4/13 Charlie AMPS 275, +2 202, +3 179, +6 185, +8 211, +10 230, PMPS 256, +2 267

[Charlie'sMom22]

Yesterday's post

Hiya friends. A sizable drop this morning down from AMPS, so I'm thinking Charlie might be finally clearing his bounce. I can't tell how many days it's been because I don't know how to identify when the bounce started--was it the morning of 4/11? Any input would be greatly appreciated!

We're due for an increase tomorrow and I once again find myself resisting it. Maybe he'll get greens tonight and then I won't have to?

One thing that's been really hanging over my head is the vet's email from this week. I had emailed her to ask about Acro and IAA testing and give her an update on Charlie in general. She emailed back the morning of 4/10 saying:

• She's concerned with the amount by which and how quickly I've increased his dose in the last month
• She thinks he's on too high of a dose which is causing somogyi effect, and that this is "more likely than insulin resistance"
• She wants me to have the libre CGM placed so we can determine "what his blood sugar is doing in the gaps of the curve"

My issue(s) with this is that 1) I disagree with her--I think the fur shot I did back on 3/10 held him at that dose for too long and caused glucose toxicity, which he is now (hopefully) breaking through when he's not bouncing, and 2) it also makes me even more paranoid than I already am about increasing him and sending him into a hypo. This is why I avoid talking to the vet as much as possible. It always just leads to more stress and confusion for me. Note, Just wanted to say thank you to @Tim & Pookey for sharing the link to the somoygi effect thread--it helped me form my opinion on that first point.

I don't really know how to respond to her. I need to maintain a relationship with her for Charlie's sake, but I feel she does not listen to me. I already told her I was following TR (and linked some info), that I will not put a sensor on Charlie, and I have shared the spreadsheet with her several times. It's like she didn't even look at the spreadsheet--it shows very clear and obvious signs of progress! And she definitely didn't read the link I sent about TR. I'm frustrated that Charlie's own vet is a barrier in navigating this disease. It's hard enough as it is, and I already have a demanding full-time job that does not include educating her.

Is there anything to her theory? Charlie would have to be dropping like 150+ points within a few hours early in the morning when I'm asleep, consistently. I just don't think it's possible given his pattern elsewhere.

Sorry to vent. I'm tempted to just not respond until he's steady in the blue so she can't deny that there's progress. However, that means I won't be able to get the Acro and IAA tests done. Seems like she doesn't want to do them anyway. UGH.

AnyHOO. Wishing you all a safe Sunday full of blues and greens!

 

[Fistuk & Shelly]

Hi Jess

I'm sorry you have to go through these pain with the vet. Pains that soooooo many of us here are familiar with. I was just thinking how amazing (or stupid) it is that all the vets are saying exactly the same thing and are fear infusing, closed to learning and feedback. Full disclosure, I'm not a vets fan. There are some good out there and they some times hard to find.

I heard the same things and then the vet ditched me because she said I'm putting Fistuk's life at risk where in fact it was her putting his life at risk and if it wasn't for TR and this forum Fistuk would have been gone by now long time ago!

I agree with you, that the glucose toxicity is when they stay too long in high numbers. At first I too was concerned about increasing the dose more proactively but when Fistuk broke through the toxicity is was evidently clear this this system works. Do check my SS and see how he was at the beginning.

When he was hospitalised for ketones the vet wanted put the sensor on him, saying that this way they can download the data and work with my reading better in order to consult me. I was very against it only for the sheer reason that I intuitively don't like these invasion to the body. But eventually I agreed. It was only bc one day the sensors didn't give a reading and I got spooked that I tested with my meter and was shocked to see the difference. I then kept the sensors on for another day and kept testing to compare and I was shocked the different reading and the inconsistency of the sensor.

Looks like Charlie broke the high in the sky number with 6.5U - well done you two It's not time to put on the patience pants and keep it up and you'll results, I'm confident in that.

If you use the question mark prefix it helps the moderators when they brows through the many condos to go to the ones that have questions first. Then at the end of the subject you can write in short what's your question such as Dose.

You're doing an amazing job helping Charlie managing his sugars

 

[Brianna & Xander]

Aww, Jess, I'm so sorry you're having to deal with this extra junk.

It's so hard to not have a good relationship with the vet. I totally get it. It's awful when they won't even hear us out or bother to look at any of the evidence presented. (I have that same problem with my own doctors too and it's the worst!!) Absolutely understand the desire to wait until you have undeniable proof of efficacy before bothering to contact her again (I just had the same thought like a month ago for Xander), but like you said, then he's not getting tests he needs.

