01/31 Fortune AMPS 174 +1 110 +2 58 +3 44 +5 99 +9 378 +11 412 PMPS 369 +1 393 +2 451

RachelG

RachelG

Member Since 2021
Last thread

Fortune has the big visit with the internist today!!

We increased Fortune's dose on Friday night to 2.75IU. He needs to be fasted for the vet visit so this morning we gave him only a half dose (vs skipping completely like last time :banghead:) and he is down to 58!

We tested again and it's at 66, so I don't think he is hypo, but we are keeping an eye. We are leaving for the vet in about an hour, and will check again. Is this a dramatic dip?

I'm also printing a list of information about Fortune to go in/on his carrier since we cannot go in, and have never been here - well we were there back in 01/2018 but they don't know him well.

Paws crossed everything goes well!
 
Yay for the 58 and the 66. Just bad timing. Just bring some karo. Max went high from stress at the vet but always liked do dip low the morning of the visits. I hope the visit is productive and Fortune behaves.
 
tiffmaxee said:
Yay for the 58 and the 66. Just bad timing. Just bring some karo
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Thank you! We have some simple syrup and will let them know at the vet's office. Just hard to know symptoms since we dosed him with gabapentin to make the exam easier which gives the same symptoms as hypo. ARRRGH.

Just checked again (it's been about half an hour) and he is at 62. Holding steady!
 
We are sitting in the parking lot at the vet waiting for them to get Fortune, so we retested.

He is now at 44! Forgot to bring the syrup in the rush, so going to inform the tech. Not sure what to do next.
 
Butters & Lyla said:
Update us when you have a chance, please. The 911 is still up!
I'd beg them to take him in immediately, have them test him and they can get his BG up if necessary.
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They took him in but the tech didn’t convey to the vet that he was low! I’m so upset rn. They fed him and are going to test his BG.

The internist was VERY condescending, and talked down about the diabetes. She lectured us that we are increasing his dose too frequently and that it can harm him. I made it clear that we understand the risks of hypo and he has never been nearly this low before which is why we have been testing frequently - even in the parking lot!

She wants us to skip the dose tonight, and go down to 2 IU tomorrow. She also told us that 350 or less is the goal with FD and we are testing too frequently, and changing the dose too often. The body takes one week to adjust according to her.

We learned he has “mild” CKD and pancreatitis, as well as liver disease. Our next step is to an oncologist.

I’m so angry and frustrated.
 
I'm so glad they are feeding him now.

:bighug::bighug::bighug: I'm so sorry you are dealing with multiple issues for Fortune.

It's so frustrating being spoken with that way. I had a similar experience with an Internal Medicine vet who refused to give Butters insulin when she was hospitalized, then told me to give her no more than .5u. She was very pushy and condescending. From someone who has been there (but I'm no vet!!!), imho I suggest you smile and nod the best that you can and then keep on keeping on with TR. Butters was at 1u and regulated before she was hospitalized. After the vet stopped her insulin and she was ill, I had to chase her up to 4.25u to see decent numbers after that. Butters IM vet also agreed with your internist that 350 or less is the goal:facepalm:. For me, that was not a good enough goal and I was unwilling to compromise on that.

When you get the lab results back, enter them into your spreadsheet if you are so inclined and interested in input.
 
Butters & Lyla said:
I'm so glad they are feeding him now.

:bighug::bighug::bighug: I'm so sorry you are dealing with multiple issues for Fortune.

It's so frustrating being spoken with that way. I had a similar experience with an Internal Medicine vet who refused to give Butters insulin when she was hospitalized, then told me to give her no more than .5u. She was very pushy and condescending. From someone who has been there (but I'm no vet!!!), imho I suggest you smile and nod the best that you can and then keep on keeping on with TR. Butters was at 1u and regulated before she was hospitalized. After the vet stopped her insulin and she was ill, I had to chase her up to 4.25u to see decent numbers after that. Butters IM vet also agreed with your internist that 350 or less is the goal:facepalm:. For me, that was not a good enough goal and I was unwilling to compromise on that.

