working with the vet

How do most of you work with your vets if you're at a clinic that doesn't routinely home test?

I've mentioned it to my vet a couple times and they didn't tell me not to do it but they're obviously not comfortable with it. I'm going to take them the info from the "convert a vet" post, the Lantus protocols, and my spreadsheet. I'm sure it's going to be information overload.

Are your vets supportive of making dose changes without their input?

I'm thinking I'll tell them I can give weekly updates and come in as often as they'd like to see him to make sure everything is ok.

I've checked a couple other offices. Two of them have patients who home test once things are under control and one said 70% of their patients are diet controlled. But their rates are much higher. I want to give the office I'm at a chance before I start over at another one.

 

hey Mel,

it is possible to work with your vet. Some of us have been thru a couple to a few vet changes.
Most vets do not encourage home testing, or a lot of home testing.

Keep in touch with your vet, keep the lines of communication open.
Many here do bring in info for their vets to read, and some vets react to that very well, and some don't.
If they are willing to learn then all the better.

If you try and try to no avail and you know in your heart some of their instructions don't sound right, then you may have to consider changing vets.

 

Mine was against me testing but I politely told her I needed to, after going her route with fructosamine testing just didn't work. Soon I had great data, Squeak wasn't stressed, and he went off of insulin. So she supports it. I'm not certain how much she promotes it in her practice, but I don't think her boss is supportive nor do I think many clients are up for it. THat said, they have a glucometer in their clinic for testing, and she wanted to borrow mine for an at home curve for a friend's cat.....

My point is that a. you do what you feel is right and b. you hope that your vet will understand that you have a brain and that you are ready and willing to do what you can for your cat.... treat your vet with respect and share info rather than announcing things that you've learned from the internet, and you'll have a better chance of working together as a team.

 

Something else to keep in mind (I had a vet who forbade me from home testing) - is this is your cat, not the vet's. You can do whatever you want to or for your cat -

YOU DO NOT NEED THE VET'S PERMISSION TO HOME TEST!

Now, as Ronnie said, you do want a vet who will be your partner and work with you. The best way to demonstrate to the vet the value and importance of home testing and that you are a capable person - is to set up a spreadsheet, home test and as you gather the data on the spreadsheet - share it with the vet.

And if the vet absolutely won't be open to this, then you may need to find a new vet.

 

Remember that your cat is YOUR cat, and YOU are paying your VET to help you take care of him; diabetes was probably a day or two worth of notes when the vet was in college; it is probably NOT a day-to-day existence with his own cat trying to maintain a quality of life. Sorry to say, but I would have overdosed my guys on insulin if I followed my vet's advice. Vets, unfortunately are not as knowledgeable as they should be on diabetes.

Sometimes, as I did, you have to take a leap of faith and trust these people on this board who deal with diabetes day in and day out. Trust me. You will not be disappointed. OK………..breathe again……….get some chocolate…….. cat_pet_icon

Also, please realize that it takes insulin about a week to settle. START LOW AND GO SLOW!! The usual starting dose from our experiences is 1u twice a day for at least a week. Insulin in cats is NOT and I repeat NOT based on weight. This is a misconception that a lot of us have gotten from our vets here. pc_work

You have to be patient, as I also had to learn!! Do not adjust the dose upwards based on one test. Don’t freak out based on one test result. As long as the levels stay on the high side, keep the same dose twice a day for at least the initial week period and you should see improvements.

If you are not hometesting already, you really need to start!! Hometesting is VERY important. Think of it as a human diabetic does. *If it were you or a child of yours, you'd be testing blood glucose levels at home prior to each shot; you'd be working with your doctor to determine a proper dose based on those shot results, correct?* Some vets do not agree with hometesting and I cannot for the life of me understand why. Most vets, sadly are not knowledgeable enough in feline diabetes. Insulin is a VERY powerful drug and you NEED to hometest before giving a shot. This is very important. The vet would rather have you bring the cat to them, stress it out more, which may spike the levels anyway and then they can charge you $$. Hometesting saved me a lot of money and it is VERY important for you personally to know the cat’s levels and how it is reacting to the insulin before you shoot so you do not pass up your ideal dosage.

