? 5/16 Oren; AMPS=268;+2.5=365;PMPS=302; advice re: vet response

Yesterday

wow. really? almost 6+ hrs of sleep?! how did that happen!
and a sunny start for Oren. not a bad way to start the day. He has only 2 doses of Bupe left, and another wk of the tresaderm ear drops (boy he hates them).
he's gone through 2 cans of the DM (i really hate to admit, I still haven't met a food he won't eat) although a bit of FF was still there. Tonight might be first meal of just DM.
it's quite early yet, but i haven't heard a sneeze this a.m. Yesterday he was kind of hiding a bit at times behind the chair in the den, but then ended up sleeping on the kitty perch in the window. definitely lower energy and I think it was from the crap numbers. He greeted me this a.m much more bright eyed.

 

Looking better with that extra juice already

 

Much better numbers since increase. Hope you have a good day.

 

Keep the bean smiling, Oren.

Marilyn and Polly

 

now there's perspective.... being excited for 6+ hours....

 

Her timing sucked, as I of course, had already raised the dose last night, and this came in while i was out paddling today. Excuse the lengthy post, but I would appreciate help interpreting the rather mixed messages I get from this? "Open to different treatment options", but here's what I do and what I want you to do...?!
I think there is room to make this work somehow, but my main concern is that this is very obtuse about how long to hold the dose she recommends "to let his body adjust". he declined seriously in the 3 days of the lower dose, showing signs of increased PU/PD which she claims to be one of her aims to avoid. And notice the language "managing diabetes". I also got annoyed by the 42$ charge to sit down and discuss my points, but I guess her time is valuable...(so she keeps up to date on recent med. literature but hasn't heard of Tight Regulation protocol?!)
I also forgot to mention to her that I was aware of the potential for too high a dose causing high BGs..but most people here felt that wasn't the case, as the dose adjustments have followed the protocol. She made sure to talk about dose decreases, but not dose increases?! Considering I sent her the bit of his spreadsheet since the dose decrease, and she should have seen the **** numbers, and I explicitly stated concern about possible development of keytones... and NO numbers anywhere near 150, now what?!

glimmers of hope but still some confusion
------------------------
Megan-

I appreciate your time and your concern for your cat and am happier to have pet owners who are attentive and involved in the care of their pets. Our mutual interest is the well being of Oren and I hope we can come to an understanding that allows him to benefit. I understand and respect the time you have invested in his care. I am not closed minded to learning new ways of managing my patients, and am flexible to different treatment plans. I have expressed to you that I am willing to work with some of the monitoring techniques you prefer.

If we are to have a successful veterinarian - client relationship I need you to respect my medical advise, and allow me to advise you on how to proceed. In order to do that, you need to trust me. Trust is not a given, and I understand that our relationship is relatively new. If you do not have that trust, it is your prerogative to choose another veterinarian, no hard feelings! Trust is the thing that will allow us to be a good team and bottom line will provide the best outcome for Oren. I need you to understand I am a recent graduate with current knowledge, I maintain a veterinary license and continuing education, keep up to date on recent medical literature, and have many resources available to me to allow me to provide you with great medical care and advice. For all of these reasons, my time is valuable and, yes while I am busy when at the clinic, I feel confident in my ability to provide outstanding care to my patients. I am not familiar with using the tight regulation protocol you are using, but am familiar with other ways of managing diabetes successfully.

I have not waded through all of the information and sources you have listed in your email. In order to do that, and thoughtfully respond I will need significant time. I believe I have taken sufficient time with you and Oren to this point answering questions, and coming up with a treatment plan.

If you would like to have a discussion about all of the points that you have raised in the email, I am happy to go point by point and respond to them, but I will be billing you for a recheck so that I can offer that service to you. that cost is $42.

Here is what I would advise you to do next regarding monitoring, feeding and follow up.

First I want to explain to you my basic goals of treating diabetes, which are guiding the recommendations I am giving you, and may help you understand my reasoning:

**avoid symptomatic hypoglycemia (this means that the exact number you are getting is less important, and is glucometer dependent). The point of monitoring the blood sugars at home is to screen for LOW BG. High BG are important, but do not warrant immediate action like low BG do.

**avoid clinical signs consistent with persistent hyperglycemia (PU/PD, weight loss) in addition to preventing a state of ketoacidosis from prolonged hyperglycemia

** it is important to remember that many things cause abnormal response to insulin (abnormal = persistent high BG despite a very high dose of insulin, very high and very low BG in the face of any dose of insulin, etc). These things a inactivated insulin, incorrect insulin dose or type, concurrent conditions and CHRONIC under or overdose of insulin . It is important to understand that chronic OVERDOSE of insulin can cause persistently HIGH BG readings based on how the body metabolizes insulin over time. Yes, you read that right.

For all of these reasons, I would not recommend that you increase the dose of insulin yet. I would encourage you to continue at the 4 units twice daily from the new bottle and stop checking BG so frequently if there have been no low readings in the first 4 days after the dose change.

If you are at home and reading BGs, and you get a reading under 150, I would have you decrease the subsequent doses by 0.5 units per dose until I am reachable. I would encourage you not to increase the dose of insulin without discussing this with me first, as this should not be an emergency measure.

If Oren is demonstrating signs of low BG (seizure, unresponsiveness, etc.) rub Karo syrup on his gums ad then get him to the nearest open vet clinic. We are open most days 8-6 pm, saturdays 8-1 and closed on Sundays. VESC on carystreet (804-353-9000) is a great 24 hour, 7 day a week clinic that can help him in an emergency if you need it.

Here are my specific recommendations:

-Monitor: food intake, water intake and insulin dose daily. If the dose is changed (increased or decreased) check about 2 BG's in the first 4 days following that (readings 6-8 hours after insulin dose is best). If no red flags (low readings), recheck spot checks (6-8 hours post insulin) weekly. Do full curve (ideally BG every 2 hours, but every 4 hours is good too) 2 weeks after a dose increase.

-Get purina glucostrips (or other product) and measure for ketones in his urine periodically. Also observe for LACK of glucose. (every 3-5 days). Call if positive ketones or negative glucose.

-Recheck ears 2 weeks (approximately... at end of treatment course)

-Recheck fPL snap test (in 2-4 weeks)

-Probiotic daily (one packet in total)

-feed DM for 2-4 weeks, if possible in 2 meals. Since he has pancreatitis, and is not overweight its not the end of the world to feed more meals. Post prandial hyperglycemia and over interpretation of this is what I am trying to avoid in his case with frequent feedings. There are OTC diets I am comfortable with for diabetes, but not one for pancreatitis AND diabetes. Is this possible for you financially to feed DM short term?

Continue bupe for 5 days, if he needs longer (declines when off of it) we can continue it as needed.

-schedule dental when hypoglycemia at home has resolved

- as I said, I can help you send out the insulin auto-antibody test and the acromegaly test, but don't think at this stage it is the best use of your money.

I will make other long term rec's at the appropriate time, lets just get through the short term for now.

I know it is KILLING you not to increase his dose. I hope the above has been helpful in explaining why I am recommending what I am. I recommend that you give this new bottle/dose and his body time to adjust.

 

I would like to know his rationale for limited home testing. He wants you to avoid symptomatic hypoglycemia but not test. IMHO, testing prevents a symptomatic hypoglycemic episode because you can catch a drop in numbers early and intervene. Why wait until you see symptoms.

He's right -- too much insulin can look like too little insulin. However, if you are raising the dose systematically, this won't happen.

Personally, I find it difficult to understand how he is applying what he knows about treating FD if he isn't familiar with TR. The other types of insulin that are available are not pharmacologically similar to Lantus or Lev. Trying to treat a cat on Lantus or Lev as though the cat was on Humulin N or some other shorter acting insulin makes no sense.

I also find it offensive that he's going to change you for answering your questions.

 

Wow Megan.
First up I think it is poor your vet charged you to answer your letter.
She says she is a recent graduate as if that means she knows it all.....well I think experience counts for a lot as well, and the willingness to learn from others is something she is going to have to learn to do if she wants to be a good vet. Many years ago when I was training to be a nurse, we were told 'always listen to the mother of a sick child, because she knows him/her best and she sees things we all miss and she has valuable information and often finds the problem first'. I saw that first hand over and over again. The same is true for beans.

She says on the one hand she is open to new ways of managing her patients, but then says she is not familiar with tight regulation and "I have not waded through all of the information and sources you have listed in your email" and "I have taken sufficient time with you and Oren to this point". In other words, she is not willing to learn new ways. She will be one of the vets who keeps all her cats from gaining remission with that attitude.

Then she wants you to lower the dose, not test as much and don't worry Megan...."If Oren is demonstrating signs of low BG (seizure, unresponsiveness, etc.) rub Karo syrup on his gums and then get him to the nearest open vet clinic" ....................WHAT!!!!

Megan, in my opinion you have enough on you plate without having to deal with a recent graduate who is trying to prove herself. Not all vets are like that. I have a great vet who is open to learning new things and wants to try more up to date things with diabetes. Look around and you will find a good one. Take your time and in the meantime the experienced people on this forum will guide you with the dose.

 

I think your obvious mistake was involving this vet in the care of your cat. My vet "fired" me. And while I'm reeling from that one because I actually sort of NEED a decent vet for management of some non-diabetic issues, having taken the "above board" approach of going to various vets in town, asking them to take on my kitty as a patient, then "coming clean" about what I'm doing regarding his diabetes has them declining to care for him.

I'm beginning to think the best approach is to simply do what I'm going to do in consultation with this board, do it in the closet, wash my hands afterwards and somehow hide my spreadsheet so the vet can't get to it. When it comes to telling the vet what you're doing about the diabetes, pull some number out of the air, tell them you're giving that amount twice a day and be done with it. Tell them your pet's appetite is perfect, he takes out his own litter, and his flatulence smells like perfume, then deal with the reality of it all.

