I fired my vet today.

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Jen & Abby

Jen & Abby

Member Since 2015
Today was Abby's three-week checkup, where her fructosamines were to be tested. I had been a diligent bg tester since Dx, and was pretty proud of the spreadsheet I'd created to keep track of her numbers and any other notes.

I was told to give two units of Lantus twice a day, but as I was testing her, sometimes she would go low, and I didn't want to dose and then have to leave for work. Consequently I've been adjusting the dose as her bg varies.

The vet told me today that my spreadsheet "means nothing", that fructosamines are the indicator of how well a cat is doing. When I asked her what glucose range I should be targeting, she says "250-385 is normal for kitties". I just stared at her without a word.

Then she berates me for testing Abby's bg, because she said it would make the fructosamine test inaccurate because I'm adjusting her dosage. She asked me, "Well, if you hadn't been testing her bg, how do you think she would be doing?"

I replied, "Without testing, my cat would have been dead four days ago when she had a 37 bg, because I would have just blindly shot her up with 2 units because that's what I was told to do."

The vet had nothing to say to that, but she knows I'm disgruntled. I'm also upset. She discounted all the effort I put in for my cat's well-being.

As a diabetic myself, why on earth would I dose myself without testing first to see how much I need? I certainly wouldn't do that to Abby. I'm NOT going back to that vet, that's for sure.

I'm alternating between being very angry and very sad, because if I hadn't been testing her, I could have killed her with too much insulin! (I learned that Abby is asymptomatic during hypoglycemia, making things a bit more complicated!)

I'm curious as to how others have dealt with vets who expect you to be a bit hands-off in treating feline diabetes.
 
Julia Rae said:
You go momma bean... YOU did the right thing! my vet was the same way but on the plus side for me.. he came around to my view of thing I am sorry yours did not!
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I cannot understand why she wouldn't want me to test her. Boggles my mind. She was more "tsk-tsk" at me because I didn't follow her directions. *sigh*
 
Jen & Abby said:
... she says "250-385 is normal for kitties".
Click to expand...

Absolute balderdash. It's not the normal range for a healthy cat. It's not even normal for a regulated diabetic. The aim of insulin treatment is at bare minimum to keep the cat below 250 (the nominal renal threshold) for as much time as possible each day. The levels she's quoting you as being acceptable are ones where organ damage can occur. If that's normal for the kitties who are her patients then she is failing them.

Jen & Abby said:
The vet told me today that my spreadsheet "means nothing", that fructosamines are the indicator of how well a cat is doing. ...Then she berates me for testing Abby's bg, because she said it would make the fructosamine test inaccurate because I'm adjusting her dosage.
Click to expand...

My interpolation of the above would be:

The vet told me today that my spreadsheet means nothing [to her], that fructosamines are the indicator [she is most familiar with] ... Then she berates me for testing Abby's bg, because [she can't use the fructosamine level and dose she picked to look up some text book containing some cookie cutter formula to help her work out what to do next because she knows frell all about feline diabetes.]
Click to expand...

A cat's body is a dynamic system, not a recipe.

Jen & Abby said:
I cannot understand why she wouldn't want me to test her. Boggles my mind. She was more "tsk-tsk" at me because I didn't follow her directions. *sigh*
Click to expand...

People in positions of authority don't tend to appreciate challenges from the laity - especially those who are not actual authorities on their subject; they don't appreciate being rumbled, IMO. (Does anyone? ;) ) As you develop a better understanding of feline diabetes and your cat's patterns in response to insulin you may well be throwing the gaps in her knowledge into sharper relief. No-one likes that much. Dissing challenges to one's authority is a very human response, but not an acceptable one when the welfare of a living being is in the balance.

Jen & Abby said:
I'm curious as to how others have dealt with vets who expect you to be a bit hands-off in treating feline diabetes.
Click to expand...

If the vet is good in all respects other than the diabetes side of things, I think most people here tend to do the smile-and-nod routine, agree to disagree with the vets and go do what's right for their cats. In fairness to the veterinary profession they do have to take into account their professional liability to their patients and it can take work to build a successful partnership with one's vet. They need to ensure that what they prescribe will not harm a patient and also to develop a level of trust in the caregiver's choices and ability to administer treatments successfully. When a trusting relationship is established, it does get easier (especially when there is a lot of data presented to support a caregiver's case when seeking different treatment options).

If the vet won't acknowledge gaps in their knowledge and agree to work in partnership with the caregiver to meet the needs of the kitty or if they have an attitude problem / god complex then I'd guess the majority of people would perhaps switch to another vet in the same practice, or go shopping for a new vetty bean.

