1/20 Max AMPS 466 - Vet's Replies to Questions!

Status
Not open for further replies.
Randi & Max (GA)

Randi & Max (GA)

Very Active Member
Good Morning
Well after 2 months of giving insulin, I had my first fur shot. grr_red
I can't believe I did that.
When I took the syringe out there was quiet a bit of insulin on his fur.
I don't know how I did that. I have been struggling with getting the syringe in at a good place
(by the scruff) lifting skin well and getting a good angle.
I feel that maybe I am not shooting well and that is why his response to insulin is lousy
Not a great day to give a fur shot when he is starting at 466.

WCR: Not much to report on him. He was not a happy camper yesterday with being poked
every 2 hours (yes I know that is less than some kitties, lol). Ate his breakfast and now he has disappeared somewhere in the house.
I will be reporting curve results to the vet today and ask a few questions.

1. How many of her patients home test (at least like I do)
2. What does she base her dose changes (increases & decreases) on.
3. Consideration to have Max tested for IAA & Acro & refuse fructosamine.

Have a great day everyone!

Yesterday's Condo
 
Re: 1/20 Max AMPS 466

Rats - what is this National fur shot day? lol
Crap! Pooh!

I guess we'll see how the numbers go...hey I can't remember if this came up before, but have u thought about shooting elsewhere, like the flank?

I'm dying to know what the vet will say today!
 
Re: 1/20 Max AMPS 466

Morning Ronnie
Ronnie & Luna said:
I guess we'll see how the numbers go...hey I can't remember if this came up before, but have u thought about shooting elsewhere, like the flank?
Click to expand...

I have never tried the flank. I have looked at the pictures (a pencil drawing of a cat??)
and stupid me can't really figure where that is. I guess maybe I should check it out again.
You have any good picture/links? Never thought of going to med school - that's why I'm a CA/CPA so body parts work only so well with me, haha.
Maybe I should check with Tina/Sami since she is shooting at the flank.
 
Re: 1/20 Max AMPS 466

Hey Randi! You just started a new dose, too soon to see it work--I did a fur shot just a few days ago..Dont beat yourself up..We all do it..
Need to wait another 4 cycles to see any changes--Even when you do a fur shot, some may have gotten in..So never give another shot!
Hope things get better for you & Max! HUGS~!
 
Re: 1/20 Max AMPS 466

yea, she's right - someone said the other day - your next dose could be the breakthru - forget the thoughts/doubts I put in ur head lol! And lets see how the dose does - well, once it actually gets in him that is - but it could be something to think about later on.
 
Re: 1/20 Max AMPS 466

Don't immediately assume that if there's a damp spot that you fur shot. Every time I thought I gave a fur shot, I had a green number. There's frequently a drop or two of Lantus on the needle. It may be that's what you noticed. Max's numbers will tell you what's up.

Good luck with the vet today and with the dosecrease.
 
Re: 1/20 Max AMPS 466

Yes Randi...Sienne is right...we never really know for sure how much went in until we see the
numbers....good luck with the new dose and with the vet too... :YMHUG:
 
Re: 1/20 Max AMPS 466

I am sorry to be so long but I wanted to post the answers for my questions to the vet.
IMHO our opinions are world aparts and I just do not agree with anything she says.
I ask all of you your thoughts because I feel sick to my stomache right now.
I did send back an email asking if the only hometesting was the once a week curve or at least
the bare bones minimum (in my opinion) AMPS, nadir, PMPS.

Okay just got back the answer. Her patients do not homestest!! She bases all of her decisions on once a week curve. Freak out that these cats are getting insulin shots with no BG test prior to the shot.
My questions are in red.
Thank you for watching over MAx.

.[[/color]size=85]- 75% of our patients are tested at home, they usually do 1 glucose curve per week until we find the right dosage and then when needed. (Before they come in for a fructosamine or and presence of clinical symptoms.)