I guess the question is whether the dishonesty could lead to a catastrophe. As an anesthesiologist, if you lie to me about not having anything to eat or drink or smoking crack the night before an anesthetic, that may be the last mistake you'll ever make.

Unfortunately, I need access to a machine to run a CBC with diff every six weeks before giving maintenance chemo to my cat. I don't keep a machine like that in my garage. The $42 is just a minor annoyance. Depending on your income level, it may not seem like it. But compared with what I'm chewing on right now, it is.

I think I'm becoming clinically depressed over the situation, beginning to show vegetative signs. I think it's related. Banging your head against the wall will tend to do that, even though my cat is doing better than he has at any time since this latest difficulty began. His chronic dandruff is gone, he no longer hides, he plays with the younger kitty. He doesn't take out his own litter yet; I'm working on that one.



Dear Dr. XXXX
Dr. Roge has shown me the train of emails regarding your self-treatment of Mr. Sluggo. Any client may legally treat their own animal and, as a physician, you certainly have the training to do so. We respect your right to self-treat your own cat. However, be advised that you are following a protocol that is foreign to us and that we do not approve of this course of action. As such, we are now serving you notice that we are not associated with this case and bear no responsibility for it. We really have no desire to see further emails regarding this treatment protocol, as it is nothing which we would ever use. We do wish you and Mr. Sluggo the best of luck and will be happy to provide you with copies of the few records which we have for him.
Steve Bentsen DVM
Managing Partner
Nolana Animal Hospital


Good Afternoon,


I have forwarded this information to Dr. Zamorano and after reviewing he's has stated that he would be happy to exam your pet and or provide medical care, but would not be able to under those terms. In-case of an emergency though we are open 24/7 and would be more then happy to care for the patient.





---


Reception


Pet Doctor 911 - Animal Medical Center


7017 North 10th, Suite T


McAllen, TX 78504


956-683-7387 office


956-683-6444 fax





On 05/13/2015 9:12 pm, XXXXX wrote:


> From: XXXX


>


> Pet Name: Mr. Sluggo


>


> Phone: XXXX


>


> Message Body:


> Dr. Zamorano cared for Mr. Sluggo long ago at Border. Mr. Sluggo was


> in diabetic remission for about 2 years but suffered a recent relapse


> due to dental issues. Another McAllen vet took care of the dental


> issues but "fired" me from the practice for employing a tight


> regulation regimen for Sluggo's diabetes like the one I used to get


> him in remission before. The regimen was developed as a combined


> effort by the German Katzen Group and University of Queensland. It is


> described here:


>


> 2009 Aug; 11(8):668-82. doi:10.1016/j.jfms.2009.04.010.Epub 2009 Jul 9.


>


> or at the following pubmed URL:


> http://www.ncbi.nlm/nih/gov/pubmed/19592286


>


> It involves blood glucose testing my cat and twice daily lantus


> insulin injections guided by those results.


>


> A public link to Mr. Sluggo's diabetic spreadsheet listing his data,


> therapy and my treatment notes is available here:


>


> https://docs.google.com/spreadsheets/d/1tuO8KAt9RVSVk_EsXNnpkfH5fvOAXj_7HwFxnGH79Jc/pubhtml


>


> I am a physician (human), and a member of the online feline diabetes


> forum where I get support from others who have followed the same path,


> and in turn offer my support.


>


> I am unwilling to stop what I'm doing as I feel it is my cat's only


> hope for a second remission. Will Dr. Zamorano accept my cat into his


> practice under those terms?


>


> --


> This e-mail was sent from a contact form on Pet Doctor 911


> (http://petdoctor911.com/wordpress)

 

I don't see a mixed message from your vet. Seems crystal clear to me. You will dose the way she instructs you.

I agree with most of what she says, but I am afraid she thinks Oren's high numbers are from being overdose. Likely she thinks high dose conditions are rare. They are not. The most recent research shows 25% of diabetic cats have acro tumors.

I suspect if you tested his urine for glucose it would show high. If you had a fructosamine, ditto.

I can't help but wonder if you, an involved intelligent cat owner, will ever be satisfied with this vet's style.

 

We see lots of high dose conditions here thumbing through spreadsheets. Lots & Lots. Seems almost more common than not. ?Patient population? What I have sluggo on is a whisper.

 

I think you did the right thing by raising the dose. The evidence in his already better blood sugar numbers.

Not sure of the best way to approach things with the vet. Neko's vet started her on Caninsulin, a locum vet got us on Lantus and pointed me to FDMB. A couple weeks after than I stopped asking about dose adjustments, and the vet stopped suggesting. I made it clear I was managing the diabetes on a day to day basis and I wasn't going to agree with her on food. But the one thing that really solidified her respect for what I was doing was the results of the acromegaly and IAA tests. She didn't think I needed to do the tests, the senior vet thought I was wasting my money. But when both tests came back positive, they realized I was getting good information here. Now she seeks my input on other issues.

BTW, Julie's number of 25% comes from several studies, the latest of which is from the Royal Veterinary College Diabetes Remission Clinic which is screening every cat they get in. They have a large sample size of data and are one of the more active Veterinary Teaching programs studying diabetes in pets.

One thing your vet mentions is:

I don't think you are in danger of hypo at the moment. If he needs a dental, he'll need it regardless of any further blood tests.

 

Wendy, where do you live? Does your hospital need an anesthesiologist?

Can I move there and kiss your vet's feet? Does he/she need his/her car washed?

 

@Sandman - LOL! British Columbia, Canada.

Seriously though, I also like Neko's acupuncture vet, and she agrees with me on food. Seems when they are trained in alternative medicines in addition to regular veterinary eduction, they are more open minded.

 

I'm unable to sleep again, so catching up on these latest responses. I wasn't sure what to make of many things in her email, but specifically Wendy, what's your take on the DM being best for pancreatitis and diabetes? He eats it quite willingly. I might be willing to feed for 2-4 wks to see how that goes. Though I'd like to know why she thinks it's better for pancreatitis.

I'm leaning toward a response that says, how long is long enough at hyperglycemia? You advised reduction, but not when to increase? When I recheck for snap fpl, do the iaa at least. 16$ I can afford. If it's positive, she may bend. She expressed knowledge of acro being under diagnosed, but apparently thinks it's more likely he's overdosed, mostly because she knows nothing of the TR, not FDMB. How can that mean she stays current?

God, this is exhausting. @Sandman, you crack me up, but I totally get your frustration. Sadly, since Oren is no where near good regulation I have little evident to convince her of the effectiveness of TR, for me at least. This is awful

 

Sorry you can't sleep again, especially if Oren is giving you a pass tonight.

My thoughts on food, and I'm only basing this on what I've seen here, is there isn't any good reason to feed him DM for his diabetes. From Marje's primer on pancreatitis:

If this is Oren's first episode of pancreatitis, I wouldn't call it chronic, recurrent yet. Very good question to ask her why she thinks it's better for pancreatitis - but only if it doesn't cost $42 to ask the question.

On the tests, I'd prioritize the acro IGF-1 test over the IAA one. The saying is that acro trumps IAA. Stop feeding DM, save that money towards tests. Hard to believe a recently graduated vet hasn't heard of tight regulation. I wonder if she knows about glucose toxicity caused by time in higher numbers.

I was breaking the mold by using Lantus instead of Caninsulin that they recommended to the rest of their clients. We weren't exactly the best example of how well Lantus can work for cats. Have you ever looked at Neko's first year SS?

 

i know i'm a broken record, and i guess everyone is sick of this, but i am really worse off than before. What really kills me is I attached the Roomp/Rand paper as a PDF, and i excerpted bits of it in my email, and she's claiming she wants to charge me for reading the paper I supplied? I also had the SLGS pasted in after the body of the email, it wasn't even an attachment, as well as the part of the spreadsheet covering the dose change (with my notes)

for the record, here is what i sent her. I think there was a failure of basic reading comprehension on her part to start with.

Dr. XXXX
I'm writing this because I feel we are still having difficulty communicating in person and I think part of that is due to your time constraints in the office(completely understandable!), and my awkwardness in handling myself in an escalating situation.

I think I can better try to express myself in writing, so I'm at least going to try! Let me start by saying I do not want to be in an antagonistic relationship with you, quite the contrary, I need a partner and an advocate, someone who can help me navigate the myriad issues associated with this terrible disease. However, I was thrown off by your resistance to the Tight Regulation protocol and I get very flustered in a situation where I feel I'm being put on the defensive and I don't explain myself very well. I would hope we can both agree that we both have Oren's best interest in mind and want for him to be as healthy as possible? I am not meaning to come across as doubting your training, but I would hope any doctor, human or veterinarian would remain open to discussing different treatment strategies and work to find the best fit for everyone.

I hope to address some of your concerns with actual cited data rather than my sputtered, poorly expressed answers.

Per your concern on the use of human glucometers
Journal of Feline Medicine and Surgery (2009) 11, 668e682 doi:10.1016/j.jfms.2009.04.010
Intensive blood glucose control is safe and effective in diabetic cats using home monitoring and treatment with glargine

Kirsten Roomp BSc, MSc1, Jacquie Rand BVSc, DVSc, DACVIM2*

...”Values obtained using human-use whole blood glucose meters are up to 30-40% lower in the lower end of the glucose range (hypo- and normoglycaemia) than plasma-equivalent meters calibrated specifically for cats and measurements obtained from serum chemistry analysers. This is assumed to be because the distribution of glucose between red blood cells and plasma in cats is substantially different from human beings (7:93 for cats and 42:58 for human beings).33,34 Therefore, if this protocol is being used together with measurement of blood glucose concen- tration using a glucose meter internally calibrated for feline blood, or using a serum chemistry analyser, it is recommended that approximately 1.7 mmol/l (30 mg/dl) be added to target glucose concentrations used in this study that are in the lower range. For example, instead of aiming for a blood glucose concentration of 2.8e5.6 mmol/l (50-100 mg/dl), aim for 4.4e7.2 mmol/l (80-130 mg/dl) when using a meter calibrated for feline use or a serum chemistry analyser. Importantly, this protocol has not been tested and shown safe for diabetic cats only monitored once every 1-2 weeks at a veterinary practice. It has only been shown safe when combined with home monitoring of blood glucose concentration a minimum of three times daily.”

