01/25 Whiskers +1 425 +11 238 PMPS 304 +3 208 +6 134

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Cheryl & Whiskers (GA)

Cheryl & Whiskers (GA)

Member Since 2010
Good Afternoon,

We went to the U today and had our consultation and will go back tomorrow for the labwork. I have to rush off to work, but will update tonight when I get home :razz: .
 
Re: 01/25 Whiskers +1 425

Hi Cheryl,
left you a quick PM. Hope the vet visit went well. I am anxious to hear all that happened.

Pattie
 
Re: 01/25 Whiskers +1 425

Hello all,

Our visit to the U of M went pretty well, although as you will see we have to go back tomorrow for lab work. This is the Detailed Care Instructions we recieved today:

You are doing a terrific job managing Whiskers DB and other problems. We will send a more detailed discharge in 24 hours for now but we wanted you to have a short notation about our plans.

For her diabetes mellitus we want you to increase her Lantus insulin to 2.5 units twice daily, and for now feed her as you have been doing every 12 hours. Being off by an hour or two in terms of insulin administration time is not a big deal in most diabetic cats.

Don't worry about checking her BG levels so often. For now since we are increasing her dosage slighly you can recheck a 12 hour curve this weekend. We generally check sugars every 4 hours for 12 hours. First one just before giving her food and insulin and approximately every 4 hours after that until just before her next injection.

Keep her diet the same for now. Once we get her regulation stable we may discuss trying diet changes.

Unfortunately, Whiskers urniated all over when we tried to collect a steril sample via a needle tap so we will have to try to collect a sterile sample tomorrow.

signed by the faculty vet, MS, Diplomate ACVIM.

The senior student told me they tried the needle tap twice, and that she urinated on the second attempt ohmygod_smile . So that is frustrating. Tomorrow they will try again as well as bloodwork, C & S and urinalysis.

Oh and she still has yeast and bacteria in both ears, they will recommend a new medication tomorrow.

Thank you everyone for your support, and a special thank you to DCIN.

Whiskers does seem to feel better with the dose increase, no urinating on the floor today. Purring and hungry. :razz:

I am off to do Whiskers PMPS and feed the crew. :razz:
 
Re: 01/25 Whiskers +1 425 +11 238 PMPS 304 U of M visit

Cheryl:

The information that the vet at the U makes me nervous.

First, raising the dose 0.5u when you're not testing to make sure what the effect of the dose increase may be could be a problem. I know we harp on this but Lantus dosing is based on the nadir and you need spot checks -- especially if you are increasing the dose. If you're at work and can't get them, then you may want to raise the dose gradually. I would hate for you to come home and find a cat suffering from hypo symptoms because you raised the dose quickly without knowing how Whiskers was responding. If you can't get tests during the day, you really need to try to get them at night.

With Lantus, being off schedule an hour or two is a BIG problem. I do not know where the vet is getting this information. If you shoot early and then shoot late to get back on schedule, you will see very wonky numbers. Lantus requires consistency. Frankly, I would ask the vet where in the research literature he has found this information. It is relatively more accurate for shorter acting types of insulin that are not depot-types of medication. It is not a valid statement for Lantus or Levemir. You may not have had a chance to notice how gradually we move shot times to accommodate a schedule change, daylight savings, or to make up for someone oversleeping. We do not adjust shot times by more than 30 min. per day. A shot that is 2 hours early can cause significant overlap between shots to have a large effect and drop BG numbers.

I'm not trying to undermine the information that the vet provided. Most vets are far more familiar with other types of insulin than Lantus whereas it's all we deal with here.
 
Re: 01/25 Whiskers +1 425 +11 238 PMPS 304 U of M visit

Hi Sienna,

Thank you, I really appreciate your advise. I was very concerned about raising the dose by .5 units as well, and questioned the faculty vet about it. As you can imagine he assured me it would be ok. To others reading this it is not the protocol adhered to on this board.

