramifications of what one or two grief stricken individuals could do to this entire board and all the other cats and caregivers that depend on it.

Not all cats that get advise in LL live. And though that is not the fault of the people with experience that have given advice... the grief stricken caregiver doesn't know that or care. Eg. One sad wife with an angry husband who never wanted her to talk to those internet whackos anyway... and, well, he figures there's someone to blame and that the fight might make his wife feel better... and you have a recipe for disaster. Even if they don't get Rebecca's home, they may have this place shut down - even temporarily.

The labels were not made by the experts in that area anyway... so I'm sure they don't care what they are called or that they are called anything. Most people do not like labels anyway. So there should not be a problem with switching gears in our minds and being able to say, "Hey, newbie, Listen to Jojo.. she's got a ton of experience and has been helping people with sick cats on this board for years." And there is no reason why someone can't say the same thing about many other people - in LL and out.

Patti and Yolanda, you both have helped many people... you have helped me understand so much about many things feline and feline health related. And I don't have a problem telling people that. But I don't need to label you, do I?


So why is it heartbreaking and devastating for so many people that Rebecca wants to protect this place so that she is not put at risk and so that the people who have experience have a place to share that experience? Other than a few words changing that have been used to refer to people, nothing else is changing... Nothing is at risk.. not the help everyone has been receiving and not Rebecca personally.

 

I can appreciate the issue of convenience and not wanting to overwhelm people with posts. However, as it stands now, Rebecca has spoken. It is my sincere hope that none of the people who so generously given of their time, knowledge, and support, will cease those activities because there are no more "dosing advisors" or other identified cooperatives/groups, or off-the-board discussions. To me, at this point, there is no reason for people to continue worrying about their ability to obtain the same information they previously received or fret that their support system has disappeared.

 

Miriam,
It's like you were typing what I was thinking, except you said it better than I ever could!!!!!!

Thank You for making perfect sense of all this!
Jan

 

I agree that it is incumbent upon all of us to try to protect the people who go WAY out of their way each day to help us.

I'm kind of new here, and not privvy to some of the things that may have happened in the past. But, I imagine one of the concerns may be that if there are not named "experts" how do people, newbies in particular but anyone, know who they should listen to? Could there be some way that people could rate one another's advice? Then if I see a reply to my HELP! from Bernie who has 1200 ratings and an average of 4 stars, I can differentiate that from the advice from Bunnie who has no ratings at all and Benny who has 1200 ratings and an average of one star. I know this invites malicious bad ratings, but they tend to get lost in the averages when the numbers are big enough. This kind of thing does work out on other sites.

 

I don't see that as being any sort of resonable option. You are again excluding people and recognizing only some individuals as being "qualified" this would also breed competition and create popularity contests. Seems very high school to me. :YMSIGH:

 

The people seeking information have to weigh that information - like all of us had to do. And of course weight will be given to information that is repeatedly given as well as when an experienced person posts and someone states, "Hey, this was good information, so and so knows what she's talking about." That's what we say when Jess jumps in and gives some advise. Jess is busy and doesn't have a lot of time to post so when she does a newbie may not know how to weigh that information... so usually there is someone around to say that it's good advice.


This is not a clinic. And it can't be perceived as one. It is a discussion forum from which people who care for diabetic cats can receive helpful information, direction about treatment and support.

 

Um, Vic, my posts had nothing to do with, nor did they mention, the terms used to describe those people doing the "opinion giving". They were about the fact that off board discussions of the "opinion" to give (is that better Karen??) does happen, has always happened and will continue to happen, and there is nothing wrong with it. Fine, don't call them dosing advisers. Being quite a bright person, I don't need the possible legal ramifications of that spelt out to me. What I can't see as being a problem is a group of people discussing the best approach to suggest (not advise ) being legally problematic to the board.

And sorry to those that don't like that these behind the scenes discussions happen, but truth is it's probably helped your cat at one time or another. Think about that, because THAT is what it's all about, the cats. Would you rather not have had our help?

 

The ISGs, started in 2005 by Venita, Alice and others, were created to help people learn. They were not initiated to serve as a clinic on what to do, but on how to do it. The founders of the concept understood that each insulin is different and each insulin affects different cats in different ways. You newbies would be amazed at how controversial the whole concept of ISGs was at the time.

Here's a post from an early Think Tank discussion on whether or not the groups were working as intended. As always, Anne and French Fry make the important points:
http://www.felinediabetes.com/phorum5/read.php?15,477629,478106#msg-478106

One last point. Each of the insulin groups has always had 1-2, sometimes more, dedicated volunteers available to hold the hands of newbies. Those volunteers come and go depending on their real lives and how burned out they got. What I see as different today is that some people are staying in the study groups for years. Those long-termers shouldn't really continue to need daily advice, but it's gotten comfortable for them to be part of the community (see Anne's post). But they also contribute to the volume of traffic on the Lantus board, and thus the need to have designated "advisors." The title of "advisor" was created, as far as I understand it, to help manage traffic. Removing that title does nothing to solve the traffic volume problem.

 

In my humble opinion.....