SOURCE: http://www.thecatclinic.com.au/medical-and-health-info/blood-glucose-monitoring-at-home/
”...Measurement of blood glucose concentration (BG) is usually the best method of determining the correct insulin dose for diabetic cats. Stress hyperglycaemia occurs commonly when cats visit a veterinary surgery and can result in the wrong dose of insulin being selected. Thus, the stress-free environment at home is the best place to measure a cats BG.
Most human glucometers are very accurate at measuring cat blood. We prefer the Accu-Chek brand which can be purchased from any chemist for approximately $60...”

Document compiled by a longterm member on FDMB:
“In general, a human glucometer will read 30-40 percent lower than a pet-specific glucometer. At the low end of values, that difference is approximately 18 points. At the high end of the scale, it really doesn't matter. If the test is high, its high and you take the appropriate action based on the insulin you are using. If there is another medical condition affecting the glucose levels, you treat that condition and adjust the insulin...

...An important note about glucometers: The FDA allows glucometers to be sold which read within 20% of what a lab test might get. This means that any test represents a range of possible values.
Ex. A test value of 100 mg/dL means the glucose could be anywhere from 80 to 120 mg/dL.
Ex. A test value of 200 mg/dL means the glucose could be anywhere from 160 to 240 mg/dL.

For any 2 tests, they may be considered equal if they overlap, ie. if 1.2 * low value is greater than 0.8 times the high value

Ex given two tests with the same meter, 280 vs 310, can they be considered the same?
1.2 * 280 vs 310 * 0.8

336 vs 248
Yes, the 2 tests may be considered the same.”

Per the Tight Regulation Protocol
I first learned of this approach from the The Feline Diabetes Message Board at www.felinediabetes.com. This is a wonderful online resource of hundreds of lay people with a huge amount of experience in the day to day treatment of this disease, and many others. It has been a source of great support and information, and really a lifeline after being thrown in the deep end after diagnosis. Many of the users there successfully follow one of two modified protocols developed out of the Roomp-Rand paper. One is the tight regulation and the other is called Start Low, Go Slow. I suspect that this approach may be more in line with your preferred dosing schedule, as well as comfort level. I have attached this at the end of this email, for your review.

The TR objective is to try and keep a cat in healthy range as much as possible to try and facilitate healing of the pancreas and possible remission. It is an admittedly aggressive approach, and does require a lot of commitment. I understand that you, and many other vets feel uncomfortable supporting this treatment protocol. In fact, many FDMB members have had similar discussions with their vets, and a common theme is that most vets feel uncomfortable promoting this for a number of reasons: most vets can't be accessible, as people are on the FDMB, at nearly any time night or day for people who are faced with lower numbers, they can't be sure who will be committed to the testing and learning when to feed and when to do the next test and so, for safety's sake, they are more conservative. They understandably, don't want to be the cause of a hypoglycemic cat. FDMB members stress safety first and commit to staying with someone if necessary to handle a situation. It is also been observed that Lantus, even using the TR protocol, tends to not result in clinical episodes of hypoglycaemia, both by FDMB members, and as stated in the Roomp-Rand article:

“...In human patients, clinical hypoglycaemia is reported to be less common when using glargine compared to intermediate-acting insulin.28,29 This is thought be associated with glargine’s consistent insulin action over 24 hours compared to a sharp peak of insulin action which occurs with intermediate-acting insulin. Based on the very low frequency of clinical hypoglycaemia observed in this trial and another trial in cats, it appears that glargine use in cats might be similarly advantageous.7 The frequency of biochemical hypoglycaemia reported in our study was likely over estimated because blood glucose concentrations were measured using whole blood glucose meters designed for human-use, which give readings that are 1-2 mmol/l (18-36 mg/dl) lower than measurements using automated serum chemistry analysers calibrated for feline plasma.30... “

Another member stated that her vet (she lives in NY) told her Cornell University Veterinary now recommends the TR protocol for all their newly diagnosed cats, and they seem to have an approach that takes into account the life/treatment balance. They offer a simplified version at diagnosis while their clients are learning to test and shoot, and then after the first 10 days they work with each client to create a modified version based on what their lifestyle will allow. They also make themselves available 6 days a week (24/7 in an emergency) for email and phone consultations to take dosing questions. I'm hoping to get a copy of their protocol when she returns in a few weeks for a follow up visit for her kitty.

I myself have concerns that I would always be able to put in the work necessary to stay on top of things following TR protocol. I can only argue that I wanted to give Oren the best chance of remission, but now that I'm nearly 5 months into treatment, I know that it is becoming less likely the longer we get from diagnosis. I think the TR or the SLGS protocols are a good place to start and give a structure and guideline to follow. But reality dictates there has to be some flexibility to make it work. The first goal is getting Oren regulated, then well-regulated, then hopefully tightly regulated. If remission happens...fantastic! If not, Oren is much better off being as tightly regulated as possible, rather than being just at or below a somewhat ambiguously defined standard of renal threshold. In any case, I just can't see how this is not a better approach then shooting a fixed dose for weeks at a time w/o home testing pre-shot at least, to catch what is going on. So many variables affect blood glucose levels on a given day, let alone across several. I would never be comfortable with shooting blind and will continue to test him several times a day when possible. Conversely, with your concerns about hitting numbers that appear to be uncomfortably low, I feel like I have good knowledge and support from the forum, to handle such situations, by steering with various kinds of foods (higher carb levels etc.) and also would not ever endanger him by shooting a low number if I know I can't be there to monitor him.

Per His Diet
I understand you feel that the DM prescription food is the way you'd like to proceed, but quite honestly, with the increased cost of all of Oren's care these days, I simply can't afford it on top of all the other costs. I also have a 2nd cat, and feeding them both would really be prohibitive. I'm stretched pretty thin as it is. I would like for you to work with me to suggest appropriate commercial options, if you truly feel Fancy feast is not a good option. High protein, low carbohydrate and even low phosphorus food is available (Friskies Special diet Turkey and Giblets is often recommended). Are you familiar with Dr. Lisa Piersons, DVM food charts maintained at catinfo.org. She has a very informative site discussing feline nutrition and food composition. I also find many references in literature and from people in the message forum that feeding smaller more frequent meals during each cycle is beneficial, rather than solely 2x a day, as it's less stressful on the pancreas. Many people find 4 meals a day works well, the main meals being pre-shot, with 2 additional smaller ones generally in the front half of each cycle. And some people continue to free feed in between the preshot meals. However, I also recognize that there is often a need to experiment to find the right food and schedule. ECID(every cat is different)!!

As you know, I came to you because I'm afraid there may be a secondary, rare condition causing his greater need for insulin, perhaps IAA or Acromegaly. I had wanted the IAA and/or Acro tests done just to rule those conditions out. Of course, It made complete sense to run the blood work and urine culture to eliminate UTI and it caught the pancreatitis before it got too severe, thankfully. However, if you look at his progress overtime, you can see the trend overall has been a dose would hold him for a while, but always seemed to begin to slip into higher ranges. Once 6u is reached, the recommendation is to check for these conditions.

As I feared, with this reduced dose his numbers are climbing even more, as are his water intake and urine output. I am extremely concerned about glucose toxicity and possible development of ketones the longer he stays in these higher BG numbers. Remember, it's not just since the dose reduction (which is now 6 cycles), but it's more like a week of numbers in the 300-500 range. His 14 day average is 335.This is backward momentum, no matter how you cut it.

I know there is more to consider than just the numbers, I try to remind myself to not get stuck there; is he eating? Grooming? Playing? Purring? Pooping normally, peeing 'normally'. Thankfully so far, yes to all those things, though as I noted, an uptick in drinking and peeing has happened in the past week especially. I can read his behavior pretty well now, and know from the litterbox and his demeanor when he is running high. He was backsliding at 6.25u, and it's only been worse since dropping to 4. I don't see any significant influence of more potent insulin from the new vial, even with any lasting effect of the depot from the last dose. He has had just over half his course of bupenephrine, and if there was any pain influence from the pancreatitis contributing to his higher numbers, there doesn't seem to be a noticeable effect yet. Thankfully, his appetite has stayed strong (though I note he eats his fancy feast first, even as it has decreased in proportion, and then eats the DM.) Waiting another 2 weeks of sending him backwards seems unnecessary and potentially unhealthy.

I will reiterate, that I have no wish to be confrontational with you, it makes me extremely uncomfortable and I know it is counter productive. Please don't take offense at me questioning everything, there is such a steep learning curve and I'm trying to soak up as much as possible. I have been extremely stressed and upset this week and I'm trying to reach out. I want to feel that we can work together, and agree to be open to finding the best course of action. I need to be a strong advocate for my beloved kitty. Again, we both want what's best for Oren! I truly thank you for all your efforts and input thus far, and for hopefully reading through all this. Depending on what I hear from you, I want to up his dose this evening. It is optimal for me on a weekend when I can be around to monitor him more closely, and I could even get a 12 hr curve today (as I'm off on Fridays)

In hope of better communication and partnership
Megan

 

I think with all the information you are providing this vet with, all nicely compiled and listed according to subject....you should be charging HER for your training experience. New graduate or not, if they can't think outside the box (veterinary training textbooks) then you need someone who is not afraid to say they don't know everything and at least be open to different approaches. My vet has 30 years in her practise and with some of the information I have given her she said "I have learned a few things". Good luck!!