2. What information/data do you use to increase/decrease insulin dose and frequency of these changes - Dre. Fifle uses clinical symptoms (drinking and urination in exagerated quantities, fructosamine levels and glucose curves. Dre. Fifle is aiming for no clinical signs or symptoms, good to excellent control on fructosamine and ideally a good glucose curve, but not essential because of possibly stress induced hyperglycemia.

3. I would like to consider testing Max for Acromegaly (1GF-test) as well as IAA, rather than spending the money on fructosamine.I still do not understand the purpose of a monthly fructosamine if he is being home-tested on a regular basis and would think it would be useful for those cats that are not tested.-I'm sending you an article on update related to Feline Acromegaly. Dre. Fifle recommend waiting to document; - I-resistance 1-1.5 U/Kg and other suggesting changes not present now. - Moneywise IGF-I combined with imaging (scan or MRI) and excluding other endocrine diseases such as cushing is over 1500$. Because of the Fructosamine showing good control when on 2.75U if there is no signs of drinking and urination in exagerated quantities or weight loss at the moments you should keep the Lantus at 5U and do a Fructosamine next week; if good to excellent we should keep this dosage. I'm sending you an article and the last fructosamine.[/size]
All these recommandations are done by Dre. Fifle.
 
Ronnie & Luna said:
I'm sorry but a fructo test every week/month??
Click to expand...

Fructosamine once a month. Only home testing is BG curve once a week.
That is what I understand.

(you can't leave us ay Ronnie. And I don't want you to)
 
Randi,

I totally know how you feel. The vet is telling you one thing and you feel in your heart that something else is correct. I have totally been there. It can definitely cause and upset stomach. Not to mention all the what if's. What if I followed the vet's advice, would it have worked better? What if I did this a little different? What if....? You know what I mean.

We all want our kitties to feel better NOW! Why isn't there some instant fix for FD? At least we know that we are doing everything we can to make our kitties better. I have spent the better part of the last two weeks doing research and learning more and more about FD and I still think I have a lot to learn, but with everything I have read I am sure to know more about FD then the vet. I still take into account what the vet says, but I don't solely rely on it when I make my decisions about how I will treat Sami.

It can be hard to go against what the vet is recommending, but sometimes it is necessary.

I hope all works out okay. Hopefully Max will see some lower numbers tonight and tomorrow.
 
I'm sorry you're not pleased with your vet right now. I completely understand! I went through 3 vets - the 3rd one referred us to a specialist. When logan wasn't eating, the second one told me he was getting too much insulin and to stop switching his food. He said it was no problem for Logan to go 24 hours with no food and still get insulin. The only bloodwork he wanted to do was a fructo - he said my 3-4 spot checks a day didn't tell us what his average was. I politely refused the fructo and asked for my script for the free pens...haven't talked to him since!

If you're not comfortable with your vet, try to find a new one. Call around and ask questions - do their patients hometest, etc. You have to find one that you're comfortable with. Are there any specialists (interists) in your area?
 
I'm sorry you're not pleased with your vet right now. I completely understand! I went through 3 vets - the 3rd one referred us to a specialist. When logan wasn't eating, the second one told me he was getting too much insulin and to stop switching his food. He said it was no problem for Logan to go 24 hours with no food and still get insulin. The only bloodwork he wanted to do was a fructo - he said my 3-4 spot checks a day didn't tell us what his average was. I politely refused the fructo and asked for my script for the free pens...haven't talked to him since!

If you're not comfortable with your vet, try to find a new one. Call around and ask questions - do their patients hometest, etc. You have to find one that you're comfortable with. Are there any specialists (interists) in your area?
 
(I am completely restraining myself from being blunt and totally tactless.) I'm going to attempt to be professional and suggest that this vet is not current in her reading of the literature. (Was that a reasonably polite statement?)