IMHO.....this is a phrase that I used to see a lot on this board and could be well served to be brought back into action here.

As to the legalities, I am not venturing in, however I do believe that the people who have given of themselves endlessly in LL and in other forums do so often with the support of conversations behind the scenes.
I know I have. Being a lone voice often in VCN-ISG , I try to make sure that at least a few people have been part of a discussion ( a check and balance if you willl ) that I would then share outloud in threads to the person I was assisting.

A good example of this is Deb and Spot and Kate and Lucky.

IMHO, we need to get back to the idea that it is about the cats. First and always.

 

This isn't about popularity. It's about knowing when you are getting an opinion from experience and when you are getting one from a person who just likes to have opinions. And we can not ask the people who truly are experts to call themselves that because they take on too much liability by doing so. The system actually can work very well. There is no need to compete with anyone but yourself. I can rate 10 people 4 stars if all 10 offer useful advice and no one knows who rated them how.

I'm not pushing this as an only answer. Just something to think about. But I wasn't even "very high school" when I was in high school 40-odd years ago!

 

That's so interesting, because everyone needs to learn how to make these decisions for themselves. I've learned quite a bit already and I'm still wet behind my kitty ears. I also do sometimes get mixed up about who told me what. It's difficult at first to get that feeling that your feet are on the ground.

I've been worrying about this! Will people nudge me to move along, get my own opinion, stop asking when the time is right? LOL! That's me--worried about when I should move on before I am all the way into the door!

 

Re: Dosing adviser clarification -- RANT

Investigation of the Challenger space shuttle disaster shown that it was likely caused by experts meeting away from the persons (launch director) getting advice. Specifically:

A group of experts were meeting to determine it the Challenger launch should proceed based on the low ambient temperature. One person provided facts of a probable o-ring burn through due to the low temperature (lowest temperature so far for a launch). In a group situation, a strong leader can smother valid dissent. That person's dissent was never passed on to the decision maker (for our cats the caretaker, the FDMB is NOT the decision maker). Many organizations made changes based on the finding of the Challenger investigation (e.g., recommendations will include dissenter's opinions). Group decision making has many pitfalls with one of them is that no one is responsible for the decision. The group decision making process has been well studied and organizations have to learn how avoid the pitfalls.

 

Yolanda, I think you've hit on a point that is the source of concern for some people; that is, absent some designation/title and the off-the-board discussions, some of the people relied upon most in the ISG's will simply stop participating. I truly hope that will not be the case and that, given the choice between some designation/title and off-the-board discussions versus continuing support for the people (and their kitties) in this community, they will choose to remain and be the positive participants we all know and appreciate them to be.

 

As one who actually concentrates her practice in civil litigation, I have to say that this is just silly.

Legal disclaimer here: I am not offering legal "advise" to anyone but merely offering my personal opinion.

Firstly, I'm rather surprise at the legal advice that is so freely being offered here. As any attorney knows, an attorney is only permitted to offer legal advice in the state(s) in which he or she is licensed. As I'm not licensed in the state in which Rebecca resides or which the LLC is organized (to the best of my knowledge), I cannot and will not offer her specific legal advice.

That being said, I can offer a few general thoughts on legal concepts. As this board is owned by a LLC, as long as that LLC follows the legal formalities required by the state in which it is licensed, the owner(s) and/or manager(s) of the LLC are generally insulated from liability. The LLC's financial exposure is generally limited to its capitalization (most often $1000). LLCs are shut down and reformed under new names all the time due to liability issues. Moreover, most, if not all, states unfortunately treat pets as mere personal property. If one were to successfully sue someone for advice given which injured his or her cat, in all likelihood, their financial recovery would be limited to the cost of replacing the cat. The thought of Rebecca or anyone else losing her house because of advice given on this board is quite unlikely.

Also, the thought that some legal liability would arise to the LLC because certain members of the board are referred to as dosing advisers is.....odd. Having practiced law for over 15 years - concentrating in civil litigation - I'm really not familiar with that concept.

If I owned a board where advice was given, I would make sure that everyone had to specifically accept the terms of use by requiring users to physically click and "I accept" or similar button which clearly specifies that the user disclaims all liability against the board, owner, moderators, webmaster, other users, etc. I would also make sure that the LLC owning the board was up to date with all legal requirements of the state(s) in which it is organized. That's my two cents.

 

Joan, I sent you a PM but then thought you might now check your inbox, so I'll repeat what I said to you privately here:

I am licensed in Arizona, although I live in a different state. I am concerned about the LLC's liability here, given that in my view it would not be difficult to pearce the LCC under the totality of the circumstances as I understand them.

Fortunately, it appears this discussion is winding down and we can all move on to other things.

 

Janet, I agree completely about any possible ratings system. The place I am thinking of lets you rate each instance, not the person in general. So, if I am talking to someone in a thread and s/he gives me 5 pieces of advice, that's 5 items I can rate, but I can only rate interactions between me and that person and only once per interaction. IOW, I can't just randomly rate someone or rate them 1000 times for one interaction. Of course, I do not know how this is made to work. It may well be custom software that is making it happen.

