12/9 Jill AMPS 259

tiffmaxee said:
Let us know what you find out. :bighug:
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They are going to run a bunch of tests and scans today - bloodwork, urinalysis, xrays, ultrasound and a dermatology consult. She says having Jill's BGs below 100 is very dangerous and I have to stop being so aggressive with her insulin treatment - I'm not surprised by that, but she basically said that she's not comfortable working with us if I can't agree to a new treatment plan that she feels is safer. They have someone who specializes in diabetic patients, I think it's this guy: https://www.vet.upenn.edu/people/faculty-clinician-search/MARKRONDEAU - so she is consulting with him, too.

She's concerned that low BGs might be contributing to some other issues. And that I will kill Jill with the low BGs. She said if any of her patients ever came in with BGs 70s or lower she should treat them for hypoglycemia. Sigh. This is the hardest part. I never feel like I can justify TR in a way that vets are ok with. And you know they hate when people do things without consulting with vets, but my regular vet doesn't know much about how to treat diabetics, TR or otherwise. But I am open to a new plan as long as it keeps Jill healthy. Maybe I have to let go of the idea of remission, but she's got other issues, so I'm not sure it's a possibility anyway.

Feeling very emotional. Crying in the library as I wait to hear more....
 
She might be knowledgeable about other issues but not diabetes. That’s unfortunate. What is happening with Jill is not due to diabetes. I am not a vet as you know but I think thee tests will reveal other issues. Her bg is not even low! I could understand her fear if you were seeing bg around 50-75 but you aren’t. Most of the time it’s not been in normal range even.

See the results of the other tests. I think she might have an intestinal disease. :bighug::bighug::bighug::bighug:
 
I hope the tests turn up something. I agree with Elise. Jill is rarely below 100 these days. Have these vet ever tested the blood sugar of non-diabetic cats and seen that they are always below 100???

I am sorry they are giving you such a hard time about treating her diabetes. Do you need to share her spreadsheet or provide them more info about it? Can you just not and say yes and then do what you want? After a few vets told me that it's dangerous for the BG to drop below 150, I stopped bringing it up with them. When they ask, I just fib and say that she BG is between 150 and 300 and they are satisfied.

:bighug::bighug::bighug::bighug::bighug:
 
Bandit's Mom said:
I hope the tests turn up something. I agree with Elise. Jill is rarely below 100 these days. Have these vet ever tested the blood sugar of non-diabetic cats and seen that they are always below 100???

I am sorry they are giving you such a hard time about treating her diabetes. Do you need to share her spreadsheet or provide them more info about it? Can you just not and say yes and then do what you want? After a few vets told me that it's dangerous for the BG to drop below 150, I stopped bringing it up with them. When they ask, I just fib and say that she BG is between 150 and 300 and they are satisfied.

:bighug::bighug::bighug::bighug::bighug:
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I don't know what we are going to do about insulin. The vet called with an update after the dermatologist looked at her and said it's probably cushing's and not to do an ultrasound because they are very afraid of skin tears with any handling of her at all. They were going to sedate her but didn't even want to run an IV line. They gave her an injection instead. She said even home testing on her ears can be dangerous. They used words like "grave condition" and "catastrophic" so I am very worried. They are running this test to see about Cushing's:
She has my spreadsheet now and will probably call the pet police for negligence. Honestly, I think she almost cried when I said we decrease at 50.
 
Yikes. Hopefully the medication will get the Cushings under control if that’s what it is. Any updates?
:bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug:
 
Does that vet realize you use a human meter and not the AT? I’d freak out too if I thought someone was using the AT and reducing below 50.

I hope the tsing gives you a diagnosis. :bighug: Treating Cushings will help the skin condition, are you noticing her tearing easily? I have seen some early stage Cushing kitties where skin tearing is not yet an issue. Even ones with later stage.

If the skin means you have to test less, then more conservative on dosing is the way to go. On the other hand, some kitties do very well on Trisolane and there are cases that have gone into diabetic remission.

Fingers, toes, and paws crossed here.
 