Let me provide a comparison. My vet, a feline specialist but the equivalent of a primary care doc, was also of the fructosamine every 2 - 3 weeks then monthly persuasion. That was fine when I didn't know any better and was still shell shocked. After spending some time here and developing a SS, and having averted 2 hypos due to the vet's dosing (not that it was wrong, I didn't know know to manage low numbers), I began working the Tilly protocol and doing everything we do here. (Ok, I'm a testaholic!) I went in for an appt., brought Gabby's SS, e-mailed my vet the Tilly Protocol and the Rand research and she was completely blown away and thanked me for the journal articles which she had obviously read. She stated that with the amount that I test, there is no need to waste money on fructosamine tests. She was thrilled with the home testing and stated that in their practice, there are very few people who will do this. (What I suspect is that the vets don't push it so the beans don't climb on board.) She did ask how I learned to home test -- I told her YouTube. We both laughed. I use one of the nurses at that practice as my catsitter. They have had in-service training, led by my preferred vet, reviewing the Tilly/Rand protocol. She's an incredible vet who is highly invested in continuing education. (Are you sure you don't want to move to Chicago?)
 
Oops - sorry about the double post!

Nicely put, Sienne. Your vet sounds fabulous!!! I just can't get over how awful some of these vets are. It's downright scary. You feel like you can't trust anyone with your babies. I do like the regular vet Logan is now seeing. She's not ideal, but she was very supportive and excited about the home testing and she could admit when she was in over her head. I like the internist for the most part - hate the office staff and most of the techs, though!
 
Re: 1/20 Max AMPS 466

Randi & Max said:
Dre. Fifle recommend waiting to document; - I-resistance 1-1.5 U/Kg and other suggesting changes not present now. - Moneywise IGF-I combined with imaging (scan or MRI) and excluding other endocrine diseases such as cushing is over 1500$.
Click to expand...

(((Randi))) Your vet sounds fairly typical....there are excellent vets out there, and you need not agree on everything, but finding one that will work *with* you is important.

When Sasha was first Dx, I began hometesting right away. Our vettybean still wanted to run a fructosamine occasionally, and I humored her exactly once. Once she saw how often I was testing and knew I had a good grasp on Sasha's BGs, she never asked about one again. There is just no need if you are hometesting, period.

It is also a shame that your vet is not up to date on Acromegaly, but that really is pretty common too. All that is needed for an Acro Dx is the IGF-1 - not an MRI, although an MRI certainly would show if the tumor is pituitary based. However, Acro cats can have a tumor outside of the pituitary, and in those cases an MRI would show little. THE IGF-1 test is about $100 here in the US - not sure how much most people pay in Canada. The IAA test is about $15. From what I have seen in the HD group, most don't test for Cushings unless there is a reason to (the other tests come back negative or cat is displaying Cushing's type symptoms).

If your vet is interested, they can go on VIN (if they have access) and look at the January 2009 rounds on Acromegaly. Dr. Lisa posted some information on the old board here.

I'm not saying that Max is one or the other. It's just hard to stomach that a vet actually wants to dismiss the possibility because they believe scanning is necessary for an accurate Dx.

I look at my own vet, whom to say I love dearly would be kind of an understatement, and know that I can bring up pretty much any topic or concern about Sasha with her and she will take me seriously (or at least pretend to). We've grown together during this process. Is she a better vet now than back when Sasha was first Dx - you bet! She's taken the time and effort to learn alongside us on anything that I voiced as a concern. Anything she is not 100% well versed in, she takes the time to research and also looks at whatever research I may present. There is new information in the veterinary world daily - new medications, new testing methods, new treatment options. It's not that you have to find a vet that knows everything right now, but rather find one that will actually keep their eyes open as their field progresses. Too many get finished with vet school and stop learning. As you've seen with diabetes, constant learning is a necessity.