But again, this is just one thought. As I mentioned earlier today, Rebecca could consider asking people to accept the terms of service, so to speak, before joining a group. That might help, too.

BTW, I am SO grateful for your food charts. They are my jumping off point for finding food and I have presented a lot of your info to my vet to show him how the prescription foods compare. I also added lists of ingredients. Don't want to hijack the thread, but I had to mention that.

 

Yolanda, I know what your post was about and I agree... like Janet said, we can't stop people from discussing stuff off the board. As long as the advice is not given off the board, brainstorming and collaborating is likely not too much a risk (that would be something for Jana to determine)... But, it's not just Rebecca here that is at risk when we talk about labels and ranking and such... People giving direct advice and long-term care over the internet put themselves at risk of being sued too. And I don't want to see anyone get into trouble.

It may be hard to comprehend if you've not work in the legal industry before... but people do get mad and they do sue even when they don't have a case... and even if they don't win what they set out to win, they can cause a whole heck of a problem for the people who have to defend themselves. This site has grown and reached a huge size... it's also developed and changed through the years and some of those changes may help more cats, but they put the beans on the site at risk... There is a way to help cats and not put anyone at risk.

I don't know why there is so much worry about this... When I came to the forum four years ago it was clear who had knowledge, what their limits were and what information I should consider. Since that time, we have taken almost all the responsibility AWAY from the caregiver... they can now get advice for each and every dose, they don't even have to weigh the information because we have ranked the advice givers... how are they to learn and pay forward if they don't take responsibility for what they are absorbing from the net?

So many more people in LL could help and give opinions based on what they've learned... but they don't feel they can because they are not experts, or that they have to because the experts are always there. So what happens when Jojo heals and starts to work again?


PS: I get what you are saying, Joan, and certainly didn't mean to be "silly"... But even if someone didn't lose their house... the hassles of a frivolous lawsuit are not nice either.

I just don't see why we can't be careful... I just don't see how this changes ANY of the advice or help.

 

And I'll respond here as well. What circumstances? As you know, piercing the corporate veil has ONLY to do with how the entity and is operated in terms of its corporate charter (i.e. does it file annual reports, have annual meetings, keep its finances completely separate from its owners, etc.).

 

Joan, I responded in detail via PM. However, for the benefit of all, Arizona has a wrinkle in its law regarding piercing the corporate veil of LLC's, one that has the potential to have impact here (and not in a good way).

 

So many more people in LL could help and give opinions based on what they've learned... but they don't feel they can because they are not experts, or that they have to because the experts are always there. So what happens when Jojo heals and starts to work again?

Who doesn't feel they can give advise because of the other opinion givers (not calling them advisors) out there? jojo has been gone for a few months for the most part due to personal reasons and there are plenty of others helping out.

 

That's great to know, Patti... it wasn't the case several months ago when I saw several posts where experienced people said, "Hang on, Team J will be here soon."

I'm happy to hear that the work is spread out... it's a lot of responsibility for only a few people.

 

Very strange. I've never heard of such a thing (other than the very unusual situation of piercing the corporate veil when an owner specifically authorizes or participates in an intentional tort). I wonder why Arizona even allows LLCs. If I were advising Rebecca, I think I would suggest that she reorganize in a state without such an odd law.

 

(God help me, I'm going to rock the boat...sigh...)

Please don't sell me, and others, short. We are learning as fast and as much as we can; we are the ones putting the needle in our cats' bodies, and we're the ones trying to get blood out of an ear that just doesn't want to bleed. We're the ones watching the poop and pee habits, and trying to figure out if a semisolid poop means something or not. It's fully our responsibility. If we didn't want to take that responsibility, not a single one of us here would be posting. We'd've put the cats down, or given them up. I take full, complete responsibility for what I put into my cat; how I put it in there, and what it can do if I don't get it right. I do. You don't. The LLC doesn't. I do. The insulin is in my fridge, the syringes in my cupboard, and the test meter and strips on my counter. So please don't see me short; and don't sell others short, either.

I don't ask for advice for every dose. I don't see anyone who does. I see people saying "oh geez, I don't know what to do with this (high)(low) number...what does the experience of this board think? Do I consider how long a person has dealt with a particular insulin to be an important piece? Absolutely. As we've all seen, vets often have no idea how to treat this disease. So learning at the knees of others who have had not just their own success but have contributed mightily to others success, in a medium which is often a difficult one to communicate accurately in, is something which is very, very valuable.

And bear in mind that to weigh information given one must have a secure base of knowledge to judge from. You can't ask a child who loves chocolate if that's a good diet; he's going to say yes. Once he's grown (experienced) a bit more, he may change his answer...because he now has a base from which to accurately assess and judge the situation.

So where does that secure base of knowledge come from? For me, it has not come from the sources I expected - not one vet understands this like I do that I've spoken with. As a student RN, it behooves me to question and assess and dig, and build my base from where I stand. But I have a headstart...this isn't blindsiding me. And did you know that at my hospital, people make more than $250K a year as - get this - a diabetic educator? The Doctors refer the patients to the DE, and the DE may indeed have no additional title other than RN. But they're the ones doing the education...and doing it well. In other words, they're narrow-field specialists, and that's all they do...educate people. And you know what? They get calls at all hours, for those folks who are new and wondering what a bs of 150 means to them, and how to deal with it.