Is switching vets even something on the table at this point? It seems like she just isn't willing to even consider looking at what you've presented which kind of puts a hard wall up between you two.

I hope some others are able to give you advice that I'm not, but I'm thinking of you!

 

[Bandit's Mom]

A sizable drop this morning down from AMPS, so I'm thinking Charlie might be finally clearing his bounce. I can't tell how many days it's been because I don't know how to identify when the bounce started--was it the morning of 4/11? Any input would be greatly appreciated!

The bounce started in the PM cycle of 4/10 (maybe even at the end of the AM cycle of that day) and this is cycle 6 of the bounce. It does look like he might clear the bounce today.

We're due for an increase tomorrow and I once again find myself resisting it. Maybe he'll get greens tonight and then I won't have to?

Let's see where he is at the end of this cycle and what he does tonight. You don't have to increase if he gives you the numbers we want. Do you worry about the size of the dose? Is that why you find yourself resisting an increase? A dose in itself is not a safe or unsafe dose - a cat needs as much insulin as it does. For some cats 0.5U can be too much and for others, 15U might not be enough.

Is there anything to her theory? Charlie would have to be dropping like 150+ points within a few hours early in the morning when I'm asleep, consistently. I just don't think it's possible given his pattern elsewhere.

Not at all! Sorry about the grief your vet is giving you! You have increased systematically and have tested more than enough for you to know how he was doing at each dose.

 

[Charlie'sMom22]

Hi Jess

I'm sorry you have to go through these pain with the vet. Pains that soooooo many of us here are familiar with. I was just thinking how amazing (or stupid) it is that all the vets are saying exactly the same thing and are fear infusing, closed to learning and feedback. Full disclosure, I'm not a vets fan. There are some good out there and they some times hard to find.

I heard the same things and then the vet ditched me because she said I'm putting Fistuk's life at risk where in fact it was her putting his life at risk and if it wasn't for TR and this forum Fistuk would have been gone by now long time ago!

I agree with you, that the glucose toxicity is when they stay too long in high numbers. At first I too was concerned about increasing the dose more proactively but when Fistuk broke through the toxicity is was evidently clear this this system works. Do check my SS and see how he was at the beginning.

When he was hospitalised for ketones the vet wanted put the sensor on him, saying that this way they can download the data and work with my reading better in order to consult me. I was very against it only for the sheer reason that I intuitively don't like these invasion to the body. But eventually I agreed. It was only bc one day the sensors didn't give a reading and I got spooked that I tested with my meter and was shocked to see the difference. I then kept the sensors on for another day and kept testing to compare and I was shocked the different reading and the inconsistency of the sensor.

Looks like Charlie broke the high in the sky number with 6.5U - well done you two It's not time to put on the patience pants and keep it up and you'll results, I'm confident in that.

If you use the question mark prefix it helps the moderators when they brows through the many condos to go to the ones that have questions first. Then at the end of the subject you can write in short what's your question such as Dose.

You're doing an amazing job helping Charlie managing his sugars

Thank you so much Shelly. It helps to know I'm not alone. Fear infusing is exactly right. I've been anxious and second guessing myself ever since reading that email. This group has helped me feel confident and given me reassurance whenever I'm freaking out. But any time I have an interaction with her all of that goes out the window and I become a scared mess again. She's selective in the questions she answers--it seems like if I ask or say anything she doesn't want to hear she just ignores the question/statement. I don't think they understand how exhausting it us for us to do a ton research of research on something and make a decision, only to have it be dismissed, ignored, or refuted. And of course, they always say "bring him in" about everything despite knowing how terrified he is--he started hyperventilating last time we were there! I agree wholeheartedly with you that good vets are very hard to find.

I've read some negative feedback before about the sensors being unreliable, just as you mentioned. That was factored into my decision as well. And I just can't justify spending the money and upsetting his quality of life for a sensor that only lasts two weeks max (and Charlie would definitely hate it and rip it off sooner). Considering how much the vet has been pushing for this thing, I'm starting to think it's more about what she's familiar with rather than anything else.

I looked at Fistuk's sheet and it's like night and day when he broke through the toxicity! It's beautiful to see, really. I'm so glad Fistuk's numbers are stable and that you're not having to deal with high numbers on top of his current challenges. I hope he continues to keep his food down and get rest. Hopefully he's turned a corner and will continue to recover through the night

I didn't want to add the question mark prefix this time because my question (or questionS rather) are non-urgent, and I noticed there are other posts that need attention more urgently than mine. Mine is mostly me just whining and being nervous as usual I'll update if I need an answer to my dosing question depending on how the rest of today goes

Thank you so much for taking the time to read my novel and respond to it <3

 

[Charlie'sMom22]

Aww, Jess, I'm so sorry you're having to deal with this extra junk.

