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New Jersey Vet recommendations?

Discussion in 'Feline Health - (The Main Forum)' started by Cinnie Cole, Jul 3, 2019.

  1. Cinnie Cole

    Cinnie Cole Member

    Joined:
    Jun 1, 2019
    Our vet in northern NJ has really not stepped up on working with us to manage Zoot!'s diabetes. We asked her about using Freestyle Libre and she said she could refer us to a internal medicine specialist at a very expensive hospital for that. We asked if she had other options but she did not and then suggested we could call a place over an hour from our home to see if they had suggestions. We need to find someone - how would you go about finding a good vet for diabetes? Thanks.
     
  2. Bellasmom

    Bellasmom Well-Known Member

    Joined:
    Feb 12, 2018
    Ana & Frosty (GA) likes this.
  3. Sarah&Soph

    Sarah&Soph Member

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    Jun 18, 2019
    Is the freestyle libre the continuous glucose monitor that they attach to the shoulder area?
     
  4. Bellasmom

    Bellasmom Well-Known Member

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    Feb 12, 2018
    Yes it is, I think u have to change it like every 10 to 14 day, u will have to check on that
     
  5. Sarah&Soph

    Sarah&Soph Member

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    Jun 18, 2019
    Sophie had one and it was a waste of about $80. They said it was typically used on dogs and not cats, and I quickly found out why when she scratched it off in about 30 hours, so it didn’t quite last the 10 days it was supposed to lol
     
    Bellasmom likes this.
  6. Bellasmom

    Bellasmom Well-Known Member

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    Feb 12, 2018
    Some put like a wide collar like thing around them on the cat
     
  7. Cinnie Cole

    Cinnie Cole Member

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    Jun 1, 2019
    We are going to test Zoot! with the collar first to see if he minds it. At 24 lb, Zoot is not agile enough to reach around to the back of his neck and scratch it off; however we will see if he tries to rub it off. Generally, he is really a laid back cat and very easy to manage. It is the difficulties we are having with BG testing using lancets that are driving our decision. I do think, given his demeanor otherwise, that he might be a good candidate for this meter.
     
  8. Sarah&Soph

    Sarah&Soph Member

    Joined:
    Jun 18, 2019
    Good luck to you and Zoot! If the collar doesn’t work maybe some type of shirt might. I considered it for Sophie but it would have made her even more mad than the monitor. I will say that the few readings I got from it were very helpful, so hopefully he keeps it on. She initially got the monitor because I was too scared to test her at home myself.
     
  9. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Not sure what area, but @JanetNJ is in New Jersey and seems to have a good vet.
     
  10. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    what are the troubles you are having specifically with testing the ear? are you having issues getting a large enough blood sample? is the cat very uncooperative?
     
  11. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    If you only just started trying to test, I would say don't give up so soon. It took testing consistently for a good 10 days for the new capillaries to start to grow. My other suggestion is to use larger 28 gauge lancents, not the 30+ size that are typically used with people. I have a link to a video in my signature showing how I test my cat cc at home.
     
  12. Cinnie Cole

    Cinnie Cole Member

    Joined:
    Jun 1, 2019
    Hi. Yes, so it is both things

    - we get blood but not enough to get a reading. We try massaging the ears before we start or use the rice-sock to warm them; then we apply a little neosporin+pain relief so the blood will bead up. If we don't use the neosporin the blood just disperses between his hairs. I use 28 freeshand, but my husband thinks the 31 is easier and he uses the lancet device. But the pricks are hap hazard - we cannot find the area in the "sweet spot" diagram that works.

    - as a result of our basic ineptitude, Zoot! is anxious and suspicious and knows the pain is coming. He gets majorly upset when we hold his ear for the test, and because there isn't enough blood most of the time he has just had it and fights and bites us. I hate to see him so upset - I can't imagine that it doesn't affect his numbers.

    Our vet wants us to stop testing entirely and just monitor via his clinical signs and do the keto diastix. We were hoping we could do more than that and steer him toward remission, but I don't see how that goal is accomplished with only watching him and using urine testing.
     
