12/15 Webster AMPS=525 +2=505+6=331 - Vet update

Yesterday's condo

Holy smokes! 525 this morning! Maybe a bounce? Perhaps inflammation or an infection? Maybe the new dose has caused his numbers to jump.

As discussed yesterday, Webster's ketone strips have been hinting towards trace ketones. He has been increased to 1u and as always, I have been watering down his food, even more so lately.

Vet appointment in 1.5 hours. Also, ketone meter arriving today.

I hope get some answers from the vet...

Post vet update:

I just got back from the vet. The original Dr. (one who had cats with diabetes) was not in today so I met with another Dr. who owned the practice. Here are the keypoints of our meeting.

-Dr. didn't seem too concerned about DKA. If I recall correctly, he said that in all his years he has not seen a cat go into DKA while being given some amount of insulin. While he's had his own practice for over 30 years, I am still very skeptical about this relaxed and generalized statement. He believed that the ketone sticks can be slightly influenced by the color of his urine so they may not be very accurate (I could see his point) and as for the NovaMax meter, he hasn't heard of using a blood meter to test for ketones.

-He wanted to put Webster on a lower dose (.25u to .50u) and leave him there for a couple weeks at a time, unless of course he goes hypo. He says its possible that the higher numbers are being triggered by too much insulin which I can see where hes coming from. I believe that I recall reading about that on here - referred to as NDW. I believe this is what he was talking about.

-He did not seem to be in favor of adjusting the dose so frequently, despite the rise in BG and concerns of ketones.

- He agreed that an infection/inflamation is a concern and ran a series of test. Written on my invoice are: Major cat profile-SA705,Fructosamine-add260,Thioglicolate culture,Cystocentesis,FPLI. I will hear back with test results tomorrow. He said that one test (FPLI perhaps) may take 2 days to come back.

- He questioned Websters true age. He asked if I had him since a kitten or adult. I was told that he was 1 year old when we adopted him. He said that its sometimes a guessing game based on teeth wear, etc and that looking at him, he believes that he may be older than 5 years. He said that sometimes shelters pass cats off for younger than they really are just to get people to adopt them. I agree and can see how this probably commonly occurs.

- He said that his teeth look surprisingly well for his age. When opening his mouth i saw a small red spot on his gums at his back teeth. I forget what he said it was but he didn't seem overly concerned about it.

- I asked about sub q fluids and he was on board. He thought Webster was well hydrated and he could later show me how to give him fluids at home if his condition progresses. Right now no needs for fluid.

While I had a good conversation with him and agreed with most of what he had to say, I'm still concerned with Ketones and DKA. If all of his test results come back "okay" I'm still going to be very hesitant to lower his dose back down.

During my visit I reiterated the fact that he was the doctor and knows the best course of action because I didn't want to come off as a know-it-all. However, during our conversation I could sense that he was familiar with text book (probably very old text books :smile info in feline diabetes but wasn't up on the latest at home treatment that many of use are using with success.

I told him that I was using the Tight regulation protocol based on Roomp/Rand findings and the success that many of you have experienced using this protocol. He appeared very intrigued by what I was doing and even commented that "most people don't go to such great lengths" or something to that effect.

Going to the vet is quickly becoming a challenge. It's very difficult to bite my tongue when the doc is telling me something that doesn't makes sense. I really wanted to question a few of his statements but once again, he's the doc with a 30+ year practice and I'm a young guy with a cat that was diagnosed with diabetes 4 weeks ago. I don't want to come off as a know-it-all jerk asking for his advice while only hearing what I want to hear. I'm open to hear what he has to say but feel bad questioning his authority.

Anyone else experience this issue while going to the vet? What are your thoughts on today's visit?

 

Re: 12/15 Webster AMPS=525

Good luck with the vet visit. I hope you get some easy to fix answers to what you are seeing. Keep us posted.

 

Re: 12/15 Webster AMPS=525

Adding my good luck wishes for the vet visit, too.