I wouldn’t give too much information to this vet about her BG or how you dose or how you manage her diabetes.

Let us know what the treatment plan is for her. I sure hope she can be better soon. I’m sorry that you two are going through this. Hearing such alarming talk from the vets is really upsetting.
:bighug::bighug::bighug::bighug:
 
Wendy&Neko said:
Does that vet realize you use a human meter and not the AT? I’d freak out too if I thought someone was using the AT and reducing below 50.
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Just wanted to emphasize the above. After OTJ, Tina was usually very close to 100 at the vet - which is always checked with an AT, and mid fifties on the human meter. I am hoping the BG numbers were all a misunderstanding! I really wouldn't fault the vet too quickly.

Kisses on little Jill:kiss:
 
Wendy&Neko said:
Dexamethasone screening test? @Lisa & Oberon went through that last year - turned out negative. But since that test involves injecting steroids, she had some high numbers to deal with for a while. Just so you know you might see that. Keep on testing for ketones.
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True, though in retrospect I'm not sure the high numbers were from the dexa test (on 9/28/20; it's noted on his SS). He was nowhere near a good Lantus dose yet and we were dealing with ketones and other stuff all at the same time, and he was pretty stuck in high numbers already, with occasional random dips. Still, good to be aware of the possibility.
 
Thank you everyone for your thoughts and concern. Jill is back at the vet for the day for a dexamethasone test which they suspect will confirm Cushing's.

Yesterday was really tough for me. I can't count the times I heard "You're going to kill your cat with these numbers." The vet thinks that having numbers under 100 are very dangerous and that Jill hasn't been allowed to have the glucose she needs for normal organ function. She said numbers below 50 cause irreversible brain damage. She also said Jill is anemic, so in addition to not wanting me to poke her ears because of the skin situation, she doesn't want me to poke and draw blood. Her comfort level is BGs in the mid 100s and she said it's fine to fluctuate up even into the 300s. So I promised that we would reassess the insulin treatment. The thing is, it looks like Jill had Cushing's and I need these vets to help us through that - and the only way they will do that is if I am more conservative with her insulin treatment. Honestly, I am ok with it. If I can still feel comfortable knowing that Jill is being kept healthy, I would love to not constantly be worrying about low numbers. So if we can find a way to keep her steady in more conservative - but safe - BGs, I am all for it. The vet said that with all her other complications, remission isn't really a goal for her now, which I get. We are going to talk more later today about an insulin treatment plan, but for now she dropped us down from 4 units to 2 and no poking.

Yesterday she had bloodwork, xrays (which revealed an old pelvic fracture I didn't know about), a dermatology consult, and the ACTH stimulation test. She's such a good girl. I love my little marshmallow. I want the best for her and it kills me to think that I might have not been doing that, but it's so hard to know. Vets have a very specific thing in mind when it comes to diabetes and I know that's based on research and practice, but what about all of us here who have good results with TR? Why haven't vets looked at a different way to treat? But when I see the vet with tears in her eyes saying that what I am doing to Jill is going kill her, it's very upsetting and very persuasive.

On a positive note, the head vet is really impressed with the whole spreadsheet thing and wants to steal it for his patients. He just doesn't want to ever see any green on it!
 
I'm so sorry... I hope the Cushing's test is definitive and you can start treatment. (Oberon was literally right on the boundary... inconclusive results but everything else pointed to it not being Cushing's.) And I'm sorry you're getting conflicting info; that can be really hard to sort through when everyone wants what's best for Jill but has different opinions about what that is. Hang in there, and know that you're making the best choices that you can for her.
 
Once again I would love to know that the doctor understands your numbers are from a human meter!
Can you confirm?
Big hugs. I was stunned when I saw Jill is your marshmallow. Tina was my marshmallow. I haven’t seen the reference much.
I’m real sorry for all the stress you are going through. Sending love.
 