Compare that to folks (like me) who got a dx of diabetes, handed a vial of insulin, and set out on my own merry way to figure this out. I've explained my experience with vets in a previous post, and won't recount again here. But I have to say, the enormity of my relief was incredible when I found this site...and I've been happy with each and every person's post to each and every one of my posts...be they asking for "advice" or not...

Vic, I'm sorry I'm ranting. But I want you to clearly understand that in no way, shape or form have I not accepted responsibility for my cat's illness. She is mine, and I am hers, and I am utterly, completely responsible for everything I do, feed, inject or test with that cat. If what you're concerned about is that I'll never pay it forward, or not ever become independent, rest assured...I already have. There are two folks who I taught how to test and inject Esse while I was on vacation...and I came home and Esse was just fine. I will contribute to other folks' questions as I gain more experience (expand my knowledge base), but until then, the LL Angels are indeed just that - Angels.

And to my Angels - please do not let this stop you from helping us. We need it. We want it. We come here for it. You spend a lot of time helping folks like me, and someday, having learned from you, I will pay it forward too. Until then, just know that I very, very, very much appreciate everything you have done for me...and you are indeed my Angels.

I'll shut up now. I just didn't want anyone to think that by asking for help it meant that I, or anyone, is a weak sister. All it means is that we're new. We're learning as fast as we can, but we're also new. And there's nothing wrong with being new.

Best-
Michele and Esse

 

I would like to add my 2 cents worth for this discussion. First of all, I don't think that there should be a group called "dosing adviser" mainly for the legal reasons described. However, I would like to see some way that our experience level with caring for diabetic cats somehow noted so anyone can easily see it without having to look at a profile.

I originally found FDMB back in 2003 when my cat Rascal was diagnosed. Even though I was only a lurker at the time, I did receive valuable information from this site. When Witn was diagnosed in 2007, I became an active member of FDMB. I have gained a lot of experience caring for diabetic cats and have even adopted 2 of them. My knowledge was gained through both my personal experience and also the information I received off of this site. I do feel comfortable about the advice I give on this site regarding the general care of a diabetic cat and will not give advice in an area that I do not have experience in.

One thing I have noticed is that the advice we generally give in most posts are consistent and also build on previous posts. I also see the newbies post encouragement to other newbies while admitting they are not able to offer advice, but do encourage the poster to listen to the experience on this board and how it has helped them.

Yes, we do have people on this board that both personal experience in caring for diabetic cats - especially cats with multiple health issues - and that also have medical training in caring for animals. But as we all know, ECID. What may be best for my cat, may not be the best for your cat. But at the same time, there also may be something that is somewhat unique in my cat's treatment that may be helpful to someone else who has a similar situation.

I know that I have personally been able to educate my vet on different insulins and hometesting. Even though my vet and I don't always agree, we do respect each other's advice and opinions.

My concern with designating certain people as "dosing advisors" is that someone could miss out on getting the advice from multiple experienced people. All of our experiences are valuable and can often help another person.

As I said, this is just my 2 cents worth.

 

It is the interesting wrinkle in Arizona...and one that not every state has. Wrinkle's aside, Arizona law is what Rebecca has to deal with and make decisions based upon that law.

ON EDIT (and with the sincere hope of wrapping this up):

Two things...

First, I notice many people acknowleding their personal responsibility for the care of their cat(s), and I think that is great. However, if I had to sit down with Rebecca a make a list of the chracteristic of folks I thought would present the highest risk for a claim, none of you - or many/most of the people on the board - would not be on it. Who would be on that list would be lurkers or those folks who only post a very few times (usually with a crisis), then are never heard from again. For reasons I suspect are obvious (and if they aren't, I won't bore you anymore with legalese), those are the people I would be most concerned about.

Second, it is true much of what Rebecca has indicated we should all do (or not do) going forward isn't going to be something that can easily be monitored or enforced. I suspect Rebecca's hope is that everyone will cooperate because she has asked us to.

 

Whoa, Michelle... read my post. I never said that you, or any other caregiver, do not take responsibility. Remember... I had a diabetic cat too. She was diet controlled quickly. She was diet controlled for 2 years. She then had multiple issues that brought back the diabetes. During that time (8 months), I did all the tests, shots, oral meds, cream meds and fluids... I did multiple vet visits a month...I came home on my lunch everyday to test. I was here to give and receive advice... and I tried my best. I didn't do it all perfectly. And since Sundance died, I have read more, followed threads in all the ISGs and read more literature than ever before and directed countless people to the LL. I don't think that doing things even slightly differently would have changed the outcome with Sundance because she had cancer, but I know that I now understand the disease and the treatments and the different insulins a lot better... NEVER would I say that any of us that are going through this do not take responsibility. We do, and you are right, that's why we are here.

My posts are not about any one person, about any group of people or about the advice given... they are about the board, the way we help and encourage others. Please don't rant at me.... I haven't made any of this personal and I hope no one else does either.