If you are unhappy with your vet in any way, there is no harm in looking around for a new one. You just never know when you may find a gem out there in the piles and piles of rocks. :smile: ;-)
 
Sadly, many people are shooting without testing twice a day at least. It is a very sad situation. We turn to our vets and doctors for their guidance and sometimes, they guide us in the wrong direction. Once you know something,, it is impossible to UNknow it, right?
You know the importance of testing Max and I doubt you could follow directions from a vet who wanted you to shoot blindly.
You have come too far and learned too much , Randi.
What about the other vet you used to use? Can you call her? Do you think you can work with her at least, even though
she doesn't use Lantus. I think the only thing the Hospital Vet had going for her was the use of Lantus. Added to all the above, I don't think you will be happy hiring her. Her policies are not suitable for you at this point in the game.
If you can't use the previous vet, then maybe you can call around and find a brand new one. You sound angry and I doubt you can go on with this one....too much separates you both.....
 
Thank you all so much.

Sienne-Yes you were very polite and I know we need to be nice around here but I can read between the lines, wink, wink,
The Chicago place is looking might fine to me now.

Well, I plan on taking a deep breath and start a new serach. I am comfortable with the board and will not rush to a regular Dr. Now that I am better educated then when I met her, I know excatly what I need.
Pathetic medical system here in Quebec - Animal or human.

BTW Cassandra, I'm not surprsised at the $1500 MRI coming out of her mouth. They are an Emergency Hospital and all they hear is caching of the register. When I brought Max into Emergency at the start and the d/x his diabtese, I was told "Here is an estimate for minimum $2,000, leave us a deposit of $1500) I brought him home and took him to the regular vet.
 
Oh dear.... (((Randi)))))
I'm so sorry that you have to go thru this. It's a horrible feeling not to be able to rely on the 'professional'. Often I ask myself... what did people do before the internet?????

I think you can feel confident that as far as diabetes goes, you have already acquired a lot of knowledge and that with the Tilly protocol and help of this board you will go a long way.

Just curious... was that a vet's office associated with the ecole veterinaire de St. Hyacinthe? I sure hope not, but .... eh.... I wouldn't be too surprised.

Please hang in there and we'll continue to support you.
 
Helene & Tizon said:
Just curious... was that a vet's office associated with the ecole veterinaire de St. Hyacinthe? I sure hope not, but .... eh.... I wouldn't be too surprised.
Click to expand...

Helene,
Guess you know the vet medical system here. Actually not St Hyacinythe, way too far from me and it is a teaching hospital. I could not consider a "grey's anatomy, lol" situation with Max having all these students around him. Although my favourite internal medicine doctor practices there now.
Actually, DMV Emergency hospital, which is the only major hospital on the Island of Montreal.
Totally pathetic.
I'm going to call vet #1
 
you are testing at home and do not need a fructosamine or curves at the vet.
periodically you'll want to get blood and urine tests to see how your cat is doing. the first time i did it was about 6 months after diabetes diagnosis, then about once a year. they'll be able to tell from both of those how your cat is doing diabetes-wise (level of glucose spilling into the urine, what the BG reading is as of that day, as well as level of dehydration, etc.). so that, along with clinical signs from looking at and feeling your pet, should be enough to satisfy your vet as to how your cat is doing.

some vets want to see our test results. others don't care. if yours wants them, you could give her a copy of your spreadsheet periodically or give her the email link to it so she/he can follow it along with you.

i wouldn't worry otherwise. i just use my vet to get prescriptions and he's perfectly happy with how i'm managing cleo's diabetes. if your vet won't work with you i'd find another. i switched vets at my vet practice three times before i found one to work well with me. he was initially skeptical but open minded, and now he's impressed with how i'm taking care of cleo and basically stays out of it. i rely on the board for daily expertise, and go to a specialist for other major health issues when needed.
 
Even if I would give her the benefit of the doubt on her approach to treating diabetes, I am disturbed that she won't respond to your concerns, open her mind, and form a working partnership with you. The same issues could come up in dealing with future health issues. You are just asking her to draw some blood and mail it away! I wonder if you could find a vet across the border in NY or Vermont who would do the blood draw and send it for you. It's probably much much less expensive in the US to have those tests performed.
 