Tina Marie (GA) and Jan said:
Once again I would love to know that the doctor understands your numbers are from a human meter!
Can you confirm?
Big hugs. I was stunned when I saw Jill is your marshmallow. Tina was my marshmallow. I haven’t seen the reference much.
I’m real sorry for all the stress you are going through. Sending love.
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I thought the marshmallow name was ADORABLE!
 
I would definitely try to see if the vet understands the difference between the human meter you are using and the Alpha Trak that they probably use.

I hope today goes okay. I totally understand your need for the vets right now. But once you get her treated for Cushings, IF she has it, you can do what you know is best for Jill. I hear a note of self-reproach in your tone. You HAVE been taking the best care of her that you could with the information that you have had. Now you may be getting a little more information to go with that, and I know that you will act in the best interest of your sweet baby. You are not to blame for her having Cushings (if she does) just like you are not to blame for the diabetes.

As for her numbers, it would be great if you could keep her in blues for sure, or at least under the kidney threshold. It think it's crazy for a vet to think that the 300s are okay. This vet may be technically very proficient in a lot of respects, but I do think that her bedside manner leaves a lot to be desired. I do not like vets who use the kind of language about how you are going to kill your cat! I think that kind of language in this situation is unconscionable. But I do hope that the vet, or team of vets, will be able to properly diagnose and treat Jill.

Hang in there! We all care here, we really do!
:bighug::bighug::bighug::bighug:
 
Hi Debra, I haven't been on the board much and am really sorry to hear that Jill might have Cushings. I don't know much about the disease but what I can offer is some sympathy. :bighug: I try hard to keep Ruby below 250 as much as possible and it's an ongoing battle for us. When it comes to vets and Ruby's diabetes, I hold my ground and tell them that I am proficient at managing it on my own. Thankfully I have been able to convince them of it and they are still willing to write the prescriptions for insulin, which is really all I need them to do. Don't take their comments too much to heart. You have 25 years of experience and thousands of cats here on the FDMB at your disposal to give you information contrary to what they are trying to scare you into thinking. I agree with @Suzanne & Darcy, it's unconscionable that they are trying to manipulate you in this way. Hold your ground. You know what you need to do.
 
Katherine&Ruby said:
Hi Debra, I haven't been on the board much and am really sorry to hear that Jill might have Cushings. I don't know much about the disease but what I can offer is some sympathy. :bighug: I try hard to keep Ruby below 250 as much as possible and it's an ongoing battle for us. When it comes to vets and Ruby's diabetes, I hold my ground and tell them that I am proficient at managing it on my own. Thankfully I have been able to convince them of it and they are still willing to write the prescriptions for insulin, which is really all I need them to do. Don't take their comments too much to heart. You have 25 years of experience and thousands of cats here on the FDMB at your disposal to give you information contrary to what they are trying to scare you into thinking. I agree with @Suzanne & Darcy, it's unconscionable that they are trying to manipulate you in this way. Hold your ground. You know what you need to do.
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@Suzanne & Darcy
I do think the vet has the very best intentions at heart. My husband met her yesterday and said he couldn't believe that she would have said those things to me because she seems like such a sweet, mild person. And I just want to say -- she was not mean or demeaning in any way. She said those things with compassion and I feel she was just trying to be as honest as possible so I really understood her. It just felt really scary to hear it. The plan now is 2 units 2x a day and a curve after a week. Once the Cushing's test comes back on Monday we will likely start her on meds for that, which - when they start to work - can make her insulin needs go down. We are also switching to Purina DM which the vet likes because there has been so much testing and research done on it with good results for diabetic cats. It's still just 6% carbs, and Jill likes it, so I am ok with that.

Thanks everyone for your kind and supportive thoughts :) I love this community so much!!
 
Debra, how's everything going? Are you and Jill okay. Have you gotten results and started treatment? I've been thinking of you and wishing you all the best. I remember when you posted asking about Jill's skin tears... wondering if it was Cushings. I'm hoping she's getting treatment started by now? Poor girl. Poor Mama!
 