It's so hard to not have a good relationship with the vet. I totally get it. It's awful when they won't even hear us out or bother to look at any of the evidence presented. (I have that same problem with my own doctors too and it's the worst!!) Absolutely understand the desire to wait until you have undeniable proof of efficacy before bothering to contact her again (I just had the same thought like a month ago for Xander), but like you said, then he's not getting tests he needs.

Is switching vets even something on the table at this point? It seems like she just isn't willing to even consider looking at what you've presented which kind of puts a hard wall up between you two.

I hope some others are able to give you advice that I'm not, but I'm thinking of you!

Thanks Brianna. I was just thinking to myself this morning, why are all doctors like this!?! I've had the same exact experiences with my own doctors too It's infuriating. I bet if I was a man they'd listen...but don't even get me started on that LOL

Switching vets would be pretty difficult, but it's in the back of my mind in case this trouble continues. There is another vet at the current place that Charlie and I saw when we first switched and I really liked him, but then they randomly started having me see this other one who I don't like. Not sure why. It would be super awkward to ask to go back to him instead of the current vet but I'll do it if I have to. I'm going to give this vet one more chance before I pull that trigger I think.

Thank you for thinking of me I hope you and Xander are having a nice weekend

 

[Charlie'sMom22]

The bounce started in the PM cycle of 4/10 (maybe even at the end of the AM cycle of that day) and this is cycle 6 of the bounce. It does look like he might clear the bounce today.

Ah, thank you. I suppose knowing the start of a bounce isn't as important as recognizing when he's clearing a bounce, right?

Let's see where he is at the end of this cycle and what he does tonight. You don't have to increase if he gives you the numbers we want. Do you worry about the size of the dose? Is that why you find yourself resisting increase? A dose in itself is not a safe or unsafe dose - a cat needs as much insulin as it does. For some cats 0.5U can be too much and for others, 15U might not be enough.

Honestly, just knowing I don't have to increase helps alleviate some of the worry. Thank you to you and Wendy for reassuring me (so many times) about the dose size. It's like, in my brain I know that the dose itself isn't safe or unsafe, but my anxiety is fixating on it. Like it's a little creature on my shoulder saying "that's a huge dose it's going to kill him." And then the recent email from the vet is only reinforcing that anxiety. Like the creature is holding up the email going "SEE? even the vet says so!" Lol I sound like a crazy person right now. I think it's also that most cats are on a much smaller dose by comparison, so it just feels like something is "wrong" I guess. Anyway, yes let's see what he does tonight

Not at all! Sorry about the grief your vet is giving you! You have increased systematically and have tested more than enough for you to know how he was doing at each dose.

Thank you for this reassurance as well. I thought so too.

 

[Tim & Pookey]

Sorry you’re dealing with this Jess, seems like I’ve read similar stories here quite a bit about vet relationships. We switched vets recently and basically told them I don’t need or want any diabetes related input, please just help me with general cat care. Since then they’ve left me alone and have still been helpful with other stuff. But I could see some vets maybe not feeling great about that… ugh, what a pain.

 

[Charlie'sMom22]

Sorry you’re dealing with this Jess, seems like I’ve read similar stories here quite a bit about vet relationships. We switched vets recently and basically told them I don’t need or want any diabetes related input, please just help me with general cat care. Since then they’ve left me alone and have still been helpful with other stuff. But I could see some vets maybe not feeling great about that… ugh, what a pain.

LMAO that rules I need to take a page from your book

 

[Wendy&Neko]

Sigh! I wish I could say your situation was unique.

Back in the day when I had to practically plead for acro and IAA testing in 2012, there was no research showing how common it was. That research paper came out in 2015. Vets "of a certain age" before that were taught - this is acromegaly, you'll never see it. Neko had no symptoms other than her dose size and extreme hunger, which they dismissed as her being unregulated. Charlie is a large cat with large paws, has stridor, and constipation issues.

Several times I had to say "please humour me" and "it's my money" about the tests. The clinic owner (only occasionally saw him when my vet not around) called them "exotic tests". I gained a lot of cred when Neko got two positive tests results. A couple weeks after Neko's positive test came back, my vet identified another acro in her practice. Which make me feel good. Move on 4 years to the last time I saw the clinic owner, he admitted I knew more than he did about acromegaly. A somewhat low bar. . My relationship with the vet I normally dealt with was that I dealt with the diabetes and she helped me with everything else. The total sum of conversion on diabetes was "what is her dose now?". I had given them copies of the TR protocol and gave weekly copies of her spreadsheets for a few months.