EDITED TO ADD:

Take heart. Many of us here have been through exactly the same experience as you are going through with your vet (myself included - I changed practices shortly after Saoirse's FD Dx). You are testing because you know it's the best way to keep Abby safe. You have already saved her life through making that choice. How can it not be the right thing to do? :) Vets are just as human as the rest of us. None of us knows everything.

I have to say how lovely a cat Abby is. She has an exceptionally beautiful face. :)




Mogs
.
 
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I wanted to keep dosing as a separate issue.

Jen & Abby said:
I was told to give two units of Lantus twice a day, but as I was testing her, sometimes she would go low, and I didn't want to dose and then have to leave for work. Consequently I've been adjusting the dose as her bg varies.
Click to expand...

The above caught my eye. Dose adjustments tend to be a bit trickier with depot insulins. Are you following a particular protocol (Tight Regulation / Start Low, Go Slow?) and how often are you adjusting the dose.
I learned that Abby is asymptomatic during hypoglycemia ...
Click to expand...

From what I've read since joining this forum last year, my understanding is that it is not an uncommon thing for cats on Lantus to experience asymptomatic hypos. Definitely a smart move to be extra-cautious.
 
I did the same thing a few months ago and interviewed 4 vets until I found one that was on the same page as me. I have been so happy with Rudy's new vet. She loves my spreadsheet and checks on him weekly. She'll send me emails when she sees something on the sheet that may require a dose change. She doesn't have him in just for a fructosamine test because she knows my frequent testing is way better than that. Great job on doing what is best for your kitty :-)
 
Good for you ! Apparently you vet has no desire to educate herself on helping these kitties. You have to be your pets advocate and make the final decision on what they need.
:bighug:
 
I can't reply to anything regarding the insulin as Goof was on ProZinc, now in remission, but you're right to fire your vet! She has a lot to learn regarding feline diabetes. My vet isn't at all afraid to hear what I have to say and has told me that I've done a really good job with Goof. He sees the value of the spreadsheet, although mine is just a log book these days as I'm only testing Goof twice a week now.
 
Sometimes it does take a while for a trusting relationship to be built with any vet. They have to trust you know enough to keep the cat safe, and you have to trust that they know proper treatments. That can take a little time.

However, some people do the "smile and nod" approach and don't always tell the vet everything that they are doing in the care of the cat. Sometimes, if there aren't many vets in the area, this is necessary. The problem tho with diabetes, is that when complications occur or if a cat becomes critical, it's much better to have a vet that is very experienced with treating these complications. You don't want an inexperienced vet at these times, and the "smile and nod" could be dangerous. You are probably right to find a more educated vet now, and not when something critical is happening.
 
As for the fructosamine test, it's like the A1C for people. It gives a snapshot of the average blood glucose for the past few weeks. It can be an important part of seeing how you are doing. (my DH takes his BG daily, but still gets the A1C every 6 month.) But it is not a replacement for regular BG tests. Pre shot tests tell you if it is safe to give insulin. Mid-cycle tests show you how low the BG goes. The pattern or curve of all these tests tell you how the insulin is doing on a daily basis and if the dose is correct.

Critter Mom said:
Vets are just as human as the rest of us. None of us knows everything.
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That is exactly what my vet said to me when I brought her info from this very message board! It is why I stayed with her even though she wasn't as knowledgable about feline diabetes as I would have wanted. (How could she be? She takes care of cats, dogs, horses, goats, sheep, and pigs!) She was open to my info, and though she might not have liked it when I said I disagreed with her, she worked WITH me. Thank you Vet Vicki!
 
Very good points there, @Meya14.

I'd like to clarify a point from my earlier post. When I was talking about the "smile and nod" approach, I should have qualified that remark to say that the "smile and nod" approach should be limited to situations where one agrees to disagree with one's vet about home testing frequency. Any dosing protocols used should be evidence-based and only followed under the supervision of a competent veterinary professional.

Thank you for picking up on my unqualified comment, Meya. :)
 
I am a major skeptic of the value of fructosamine testing. My girl's fructosamine came back indicating she was in the Good control range when her daily BG readings were obviously still way too high, she was still peeing like it was an olympic sport and drinking the well dry. Fructosamine testing is a measure of fructosamine protein in the blood not a measure of the concentration of insulin in the system so how could it be negatively affected by dose changes? Either the cat is well regulated or it's not.

Any vet who relies on one test without paying attention to the Whole picture should be fired! Your vet is obviously is NOT well versed in dealing with diabetic cats.

Your comment to the vet that your cat would have been dead had you followed her advice along with your detailed data proving your statement was the vet's opportunity to drop the hubristic attitude but it doesn't seem she was willing or even has the ability to admit her shortcomings! Not someone I would want to be depending on in an emergency situation!
 