 

Do you even know for sure what state the LLC was organized in? Until not too long ago Rebecca lived in Colorado if I am not mistaken. Just because she moved, doesn't automatically mean the LLC changed states as well.

 

Jana, I cannot find that provision in the Arizona statute. (I can't help myself; I'm curious.) Would you be kind enough to PM the cite to me? Thanks.

 

so just to sum this up in my brain since i've been out stuffing myself with wonderful cuban food this afternoon and then actually doing some useful stuff around my house, i can still ask for dosing advice as long as i don't say "dose advisor" in my request for it???

 

No one thinks that. Even those of us that have been caring for diabetic cats for years have questions. I know that I have. And no matter how long you have been on this board, there is always the opportunity to learn something new. Please never feel like you can not ask a question - even if you think that it is something so simple or dumb. Most likely there is someone else who is wondering the same thing and is also afraid to ask.

 

Wow....I am quite surprised to see something like this. I for one am so grateful that those "long-termers" stayed in the community. Without their long term knowledge I would have never learned as much as I did when I was a newbie. As far as those long-termers continuing to need daily advice, I do not see how this is a problem. FD as we all know is a very unpredictable disease which can change on any given day. It is the continued posting from those "long-termers that have probably helped me the most.

I don't believe the reason that the Lantus board needs designated advisors because of the traffic of the old timers but rather the influx of newly diagnosed cats that have been prescribed Lantus. As I said in my previous post......legally I worry about the misinformation that I have seen been given to newbies and continues to be given without the newbie having any knowledge of how experienced the person giving that information is. That is where I would worry about a lawsuit. As far as the advisors in the Lantus forum, I think they have always publicly stated they are not vets or vet techs and do not give any medical opinions. Their dosing expertise comes from being one of those "old timers" that have stuck around to help the rest of us.

I have seen old timers refrain from posting so that they do not get in the way of the newbies only to be told that they are part of the Lantus community and have the right to post just as anyone else does, which I couldn't agree more with.

I do not mean to show any disrespect for Rebecca by posting in this thread. I am very grateful for what she has done and continues to do to make this board what it is today.

 

Cindy, it is business as usual with the exception of the prohibition against "dose advisors" and the off-the-board discussions. Neither you (or anyone else) should see any difference.

BTW, did you have to mention Cuban food??!!?? I'm starving as it is! :lol:

 

I didn't say the long-termers shouldn't stay in the community. FDMB is built on the pay it forward concept so of course we want experienced people to stay around. My point was that many of the daily threads on Lantus come from individuals who don't want or need help; they aren't there learning, but they are there socializing. That was not the intent of the ISGs. Please don't take that to mean that I don't think they should post of Lantus. They could offer encourage and support without having to start a new thread daily. That would be more in the spirit with which the ISGs were formed (IMHO). And it would reduce the volume of traffic on Lantus.

 

This is IMO the best suggestion yet. I had to sign a waiver absolving my riding instructor of all legalities in the case of injury riding. How would this be any different? This sounds like a good idea. No, it wouldn't cover a lurker who did not register taking advice in health, but then, that would be like any internet advice and non-specific to the person.

 

This is what I believe is the real crux of the matter. If people would just carry on I think everything would be fine.

 

When someone is signing in to find help for their dying cat, clicking "I Accept" is a no-brainer... as is not reading the conditions which were just accepted in order to get to the info faster. They want info and they want it now.

I'm not saying that should not be done. It's probably another good safety net.

Are all these suggestions being made so that we can use the term "advisor"? That just opens up a huge can of worms about who is the advisor, who chooses the advisor and such... Individual support for a post or poster in a thread is much more effective overall.

 

"it is business as usual with the exception of the prohibition against "dose advisors" and the off-the-board discussions. Neither you (or anyone else) should see any difference."

It is easy to ban a term like dose advisor how do you propose to stop the off-the-board discussions that have been part of the process since this beginning? How would that even be monitored?

 

I was thinking the suggestion was made as just another safeguard for Rebecca. Yes, it's a no brainer. I do it all the time though for things that I *want* info on. Including the waiver on riding. I *wanted* riding lessons. End of story.

*sigh* I guess everything just has to be difficult.

 

I'm guessing the *point* is it can't be *but* if the idea of the "formal advising" is formally rejected, not mentioned or followed, things would be ok. Man, this is the point. Someone officially brought this up. It had to be addressed for legalities sake. It's not like people will suddenly be tracked in all points of their life. It's just common sense.

 

(because i can't seem to get two quotes to work in the same post) from Jana: "Cindy, it is business as usual with the exception of the prohibition against "dose advisors" and the off-the-board discussions. Neither you (or anyone else) should see any difference."

so are you saying prohibition of people giving dose advice or the use of the words "dose advisors"? if you mean prohibition of people giving dose advice, then i think a lot of people will not stay here. taking away dose advising eliminates the need for 99% of the board.

and like someone else said, who can really prohibit off the board discussions?? if anything, this latest brouhaha has or will increase the amount of off the board discussions.

and why may i ask is it a concern how much traffic there is in lantus?? you don't use lantus nor do you post there, heck for that matter, the people with the biggest itch here about "dose advisors" aren't part of that isg at all, so this is completely irrelevant if you ask me.

and since most of the people complaining here are against the words "dose advisors", and the issue is apparently not actually about giving dose advice, i hereby announce i might want dose advice sometimes from the people I will now refer to as the Holy Ones!