Contrast to Neko's acupuncture vet, before my first visit she had printed off a bunch of articles on acromegaly and read them all. She loves to learn. We had lots of discussions on the disease. Turns out a stray camped out at her house was likely acro, once we started to talk about symptoms. Needless to say, she became my vet for later cats. There are good vets out there. Mine unfortunately retires in 3 weeks.

As to the vet's question. You are following TR and testing plenty, you would know if he was going too low. Which he would do if he was overdosed. He's not, therefore he's not on too much insulin. His spreadsheet looks like a cat who has insulin resistance that is growing. You need to find out what type of insulin resistance it is, hence the need for tests to "rule out" other factors. The fur shot on 3/10 had little to do with it. I did way more fur shots that you do.

Another though for you, if he does have acromegaly, there are treatments, which I've posted about previously. For all those treatments, including cabergoline that you give at home, the earlier you identify the condition and start treatment, the better the outcomes. If this vet doesn't work out, are there internal medicine vets in your area? I hate the idea of him having to go to yet another vet, but IM vets are more likely to be in tune with complexities of diabetes.

 

[Charlie'sMom22]

Sigh! I wish I could say your situation was unique.

Back in the day when I had to practically plead for acro and IAA testing in 2012, there was no research showing how common it was. That research paper came out in 2015. Vets "of a certain age" before that were taught - this is acromegaly, you'll never see it. Neko had no symptoms other than her dose size and extreme hunger, which they dismissed as her being unregulated. Charlie is a large cat with large paws, has stridor, and constipation issues.

Several times I had to say "please humour me" and "it's my money" about the tests. The clinic owner (only occasionally saw him when my vet not around) called them "exotic tests". I gained a lot of cred when Neko got two positive tests results. A couple weeks after Neko's positive test came back, my vet identified another acro in her practice. Which make me feel good. Move on 4 years to the last time I saw the clinic owner, he admitted I knew more than he did about acromegaly. A somewhat low bar. . My relationship with the vet I normally dealt with was that I dealt with the diabetes and she helped me with everything else. The total sum of conversion on diabetes was "what is her dose now?". I had given them copies of the TR protocol and gave weekly copies of her spreadsheets for a few months.

Contrast to Neko's acupuncture vet, before my first visit she had printed off a bunch of articles on acromegaly and read them all. She loves to learn. We had lots of discussions on the disease. Turns out a stray camped out at her house was likely acro, once we started to talk about symptoms. Needless to say, she became my vet for later cats. There are good vets out there. Mine unfortunately retires in 3 weeks.

As to the vet's question. You are following TR and testing plenty, you would know if he was going too low. Which he would do if he was overdosed. He's not, therefore he's not on too much insulin. His spreadsheet looks like a cat who has insulin resistance that is growing. You need to find out what type of insulin resistance it is, hence the need for tests to "rule out" other factors. The fur shot on 3/10 had little to do with it. I did way more fur shots that you do.

Another though for you, if he does have acromegaly, there are treatments, which I've posted about previously. For all those treatments, including cabergoline that you give at home, the earlier you identify the condition and start treatment, the better the outcomes. If this vet doesn't work out, are there internal medicine vets in your area? I hate the idea of him having to go to yet another vet, but IM vets are more likely to be in tune with complexities of diabetes.

I wish I could teleport you here and have you come to the vet with me I'm so bad at dealing with them in person. I thought I would fare better via email and it was working for a while, but she's just so difficult.

"Exotic tests" made me laugh out loud. Good lord.

Tomorrow I'm going to call around to see if I can find a vet who will do home visits. The closest IM vet is over an hour away. I don't know that Charlie will even tolerate a non-emergency vet visit at this point, even with Gabapentin. Your comment about your acupuncture vet reminded me that there is holistic home visit vet on my island--they do integrated medicine (including bloodwork, food therapy, acupuncture, and western medicine). The vet tech that came to my house when Charlie first got diagnosed used to work for them and told me about them, actually. They seem like they'd be a better fit for our lifestyle and for treating this disease, so I'm going to email them. They have a wait list, though they're prioritizing patients in need of acupuncture and herbal medicine. Maybe Charlie would be a good candidate for prioritization. Did you find Neko's acupuncture treatment helpful?