Critter Mom said:
I'd like to clarify a point from my earlier post. When I was talking about the "smile and nod" approach, I should have qualified that remark to say that the "smile and nod" approach should be limited to situations where one agrees to disagree with one's vet about home testing frequency. Any dosing protocols used should be evidence-based and only followed under the supervision of a competent veterinary professional.
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I wasn't really commenting on your comment specifically, but rather a more general issue that many of us face with our vets and the lack of experience they have in treating diabetics. I've seen people here with a wide range of WTF vet moments ranging from advice "to PTS because diabetes can't be fixed", to wacky info relating to blood sugar control, to poor management of complications, to not identifying complications early enough to treat, to just being not so nice people. There will always be times when there aren't agreements and like you said, trust in their competence and good communication is the key to dealing with that. Sometimes you -do- have to agree to disagree, as long as that trust is there and communication is open, it should be ok.

It is worth finding a vet that treats many diabetics though, and that has a good success rate with the diabetics. Questions like, "How long does your average diabetic patient live after diagnosis?", "How often do your diabetic patients go into remission?", "Can you tell me about the major complications I should watch for and how do you treat those?" Will give a pretty good idea how familiar they are with the topic. The experience level can range from they've only really talked about diabetes in vet school 10 years ago to they treat almost all the diabetics in the town because they are the specialists in the area. I'm lucky that my vet is the default diabetes vet in this area. Many around here turn to her because of trouble with their original vet.
 
Meya14 said:
"Can you tell me about the major complications I should watch for and how do you treat those?"
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Excellent question. And one which 'vet shoppers' should be waiting to hear mention of DKA in the answer. The focus seems to be on hypoglycaemia and infection. Ketones were barely mentioned to me when Saoirse was diagnosed; certainly no mention was made of DKA.
 
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Meya14 said:
Add away. The vet interview topics is a nice thing to have for people.
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Couldn't agree more! I used this list when I went back to my vet after the initial consult and it helped a lot.

I'm lucky my vet is like @Maggies Mom Debby 's vet - not an expert and doesn't profess to be. He was happy to go with what he knew (Caninsulin) BUT was very happy with my involvement in managing Genghis' diabetes and encouraged me. When he saw my spreadsheet, he said, "I wish all my patients' parents would invest in their cat's recovery like this" and "Well, looks like you did my job for me!" - and said with genuine delight. I knew then that he put my girl's health first and really just wanted her to get better.

@Jen & Abby, I can't imagine your frustration at being "tsk-tsk"-ed especially when you are a diabetic yourself. Type II runs in my family and I have never, ever (and may I say again NEVER EVER) seen any family member inject insulin without knowing their blood sugar reading first. Shooting blind is just … ludicrous to me!

So many good points made here. No, the board is not made up of vets. But there is a vast wealth of experience here should a vet or anyone want to take advantage of it.
 
Brashworks said:
Couldn't agree more! I used this list when I went back to my vet after the initial consult and it helped a lot.

I'm lucky my vet is like @Maggies Mom Debby 's vet - not an expert and doesn't profess to be. He was happy to go with what he knew (Caninsulin) BUT was very happy with my involvement in managing Genghis' diabetes and encouraged me. When he saw my spreadsheet, he said, "I wish all my patients' parents would invest in their cat's recovery like this" and "Well, looks like you did my job for me!" - and said with genuine delight. I knew then that he put my girl's health first and really just wanted her to get better.

@Jen & Abby, I can't imagine your frustration at being "tsk-tsk"-ed especially when you are a diabetic yourself. Type II runs in my family and I have never, ever (and may I say again NEVER EVER) seen any family member inject insulin without knowing their blood sugar reading first. Shooting blind is just … ludicrous to me!

So many good points made here. No, the board is not made up of vets. But there is a vast wealth of experience here should a vet or anyone want to take advantage of it.
Click to expand...
See, I'd hoped that my vet would be glad I was taking control of Abby's health. How fortunate you are to have a caring vet!
 
Critter Mom said:
Absolute balderdash. It's not the normal range for a healthy cat. It's not even normal for a regulated diabetic. The aim of insulin treatment is at bare minimum to keep the cat below 250 (the renal threshold) for as much time as possible each day. The levels she's quoting you as being acceptable are ones where organ damage can occur. If that's normal for the kitties who are her patients then she is failing them.



My interpolation of the above would be:



A cat's body is a dynamic system, not a recipe.