Suzanne & Darcy said:
Debra, how's everything going? Are you and Jill okay. Have you gotten results and started treatment? I've been thinking of you and wishing you all the best. I remember when you posted asking about Jill's skin tears... wondering if it was Cushings. I'm hoping she's getting treatment started by now? Poor girl. Poor Mama!
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We just got confirmation of Cushing's today. Jill will start Vetoryl in a day or two and then she gets tested again in about 2 weeks to see how it's working. She's doing well, adjusting to the new eating schedule - now there are times when all the other cats eat and she doesn't :( But then times when she eats and no one else does! I think she likes me fussing with her less. Thank you for thinking about us :)

Are there other Cushing's cats here?
 
There is a separate forum on the FDMB for Cushings, IAA, and acrokitties: https://www.felinediabetes.com/FDMB/forums/acromegaly-iaa-cushings-cats.12/

I am happy the vet is speaking from a place of compassion, but I still don't think she understands much about feline diabetes. To be frank, I don't think you should change what you have been doing with regards to testing Jill. And the Purina DM does not offer much more nutrition for diabetic cats than Fancy Feast. The whole category of "prescription diets" for dogs and cats is under dispute right now in a lawsuit that challenges the claims made by pet food companies that these products can cure diseases, so I and many other people here are generally skeptical about them except in cases of food sensitivities. You can read more about the lawsuit here if you are interested: https://truthaboutpetfood.com/significant-hills-prescription-pet-food-lawsuit-will-continue/ You can feed the DM food to Jill if it gives you peace of mind, but I gave it to Ruby when she was first diagnosed with diabetes and she didn't like it after a few weeks and then fed her Fancy Feast, then Weruva once she had kidney disease.
 
Katherine&Ruby said:
There is a separate forum on the FDMB for Cushings, IAA, and acrokitties: https://www.felinediabetes.com/FDMB/forums/acromegaly-iaa-cushings-cats.12/

I am happy the vet is speaking from a place of compassion, but I still don't think she understands much about feline diabetes. To be frank, I don't think you should change what you have been doing with regards to testing Jill. And the Purina DM does not offer much more nutrition for diabetic cats than Fancy Feast. The whole category of "prescription diets" for dogs and cats is under dispute right now in a lawsuit that challenges the claims made by pet food companies that these products can cure diseases, so I and many other people here are generally skeptical about them except in cases of food sensitivities. You can read more about the lawsuit here if you are interested: https://truthaboutpetfood.com/significant-hills-prescription-pet-food-lawsuit-will-continue/ You can feed the DM food to Jill if it gives you peace of mind, but I gave it to Ruby when she was first diagnosed with diabetes and she didn't like it after a few weeks and then fed her Fancy Feast, then Weruva once she had kidney disease.
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I agree.
 
Debra and Jill (the cat) said:
We just got confirmation of Cushing's today. Jill will start Vetoryl in a day or two and then she gets tested again in about 2 weeks to see how it's working. She's doing well, adjusting to the new eating schedule - now there are times when all the other cats eat and she doesn't :( But then times when she eats and no one else does! I think she likes me fussing with her less. Thank you for thinking about us :)

Are there other Cushing's cats here?
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I am praying that Jill will do better with the Vetoryl.
 
tiffmaxee said:
You haven’t posted in awhile and your spreadsheet isn’t updated. I hope all is okay.
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Hello :)
I haven't been posting because I haven't been poking! Although I did a curve last Friday;l I should have posted that, but she was mid/high 200s most of the day. We have another appointment at the vet today for another ACTH Stimulation Test to see how her medication is doing. Jill seems good, though. Even with the lower insulin dose, she's still seeming to be ok. We will see what they say about the Cushing's treatment today and I'll probably do another curve in the next day or so and see where we are at. Hoping that with the Cushing's meds (trilostane) we get less insulin resistance.

Thanks for checking in :)
 
Sorry I'm just seeing this update now. :bighug::bighug: I would strongly recommend continuing some testing if you are now giving Vetoryl/trilostane. When it starts to work, it works like gangbusters. We had one kitty (Rose's Zoey), who passed from hypo when it suddenly started working.:( Makes me a fan of conservative dosing in such cases.
 
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