Got to tell you, I shot for 11 months without hometesting :shock: :shock: -I did however urine test which the vets recommend--Shooting Blind!!
My recommendation: DONT DO IT --LEARN TO HOMETEST!! I feel that Moonie would possibly be OTJ if I had been bg testing-She was on MICRO DOSES of 0.1 & 0.2U for a long while!! She had negative urines all the time!
It's a Miracle she never, well, you know what!!!
Hometest--It is the only way to go..Vets are wrong! The stand in vet at my new vet was chatting with me without Moonie there & he said what's her numbers--I said about 200-70's varies day by day--He says Oh that cat could easily go into remission @-) @-) @-) cat(2)_steam
Was he kidding!!
So, what we know is more than they know about FD--That's a fact!!
Hope you find the right way for you & Max--HUGS~!!!!!!
 
Right on Roni
I am not giving up my testing. Instructions today for nanny was full steam ahead.
Test as always.

I left a message for vet #1 to call me. Spoke to receptionist, who knows me very well and told her I want back and vet should call me at home tonight to discuss Max. If she will allow me to manage my dosing and testing then I think we will make a good team.
She is very loving and cares about Max. When I told her that I went for the second coinsult and had not been around she was happy that I was caring for Max and only wants him better.
Paws crossed that she will work with me.

I will update all.
Thanks guys for listening to me and giving me your opinions.
 
Randi,
I think it's very important that you trust your vet and feel comfortable that the vet will work with you. I sense that you don't feel any of those things about your current vet.

It does not matter if it's one of my drs or one of Shadoe's I doubt and gather my own info.
Each and every one is different, and at the animal hospital where I take Shadoe, each of the 3 I have seen is different. After dealing with drs for myself, I have no aversion to making demands, and I intend to get both the IAA and IGF-1 tests done. I'll take them info and if I have to go to a bunch of vets in the area to ask about the tests, I will.

And you must do the same because Max can't do it without you. Get pushy, get loud. OK that works for me, but you need to find your equivalent.

I think what I would do would go back to that vet and say, I want the two tests done; no discussion. Tell me how much for the two tests and let's get crackin'. If the vet comes right out and says no, then you know that you should get another vet.

Somebody earlier said that they use their vet for rx and stuff like that; I fee the same about mine now too. With the awesome knowledge and experience base to be found on this site, the vets almost seem like a minor part of the picture.

OK rant off. Give some nice scratches from me and Shadoe.
 
((((Randi)))) it sounds like you're making a good move by calling back the vet that you like. I bet you can work something out.
 
Hi-

I was having issues with demanding what I wanted from our vet. Then I had a bit of a revelation.

I realized that legally, as crude as is seems, your pets are your personal property. You have the right to demand to do as you see fit with your personal property as long as what you are doing is not cruel or abusive to the animal.

Vets don't have the same threat of liability as with humans because the life of an anaimal is sadly valued so low. Therefore any vet that will not do what you want is just being difficult. There is no other reason since you are asking for a service to be performed on your personal property.

Thinking of the situation in such a cold manner helped me to get over the funny feeling of being completely assertive rather than apologetic in any way. I'm not saying I think you have the same issue I had. I just was thinking that somehow the experience I had was relevent to the discussion and may help someone who is reading your condo.
 
(((randi))) i have nothing to add that the others haven't already said.
when alex was diagnosed, i was lucky to already have a vet who was willing to work with me. his patients did not hometest and he was highly amused when i told him i was going to test alex myself. i knew i had to. i had taken her to the vet for a curve and they were only able to draw blood once in a twelve hour period! so much for getting a curve done there! the rest is history.

i'm sure you'll find a vet who is willing to be partners with you...
 
hey Max!
that is a mighty fine lookin' yellow on your ss! Shadoe is very impressed and hopes you can keep her company on the LL yellow brick road to the Blues!

Randi,
Maybe if you are very firm with the vet, saying EXACTLY what you want done, you may see a change in the vet's attitude. At any rate, you are going to see the vet's true colors!
 
Status
Not open for further replies.
Back
Top