 

well now, we each can decide on what we each want to call the people we trust and respect with our cats lives i suppose. figure that's how the words "dose advisor" came along to begin with right, Oh Holy Food & Statistician One ;-)

and yes, when it comes to nutrition, there are two people who come to my mind as the advisors in that field, Janet & Dr. Lisa.

 

I said the following in a previous post:

I suppose there may be a few people for whom Rebecca's request for cooperation just will not be enough. How Rebecca handles that will be up to her.

 

Cindy, I don't mean to get snarly with you or anyone else (although I am tired and still starving!), but on behalf of myself, I've said that my interpretation of Rebecca's post was she did not want the term "dose advisor" being used at the same was currently being defined. It is my understanding that was the correct interpretation. Between that, what Rebecca posted, and the discussion that has been ongoing, I don't know what else there is to say that hasn't been said over the last two days...truly, I don't.

I believe my response to Patti above addresses your question about off-the-board discussions.

To be honest, I don't remember exactly who it was the brought up the issue of traffic in LL, but I believe it was one of the reasons given for off-the-board discussion regarding dosing (i.e., to avoid clogging up the forum with multiple posts that could be confusing to some).

 

Jana, maybe you should read Rebecca's post. Here it is:

There are certainly no official dosing advisers and there CANNOT be. There should not even be UNOFFICIAL dosing advisers and I was totally unaware until now that there were such people or teams. If someone is a veterinarian and wants to take on the professional liability, they can go for it. This is dangerous, this is illegal (practicing veterinary medicine without a license), and it should not be going on. I will speak to the forum moderators about this. Such practices put FelineDiabetes.com, the FDMB, and the whole LLC I operate this shebang under in perilous legal territory by doing this. We do not give medical advice. We can relay stories, we can express opinions, we can point out evidence, we can cite literature. :arrow: WE PERSONALLY GIVE NO ADVICE ON TREATMENT. ALWAYS CONSULT YOUR VETERINARIAN. :!:

Of course, we all have people we trust more than others, but that is it. If there is any reference to "dosing adviser" or even saying in a public post that someone's advice should be more trusted than another person's advice, it should be reported to me.

Others have already said it much better than I can: this is an OPEN, PEER review board. If you want to discuss things privately, that is of course your business. But I agree with what someone else said. If you disagree with a post on dosing, you should post & disagree, but there are to be no personal references, and you should support your reason for disagreement with sound evidence, not anecdotes and not dislikes of other people.

If we want to be respected in the world of feline diabetes treatment, we must be professional and we must recommend evidence-based decisions. I know the literature is ever changing (thank goodness!) and it can be hard to keep up - or agree with it. But anecdotal evidence and personal bias are NEVER professional.

Be respectful, be kind, and no dissing of other people's advice or personality or any personal references, even names. I am proud of this board and the people who use it and I want to continue that. Please.

_Rebecca Price
Owner, FelineDiabetes.com, its subsidiary FDMB, and Feline Diabetes USA LLC
owner@felinediabetes.com

You are continually stating that there be no off-board discussions and I believe you may be confusing "discussions" and "advising". There should never be off-board advice, and that has been a statement of FDMB since maybe its inception. Rebecca has stated that these things may be discussed privately, however they must be posted publicly. I think you also seem to not have any idea that this is exactly what has been going on in Lantus, and every other insulin support group. Still not clear on why Lantus ISG is such a target and the others are being ignored. Discussions have always casually happened, where (say for instance) I send a PM to Experienced User A and say "Hey did you notice that Betty's cat Fluffy is having a weird response?" or "Can you take a peek at Betty's cat Fluffy's spreadsheet and see if you notice anything odd?" Then a post goes up to Betty from me saying "hey I talked about this with Experienced User A and we both are wondering if there's something going on with Fluffy's reaction to her insulin, and we are concerned that you should start getting a +2..." I do not see where this is a liability problem, and I do not see why you are telling people that they can no longer do this when the owner of the board is not saying it.

Rebecca: If I have confused something, please tell me.

 

One more perspective:

As one of the very early (and long-term!) users of Levemir (before it was even available here in the US), I tried to stick around and help out new people in Levland, which wasn't getting a whole lot of traffic. At one point someone suggested to a user that they post in the Lantus group instead, because there they would find "people who really knew" (meaning Team J) how to give advice. I was generously invited to stick around by that same person because I have a sense of humor.

That pretty much burst my bubble, as far as hoping to pay it forward. Anyone who read those posts would consider me an incompetent, or at least less competent source of experience. Maybe it was me being paranoid but I felt I lost credibility. I'm not saying I don't have the utmost respect and admiration for those advice givers in LL, I do. And I never did use lantus, so really it had no bearing on my day to day dealings on the board. But indirectly it affected me, and potentially anyone I could help because someone else decided I am not a Wise One.

