Veterinary Smack-down

So I took Tigger back to the vets today. I arrived with carrier in one hand and clutching SS in the other, anxious to share our new insulin odessey. The first thing I heard was "I told you not to change the insulin until you saw me again". Granted he was sick last time and being treated for a presumed infection but I was so worried about him being in the 500-600s I just could not stand idly by. Then there was a salvo of criticisms, or at least that's what it felt like to me. She tried to be pleasant and keep a smile on her face but I could tell she was Not Pleased. I was informed in quick order that I was using the wrong meter (Bayer Contour- not calibrated for feliness) and the inaccuracy was putting my cat at risk. I might be using the wrong syringes. She did not believe that MY 3/10CC syringes were U100 and marked off in half units on one side making it possible to adjust dosage by .25 units. I was told that Levemir was not recommended for cats and was "four times more potent than lantus" so I had better be really careful if I chose to continue using it. She dismissed the dietary changes I had made ( eliminating dry foods) and ascribed his lower BGs to successful treatment of whatever infection it was that he had. Indeed the good news is that his white blood cell count is back to normal and the number of eosinophils(a type of WBC that proliferates during an allergic or inflammatory reaction) was almost normal. She gave him another long-acting antibiotic injection.

This is the 6th veterinary office I have tried in 8 years since moving to this town. I have been pretty disappointed in all of them by-and-large. When Tigger was diagnosed with diabetes the first vet sent the tech in to instruct me and I never got the chance to ask any questions. The tech could not answer some of them. I was not given appropriate follow up appointments and when I did come in for a glucose curve the cost was huge. Another vet forgot I was in the exam room with a different cat whom I had brought in to be euthanized. I sat for 90 minutes trying to be a "good patient" until I stuck my head out and asked where she was. She was apologetic but I never went back. So I am pretty burned out on vets as a whole and just needed to spout off. I am sure there are some good ones out there. I just haven't found one yet.

Back to the matter at hand. I need to know if Bayer Contour meters are ok and if Levemir really is "four times more potent" than lantus. I use these products because they are available to me from my office. I could switch to lantus but it is less available and Tigger has been on Levemir for 4 years now. If I continue to monitor at home, surely I can keep him safe? Input will be appreciated. BTW, his BGs have plateaued over the last 3 days so I increased levemir from 2 units to 2.25units.

 

Hi Kate,
These kinds of reports make me shake my head. First of all, the vet is completely misinformed regarding Levemir. Lantus is also not approved by the FDA for cats, so I don't know where she's getting this regarding Levemir. You should have asked her "who doesn't recommend it?" Levemir does seem to need a little lower dose than Lantus when cats are switched from Lantus to Levemir, but it's not much difference, certainly not anything like 4 times. That is outrageous and completely false.

Some people simply don't accept when a patient or client finds out info on their own (and omigosh if it's off the internet it must be false!) and instead of working with you, works against you. I cannot abide by anyone giving you false information like that. I understand you're tremendously frustrated with vets in general in your area, but I recommend you not go back to this one either.

The fact that she does not understand what a 3/10th cc syringe is makes me call in to question both her training and her knowledge. I would not go back to a vet that cannot read a syringe. That is vet school 101.

Please tell me the name of the antibiotic was NOT Convenia? There have been reported feline deaths from severe anemic reactions to that drug. It has not been pulled from the market, but frankly should be. Please read about it here: http://www.catinfo.org/?link=convenia Why is she giving an anti-biotic when no infection was determined???

I am not familiar with the Bayer Contour meter myself. There are only a few meters we don't recommend, but I'm pretty sure the Bayer Contour is OK. In fact, Venita from DCIN is selling some of their extra strips for that meter right now since she has some that expire next month.

I haven't had a chance to look at your spreadsheet yet, but if the trend I saw the other day is continuing like you described, then increasing to 2.25U should be fine.

I think you're doing a marvelous job with what you've had to deal with. As far as his diabetes goes, the board can help you manage it, if you are comfortable going it alone and he doesn't have complications. At home monitoring of his blood glucose will give you the information you need. There is no reason to switch insulins at this point. Levemir is a great insulin and maybe one day will be more widely recommended.

 

I get just about the same readings with my Beyer contour as I do with my Relion Confirm - the lower the number the closer they are so rest at ease about that.