Marilyn and Polly

 

Re: 12/15 Webster AMPS=525

Thanks guys... Headed to the vet now..

 

Re: 12/15 Webster AMPS=525

Vet update posted above in opening thread.

 

Re: 12/15 Webster AMPS=525

I'm glad you got into see the vet. I just have a few responses.

 

Re: 12/15 Webster AMPS=525

Thank you Marje. I completely agree with everything that you said.

Only being here for a month, I have already seen others who had cats go into DKA while being given insulin. (Noodles being one of them) I really wanted to tell the doc this but bit my tongue and kept my mouth closed. This was a hint that he wasn't well versed when it comes to FD.

I could sense that he was interested in what I was doing but didn't seem a fan of the TRP. He's most likely accustom to working with people with very busy lives that don't have the time to monitor and adjust as we are - sort of the set it and forget it solution.

As for the fructosamine, that was actually one test that really popped out when he mentioned it. I specifically remember thinking "well, isn't this basically what I have been doing?" He said that he likes to have the info to compare from one visit to another. I don't know.. I just let that one slide. I'm sure that I just flushed that $63 down the drain.

I will request his lab results and post here. How do you guys normally do this? Upload a PDF to google docs and post? Actually, you mentioned adding a tab to ss. Do I have to manually type in the results?

What do you mean PM you? For lab result uploading instructions?

As for dropping his insulin back down, I'm not at all in favor of that at this time. Perhaps with tomorrows test results this might change but as of now, the extra insulin sounds like a great idea, despite what the doc says.

BTW, today's visit was $366. Here's the breakdown:

Major profile: $131.25
Fructosamine: $62.88
Exam: $53.05
Thioglicoate culture: $23.53
Cystocentesis: $20.49
FPLI: $75

Does this sound fair or am I getting hosed?

 

my experience is that every vet visit was expensive. punkin was more expensive than some diabetic cats, probably because he was 15ish and senior cats have more things going on, plus the acromegaly was very expensive. In any case, my vet's office put me on the "frequent flyer plan" because i was basically in there weekly. When i told them i had to go back to work to help pay for punkin (which was half-joking) i suddenly found a 10% discount on the next bill. ;-)

Marje meant for you to send her a pm if you want help setting up another tab on WEbster's ss that is for his labs. If you know how to add a tab, then just go for it. Lots of people seem to struggle with the spreadsheets, which is why Marje is offering. If you look at punkin's ss, you'll see a tab for "labs" at the bottom. Click on that and if you want, you can copy the first couple of columns that show the name of the tests and the reference ranges. Every lab has different reference ranges, so you'll have to double-check on those when you get results back, but even copying the columns will save you some effort.

Then when you get Webster's labs back (always ask for a copy of every test result) you can put them on the ss and they are easily found. You can see on punkin's that i put results that were out of normal range in red so i could keep an eye on those tests. I found it really helpful to have that info there and used it over and over again.

Many people have the same issues with the vet. Most people use the vet for everything except adjusting the dose. My vet stopped advising me on dose. I had started with another vet that really didn't know FD and made several really serious mistakes with punkin's care, including having me switch from Prozinc with u-40 syringes to Lantus that needs u-100 syringes, meaning punkin got 2.5x as much insulin as he was supposed to get. Been with that vet forever and really liked him. But I thought punkin's needs were more important than me liking the vet. So I tried out 2 other vets in town. One made it clear she would be in charge of dosing. The other had 2 diabetic cats of her own, although she didn't hometest and didn't follow TR. I went with the second one because by that point, it was clear to me that FDMB was more up-to-date than anyone on diabetic cats, and I was going to get my dosing advice here.

So you may want to stop sharing the spreadsheet and just nod your head about the dosing. Then use the TRP as your guideline.

New Dose Wonkiness lasts a day or two. Not several. Your amount of testing makes it abundantly clear what is going on with his blood sugar. I don't think you need to do anything differently than you are doing.

The spec fPL is the test for pancreatitis. I don't know what the Thioglicoate culture is - did the vet explain that one?