  13. Sarah&Soph

    Sarah&Soph Member

    Joined:
    Jun 18, 2019
    I know you’re probably frustrated that you keep hearing about home testing, I know I was when I first started and I put it off for a long time. It was hard and my cat was uncooperative and it stressed me out, which then stressed her out. But it really does get easier and it’s so helpful in figuring out what’s going on with your kitty. I tried just monitoring her symptoms for a while but she didn’t start to get really better until I started home testing.

    I know you’ve probably already been told to warm the ears, but also the more you test the easier they bleed as well. Sophie’s didn’t bleed hardly at all at first. I’m not sure how big of a sample the meter you use needs, but I started out with the AlpaTrak which only needs like 0.3 microliters of blood, which was really helpful. It might also help to get him used to all the motions before you try to test. I know you said he gets suspicious when you touch his ears, so try rubbing his ears and then leave it at that. If he likes treats give him a treat, or do whatever is rewarding for him. Sophie used to fight me anytime I went for her ears and she is a biter, so I would just mess with them a few times a day and then give her a treat afterwards (she’s a treat kind of girl). Same with the lancet pen, if you want to use the pen then click it and give him a treat.

    Everything I’ve read says cats don’t have many nerves in their ear tips so it shouldn’t be hurting him. But I definitely know where you’re coming from; I thought there would be no way I would ever be able to home test Sophie, but I now test her daily
     
    Last edited: Jul 3, 2019
  14. Cinnie Cole

    Cinnie Cole Member

    Joined:
    Jun 1, 2019
    Thanks for this. I really don't want to give up home testing so will keep trying until we decide whether to go with the Freestyle libre.

    Another question - how much earlier than giving the dose is it acceptable to get the pre-dose BG reading? A big problem we have is that he is so food focused - if we wait till right before feeding/dosing he is literally pacing in wait for food, so he is not calm at all and nothing we can do will calm him except giving him food. Giving a treat only makes him more anxious.
     
  15. Sarah&Soph

    Sarah&Soph Member

    Joined:
    Jun 18, 2019
    If you can get a vet to place the freestyle libre, then it might a good option in the meantime until you get a better grasp on home testing. It’ll at least give you some data to work with. But like I said, I definitely understand. And all the cats in the videos are always so good, which is not my cat lol.

    Someone more experienced might be able to give you a more accurate answer in regards to when you test, but I don’t think it has to be right before you feed him. I’m sure 15 or 30 minutes before would be fine at the very least
     
    Cinnie Cole likes this.
  16. Cinnie Cole

    Cinnie Cole Member

    Joined:
    Jun 1, 2019
    At both places referred by our Vet, we have to see a internal medicine specialist and the consultation is $200 and that is only to look at Zoots! records; then they will prescribe a course of action. It is a bit of a matter of money for us so that initial fee (no labs or other tests included) is a big ticket. I was able to put a fleece around him this afternoon so we could get a reading, but he is definitely fighting us more and more; so big discussion on our part ahead.
     
  17. Dyana

    Dyana Well-Known Member

    Joined:
    Dec 28, 2009
    I am from New Jersey, and remember trying desperately to find a vet that I thought knew something about diabetes. I never found one. My cat eventually had DKA and was hospitalized at the UPenn Vet hospital. Later in life, I even took him to an Internal Medicine Doctor and they were "behind" in knowing about diabetes in cats. I found the advise on this message board to guide me along, and J.D. live 9 years with diabetes and passed of old age just past his 20th Birthday. I know it's hard to just give up trying to find a vet that seems to know about feline diabetes. I still remember, and that was 15 years ago. I don't think they are getting any more education on the subject, unfortunately.
     