I don't have the answers to this issue - what about a short standard disclaimer that advice givers could include in their signature - that they are not licensed vets, they are giving advice based on their own experience with their cats, etc.

When I did help, I would usually post such a disclaimer anyway. Especially when talking about my experience with Tritone, who as some of you may remember, was an extremely difficult case.

 

yes, exactly. i think this thing has been beaten to a dead horse. after all this carpal tunnel forming typing, i think we know that the words "dose advisor" are not going to be used anymore and everything else will go on as it has for several several years.

and if that is how the traffic issue came up, then yes, i'll give you that one except i do want to point out that could you imagine jill and jojo or jill, jojo, and libby or any other group of 2+ people trying to have a conversation via the keyboard about this cat responded this way and their bean is iffy on this part and i think this and i think that, and on this day he did this, etc......my god, yes, not only would it take up tons of space on the board but it would also take so damn long that beans could get impatient waiting and hurt their cat because they had to get to work and couldn't wait any longer. give me off board as fast as humans can move their mouth discussion anyday.

 

Carolyn, I'll begin my response with the "easy" part...As I said above, I don't remember who brought up LL specifically, but it was cited as an example of why off-the-board dosing discussions began and it was in an effort to not clog up the forum with multiple posts that some may find confusing. I seriously doubt Rebecca intended her decision regarding "dosing advisors" to be limited only to LL, and I know my posts were not intended to relate only to LL. To the extent anything I've posted appeared to be directed at any one forum, I apologize.

On to the more thorny issues...

I do understand the difference between "discussions" and "advice." Given the feedback I've received, it certainly sounds like dosing advice was being given off the board. Let me be clear...I am not saying you (or anyone else in particular) engaged in off-the-board dosing advise. I am saying that it has become clear it was happening. I don't think anyone is seriously suggesting that off-the-board dosing advice is a good idea; in fact, I think the fact it is not a good idea is something we can all agree on.

As for "discussions" being conducted off-the-board (and particularly in light of the reason given for the necessity of those discussions), I can only repeat for you what I've posted publically and said privately to Rebecca: Anytime you have a the formation of a cooperative, group, etc., that either immediately or over time becomes known by certain chracteristics, names, members, functions, etc., you are heading down the same road that "dosing advisor" went down...and that is not a good thing. How any one individual interprets the fact that Rebecca appended my opinion on this topic to her original post is up to each individual, I suppose. The question I would ask is this: Is there some particular reason(s) those dosing discussions can't be held on the board? I'm not trying to be snarky...there may be some issue surrounding that practice that I haven't heard about and should be discussed.

 

Carolyn, your example of off-forum discussion or collaboration is exactly what I understand to be ok. It cannot be monitored and there is no need or reason for it to be stopped - or forced underground. People are going to do it. I get PMs often from other members bringing a thread to my attention when someone posts who has a fractious cat and thinks they cannot home test. I thank the person sending the PM and often I then PM a few other people who have fractious cats so we can all share our experiences. Now, I know that is not collaboration on advice, but it's discussing someone's cat off-forum.

Jana, I think there may be reason sometimes to have a discussion off the forum... and ok if the process by which the given advice was determined is disclosed in the subsequent post to the OP. I see what you mean by it being a cooperative or group... but if that "group" is dynamic and it's not a set list of advisors, just a random group of people getting together to ensure their thoughts are sound, I can't see the harm or risk there.

I think Lantus ISG was used as an example only... and due to the heavy traffic there, it seems to affect and, therefore, upset more people in that group who have posted their concerns. Certainly ALL the people who have dedicated themselves to the board and to helping people in those groups, and in the general Health section, on a regular basis should be thanked and protected. People mention Team J all the time with good reason, but Sheila and Kimmee have been a great help to those in the Vetsulin group... as Patti and Carolynn have in High Dose and others have in other ISGs.

Cindy, your perspective is not an anomaly. I won't say it runs rampant, but there are a lot of really good people out there with great experience that get turned off when they are trumped because some other person with experience has more exposure and seems to have a PR team. And that is not at all the fault of the experienced people giving the advice, by the way. It just happens through enthusiasm. But if labeling were permitted, it would happen more often.

 

So, this thread is now up to nine pages. Anybody changed their minds yet? Has anything been accomplished besides people picking a side and some talking it to death?

I do apologize for being just a tad facetious but pictures of horses keep running through my head - horses and/or spinning wheels.

 

Under the conditions you suggest, I think the difficult issues are lessened; however, from what I understand, it was the informal off-the-board give-and-take that ultimately spawned "dosing advisors" as the group of people participating became less dynamic and more set.

 

Somewhere along the way, it was forgotten that this is the community forum, a place to have fun. I'm not really sure why this is still going on either.

COMMUNITY (non-cat health topics)
Social butterflies flock here! DO NOT POST CAT HEALTH TOPICS HERE - go to the Diabetes Health Forum.

Have fun!

 

Sounded like?? Show me. No one would ever say it because it is not, nor was it, happening with ANY such teams, on ANY ISGs.