 

Hi Mike, It sounds like you've had quite the day! I hate that uncomfortable feeling of disagreeing with the vet. My vet doesn't quite know what to make of me. My last visit ended with him saying, "I have no idea how you're measuring .25 units. You know what you're doing, just keep doing it." He doesn't yet know that I'm now measuring .1 units. Did the ketone meter come?

 

I'll be sure to post his results once available.

I find it shocking (then again, not really) that a vet with so many years experience didn't seem extremely well versed when it comes to current FD treatment. I suppose that you can look at is as if feline diabetes is more of a specialty disease that requires lots of special knowledge. You really can't expect a general doctor to know everything about every disease I suppose - that's why you have specialist. I do have some degree of understanding why doctors are not always up on the latest info and treatment options for every disease.

As for the Thiglicoate, he briefly mentioned this test. I think it had something to do with checking his thyroid? I'm not sure. I just went along with it because I was not knowledgeable enough to make an argument against it.

 

Yeah. It's difficult trying to discuss the protocol that we are following when they are unfamiliar with it and are stuck on the old school text book treatment of giving them 1u and coming back every few weeks for a curve. This seems to be the norm that I keep on hearing about.

Got the meter a couple hours ago. UPS is running slow with the holidays.

 

Hi Mike,
I was going to comment on many of your points from the vet visit today but they have already been eloquently addressed by Julie, Marje and others. And as already mentioned, Noodle was on a fairly hefty dose of insulin when he went into DKA so don't anyone believe that their kitty can't get dangerous ketones while on insulin. What a terrible assumption--that ketones can't become deadly as long as a cat is on some insulin. I'm so glad you're not buying that nonsense. I have been amazed at some of my previous vets' lackadaisical attitude about ketone testing. We on the board know better that that, some of us through hard, expensive and frightening experience.
I know what you mean about how hard it is to stand there and listen to a vet give (often outdated or inaccurate) advice when you KNOW better from the forum. I fear I've bruised a few egos by even asking questions, no matter how diplomatic I try to be. And heaven forfend that you actually pin down a vet on a point that you know to be wrong. No matter how hard we try to not act like know-it-alls, some vets just will not work with you and are not willing to learn. But the bottom line is all that matters is our kitties' safety and health and the best place for advice is right here. Of course vets have their uses and we need them for some things but most seem to be sadly deficient in feline diabetes.
Please keep us posted on Webster. You are a really great cat-dad and you should listen to your gut, as you are the best observer and judge of Webster's well-being and happiness.

Christi

 

Yes, whenever he said that, Noodles recent DKA episode was the first thing that popped into my head. I knew at that moment that he wasn't very well versed when it comes to FD.

I really hate to bruise another persons ego but when you are paying a considerable amount of money, there is some sort of expectation that they are offering good advice. I just don't know what to think anymore. :-|

 

Did he say thioglycollate? That's a medium to grow organisms....such as bacteria. I've never heard of a vet referring to it like that but....who knows....maybe it's a local thing.

On the lab tab, I was just suggesting you PM me (send me a private message) because if you temporarily add me as an editor on your SS, I can add a tab and then copy and paste the lab tests and ranges typically done so you don't have to retype all of it.

Usually to test the thyroid, they do a total T4 and a free T4 with ED. Those tests would not indicate any infection although if he is hyperthyroid, that could potentially explain any regulation issues but not likely ketone issues.

 

Hi there

Your instincts about this vets opinion on DKA were spot on. I'm glad Marje and Julie chimed in on the whole visit.

Every LL cat likely has been through at least 2 vets. . . .we learn to nod politely. ;-)

We dumped BKs first vet after about 5 months. Check out the last tab on BKs ss - 'Prognosis 6-2008' - the vet included his mobile number because he knew before morning came BK would be needing the pink shot. . . :YMSIGH:

when I brought BK to the ER for his first DKA episode, there was a young vet on duty who upon entering the examining room looked at the paper work, looked at BK, then looked at me and said in a very condescending tone 'You know treating a cat who is FIV+ and diabetic is an uphill battle' . . . :YMSIGH:

Without the folks here propping us up those early months BK would have been a goner.