  18. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    OK... so the 28 guage is more likely to get you a big enough sample. Maybe you should get a meter that requires a smaller sample. My meter only requires a .3 size sample which is SUPER tiny. as far as location, anywhere along the edge is ok. there are very few nerve endings there... so as long as you aren't hitting the vein, it shouldn't hurt much. put a cotton pad behind the ear for some resistance... it's ok if you poke through. In the beginning I would sometimes have to poke twice in the same spot in order to get a large enough sample. To make him more cooperative, try giving a favorite treat that he ONLY GETS during testing time. for CC it was deli meats. after a week of that she didn't struggle during tests anymore. If he needs a break for a few days stop and just desensitize him to having his ears touched. rub his ears, give a treat. do this several times a day until he seems calm enough to test again.
     
  19. Cinnie Cole

    Cinnie Cole Member

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    Jun 1, 2019
    If UPenn was closer we would go there (2 hr drive) - but at least there - in a teaching hospital, there are some options for multiple specialists to confer. We have been there with two of our cats for special health situations (but not diabetes). It is a shame they don't realize how common this is and get more informed.
     
  20. Cinnie Cole

    Cinnie Cole Member

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    Jun 1, 2019
    Thanks! We didn't get the Alphatrak because we have meters here (my husband is a type 2) so we wanted to use what we have. the one we are using is supposed to only need .4 so we thought that would work. Another thing to rethink. :banghead:
     
  21. Sarah&Soph

    Sarah&Soph Member

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    Jun 18, 2019
    Our old vet before we moved was a teaching hospital and we were in the internal med department, and those vets still sadly did not know hardly anything about treating diabetes. It was because of their (lack of) advice that Sophie had a VERY bad hypo and took so long to get regulated afterwards.

    Even though it’s more pricey, it might be good to start out with the AlphaTrak for now and then switch to the other when you get better. I think it definitely helped me to start out on one that takes less blood
     
    Cinnie Cole likes this.
  22. CandyH & Catcat

    CandyH & Catcat Well-Known Member

    Joined:
    Apr 23, 2019
    the OneTouch Verio requires a .4ul blood drop, about the size of the end of a ballpoint pen that you push on -- the Freestyle Lite, the AlphaTrak (expensive strips) and the ReliOn Conform or Micro (both discontinued but available online) take a .3 ul blood drop, more the size of the head of a standard sewing pin

    one thing I notice, Catcat's blood coagulates FAST so you need to get the blood drop up to size very quickly, get the strip (in the meter) up to the edge of the blood drop so it "sips" very soon, approach it as if you were going to scoop from the bottom of the blood drop rather than from on top of it -- hard to describe, but I found if I tried to place the strip on the top of the droplet, it would just smear and I'd get a "not enough blood" result on the meter

    I often have to "milk" the drop, put finger below the prick point, nearer the head, push towards where I pricked

    sometimes he wants to fight me, I found a hair clip (like you'd use to hold a child's hair in a ponytail) and attach that to his scruff -- where mama cat would grab him -- this quiets him down enough that I can get things done before he wriggles or jerks away .. acts like a third hand, sort of
     
    JanetNJ likes this.
  23. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    Another trick is to scoop the drop onto the back of your nail and test from there so kitty can leave quicker
     
    CandyH & Catcat likes this.
  24. Cinnie Cole

    Cinnie Cole Member

    Joined:
    Jun 1, 2019
    UPDATE! We switched to the Relion Micro meter that DCIN sent us. And I wrapped Zoot! in a piece of fleece to prevent him from running/scratching, holding it firm but not "constrictive". Holding him made it so much easier to get the blood we need and we were able to get the BG in one shot with the new meter. After I released the fleece he just sat while I applied pressure to his ear; then he got his treats. Seemed good this time.

    Fingers are crossed in our household.
     
  25. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    whoo hoo… well done
     
  26. Cinnie Cole

    Cinnie Cole Member

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    Jun 1, 2019
    Honest to god, I could not have managed the last couple of days without the support of this group and all your advice. I was truly despondent on Tuesday (my hubby can attest to that). I am now cautiously optimistic this can be done. Thanks to all.
     