And if you say it's a good idea and we can all agree on it now, why have you been stating that we can't do it throughout this thread? There is no need for this level of confusion and wolf-crying to be put out there. To date, you are the only person who has stated that off-board advice is happening, so I must ask you why on earth you would make a legal argument out of a fictional idea?

Well then I guess Rebecca and this board have been "down that same road" since 1996. It has been stated over and over again that these discussions happen offboard to slow down the onboard traffic. I don't know if you were paying any attention but FDMB has been crashing and unstable since the time of the new ISG setup when each ISG got their own specific subforum, rather than just a thread under one subforum. In fact, I don't believe you were a member at that time. Other reasons include inadvertently scaring a newly diagnosed member by stating an observation that this person may not be ready to hear (such as questioning if a cat might needed to be tested for a specific disease) and finally to ease confusion in a person's thread. It's rather obvious (I would think to most people) that if I have a thread and I say "my cat is 900 what should I do?????" and 25 people get on my thread and ask or say 25 different things, I might become overwhelmed by this and not come back. Or I might miss something important that's been posted to me, or I might get confused and misread something that's been posted to me. Making a mountain out of a molehill is making trouble where there is none.

 

Oh Cindy---you know from my perspective (and I know I don't speak for myself alone), your advise is pure GOLD. You are the only one of the original Lev users who cared enough to stick around. You bring not just knowledge of the "ideal" protocol, but an understanding of how to use the insulin for toughies like Tritone and Lucy.

As for the off-board discussions, let's bring some reason to the discussion please. If people want to email back and forth about how a certain cat should be treated, it's their business. Rebecca is not responsible for what people do off the board. It's what happens when they post back on FDMB that presents the challenge. I pay $75 a pop for my oncologists to have a "non-face-to-face" conference about my case. From that conference, I get nothing except the bill and the knowledge that they remember my name. It really isn't acceptable, but I don't have a choice.

If it was my vet trying it though, I would be screaming bloody murder. Discussions about my case or Lucy's case need to be laid out for me. I want to know what the various "experts" think, if they don't agree, if they are ambiguous, etc. No one on FDMB should accept anything less than full knowledge of whatever is being discussed. If the off-list discussions return that kind of information, I can't imagine why anyone would object. It leaves the bean the information they need to follow the advice or pursue other avenues. But if those off-list discussions do not return that kind of detail, we should all be objecting--it's no different from all the PM dosing advice many of us have railed against for years.

 

quoting again this way since I can't seem to master it via the button named quote:
"Under the conditions you suggest, I think the difficult issues are lessened; however, from what I understand, it was the informal off-the-board give-and-take that ultimately spawned "dosing advisors" as the group of people participating became less dynamic and more set."

Where did you get that idea? I have been on this board just short of 4 years and that is not what I saw happen. As many have stated previously in this thread, off board discussion of what advice to give publicly has gone on since the beginning. The "dosing advisors" had not really been a formalish idea until much more recently. And I AM referring to LL because that is where there was more of an established presence of regular advisors. But from what I see, others also share their experiences there.

 

Perhaps it is time to send this thread to think tank for ongoing discussion?

 

Like I said......Somewhere along the way, it was forgotten that this is the community forum, a place to have fun. I'm not really sure why this is still going on either.

COMMUNITY (non-cat health topics)
Social butterflies flock here! DO NOT POST CAT HEALTH TOPICS HERE - go to the Diabetes Health Forum.

Have fun

 

from what i've seen they do. i don't recall seeing "do this!" with no explanation as to why. come on people, we're talking about some of the smartest people we could ever come across in our lives here. these people know insulin and diabetes better than most of us know our own homes or bodies.

those of you offended by them being referred to as dosing advisors or experts (yes, some of you *****ed about that term being used too in the past) can be happy that they won't be called that anymore. end of conversation it sounds like to me

 

Carolyn, I'm going to keep my reply as short as possible and ignore the personal attack.

Yes, it is clear to me that dosing advise was being given off-the-board and that is not an assumption, it is based on information sent to me from other members. I understand you don't like hearing that - I didn't like hearing that - and if nothing else comes of this discussion, hopefully it won't ever happen again. I also made a point of saying I wasn't accusing you or anyone else in particular, and I won't do that now. If the individuals who received off-the-board dosing advice want to discuss it with you further, I'm sure they will contact you.

What I said was a good idea and something we could all agree on was the fact that off-the-board dosing advise should not happen, and that position is entirely consistent with every post I've made in this thread and the one yesterday.

Beyond that, I've made my views regarding off-the-board dosing discussions - as distinguishable from off-the-board dosing advise mentioned above - and the reasoning behind my opinion clear to all. I understand you don't agree with my position; however, to chracterize Rebecca's concerns about liability as "making a mountain out of a molehill" strikes me as unfair to Rebecca. Please remember, it wasn't until another member innocently mentioned "dose advisors" yesterday that Rebecca even became aware of this entire situation (and me too, for that matter). I'm now at the same place I find myself in the discussion of "dosing advisors"...given what Rebecca has posted, what I have posted, and the two-day discussion that has ensued, I can't come up with any better/different/unique way to explain myself. If I could, I would, but I just can't.