If nothing else pans out, I think I may just tell the vet that I respectfully disagree with her, I believe I'm testing enough to know if he were going too low, and to please just do the tests to "humor me." I had to do that with the blood tests in the beginning when I first started bringing him in for constipation--the very blood tests that led to this diabetes diagnosis, mind you!

 

[Wendy&Neko]

I started taking Neko to the acupuncture vet, because of her really bad arthritis. A common acro symptom. She was already getting other meds for it, including buprenorphine, but it wasn't enough. The acupuncture really did help her. The vet also taught me how to do acupressure at home, to supplement and lengthen how long the acupuncture worked. Neko grew to enjoy those acupuncture visits, because she knew they helped. I remember one time the vet and I were yacking and Neko went over to the treatment sofa and gave us a "get on with it!!" look. This vet has a conventional medicine background, but also holistic and Chinese medicine training.

A couple times the acupuncture vet did blood draws on Neko, and I was there with her and it was easy peasy. Her regular vet had me leave the room, and had to don gloves and use a towel and once I saw her go in with a muzzle. As she said, she wasn't Neko's favourite vet.

 

[Briana + Binx]

What a terrible experience you're having with your vet and as everyone above as had, way too common for us. A willingness to learn and listen should be the bare minimum at least and it's still so hard to get that! You're advocating for Charlie so well and asking all the questions, which is great. I hope you're able to find some answers and a vet that will help you find them.

I'm so sorry, Jess

 

[Charlie'sMom22]

I started taking Neko to the acupuncture vet, because of her really bad arthritis. A common acro symptom. She was already getting other meds for it, including buprenorphine, but it wasn't enough. The acupuncture really did help her. The vet also taught me how to do acupressure at home, to supplement and lengthen how long the acupuncture worked. Neko grew to enjoy those acupuncture visits, because she knew they helped. I remember one time the vet and I were yacking and Neko went over to the treatment sofa and gave us a "get on with it!!" look. This vet has a conventional medicine background, but also holistic and Chinese medicine training.

A couple times the acupuncture vet did blood draws on Neko, and I was there with her and it was easy peasy. Her regular vet had me leave the room, and had to don gloves and use a towel and once I saw her go in with a muzzle. As she said, she wasn't Neko's favourite vet.

Hahaha aww that’s so sweet about her waiting on the couch. It’s amazing to witness when they take to something because they know it helps them, even though they don’t fully understand what the heck is being done to them haha. Like Charlie going and sitting for his shots every day. It makes my heart swell.

He also has some mild arthritis starting in his hips/lower spine, and I think that’s part of the reason he doesn’t play much (and mostly uses the stairs to get on the bed) I wonder if I do get on the list with this vet, if the acupuncture might help get ahead of it? Worth mentioning to her I suppose. I could probably use some of that acupressure advice myself what with all the tension I carry

I think a lot of problems could be solved by letting the owner be there with the pet for bloodwork and other procedures. They told me they put a cone on him whenever they take him in the back for something. Poor guy is a mama’s boy and is scared enough as it is!

 

[Charlie'sMom22]

What a terrible experience you're having with your vet and as everyone above as had, way too common for us. A willingness to learn and listen should be the bare minimum at least and it's still so hard to get that! You're advocating for Charlie so well and asking all the questions, which is great. I hope you're able to find some answers and a vet that will help you find them.

I'm so sorry, Jess

Thanks for saying that Briana. Some days I feel like I’m not doing enough, as I’m sure most people here feel.
I agree that vets at a bare minimum should be open to learning and the possibility of changing their thinking on something. Maybe bedside manner and open mindedness 101 should be a course they have to take in vet school

 

[Charlie'sMom22]

Well now he’s gone up (or stayed flat-ish I suppose). Could he bouncing from the fast drop this morning or has he still not cleared the bounce from the other day? Not sure what’s going on.

I’m thinking I’ll stay up to get a +3 and see what he’s doing then maybe set an alarm to wake up and get a +7 in case it’s a later nadir?
@Bandit's Mom what do you think?

 

[Bandit's Mom]

Sorry! I just saw this. Not much of a drop till +3, but yes you could set an alarm for +7 or even +8 and see if he has a late nadir.

Looks like you go up in dose tomorrow.

 

[Charlie'sMom22]

Sorry! I just saw this. Not much of a drop till +3, but yes you could set an alarm for +7 or even +8 and see if he has a late nadir.

Looks like you go up in dose tomorrow.

No worries! I did just that.

Looks like he did have a late nadir and is still low. AMPS is 182 this morning Should I still increase or hold it for another cycle/day?