    Sharon14 and JanetNJ like this.
  27. CandyH & Catcat

    CandyH & Catcat Well-Known Member

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    Apr 23, 2019
    you can do it, you CAN do it -- even Catcat would tell you -- :cat::cat: -- no, it isn't easy but think of it this way, you're saving a life, one step at a time

    :bighug::bighug::bighug:
     
    Cinnie Cole likes this.
  28. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    Absolutely you can do this!!!!!
     
    Cinnie Cole likes this.
  29. Sarah&Soph

    Sarah&Soph Member

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    Jun 18, 2019
    I used to nearly have full blown panic attacks at the thought of testing Sophie’s blood sugar - sweating, heart racing, all of that. But it truly does get easier! And (usually) once you start feeling more confident the cat will calm down as well. I say usually because Sophie still is an impatient brat sometimes! But at least no more freak outs by me or her
     
    Cinnie Cole likes this.
  30. Ana & Frosty (GA)

    Ana & Frosty (GA) Well-Known Member

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    Jan 19, 2018
    based on what i know is diabetes management in cats, not many regular vets would feel comfortable with the continuous glucose monitor. It’s a new product even for humans, and it always takes longer before something like that is accepted and proven to be effective in animals. Not every cat is suitable for it also, so it really will take time before even specialists in veterinary have enough patients to be comfortable with it. From my experience, Internal medicine vets are generally more comfortable with diabetes and other complex diseases in cats, especially when the disease is not well controlled. I also had to drive my cat 1 hour each way to see a specialist (for cushing’s, which was causing his diabetes.) unfortunately here in norther nj, specialist are either at parkway exit 164 or 105. If you’re anywhere in between of the, you’re stuck driving about an hour to get to a specialist. Although I no longer have a diabetic cat, i agree with those here who advise simply doing regular glucose testing, for many reasons. Hope this help.
     
    Cinnie Cole likes this.
  31. TSP

    TSP Member

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    May 30, 2019
    Cinnie-GREAT job with the testing! Prayers that it continues to go well for you! A couple of options to find better vet options/ones that may use Freestyle Libre:

    1) Have you tried calling UPenn & putting a message into one of the vets you have used in the past to see if they have any alumni they know of near you? Thats one option.

    2) Another option is to use the American Association of Feline Practitioners (AAFP) site to locate Cat Friendly practices near you. The top ones are rated Silver & Gold. I don't know what city you are in so I just chose feline only practice, New Jersey & I got a list. Here is the link to the results. I hope one of them is near you! If one of them aren't, call a few of the practices & ask the vet does know of anyone they would recommend that is closer to you :).

    https://catfriendly.com/find-a-veterinarian/
     
  32. Cinnie Cole

    Cinnie Cole Member

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    Jun 1, 2019
    Thanks for the information. So sorry you lost your Frosty. We are going to hang in with our Vet but and not go the freestyle route just yet. Zoot! seems to be adjusting a little better. I did read that a Blue Pearl Animal hospital in Paramus NJ they have a specialist with long experience with Diabetes in cats. From their site - "Dr. Carly Bloom particularly enjoys cases involving the urinary tract, anything from kidneys to bladder stones to incontinence. She also enjoys endocrinology, especially the management of diabetes mellitus in dogs and cats, and performing minimally invasive procedures such as endoscopy and cystoscopy." So we will definitely go to her if needed. After checking with most vets in our area they were the only ones that called out diabetes mellitus. And in conversations with other "big" hospitals around no one could even name a vet that would handle or had experience. I find that shocking - I knew when the staff said "any of our internal medicine vets can handle this" that they didn't have a clue about their vets' expertise.
     
  33. Cinnie Cole

    Cinnie Cole Member

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    Jun 1, 2019
    Great idea re:UPenn; we def have contacts there we could reach out to. Thanks I will look at the list now!
     
  34. TSP

    TSP Member

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    May 30, 2019
    Crossing fingers & toes that they have a great contact for you :)
     
    Cinnie Cole likes this.

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