 

Wow....the fact that you are having to go through this with your vet says A LOT. I feel just awful for you that you are having to deal with this.

The experience I have had with my vet is so opposite. Like Wendy, my vet actually encouraged me to come to this message board to get all the information I could. When I told her I would like to try to learn to home test she literally jumped for joy. She said the only reason their office doesn't suggest it is too many people are scared to even try and learn. We have also gotten to the point where when he comes in for an appointment, she accesses his spreadsheet that way. Recently, we went in and there was a new vet tech and she made a point of showing that vet tech Skooter's spreadsheet and explain that I am basically the poster child for diabetic cat owners for them. She has also said on numerous occasions she trusts me judgment in making all decisions in relation to his diabetes because I have demonstrated I know what I am doing (with the help of everyone here)

You shouldn't have to spend so much time convincing nor defending how you choose to treat your cat. Yes, she has gone through schooling etc, but she is not the one with Oren 24/7 YOU ARE. You need to take charge of how you want to treat this. I was very disheartened when I joined this board after reading how so many vets seem to be closed minded. I consider myself blessed to have such an open minded vet. I wish for you to find the same.

 

I think you did a great job with that letter.
Nonetheless, she has put her back against the wall and I would be surprised at this point if she would back down.

I would start looking for another vet.... she is stressing you out way too much. And charging you for emails, ridiculous.
My vet actually calls me on the phone to check on my girl and I can't get her off the phone. ( no charge)
You really need them for the blood tests, and prescriptions but you've got plenty of help right here for the rest.
So many of us have our vets for those reasons and when other things crop up but not for the day to day management of FD.

 

I'm afraid Sluggo achieved good tight regulation shortly after they discharged me from the practice, and I'm still a couple days away from attempting my first dosage reduction (based on a week in TR).

I am quite literally at my wits end with this. No good options. At least Mr. Sluggo is doing really well! My coin collection including my nice collection of gold double eagles goes to my cats and designated caregiver in my will, so they'll make out fine.

If you can find another vet, I'd do that in a heartbeat. And honestly, I'd keep what you're doing with the diabetes a secret. Lie if you must. I'm deadly serious.

 

I saw what you wrote before you edited [deleted] and I'm concerned.

 

When I moved to Columbus, one thing that I found is that rather than having a phone or e-mail discussion with a new vet, I asked to make an appointment so I could interview the vet and see the practice. I had time available and they were happy to set up an appointment at a non-busy time. The vet spent probably close to an hour discussing my cats and I was very clear that I practice TR and had been doing so for several years. I also indicated that I wanted to know her familiarity with the approach and whether she would support me in continuing to manage Gabby's FD and that we would be partners in the care of my cats. She was fine with it. She also toured the clinic -- exam rooms and surgery. The place was immaculate -- just the way it should be.

I tend to think the face-to-face contact assures a vet that you are a reasonable human being and invested in the care of your kitty. There is so much that is lost without being able to see someone when you're communicating electronically or by phone that it's easy for both sides to misread communication.

Oh. Despite the time involved, I wasn't charged for the informational visit.

 

Megan,
That was an incredibly well worded email. I completely understand your frustrations.

After Tennessee's bout of pancreatitis, he was making little headway in reducing his BG numbers until I made the decision to follow TR, even though my vet is more of a SLGS person. Even though we are at a quite high dose- the number dont lie. The TR is working. My vet realizes that I am going to do what is best for him, and seems to trust my judgement. (but we will see what happens once the Acro and IAA tests come back)
Both you and Oren deserve a vet who will work with you, not charge you to read emails!

I'm hoping that you will be able to find a vet that trusts your judgement and the TR protocol. Sienne seemed to have some great suggestions about interviewing new vets

You both deserve better!

 

Having a very bad go of this whole issue. Through it all, the cat is fine. Caregiver is not.

 

What would you find most helpful from us right now?

 

What I need is a flesh and blood vet advocate. I was very angry with that nameless, faceless McAllen vet and beginning to turn that anger inward. Like sluggo's response to TR, it's another thing I can do nothing about.

About all you can do is look at my SS and reassure me I'm doing fine, doing all I can for my cat.

But I can't stand not knowing. I can't stand being put in the position of giving my cat chemo without a neutrophil count versus not giving it and hoping he really had IBD and not cancer. Just giving the chemo and rolling the bones is like fingernails on the chalkboard to me. Just having access to a CBC in 3 weeks and knowing I will would take a tremendous load off my mind. But it is impossible.

 

Well, this is my specialty! Try to do something proactive. There's a list of "cat friendly" vet practices that is published by the American Assn of Feline Practitioners. It's a place to start. It there's not a practice close by, call the closest place and see if they have a vet they would recommend.

If you have the time available, go and meet with a potential new vet. (See my post above re. in-person vs other forms of interviewing vets). Try to not go into your professional background. Instead, use your profession as a means of asking good questions -- after all, you're standing in the vet's playground. We've seen too many people who have some rather peculiar ideas about how to care for their cat and a vet needs to know you're a reasonable person invested in the care of your cat.

We all need a vet we can trust for the myriad of health issues that can crop up. This can easily turn into a power struggle and in some cases, a vet (or an MD, for that matter) will take a "my way or the highway" approach. It's not productive, especially in the age of social media. And, BTW, I'd also look on Yelp for vet recommendations and post on the Health board to see if people know of other vets in your area.

At the very least, might it be possible to use one of the vets for everything except the management of FD? The polite nodding and agreeing and not giving the vet access to a spreadsheet might work.

 

Maybe look for a vet who will treat the IBD/cancer first and after getting to know the vet, start educating on feline diabetes.

And what Sienne wrote.

Here are Google listings, some with reviews to cross check with the list Sienne provided.

And here is a map of locations near McAllen, TX.

Some referrals of vets within 20 miles of McAllen, TX.

 

thank you all. I feel, a bit like Sandman, quite overwhelmed. Full confession; in the horrible paralysis of this situation, I caved and went back to the 4.5u dose last night and this a.m., as I thought I would respond to her with "how long do you require the reduction to be tested" before recommending an increase. She was specific about reductions, but left out the critical factor, citing she knows its killing me to not up the dose, but not saying "we'll know after xx days"... WTF??

anyway, now I'm reeling with even more guilt and confusion.
I put in the search for 'cat friendly practices' Sienne offered and now have the question, if a practice DOESN'T show up in the results, does it mean it's likely a waste of time to contact them? Should i really focus only on the ones that come up there?

hanging by a thread.
ETA: the only 'feline only' practices are 100 miles away in No. VA, near D.C. Not gonna work.

 

Megan.....

I think when dealing with "cat friendly practices" that may mean they only deal with cats or maybe they separate out the waiting areas for cats and dogs etc....

I like the suggestion of setting up an informational appointment, where you don't even bring Oren with you and get a feel for the clinic, the staff, the vets etc. You need to be comfortable with them. It truly should be a team effort and they should be open to what you want to do as well as you being open to their opinions. I wouldn't necessarily say not to contact one that doesn't show up on that list as it may be the perfect fit for you. I think @BJM has some interview questions in her signature line that you could use when going to the vets.

You will get through this and find a vet that is the perfect fit for you and Oren. As much as it sucks, you just got to hang in there a little bit longer....throwing you a rope to replace your thread with

 

Thank you all. There's a new practice in town I'm going to try out called "furry friends". Seems to have good reviews. I think I'll give them a call & see. I think I'll just not mention what I'm doing with the DM issue or say something like, "my cat is a diabetic on 1.75U BID lantus with stable blood glucoses" and not mention spreadsheets monitoring or plans to wean. A lie by omission, I guess.

Just had a good cry and feeling a tiny bit better.

 

Duran is at Altas Palmas. I don't know how they consider the place "cat friendly". That was the place that originally let my sluggo sit with an abscessed tooth until he fell out of his DM remission. It's a big waiting area with hard benches and barking dogs. My cat freaked out. For lack of concern over DKA when I called them a week into their antibiotic non-therapy with a BG of 330 and telling me "I can't see your cat today or tomorrow...". I gave them the heave-ho. And they're on the "cat friendly" list.

Maybe I should apply to be on that list. Looks like I could get on there too!

 

Hugs, Megan. Your letter is great, so articulate, factual, and expressive of your feelings. I get a bad feeling from hearing that your vet wants to charge you $42 for answering your questions. Unfortunately, there are those in the medical profession who get their backs up when questioned or challenged (the God complex, if you will). Thankfully, those are in the minority. I have a fabulous vet, responds to emails without charge, gives plenty of time in appointments, she is a board certified feline specialist with a cat only practice, and has treated all my kitties, extremely compassionate when I've had to say goodbye to a couple of my babies who've gone ahead. A friend who uses the same vet said that the Dr. came in to the clinic on Sunday, when they're usually closed, to treat a situation with her kitty. My vet is extremely knowledgeable about feline medicine. However...I don't share exactly how I'm managing Lulu's diabetes. My vet had recommended some kibble daily, I feed only wet, no kibble whatsoever. She has asked that I give dosages based on Lulu's BG levels, which vary from day to day. I don't do that, I follow TR protocol here, with coaching from a few experienced members. My vet did say that I was doing a fantastic job managing Lulu's diabetes, that she looks better and is more chipper than she's been in a long time. Good enough for me to continue on with TR and this forum. Also, she did not criticize when I told her I had changed to Friskies and FF, rather than the Rx food they sell at the clinic. I guess what I'm trying to say through this lengthy discourse is that you shouldn't have to tolerate this, and good for you for writing that letter. If your vet is unwilling to work with you in a partnership, I hope you find a new vet who is more flexible and easier to deal with.