I was also very concerned about the advise that 1 or 2 hours variance of the 12/12 hour dosing was ok, and do not intend to vary ours any more than the 1/2 hour as recommended by the protocols adhered to here.

I thought about withholding the information I was provided from my condo, but I wasn't comfortable with that either. I would like all persons, especially newbies to know that this advise is not the protocal adhered to by members of FDMD. We have very slowly increased Whiskers dose according to protocol the last few months, and the advise we were given today is contrary to protocol and is not recommended here.

That said, I wanted to be honest about what we were told, and also to let people know I do not necessarily agree with it.

Thank you again Sienne. I will get some BG test tonight.
 
Re: 01/25 Whiskers +1 425 +11 238 PMPS 304 U of M visit

Glad that Whiskers is getting the tests he needs tomorrow... Prayers said that they will get a sterile urine sample on the first try!

I too would probably reiterate your dosing concerns tomorrow and ask that they point you to specific literature regarding Lantus/Levemir that indicate that their suggestions are sound. I know this probably means being labeled as a problem child, and we all obviously know that I have no problem with that label. LOL Obviously, you may choose to take a different approach with them. At least they didn't tell you to just dose once a day? :razz:

Hope you all have a good night and a good visit tomorrow!
 
Re: 01/25 Whiskers +1 425 +11 238 PMPS 304 U of M visit

Hi Christie and Willie,

I will discuss the dosing concerns tomorrow. Thanks for visiting our condo and for the well wishes. Hope both of us get a little rest tonight, sleep is overated :lol: :lol:
 
Re: 01/25 Whiskers +1 425 +11 238 PMPS 304 U of M visit

Hi Cheryl,
You were warned that he would tell you not to test as much. :lol:

I would agree 100% with Sienne about increasing so quickly, especially without spot checks. How soon after giving the evening shot do you go to bed? Is it possible to add to your already overloaded routine (*sigh* I know) a check right before you go to bed?

Anyways, I think its really important to get the feedback from Dr. H and dont be afraid to ask questions if its conflicting information. He told me the same thing about testing (though I tested a lot), and encouraged an increase similar to yours. When expressing my concerns and asking him to look closer at the ss, he agreed that maybe increasing a little less would be safer. He also acknowledged I would not test less, and accepted it. Ask if he is familiar with the protocol. Ask if he has any problems with you following it? Have a dialogue with him, so you can both learn from each other and do whats best for Whiskers. And talk with those student vets. You may find they have a completely different train of thought on the matter.

You probably wont see him today, if youre just doing labs. But NOW you can call anytime and speak with him. :mrgreen:

I completely trust that all the appropriate labwork will be done, and done properly there. I have 100% faith that everything will be interpreted correctly, and excellent feedback/tx will be given if there is a problem.

So you increased yesterday by .5?
 
Re: 01/25 Whiskers +1 425 +11 238 PMPS 304 U of M visit

Let me clarify a bit. According to the protocol, there are times when it's fine to increase by 0.5u (i.e., when nadirs are over 300). Where it may be necessary to deviate from the protocol is when there are lifestyle issues that intervene. If you are not able to test because of work or other personal commitments, the safety of your cat will always trump the dose increase or at other times, like if ketones are present, encourage an aggressive plan of increasing the dose. Either way, Whisker's safety is always the primary concern.

I love Carolyn's suggestion of developing a relationship with your U of M vet and creating a dialogue. A good professional, especially someone at a teaching hospital, will encourage you to learn about how they are approaching Whisker's care and, just as importantly, take your input about your cat into consideration. It becomes a partnership.
 
Re: 01/25 Whiskers +1 425 +11 238 PMPS 304 U of M visit

Hi Cheryl,
This is sound advice from people with knowledge and experience. Doing the right thing for Whiskers is the most important thing. I hope you can work out a partnership with the vet and am keeping fingers crossed that the tests can be completed today and sent to the lab. Thinking of you (very positive thoughts),

Ella
 
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