No they're not 'feline calibrated' - WE can adjust for that. Human meters, we react to less than 50, pet meters we react to less than 80....sure not rocket science!

HUGS!

 

Kate, I use the Contour and it is fine. No meter, not even the exceedingly expensive "feline" one is 100% accurate. We don't need 100% accurate, we need reliable and close enough to make doing decisions.

I have to ask, if Tigger has been on Lev of four years, was that the last time she saw him? And if he has been on it for four years the fact that he is doing well and not dead yet is proof that her "sky is falling" dramatics are ridiculous. And, yeah, a u100 3/10cc insulin syringe is the same across all brands. No doubt the ones she sells are more expensive and that is her real concern. Frankly, if her concern is for HER profit over the ability of her patients owners to pay for supplies then she has her priorities all wrong.

It's really too bad she is stating all this misinformation as fact. And that she won't work with you. Did she even look at your SS? Or was that when she denounced your meter as useless, thereby making the SS, in her eyes, worthless as well?

Sigh. Well. Stick with lev, stick with your syringes, don't ever let another vet give your cats "long acting antibiotics" again, and maybe find another vet. You might ask on Health for vet recomendations in your area - like "who knows a good vet on the north side of (your city)?"

 

I just read your post. Although my diabetic cat has been gone now for awhile I went through exactly the same thing you are going through now with several different vets. I was told not to test at home, just to shoot insulin blindly, I basically was told after taking in a SS and talking about this board that there were alot of "nutjobs" on the internet that did not know what they were talking about.
Personally either vet I went to and I went to several as well did not have enough knowledge to treat feline diabetes. You will find that most vets know very little about feline diabetes or about insulin dosing.
I was using an Accu Chec Aviva and was also told it was not calibrated for feline use that I had to use Alpra Track which was not true. The Accu Chec was a very good meter I used it the whole time Lilly was alive.
If I ever had another diabetic cat I know now I would listen to what these people here are telling me. They have been keeping their cats alive and well for years and know the insulins, the dosing and can look at a SS and tell you what you need to do or not do.

Terri

 

Your vet seems to have the "World revolves around ME" complex or the "I am the doctor, spent way to much money and time in school and YOU are just the measly little pet owner who pays me" complex that includes the "I have FORGOTTEN way much more things about ferrets than you have EVER learned!" complex (though why you would want to learn about ferrets is beyond me)- which is a problem.

Either way she is NOT up to date on FD and probably never will be with her mind-set. See if the clinic has a rating on-line and say that she is unreasonable, out of date, and a prig who only cares about money. I wouldn't go back.

You, on the other hand, HAVE been doing your homework and have found something that works and is good for Tigger and you. And we are crazy cat people, not nut jobs, there is a strong distinction :lol: .

Lev is a great insulin for Tigger and is not 4x potent than Lantus, and your meter is great for this- her problem might be you aren't forking over the $100+ for the alpha track plus than much for strips every month to help pay off her student vet loans or clinic mortgage.

Rest easy- you are doing great. how many other vets does your town have? And where are you located?

 

I"ll make this easy - I concur with everything everyone has already posted here!

Please let us know where you're located so maybe someone will have a referral to a FD-friendly, knowledgeable vet that may better SERVE YOU. Yep, that's right... they work for US! About 3-4 months ago there was a wonderful post (or series of posts) on interviewing prospective vets. May be worth a little search on the Health, or PZI forums - it had great questions to ask and info to help you find someone over the phone before you go plunking down money for an exam, only to get beaten up by someone YOU are hiring!

I've only heard good things about the Contour, and from the looks of things, you're doing an awesome job! Hopefully you can find a vet who will "Partner" with you in the care of your furries! No more smack-downs!!!

Good luck - and keep up the good work!!!

 

I want to thank everyone for the encouraging words and support. I am located about 25 miles outside Nashville, TN. There used to be a good feline vet in Nashville named Mark Waldrop who ran the Nashville Cat Clinic but I don't know if he "does" diabetes or not. He treated my cats eight years ago when I lived in town and was always a kind and compassionate person with good clinical skills and knowledge. I really would like someone who would "partner" with me in Tigger's care but be willing to let me think my way through these problems and not just dictate dosages to me. If anyone knows a good vet in the south Nashville/Franklin/Murfreesboro triangle, please post here!

 

Kate, you should post your vet recommendation request on health as well - more people will see it and, hopefully, you can get some suggestions.