 

@Sandman, I totally get your situational depression; I too am losing sleep (was awake for hours last night even after going to bed at 'reasonable time') hardly ate yesterday. On top of all this, as I mentioned, I'm having other personal issues w/ my significant other (trying to make some significant life changing decisions since we live 400+ miles apart). Huge PTSD feelings from this Amtrak incident as it's the route we use to see eachother. It is all combining to overwhelm me and so I know I'm not making good decisions right now, and can hardly find the focus/energy to keep struggling on. I know i need to be proactive on Oren's behalf so I have to try and do something
ironically, one practice i did find via Google search here in town that claims to be Cat only, didn't show up on this search and the single Yelp review was not great. It is a single doctor with a vet tech assistant. And the review was about a dog?!

I do appreciate everyone's encouragement and suggestions. (damn, I sound so pathetic, it's pathetic. I'm sorry for the downer downer downer...)

 

Megan, you do not sound pathetic. You love Oren very much, and you're a human being with feelings who has a lot on her plate right now. Please be gentle with yourself

 

Megan, if I could figure out how to find the old platform that the site used to be on, I could cut and paste SEVERAL posts of mine where I was crying, wondering if I was doing the right thing, if there was someone better suited to take care of Skooter etc....pathetic was an understatement.

You can only do what is in your control. One thing I found helpful as when Skooter was diagnosed, as it seemed everything that could go wrong in many areas of life did go wrong around that time, is take one thing at a time. Unfortunately, all of the issues aren't going anywhere, so if you try to work on one or two things at a time, it may be less overwhelming....

 

The "cat friendly" designation isn't restricted to a cat only practice. It's also no guarantee that the vets will listen to you. It implies that they separate out the cats from dogs in the practice, they at least has a concept about feline behavior, someone in the practice is a member of the AAFP professional group, and they are paying to have the designation. It's a starting place. I'm sure there are wonderful vets who don't want to jump through the hoops for the designation.

No self-recriminations allowed! We've all climbed out on that ledge and felt miserable in the process of trying to manage our cat's diabetes. none of us dance this dance without tripping over our own feet at some point. You're doing your best and doing the best your can for your cat. That's what matters.

This is a community where it's all about the cat. However, it doesn't mean that we don't support the caregiver. People are incredibly supportive of each other when there are difficulties in their personal lives. It's what makes this such an incredible place.

 

I have two vets that work with me just fine, one LOVES me fostering the diabetics. And we have a huge hospital soon to be opening (along with the 3 already here) so medical field jobs are plentiful in our area. Do you like winter with 40 below windchills?


Megan - there is no reason a vet should be against home testing. I don't get it. Its not logical and no one should have to argue about that with their vet! With Smokey, before we started to home test and the vets didn't want to test often enough or the dose seemed off all we had to do is say "I'm not comfortable with that" and our vet worked with us. When she recommended a food for any of the cats, I'd ask for the carb content and if she looked it up and found it to be high, I'd say "I'm not comfortable with that in the house with Smokey" and that was the end of the conversation on that food. Respect needs to go both ways. We need to respect our vet's knowledge, but our vets need to respect our level of comfort, financial ability, and need to feel like we are not doing harm to our pets. Your answer to the vet on home testing should simply need to be "I'm not comfortable giving insulin without monitoring his BG. there is no harm in this and gives me more information to feel comfortable in his care. " If a vet argues with that, they aren't worth spit.

 

Megan, maybe you could just focus on something you have total control over: Oren. He looks to you and only you for his needs. If it were me, I would try not to worry so much about the high dosage of insulin and I would focus on getting his numbers down. Once his numbers were down (and they're already coming back down), I would find a vet and take him and say he's regulated, please give him a dental and some blood work and while you're there, please run this specific test just to give me peace of mind. I probably wouldn't tell them all the what fors and whys, just that it's time for a cleaning and you'd like to see a current blood panel. Follow the advice from others and don't share everything until you have a relationship and they see your level of care for Oren. The food Oren is on, use Dr. Lisa's site and compare it to the less expensive stuff. If the carb count is low and you're not seeing any issues in his BG from it, he likes it and you don't mind the cost, then go with that.

Please don't worry about losing it or being pathetic. My personal mantra that I now chant out loud is: This too shall pass, this too shall pass. I'm happy to share it with you. And don't worry if people think you are crazy. They tend to give you more space and personally, I've come to like that part of it.

Hugs for you and scritches for sweet Oren.

 

(((Megan)))

I have had meltdowns simply out of frustration with Tuxie's numbers not coming into a good range. A few weeks back I had a major meltdown and was ready to "give up"....and that was without any other complications. Considering everything you are dealing with and the sleep deprivation you are doing a wonderful job. This journey we are on with our kitties is a rough road indeed and any of us who choose to be proactive and informed are far stronger than we often give ourselves credit for. With having to be so strong it is totally normal that we have our meltdowns from time to time, but then we pick ourselves back up and continue on...because we love out furkids so much. Hang in there...you are doing a SUPER job

 

If you have a nextdoor neighborhood site available it might be a good place to ask for vet references. Maybe someone in your area has a similar situation. I have found nexdoor to be a great resource for all sorts of things. Also if you have a really good small pet store perhaps they might know. A pet pro store opened in my area recently. The owner was a vet tech. And although she didn't badmouth vets she did have strong recommendations. And just a thought, maybe a vet practice that also has a holistic or naturapathic approach might be more open to you.

 

Everyone here has had their low moments. I think you wrote a good letter....heehee although the devil on my shoulder whispered to me to tell you it was going to cost you $42 because I read every word you wrote!

All I can do is offer you support. Been in your shoes and was able to find a new vet that was a good partner for us. I hope you can too.

 

Haven't sent this yet; comments? edits? after this, I'm probably done here. She'll either boot me or I'll boot her. Just trying not to burn bridges and get a reputation that spreads around town so that I can't find a vet at all!

--------------------------------------------------------------------
Thanks for your response. Unfortunately, I did not receive your reply till late yesterday afternoon. In my email, i had said I wanted to up his dose Fri. night, and when I did not hear back from you, I made the decision to do so, and again Sat a.m. After receiving your email, I felt so confused that i went back to the 4. I know this isn't good to do. And now I'm in a huge funk about all this.The TR protocol has a good track record of success and I had been comfortable in following it along with support from the members of the FDMB forum. I don't feel you can effectively argue against the TR protocol if in fact you are not aware of it.

a few more points of clarification; are you saying you already have charged me for reading the information I supplied? As in, I will be receiving a bill? Or are you saying you won't read it unless I agree to that? I understand your time is valuable, but it took me considerable effort and time to put together the information for you too...This is most disheartening to me, considering I expressed my already shaky financial state.

How long is long enough re: holding the reduced dose? You were specific in making recommendations for when to reduce, as in if a 150 reading showed up. But you made no recommendations other than to check with you first, about an increase. You said something about the first 4 days, and not checking BG frequently if no low numbers turned up, and doing a 12 hr curve 2 wks later. Certainly, no low numbers have showed up in the 4 days since the decrease, or in quite some time. But how long are you saying he needs to 'let his body get used' to the new vial/dose before an increase is warranted? This seems a crucial missing piece of your recommendations?! I increased in the face of not having specifics and knowing that he was going backwards, and following the best, most specific advice I've had to date, which is from the protocol.

Since you expressed part of your strategy is to prevent prolonged hyperglycemia; and PU/PD, I noted that Oren's water intake and urine output had indeed increased from Tue to Fri. am when I wrote you. I had been testing for keytones already (and have been all along), as I was afraid of them developing with the increasing BG numbers (and again, duration of close to a week of them). Thankfully, i have not recorded any as of yet. But the longer he stays high, isn't that a risk that we are trying to avoid? As for his weight, I cannot measure it as exactly as at the clinic, but this morning i got 8.8lbs. which would be ca. 1oz down from the last visit.

Yes, I was aware that too much insulin can cause high BG readings also. I had discussed that concern w/ the FDMB members, in fact that's where I learned of the phenomenon. Since you are unfamiliar with the TR protocol, what they told me is if you are systematically increasing per the protocol, it is highly unlikely to be the case. Hence the suggestion for the IAA and Acro tests. And so, back to the issue of chronic over or under dose. How long is long enough to know? The pancreatitis as a concurrent condition may be another reason, I understand that. The bupe did not seem to make a positive difference either in his numbers, though if that is due to not a long enough course I guess we can't say at this time. The IAA test is only $16 dollars, I don't know how expensive the Acro test is, but if they had both been sent out w/ the last bloodwork, we'd likely have some more answers now. It now seems to make more sense to have those processed w/ the next fPL test, to save yet another draw later.

can you explain why the DM food is the only diet you're aware of for Diabetes AND pancreatitis? I probably can see my way to buy another 1-2 wks. worth. He has transitioned to it fully now. You had mentioned FF being "difficult to digest" , but what makes it so? Is the probiotic (fortiflora) meant to resolve this? I read that it is generally used to resolve diarrhea (which he hasn't had), promote intestinal health and as an appetite stimulant, which he also hasn't needed. He's a hoover. Even pre-diabetes.

as of this morning (Sun). he has finished his bupenephrine. Since he was not really showing any signs of pain before starting, I can't say I've seen much difference in his behavior/demeanor while he was on it except a trend towards a bit more lethargy(probably more from the higher BGs) along w/ some slight pupil dilation.
We are just over 1 wk. into the 2 wk. course of Tresaderm for his ears. He doesn't appear to be scratching at them as much.

I will definitely bring him back for a recheck of the fPL, and feed him the DM until then, but without specific information on your strategy for increases in the dose,I am not comfortable at all in maintaining a dose that keeps him high for this long. Keytones can develop and advance rapidly.
I'm the one in the trenches 24/7 with him, feel comfortable in my use of home testing and monitoring his overall condition.