People in positions of authority don't tend to appreciate challenges from the laity - especially those who are not actual authorities on their subject; they don't appreciate being rumbled, IMO. (Does anyone? ;) ) As you develop a better understanding of feline diabetes and your cat's patterns in response to insulin you may well be throwing the gaps in her knowledge into sharper relief. No-one likes that much. Dissing challenges to one's authority is a very human response, but not an acceptable one when the welfare of a living being is in the balance.



If the vet is good in all respects other than the diabetes side of things, I think most people here tend to do the smile-and-nod routine, agree to disagree with the vets and go do what's right for their cats. In fairness to the veterinary profession they do have to take into account their professional liability to their patients and it can take work to build a successful partnership with one's vet. They need to ensure that what they prescribe will not harm a patient and also to develop a level of trust in the caregiver's choices and ability to administer treatments successfully. When a trusting relationship is established, it does get easier (especially when there is a lot of data presented to support a caregiver's case when seeking different treatment options).

If the vet won't acknowledge gaps in their knowledge and agree to work in partnership with the caregiver to meet the needs of the kitty or if they have an attitude problem / god complex then I'd guess the majority of people would perhaps switch to another vet in the same practice, or go shopping for a new vetty bean.

EDITED TO ADD:

Take heart. Many of us here have been through exactly the same experience as you are going through with your vet (myself included - I changed practices shortly after Saoirse's FD Dx). You are testing because you know it's the best way to keep Abby safe. You have already saved her life through making that choice. How can it not be the right thing to do? :) Vets are just as human as the rest of us. None of us knows everything.

I have to say how lovely a cat Abby is. She has an exceptionally beautiful face. :)

Mogs
.
Click to expand...

Aw, thank you for taking the time for such a thorough reply. :)

I hadn't considered the challenge-the-authority position, actually, but it certainly makes sense...I've dealt with physicians with the same type of attitude that I've had to drop. I suppose I just naïvely thought that vets were of a different breed, no pun intended. :)

And thank you for your kind compliments. She was a stray that was pretty skinny and rough when I adopted her 10 years ago. :)
 
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Critter Mom said:
I wanted to keep dosing as a separate issue.



The above caught my eye. Dose adjustments tend to be a bit trickier with depot insulins. Are you following a particular protocol (Tight Regulation / Start Low, Go Slow?) and how often are you adjusting the dose.


From what I've read since joining this forum last year, my understanding is that it is not an uncommon thing for cats on Lantus to experience asymptomatic hypos. Definitely a smart move to be extra-cautious.
Click to expand...

I'm only adjusting the dose when I have to leave for work in the AM. For example, if her bg is 100 after eating, she's not getting a shot. But if she's in the 250 range in the evening, I'd give her 1.5 units.

I suppose Start Low Go Slow is accurate because at the same time, I'm trying to learn how she processes the Lantus and how it translates to her numbers.
 
Brashworks said:
Couldn't agree more! I used this list when I went back to my vet after the initial consult and it helped a lot.

I'm lucky my vet is like @Maggies Mom Debby 's vet - not an expert and doesn't profess to be. He was happy to go with what he knew (Caninsulin) BUT was very happy with my involvement in managing Genghis' diabetes and encouraged me. When he saw my spreadsheet, he said, "I wish all my patients' parents would invest in their cat's recovery like this" and "Well, looks like you did my job for me!" - and said with genuine delight. I knew then that he put my girl's health first and really just wanted her to get better.

@Jen & Abby, I can't imagine your frustration at being "tsk-tsk"-ed especially when you are a diabetic yourself. Type II runs in my family and I have never, ever (and may I say again NEVER EVER) seen any family member inject insulin without knowing their blood sugar reading first. Shooting blind is just … ludicrous to me!

So many good points made here. No, the board is not made up of vets. But there is a vast wealth of experience here should a vet or anyone want to take advantage of it.
Click to expand...
Absolutely agree that this board is incredible. When I was in that shocked fog that I'm sure we all experienced after diagnosis, I started lurking and collecting information.
 
KarenBlasky said:
I did the same thing a few months ago and interviewed 4 vets until I found one that was on the same page as me. I have been so happy with Rudy's new vet. She loves my spreadsheet and checks on him weekly. She'll send me emails when she sees something on the sheet that may require a dose change. She doesn't have him in just for a fructosamine test because she knows my frequent testing is way better than that. Great job on doing what is best for your kitty :)
Click to expand...
That's wonderful! I'm going to start interviewing a few local vets next week!
 
MrWorfMen's Mom said:
Any vet who relies on one test without paying attention to the Whole picture should be fired! Your vet is obviously is NOT well versed in dealing with diabetic cats.