When you get the lab results back, enter them into your spreadsheet if you are so inclined and interested in input.
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Thank you! I’m still processing, my poor baby has been through so much. I agree on the smiling and nodding piece, but also I want to find a vet that takes patient/owner experience into account and doesn’t just read from a textbook.

The idea that it’s ok because they “see it a lot” is not a comfort, nor is blaming everything on his age.

I put his latest numbers from January in the sheet, but I need to review and make sure I have copies of everything.
 
What do you think about not shooting tonight, and bringing his dose down to 2IU? I don’t want him to go hypo, but keeping him in the 200-300s also is not acceptable.
 
Some cats go lower after a car ride and/or a vet visit. See what the experts have to say about dosing tonight. And make a note that Fortune is one who can go low so you will remember in the future.

Did the vet give you anything for the pancreatitis?
 
It is a lot to take in. :bighug:It took me a long time to find a primary care vet for Butters that supported me when I said I was fine to manage her FD and would send him the spreadsheet. The others I saw before were more harmful to her progress than anything.

I don't give opinions on dosing, but I recommend not making that decision until you get closer to PMPS. Get some more tests in between now and then. Skipping wouldn't be ideal, imo, unless there is something about Fortune I'm not aware of.

A couple of things to think of:
First, if you're following TR, then Fortune earned a reduction to 2.5u with that drop <50 today.
Second, with TR we shoot 50 and above as long as the CG is able to monitor him and has plenty of test strips, karo/honey/MC/HC foods.

I know it is scary to see greens for the first time, but with TR we want him to spend more time in greens. Just some things for you to think about.
 
How could 350 be good for the kidneys? I am glad my vet told me the gold was 4 (72) -9 (162) and if not possible, 50% below 15 (270) on AT2.
I think some of these internists have a big ego and cannot recognize that they may be wrong or don't know enough. I am not sure how long they spend on diabetes at school but the way they prepare owners of diabetes animals when the animal is first diagnosed tells me they don't understand that disease that well.
They tell you to do a curve. We all know a curve can vary immensely before achieving regulation from one cycle to another. This is way more dangerous than testing frequently. Sorry for your experience.
 
Red & Rover (GA) said:
Did the vet give you anything for the pancreatitis?
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They did not, even thought I explicitly asked about it. She confirmed that he has "mild" chronic pancreatitis which I had suspected based on the blood test, but told me that only acute pancreatitis causes pain. Which - excuse my French - is BS! My sister has (human) CP and it doesn't only hurt when she is having a flare.

They ordered no additional testing or treatment. Apparently one of his meds is also for his liver.

Butters & Lyla said:
A couple of things to think of:
First, if you're following TR, then Fortune earned a reduction to 2.5u with that drop <50 today.
Second, with TR we shoot 50 and above as long as the CG is able to monitor him and has plenty of test strips, karo/honey/MC/HC foods.
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This is very helpful! I have been re-reading the hypo sticky a lot today! We fed him again when we got home and are going to continue checking. I'm just a bit nervous about him going this low overnight! At least there's a snowstorm tomorrow so I'll for sure be home all day and can be up in the middle of the night.

Marj & Djoko said:
I think some of these internists have a big ego and cannot recognize that they may be wrong or don't know enough. I am not sure how long they spend on diabetes at school but the way they prepare owners of diabetes animals when the animal is first diagnosed tells me they don't understand that disease that well.
They tell you to do a curve. We all know a curve can vary immensely before achieving regulation from one cycle to another. This is way more dangerous than testing frequently. Sorry for your experience.
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Exactly! She told me to do a curve ONCE A WEEK - yet he has a huge amount of variability! I came with a print out of info on Fortune's meds, symptoms and questions since I wouldn't be there in person, and I definitely got the vibe she didn't like that. I have learned from going to human doctors that if they get intimidated by my knowledge and drive to research and be informed, they are not the right doctor for me. Same goes for my kitties. They should be collaborating, as subject matter experts. Looks like we are down the rabbit hole to find a good IM and Oncologist.