If you feel this is an inappropriate course of action, I see two alternatives; we agree to disagree on the explicit management of his FD, and you treat him for related issues, like the pancreatitis etc. Or, if it is completely untenable to you, please let me know so I can make arrangements with another vet. I simply can't take much more of the stress that has come from this diagnosis and all the attendant issues. I hold no hard feelings either, it is simply a matter of comfort for both of us, and neither of us should feel we're going against our better judgements.

 

This may become a running joke. Got a question? that's $42 please...

 

Megan, it's a good letter, but I would reduce it to one paragraph. I'd also wait and not send anything just yet.

The iaa test will total more than $16. You'll have to pay for a blood draw and overnight shipping as well. Some vet's tack on fees for "interpreting test results" as well. If you were doing the acro with it, it would probably total about $200. You could ask Marilyn/polly what she had to pay. I think she's the most recent to get tested.

You don't have to have these tests done right now, either. You can wait a bit. I was only pushing for them now so your vet would see proof that Oren needs the higher dose.

I think rather than respond to your vet right now, I'd give it a week and let everyone's emotions cool off. If you answer immediately it can look like you're arguing. I'd also try to take a break. I didn't look at Oren's ss this morning, but assuming he's in no danger of going low, can you get out of the house and do something for yourself? Just get a break from this stress.

Haha I just saw your last post. Sometimes humor is the only way to get through things!

 

@julie & punkin (ga) ; point taken, but i almost feel like i have to ask the question about the 42$ thing at least?! And if i go ahead and keep him at 4u for another week, it almost seems a moot point to send most of this then?! But if I go back up to 6.25 I'll antagonize her further most likely. Rock, meet hardplace all colored black, like my mood...

Indeed I have spent far too much time w/ this over the last few days. I do need a break.

 

I see the rock and the hard place.

Maybe if you don't mention the $42 it won't come up again.

 

until a bill arrives in the mail?! or when i go in to buy more DM food... that will be 20$ for the food and 42$ for daring to ask questions!

 

If she's going to charge you for email advice, do you really want to email her again?

 

Megan,
I just did the Acro and IAA tests last week. The totals were as follows:
Vet time/ blood draw-$ 56.00
Test fees - $68.00 sent directly to Michigan St. University by check with the blood samples
Overnight fees- $35.00
The vet ended up drawing, spinning and packaging the blood/serum for me and I ended up sending it out because the vet did not want to set up an account. So you CAN send the sample in yourself- you would just need to get the blood drawn and spun- as per the requirements of MSU. Just be aware that there is a form that needs to be filled out and sent with the samples. The vet filled out this form for me so "technically" the results belong to the vet. I had 2 people from MSU tell me that on the phone.

If I were to do it again, I would order the "insulated UPS Mailers" from MSU. As this seems like it might be an easier option than trying to find a box that would fit the samples and rushing to the post office to have it overnight shipped. You pay for the shipping when you order the box from MSU so once everything is packaged with an ice pack you can just drop it off at a UPS location.

 

Here is the website with all the info you need.
http://www.animalhealth.msu.edu/

 

On a side note, I noticed this mention of Tresaderm. I looked at your spread and it looks like the last time you saw a green was the day before starting that. I have used Tresaderm on diabetic cats twice, Smokey and Cecil, and it caused a rise in both their numbers. Smokey was still insulin dependent and it was bad enough we stopped the med. Cecil was in remission and the high numbers broke when we went down to once a day instead of twice. It is not something I will use on a diabetic cat unless absolutely necessary.

 

I'm so sorry you're having so many problems with your vet Megan. I'm also not sure I would spend too much more of your time on emailing her and trying to educate her, especially if she's going to bill you for providing her with information and ongoing training!

While it may be asking too much to expect most vets to fully agree with their clients making dosing adjustments etc on their own, it is possible to find a vet who will at least only question or raise mild objections without firing you. I'm only now realizing how lucky I was with our vet - the vet we see most at the practice we're with wasn't really all that happy with what I was doing, but she did at least concede that it was to an extent up to me how I treated my cat. Though that may, with hindsight, have been influenced by the senior vet who also owns the practice as the one time since Rosa's diagnosis that we saw her for something completely unrelated, she seemed to be unconcerned about what I was doing as it was clearly working - I would have to put that down to experience over recent graduation. I did have to agree to keep them in the loop by sending Rosa's ss to them every couple of weeks to stop their constant nagging about fructosamine tests and in-office curves and I was given some fairly in depth questioning by our regular vet at the practice (who refuses to this day to believe that Rosa wasn't symptomatically hypo at readings in the mid-upper 40s) but at no point did they threaten to fire us as customers!! I also did a lot of nodding and smiling (even to the extent of saying "OK" when some things were suggested that I knew I wasn't going to do). I do think it's probably best not to mention the protocol you're following in any detail when you're looking for a new vet unless you can find a practice that specifically mentions it themselves - I did all my dose adjustments very quietly...they were on Rosa's spreadsheet but at no point did I draw attention to them (well, until she passed her OTJ trial - I took a lot of pleasure in emailing them with that information of course )!!

I have to say that as this vet is advocating a dose reduction any time that Oren gets a reading below 150, it sounds as though she is aiming for regulation only and is not really considering remission as a possibility. IMO, 150 is too high a number for a dose reduction - it's below renal threshold but above the normal range for a cat. I'm not sure why she would want you to reduce if he's not even getting into normal range unless her main aim is regulation and management (and not particularly tight regulation either if she doesn't ever want him running in normal numbers).

I think if I was in your position, I'd be looking for a new vet rather than trying to educate one who thinks she's already had all the education she needs!! Maybe one day she'll realize that there's always something new to learn and that graduating doesn't mean she knows it all already, but it's not your job to teach her that especially when she wants you to pay her for helping her learn!

 

oh lovely! He hates getting it anyway, i think I'll drop to 1 drop per ear 1x a day, and lie about that now too. Do you know what ingredients in it affect the BG levels? Jeebus, who would have thought???

 

It has dexamethasone in it, a corticosteroid. I believe that is the problem ingredient.

How much longer do you have to go on it? Cutting down the dose but still using it might leave you with high BGs but reduced benefit. If you are almost done with it might be best to just finish it out at full dose. I haven't read enough to know what you are treating with the Tresaderm, sometimes we need to treat the other things and take our lumps in the diabetes arena for a bit. Just wanted to give you a heads up that you have something there that might be throwing you into higher numbers.

 

ack, i have 5 more days!! After you mentioned I started googling and found out about the steroid. Another reason his thirst may have increased. she prescribed it for 2 wks? His ears were dirty/itchy, she did an ear cytology. No mites but bacterial infection. the pres. says 1-2 drops/ear 12 hrs apart. I have been doing 2 drops, perhaps 1 is enough? She also gave me a wash to use 1x week, T8 keto flush. I have used it 2x now. I do note on petmeds site it says Tresaderm dose is 5-15 drops, so perhaps vet was aware of potential and cut it. Still would have been nice for her to mention it might elevate BG??

 

Just a comment..the vet is basically a general practioner...she has a bit of knowledge about a lot of disorders, but does not have a specialty. Here in Canada, if a person sees their GP doctor and has any kind of serious condition they are usually referred to a specialist who actually knows about that specific condition. I would certainly not expect my GP to have all the answers if I was diagnosed with diabetes and she would be the first to agree. Ity is too bad that vets, especially newer vets, can't admit that they do not have in depth information about various pet diseases. You need a vet for unusual happenings or problems but you can probably work your way through a lot of the treatment program with the help of the longer term people on this forum. Fighting with the vet will end up being an exercise in frustration especially if she is still "green" enough to have a "god complex"

 

Unless you're lucky enough to have a super cat specialist in town, I think the best you can ever hope for is a vet that's not a fool in the classic sense. By that I mean a vet who knows his/her limitations, refers appropriately, and understands even a semi-intelligent caregiver armed with an online community of 10K+ individuals, many of whom have been dealing with this tiny little problem in a specific animal species for many years, with online access to the best research, and available 24/7 just MIGHT maybe be capable of a better result than she can in a 9-5 office treating every animal and problem under the sun. I think that proposition is a real "no brainer". Maybe that's just me. But the beginning of common sense is knowing your limitations. Ask a medical diagnostic system how to fix a bicycle tire and the results might be interesting.

Common sense ain't so common. I'd trust implicitly a doctor with a little knowledge and a lot of common sense. It's a far better situation than the reverse. Replicating it in a computer is one of the great unsolved problems of computer science. Long ago, a young student was showing off an early version of a medical expert system to Marvin Minsky at the MIT AI Lab. Minsky, the wise guy, typed in "sick". The program asked him if he'd been having problems with his teeth as the result of a hyperactive spelling corrector that corrected "sick" to "sig" as in flexible sigmoidoscopy and had gotten to his teeth through a complex sequence.

Yes, I know this is far afield and please excuse me for this diarrhea of the brain and flashback to my days as an engineer at Schlumberger-Doll Research in Ridgefield before I stood on the wrong line and went to med. school. I frequently get a little hypomanic as I plunge into the depths.

 

In case you decide to go vet hunting, Megan
Google Search results for "veterinarian near Richmond, VA". If you do the search using your address, you'll get a better feel for the locations. Many of them appear to have some reviews.
There are some Vet Interview Topics in my signature link.

 

How's that sweet boy? And how are you? If you need some duct tape to tape your head to keep the brains from splattering everywhere when your head explodes from all the information overload, I can send you some.

 

Hi Rose; you are so amazing; thanks so much for finding time in your incredible whirlwind of dealing w/ Ms. Zoey to check in on us!. It sounds like your little fighter is holding her own, and you and DH are as well. I'm so glad!!! Still sending truckloads of vines to all of you!!