 

Just remember that when you start home testing there is a fine line with asking dosing questions of your vet. This is because you vet is not compensated for answering dosing questions. Most vet will answer a few question with no problem.

 

If you have been pleased with your vet, then trying to work WITH them is preferable. You don't need their premission to hometest or to change food. And if you can show how helpful the testing is, your vet could become a convert. I avoid arrogant doctors, for both humans and animals!

My vet was open to the information I printed out from here. I told her I found a bunch of information (the petdiabetes wiki has some great stuff, too) and was she interested in seeing it. I even complimented her on being cool with my net research. I'll never forget her answer - "I don't know everything. I'm always open to new information." I said I wanted to home test and she gave me her mother-in-laws old meter to try! And when we needed to try a new insulin, she read the information I printed out about Lantus and Levemir - she hadn't heard of either before I took her the information because they are human insulins. After her own research she picked Levemir and Maggie did really well on it.

Hope this helps!

 

That's great if you can work with your current vet, and hopefully they will learn some good stuff that might help other clients. I have found that what often works best is to present spreadsheet updates at a point where the #s are good (or at least improving). Then it's hard for any vet to argue, and it helps them see that what you are doing is working.

I found that when I presented #s that weren't going well, or when I wanted dosing advice, it just got confusing. As a professional, they will (most times) offer their opinion of what you should do differently, which may well be a different route than you want to take. For me, that just added to my stress and ultimately I found that trying to consult with my vet first about each dosing change, rather than presenting good results after-the-fact, just made it too confusing for me.

Of course everyone is different, and every vet too, so I would say do what feels right to you. Remember than you are not under any obligation to them to do what they say or convince them that you are doing the right thing. If you can, that is awesome, but your obligation (IMO) is only to yourself & your cat. I know I used to worry about "getting in trouble" with my vets, and have heard others express similar sentiments, like we are 6 years old and they are our parents or something! But really, they are professionals that we are hiring to give us advice and access to medical tests & treatments.

With my vet, who encouraged me to home test (but I think I am their first client who has done so), I felt like at the end of the day, they were just happy to see my cat in good numbers.

 

My experience is from long ago when 99 of 100 vets had never heard of home testing a cat. I didn't ask permission, I just did it. I didn't share daily numbers, but I did a curve once a week and talked it over with my vet. I never made a dosage change without discussing it first (except, of course, to skip a shot or reduce a dose if the preshot was too low to shoot the full amount).

There was no discussion about my changing a dose on my own, I just wouldn't cut my vet out of the loop like that. Of course, there were no insulin specific groups with experience back then, all of us were still learning and we hesitated to tell one another how to treat their cats, we only talked about possible avenues to discuss with our vets. If I had a diabetic today I would do things exactly the same way, except I would add daily visits to the appropriate ISG, there is no such thing as having too much information.

 

I'm biased but I think that you should work WITH your vet (not against them). You vet is most likely worried that you SAY you will be home-testing and then don't because of the time, cost, difficulty, whatever. MOST clients are barely willing to give the insulin, much less monitor BG. You are an outlier to her. The big fear is that you will go saying you will home-test alone; refuse further treatment (*treating* your cat on your own); kill the cat; and sue because the cat was under her care. I think that once you can SHOW her the BG-checks and once you can show her how you will stay in regular contact, she'll change her mind.

As for the cost of advice, I would ask your questions and start/continue a dialog with her. If you are using her for physical exams, other well-cat testing, vaccines, dentals, etc... she shouldn't mind answering questions.

With all of that said, if your vet gives you the impression that *they* are ALWAYS right, go elsewhere. I wouldn't march in there telling her how to practice medicine (heck- no one wants to be told how to do their job) but talking about your case with her will help everyone. Any vet worth their salt recognizes that they have room to grow.

good luck!