Your comment to the vet that your cat would have been dead had you followed her advice along with your detailed data proving your statement was the vet's opportunity to drop the hubristic attitude but it doesn't seem she was willing or even has the ability to admit her shortcomings! Not someone I would want to be depending on in an emergency situation!
Click to expand...

This.

She didn't even have the grace to look sheepish after I said that. Argh.
 
Jen & Abby said:
I've dealt with physicians with the same type of attitude that I've had to drop. I suppose I just naïvely thought that vets were of a different breed, no pun intended. :)
Click to expand...
Good pun! Having written for a wide variety of professionals over the years (CEOs, attorneys, physicians, etc.) I can confirm that egomania and tunnel-vision often go hand-in-hand. :banghead: Sadly.
 
Jen & Abby said:
The vet told me today that my spreadsheet "means nothing", that fructosamines are the indicator of how well a cat is doing. When I asked her what glucose range I should be targeting, she says "250-385 is normal for kitties".
Click to expand...

Glad you fired your vet. I shudder to think how many other cats could fall victim under her "care" due to her lack of knowledge on feline diabetes.
 
Jen & Abby said:
I'm only adjusting the dose when I have to leave for work in the AM. For example, if her bg is 100 after eating, she's not getting a shot. But if she's in the 250 range in the evening, I'd give her 1.5 units.

I suppose Start Low Go Slow is accurate because at the same time, I'm trying to learn how she processes the Lantus and how it translates to her numbers.
Click to expand...

I have a great interest in dosing techniques that are tailored to the differing needs of the cat and the caregiver. Between Saoirse's numbers and my own health limitations I had to modify my use of the Tight Regulation Protocol to keep her safe (and my last vestiges of sanity intact). Would you consider linking your spreadsheet into your signature? I'd be very interested in seeing how you're managing the work/cat balance! :)
 
Critter Mom said:
Would you consider linking your spreadsheet into your signature? I'd be very interested in seeing how you're managing the work/cat balance! :)
Click to expand...

Sure...if I can figure it out. :D It looks like most folks here have them on Google Drive, so I'll tinker around a bit!
 
1) Get a Google Drive account.
2) From Drive, import the spreadsheet.
3) Click File, Publish to Web; do not use the link provided.
4) File, Share and use this link in your signature.
5) To reference the link, type Spreadsheet, select the word, click on the chain link icon, paste in the link, and click Insert Link
 
I would also like to point out that I visited one vet and we got a fructosamine check on Luna about 3 months ago. We were told she was 'in remission' after being given 1 unit bid for 2 months. The vet told us not to give insulin any more and come back in 3 months to check again to see if everything was ok. Well we went back to a different vet in 3 months and found Luna had been 350+ at the spot check, and was probably never in remission, and had minor liver problems along with high levels of ketones. We went 3 months without giving her any insulin (foolishly) and it was then I realized I needed to take matters into my own hands and start testing at home. But yes the one vet told us with the fructosamine test she was in remission, to stop giving insulin, and come back in 3 months. Pfft! Can't believe I listened, I should have educated myself much sooner then trusting that vet. Now I'm doing the right thing which absolutely involves home testing and adjusting doses.

And in terms of actual human physicians, I had a surgery for acid reflux awhile back in the military, and when I got out I saw 2-3 civilian doctors whom asked what surgery it was, and I explained it to them and told them I had a lot of pain/complications from the surgery, and all 2-3 of them said "well I would refer you to the GI clinic but I guarantee you know more then they do about the surgery... so... sucks to be you.". Great. I should have been a doctor.
 
Good start to it. It would help if you used our template, though, as it shows the day horizontally, plus color codes the numbers for you.
She has earned a reduction to 1.75 units from going TOO LOW. You'll have to eyeball that on the syringe and magnifiers may help.
 
@Jen & Abby ...We have a specific spreadsheet we like to use. It's specially set up for us here and color codes the tests so we can easily see "patterns" that are really important to look for in dosing. It's already set up for us. If you look in my signature, you'll see China's spreadsheet and what it looks like.

Since you live in the US, THIS is the link that will take you to the spreadsheet we use. Go there and choose "Use this template" and a new one will pop up for you to use.

You'll need a Google account, but you don't have to have a Gmail email addy. You just have to sign up for a Google account (if you haven't already)
 
Can we get you started using our grid to record your glucose tests? It will help us give you better feedback. Instructions are here.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.
 
BJM said:
Good start to it. It would help if you used our template, though, as it shows the day horizontally, plus color codes the numbers for you.
She has earned a reduction to 1.75 units from going TOO LOW. You'll have to eyeball that on the syringe and magnifiers may help.
Click to expand...
Thank you - I'll work on getting numbers transferred to the template!
 
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