Well, it's not going great. I have been toying with whether to post the 2nd follow-up email I received this a.m from vet, as it's still making steam come out of my ears. I know that email is an imperfect medium for communication at times, and I'm trying hard to give the benefit of the doubt but when I get a few paragraphs, separated with "Is that clear?" (yes literally bolded like that) 3 times, I find it hard to not be insulted, offended and angry! She was clear about when she would reduce a dose, but not when she would increase. My 2nd communication to her asked for that clarification, and what exactly was her target BG for this reduced dose, here is the answer:

"The length and detail of the emails that you are sending will be beyond the scope of me to answer regularly, I apologize. I know that I have taken a lot of time with you in the initial visit, our phone conversations to discuss follow up, in person in the lobby and on the phone, and in this email and in my previous email to you, and feel that I have answered all of the questions that you need to provide great care to your cat, bottom line my goal. When I give diabetic cats owners email address I am able to make recommendations based on curves that they supply me, and these interactions are kept brief, unless of course there is a crisis."
The extra charge I was referring to will apply in the following situations:

-When you come in for recheck visits you will be charged.

-If you want me to go through your first email, read all of the attachments about the TR method, answer your very specific questions about food, BG levels etc. I know that I will not soon be adopting this method to care for my other diabetic patients, it is just not widely accepted enough yet. For that reason I would be spending that time in order to answer your questions and to help you and your cat in a way that you require.

-Also, if the follow up communications need to be as lengthy as they have been, I will need to charge you a recheck.

Is this clear?

"I am in the process of consulting with a veterinary nutritionist about Oren, and will contact you regarding the results of that consult shortly. I hope to be able to provide you with an answer about short term and long term diet that are satisfactory to you.
I can’t describe to you how I interpret my curves, there is no algorithm (no high, no low…this is one of my problems with skimming the protocol that you are using). In general I like my cat curves on lantus to range between 100-300 per day. But more importantly , it has to do with how the curve looks. I would not like you to increase the dose of insulin on your own EVER without speaking with me (email or person).

To review, here is what I am recommending to you for follow up:

Change in dose: check bg 4 days after, most useful is 6-8 hours injection (not preshot)

Get ketones in urine call office

Get negative glucose in urine email me or call me

Get a BG reading under 150, decrease all subsequent doses by 0.5 unit until we can talk

Emergency: go to the clinic

Is this clear? Hopefully this makes your life easier and less stressful, and I do believe it is what he needs.

I don’t think we need to refill the buprinex. I would finish the fortiflora and ear meds (2 weeks). Systemic absorption through the skin of steroids is limited but ultimately the effect is unkown.

she basically offered for me to bring him back for the recheck of his ears and blood just for the fPL test, and would not charge me the 'recheck' fee for that.

"The 22nd is not too soon. We can make that visit a technician appointment, if all we do is weigh him, take an ear sample and a blood sample. That means we would not do a PE at that time, but I will still call you with advise/communicate results. I can make that exception for you if you think that the above outlined plan will work for us in the future."

Is this clear?
I am encouraged by the last reading on Sunday night preshot of 299! I can’t wait to see the curve. Hope we can continue to work together to help him through this...
Dr. XXXXX

I'm beginning to wonder if I should ask if there is a word count or perhaps if she has to scroll down beyond the visible screen, is that the criteria for 'length and detail" that she will respond to. For the record, my 3 questions were when she felt we'd determined his body had had time to adjust to the dose, and when to increase, what makes FF food "hard to digest" (apparently she can't answer that w/o consulting a veterinary nutrionist, hm, I thought she was fully trained and up on all the latest?) and could the steroid in the Tresaderm ear drops be affecting his BG levels?
The rest of my email was providing info. on his weight, assessment of him after completing the course of Bupe, his ears at the halfway mark of treatment, noting that i was checking ketones regularly already, and that I would agree to continue the DM diet through until the followup. Ok, 4 questions, if you count asking for clarification on was I getting charged for providing the previous info?!

It's clear to me i cannot work with her, I think I will take him in on a day when she is not in for this follow up, then not return. My struggle is to know whether I should respond again. I should to take the high road and not cause a scene, but I feel her manner was most unpleasant and unprofessional and I am smarting at being treated like a pesty 4 year old. I think it is extremely poor form to essentially tell your client to STFU and just send me a BG curve every 2 wks. How dare you pay me and expect to be able to ask questions about your cat's treatment? and anyway, she's already sufficiently answered all my questions
She, a practicing professional of 6 years after all, should not be questioned. Apparently, her opinion of 'doing the best for him' is to keep him at numbers that will still cause him long term damage, and be reactionary if something goes south.

I no doubt am persona non grata around that office now(or will be soon) and it will likely be extremely uncomfortable to even go back in. I'd appreciate honest opinions, Am I really such a PITA, unreasonable person?

I wish I had your sense of humor, resilience and patience Rose; feeling a bit shaken in my self-confidence right now.

I promise to shut up about this now, before you all consider me a whiny, pesty 4 year old too..

 

NOPE NOT AT ALL!
You are doing what is best for Oren. You have every right in the world to ask your vet questions and keep asking until all questions are addressed and you get the information in a way that you understand.
At this point I guess you can agree to disagree and start looking for another vet. If you feel that you need a follow up, I would do like you said and go when she is off that day.

Please don't feel the need to stop posting about this. I needed support last night and I'm sure that I will need more. That is what we are all here for- to support each other!

 

Thanks Andrea. It's all so exhausting, no?
It's those "IS THIS CLEAR" statements that are digging me.. perhaps I'm misinterpreting, but I find that very condescending and rude???

 

No you're not! You're asking the questions you need answers to so that you can do the best thing for Oren. It's been a long time since I've read such a rude and condescending email from anyone - I completely agree with you on that. I don't see how she can claim that she can maintain a valid vet-client relationship with you if that's the way she's going to speak to you, by email or otherwise. I'd be calling new vets right about now rather than replying to her - frustrating though it is to have her refuse to listen to you, I really don't think she's worth the time and effort of you even attempting to reply.

 

That email would make me furious. The attitude is condescending. Her goals are probably fine for a person who isn't hometesting and doesn't want to be involved. But you are an involved cat parent and you want to understand the reasons behind everything. A secure professional likes dealing with someone like that. She strikes me as young and insecure and like she has to be the Person In Charge.

I can't believe she is excited at a 299 preshot. She can't see a high dose cat because she doesn't have any experience in spotting it. I don't think you're ever going to be satisfied with not being able to respond to his high numbers by increasing his dose. Trying to figure out how to deal with her is like repeatedly picking at a scab - it's just prolonging your anguish and dissatisfaction.

I just think you need a new vet. There's gotta be someone out there who would see you more as an involved partner.

 

yeah. my assessment is she is completely coming across as in insecure relatively inexperienced person who is threatened by someone who does present info. she might not know about. Pretty lame. Also, she had the gall to talk about importance of a trust relationship?? Apparently, it's a one way, I trust her completely and don't question her vast knowledge, and she trusts me to STFU. Nice client/dr. trust building there sweetie.

All that being said, I don't want to let her get away scot free w/ being that rude and condescending. I don't deserve to be spoken to that way, and I feel it's important I let her know that, in a polite, non-condescending manner, as I leave her practice behind.

and all THAT being said; his preshot number tonight; 201?!! oh man...

 

well that IS much better than a 299. See what happens.

 

You have to do what is right for you, but personally, I'd walk away without another word. She's not going to get it, and you only have so much time and energy. It seems like it wouldn't be hard to find a better vet. The bar is set pretty low.

 

I agree, the bar is set pretty low...
I wouldn't go back at all, she'll get the message. ( maybe if you make it to remission, send her a card celebrating how you did it Your Way.....)

and with her condescension....
I be posting negative reviews all over the internet.....
yelp... and such....
couldn't work with dictator approach.... and not open to suggestions.... come to mind....

 

The secret to being resilient is making a conscious decision, each and every day, to face what lies ahead and find the humor even when you want to scream and cry. That's it. You choose to not let something get the better of you. You choose to let go of things you can't control and move on, giving your best because at the end of the day, that's what helps you sleep. And then you find your inner sarcasm and figure out how to laugh or joke about it. Laughter, even sarcastically, heals the hurts/frustrations and eases the tensions.

Oren is your boy and you want what's best for him. I feel you put that out there to this vet and she just doesn't get it. If it were me, I'd move on and not waste any more of my time. I'd let her have the last word. (for a while) If I wanted that test done I'd do just like you said and go when she's not there, get the results and then move on. And that letter? I'd probably post it on Yelp for all to see how it is she treats her clients. The letter speaks for itself. Those who do not find it offensive will not find her offensive. You've not slandered or libeled her ...it's her own lesson to be learned at her own hand. Then, after securing a new vet, I'd send a break up letter that simply said: You are not the caliber of vet we feel we need to best handle our case so we are terminating our relationship. IS THIS CLEAR.

Thumb your nose at her (and use your middle finger if it makes you feel better) and start the search for someone new. (IMHO... LOL)

Let us know if you want us all to send our LB waste to her. She's a really crappy vet.

 

Oh, no... this is the perfect break up letter: We've found another vet and we wanted you to know: It's not us, it is definitely YOU. IS THIS CLEAR?

 

Rose, I love you!!! maybe I should start a contest now; send me your suggestions for a breakup letter, incorporating IS THIS CLEAR... this could get fun... I'm feeling better already. How is sweet Zoey tonight?

 

My first reaction would be to tear a strip up one side of her and down the other. Her e-mail and attitude is beyond ignorant.

HOWEVER...I don't know what it is like where you live, but many vet clinics keep in touch with each other. As tempting as it would be to let her know that her 6 years as a vet means basically squat when it comes to diabetic cats and her inter-personal skills are non-existent, I would be concerned about you getting labelled as a "rebel pet-parent" "trouble-maker" "non-compliant client" etc.