In all fairness most vets are general practitioners and it's true that most folks they see don't go to the lengths we do. There is however no excuse for a closed mind.
It boils down to finding one that's willing to work with you.

I know I'm in the minority on this, however I think it's quite possible Webster took a trip to the lowlands on the 12/14/PM cycle, sometime after +5 .
Why do I think so? Besides it being common for many kitties to run lower on the overnights :

He was clearly on his way down
PMPS>>>355 - meal
PM+1>>> meal
PM+2>>>329 - mini meal
PM+3>>>mini meal - last food for the rest of the cycle
PM+4.5>>260
and then. . .
PM+11>>>Webster woke you up begging for food
AMPS>> 525

Just my $0.02.

 

He had it written down as Thioglycolate culture and urine. He did mention testing thyroid but it sounds like I may have gotten the word mixed up.

During the visit, I asked him to write down all of the test that we discussed and he did write down "biochemical profile including electrolytes and thyroid (t4)". Looking over things, I was able to match up everything that he wrote down while at the visit with the invoice except:

written:
-Complete blood count
-Biochemical profile including electrolytes and thyroid (t4)

invoice:
-Major cat/dog profile-sa705
-Frutosamine-add260

Is the Major cat profile the "complete blood count" and Biochemical profile the "Frutosamine -ADD260"? All else seemed to match up with what he wrote down. I just want to make sure that I receive all of the tests that Webster needs and that I paid for.

PM sent. Thanks so much for helping out!

 

WOW. That's crazy... and less than 1.5 years later BK was OTJ! How often do you test BK now?

I agree. I have no hard feelings for the vet that I saw yesterday. I completely understand that FD requires special knowledge and no vet will know everything detail about every disease. This is why they are general practitioners.

I do plan to continue visiting the vet but only scheduling with the first Dr. that I saw who actually owned 2 diabetic cats (and a dog) and seemed more up on FD.

As for taking a trip to the low lands, this does sound quite plausible. After watching him drop 95 points in 4.5 hours I was thinking that he was sliding down gently and I went to bed. However, he may have fell off quickly at +5 to +6. Should I spread out his food a little more? Perhaps go with 1.5,1.0,0.5,0.5,0.5 @ PS,+1,+2,+3,+4.

 

Hi Mike.

I don't think I've posted on your condo before, but I just had to chime in on the vet issue. I currently take Cinco to the UC Davis Veterinary Teaching Hospital because I figured they'd be up on the latest in FD treatment. Wrong. The student that worked with us (you get a 3rd year student and a vet - the student does most of the talking after conferring with the vet) was overwhelmed by the info I had and the questions I asked. She told me that they spend 5 hours studying diabetes - not FD, just diabetes! Is it any wonder most vets are clueless? Unfortunately, a lot of people just have their cats put down when they get this diagnosis, so many vets don't have to deal with people that treat it. Stick to your guns. Your results will speak for themselves. Check out Cinco's story to see how his original vet wanted to give up on him and, thanks to FDMB, we saved him and actually got him OTJ.

In January, I am taking Cinco to see a doctor at UCD that is a recognized expert in diabetes. I can't wait to find out what he has to say. I'll be posting about it, so watch for my post - his name is Dr. Nelson.

You seem to be a very responsible, caring and intelligent bean. I think Webster is lucky to have you.

 

Thank you Tricia. I'll check out cinco's story and be sure to watch your post... Right now, I have to hop write a long rant because I am about to pop with frustration!

 

I would think the major cat/dog profile is the CBC/superchem/thyroid.

It's possible the thioglycollate is the specific medium which they use for the culture and sensitivity for the urine.

 

I loved Cinco's story.

I guess some vets like to push the easy button and put diabetic cats down quickly because they don't want to deal with the constant battle of helping caregivers manage their cats. It's a difficult thought to fathom but I guess this is the reality that we are dealing with. :-|