My suggestion would be to find another vet who is open-minded and you can work with, establish a good relationship and later down the line, let her know that you are doing quite well with a knowledgable vet. Just like dealing with diabetic kitties sometimes patience is good when it comes to payback.

Good luck with finding a real vet!

 

Hi, I would move on and look for another vet. There is enough stress that goes with diabetes and other conditions in itself. I don't feel all the effort with this vet is worth it. You need a vet that you are comfortable with

I had a vet that didn't want me to up the dose for my cat either since his clinical signs were fine and he consistently mentioned overdosing. ( I was only at 1.5 units) My cat was in the 200-400 range on the alpha track. He felt 200 was just as good as 100 and that I was overstressing about the numbers. He felt two weeks were needed for the cat to settle into the dose. I decided to look for another vet, although I kept this vet until I found a new one. I called other vets and asked to make an appointment. I asked how they felt about home testing for diabetes. I asked them what they thought were good insulin, good control of diabetes, diet, etc. I explained that I could do curves at home and mentioned the e FDMB website.


One vet told me frankly, " your cat will hate you with all those pokes" I moved on quickly. Another vet new a lot about Feline diabetes , but she was definitely not comfortable with me doing curves at home. I found a vet now-- who is more responsive to my needs. Many times she will spend 30 minutes just discussing my cat or new information after check ups. We disagree a bit on food choices, but I make the discussion and she is supportive. I feel confident when I need to raise the dose and I give her my curves periodically during check up times. However, I feel this vet is very good in many areas and is caring and respectful. She is very informing for dental, heart issues, and other care of an older pet.

 

MaryAnn; I had the exact same thought, my name will be mud if I were to let her have it now. I recognize that I may already have a rep w/in this practice and I will low-key it until I can find someone to trust and work with well. And then, tell her to take her condescending attitude and shove it up her 6 yrs of experience...
I kind of like the idea of telling her to keep an eye out on YELP or other social media for my review (but never actually do it, just so she sweats it).

 

love the Is that Clear? Lololololololololol

 

Maybe you could just pick any clinic and get the CBC done even if you never go back there again. That would give you more time to look for a better vet. Thankfully we have found a vet who is open to the Roomp/Rand protocol and whenever I have a question I email her and she gives me her opinion and then says just follow the protocol so we are very happy to have found her and she often doesn't even charge a fee when we go in for a chat. But I had a similar experience with an internal medicine specialist who refused to do the best treatment protocol for lymphoma and I had this same tension as you and Megan are having with vets who won't listen so after some conflict we found the most wonderful oncologists who were not only skilled but so respectful and so willing to listen to my opinion. They were a blessing and so along with our current general practice vet we have been very blessed with our vets. The internal medicine vet was excellent but not for us at that time. I hope you and Megan find a vet who is suitable for your needs. Dealing with illness is hard enough without having to battle your health care professional every step of the way. I would follow the protocol as it is written and that way you have no doubt you are doing the right thing for your cats regardless of what other vets say. Dr. Rand is an expert in this field and following the protocol you are following what she would recommend. All the best to you and Megan in finding the right vets and if you don't just follow the protocol and use the vets you have for other issues.

 

I had a bad experience with another vet and although it has been 5 months since I changed I am still biding my time. I never contacted them that I was not coming back...I had all the test results already and I never heard from them either. The clinic she works on has a FB page and ONE day I will be posting my review. Sometimes I just drool in anticipation.

 

i'm a bit curious as to whether she's shared anything w/ the other vets in this practice, and if so, how they feel she's handling it? I had seen one other woman before her, who was not super thrilled by the TR thing, but was so very much more skilled at being supportive. "You're doing a great job with him", shaved the little patches on his side to help reduce fur shots, showed me her technique for it etc., even offered to give me an old alpha track she thought she had (she too was a little skeptical of the human meter thing). I can respect differences of opinion, but not the way in which you treat someone. She has been there 12 years, and obviously has WAY more people skills than Doc ISTHATCLEAR. Problem is, I can't very likely continue w/ her now either...

Maybe I should make a hashtag #ISTHATCLEAR for twitter?! (I don't tweet)...

 

At this point you need to find a vet you can work with and plan your revenge for later. Dealing with a sweet kitty is draining enough..save your energy for the sugar dance and wait for your "revenge". I am sure that no matter what you said to this vet she would be offended. I still remember a people doctor years ago who gave me a prescription for an Rx for headaches. It made me so, so dizzy. I called her office and spoke to her...she said "that medication won't do that". I said "well I looked it up in the CPS (medication bible..I was working at a drugstore warehouse at that time) and she got all in a huff and said "do what you want". How professional was that???? Vets are the same and since this one is still a newbie in the amount of time she has been practising, you are challenging her "vet status" and being a threat to her "I am god" image.

When I interviewed my current vet I only wanted to know if she approved of home testing, would communicate directly with me and was open to me being an active participant in Tuxie's treatment. The rest has evolved from there. I have never told her I am following any protocol, simply that look at the spreadsheet and if you see any other approach let me know. So far she is letting me call the shots on how I deal with it. She has come to understand that I am not going all over the place like a yoyo and that I have a decent grasp of feline diabetes and its treatment.

 

I'd vent here with us, and then take the high road in real life. Your revenge can be getting the best possible care for Oren.

She may be an awesome vet in other ways, just a little over-controlling for this situation. You never know what's going on in her own life that could have contributed to her "IS THAT CLEAR?"

 

@julie & punkin (ga) , true I don't know what's going on in her life, and everyone can have a bad day... however, I DO KNOW what's going on in my life, a whole hell of a lot right now, and I kept my interactions with her on the up and up and not rude or condescending. I asked for help and information, from a professional that I'm paying, and didn't treat her in an unprofessional way. That's all I'm saying. I don't think her attitude was warranted, and I won't kiss her ***. I have and will stay on the high road. I should be able to expect the same from a professional.

 

I agree....vent here, high road with her.....until you get Oren regulated into beautiful numbers between 50 -120 or off insulin all together....at which point I would send her another email, including the "protocols that are not largely tested" that she will not be adopting anytime soon, and perhaps the spreadsheets of the, I believe 300 and some cats, this protocol has worked for on this site alone. I would also remind her that this is ONE SITE and there are MANY MANY others who follow this outside of that.

I would conclude that due to the length of the email you are sending and the research steps you have included, a fee of $300 may be made payable by her to you, along with a note of apology.....

 

I'm not saying she was ok to do that, just saying that sometimes walking away is a good option.

 

Ugh!!!!! That vet is just wretched. How ignorant to want payment to read about a protocol that she should be reading about regardless, for her own professional insight. It's her job! And it's fascinating material! What a tool.

I would be tempted to rip her a new one, but I agree that it's better to just focus your energy on finding a new vet. People like that don't listen and always need to have the last word. I encountered one vet who got uppity with me for asking questions. I said something like "I'm sorry, is my concern for my cat an inconvenience to you?" She just got more assertive and told me that I should do exactly what she said, not question it, and if there was anything else I needed to know, she'd tell me. I did not go back to that practice.

I think if you can find a vet in your area who is on board with TR and understands high dose cats, that's awesome. If not, the next best thing is a vet who is openminded and understands that he/she doesn't know everything. Billie is on vet #4 now but he is great like that. He is super patient with my questions. When he doesn't know the answer or there isn't a clear cut answer, he'll say so, and I really appreciate that honesty. Billie has asthma and uses an inhaler now, but when she first started having attacks, I went through two vets who refused to put her on a steroid because they had it in their heads that diabetic cats can't take steroids under any circumstances. Meanwhile, she was having trouble breathing. We switched to our current vet and he put her on pred right away and got her coughing under control. I guess what I'm getting at is there are a lot of sub par vets out there, and it's worth shopping around until you find one who has his/her head on straight.

Good luck...sorry you had to deal with such a jerk!!!

 

as galling as it is Megan, I would vote with your feet and walk away, too much wasted energy on such a nonentity. Your revenge will be to get Oren OJC (just my humble opinion) . Get a new vet, one that respects your concerns and who will support you. Good luck.

 

Megan

I also thought your email to her was extremely well written. While maybe she's a good vet in other ways, I couldn't work with a vet that did not see me as an equal partner and my cat's true advocate. A veterinary practice is not a dictatorship and regardless of whether she was having a bad day or not, it is unprofessional to write to you in such s condescending manner.

I'd walk. And while I absolutely LOVE Rose's idea....I'd probably not say anything. If I got w bill in the mail for the email time, I'd send it back with the charges for your time.

 

I agree with Suki. If I don't like a shop or a business etc I always vote with my feet. I have done it several times; most often with hairdressers who get half way through your hair then make you wait while they finish off someone else. I never give them a second chance.

Good luck finding a good vet. There are many very good vets out there who are mature enough to listen to their clients and learn.
You are doing a great job being Oren's advocate and carer.

 

oh, and just to be clear; earlier in this thread i posted a first draft of the letter that got me the "IS THIS CLEAR" response. Let it be for the record, that the version i sent was actually edited down. I deleted the last paragraph entirely, took out any specific references to the TR protocol, and simply stated I'd agree to feed him the DM food for the short term of dealing w/ the pancreatitis and would bring him back for the fPL recheck, and deleted the comments about IAA and Acro tests and being uncomfortable with holding a dose causing such high numbers. Just stated that I was aware of overdose causing elevated BGs. In short, I neutered my comments to NOT be inflammatory. And still i got flamed.

Ok, I'm done. Just wanted to get that out there.

 

Just as an afterthought, I frequently send my vet articles, etc. she's always thrilled and has never billed me for it. She has even said "I learn so much from you". Well, I've learned a lot from her, too. Partnership. A vet should always strive to further educate themselves.

And on second thought, I might also consider writing a very, very polite response and telling her you appreciate her time but that you are leaving because you must have a vet who is willing to be open to learning and considering other options. If she responds, just thank her. Move on.