Literally looking up other specialists right now...
 
RachelG said:
They took him in but the tech didn’t convey to the vet that he was low! I’m so upset rn. They fed him and are going to test his BG.

The internist was VERY condescending, and talked down about the diabetes. She lectured us that we are increasing his dose too frequently and that it can harm him. I made it clear that we understand the risks of hypo and he has never been nearly this low before which is why we have been testing frequently - even in the parking lot!

She wants us to skip the dose tonight, and go down to 2 IU tomorrow. She also told us that 350 or less is the goal with FD and we are testing too frequently, and changing the dose too often. The body takes one week to adjust according to her.

We learned he has “mild” CKD and pancreatitis, as well as liver disease. Our next step is to an oncologist.

I’m so angry and frustrated.
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Do you have labs on him to see what “mild” CKD is?
 
I'm so sorry you had such a bad visit. Don't know if you saw this response
@Bronx's dad (GA)
Don't know if this is too far away from you.
Your baby has been thru enough.


Hi Rachel. I am in NNJ and was referred to internist Dr Christian Eriksson at Blue Pearl in Paramus after my Ho-Ho-Kus vet gave up after Bronx reached 3u BID of insulin and was still unregulated. Dr Eriksson is very familiar with feline diabetes and was willing to work with me on using Cabergoline to treat Bronx's acromegaly and even knew about TR. I think we were one of the first cats in the US to try Cabergoline. Bronx ended up getting SRT radiation at Red Bank Hospital in Tinton Falls by Dr Dustin Lewis (they had just gotten a brand new machine). I would recommend both doctors. Dr Eriksson's email is christian.eriksson@bluepearlvet.com. I know Oradel is known for their specialists, but I was happier at Blue Pearl and I don't think it is as pricey as Oradel. Also, I heard Oradel uses residents during off hours, while Blue Pearl always has experienced doctors 24/7. Hope that helps.
 
@Bronx's dad (GA) I totally don’t see your post and I’m not sure why! Thank you @Diane Tyler's Mom ! I went to the Paramus location but didn’t see that doctor. I was very fond of the internist who initially diagnosed Fortune with SCL, but he moved to DE.

I wonder if she moved too? I will email and see. Thank you! At this point it seems like our next step is an oncologist since the IM vet we spoke to didn’t make any recommendations for changing his meds or managing the SCL differently, but did think it was the SCL out of remission vs the IBD (without seeing the latest u/s :banghead:).

you give me hope though, that it’s possible to find a supportive specialist. I feel like it’s lazy to shrug and say “well he is old,” as a treatment.
 
Diane Tyler's Mom said:
Do you think your vet will give you something for the pancreatitis if he's in pain.
I just want to strangle who you saw today
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The one today said CP isn’t painful which wtf? Truth is idk if he is in pain, but I know he isn’t purring :( He is still snuggly and eating, so I hope he isn’t!

I’m very frustrated, but will keep digging in! I appreciate you linking to all of the different vets! I have lots of calls to make tomorrow. :bighug:
 
RachelG said:
The one today said CP isn’t painful which wtf? Truth is idk if he is in pain, but I know he isn’t purring :( He is still snuggly and eating, so I hope he isn’t!

I’m very frustrated, but will keep digging in! I appreciate you linking to all of the different vets! I have lots of calls to make tomorrow. :bighug:
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Try the link above too, don't know if you might have missed it. I just want you to find someone to help that sweet baby. My heart breaks for you and Fortune ♥:bighug::bighug:
Keep us posted ok
 
Oh, that's not a good experience at all. So many wrong things there. I hope you're able to find a better vet soon.

Stay safe, everyone! We're stocked up. Assembling pot roast tonight to start in the crock pot tomorrow morning, so we have a good dinner ready when we're tired from shoveling. Luckily there's nothing we need to leave the house for until later this week.
 
Butters & Lyla said:
First, if you're following TR, then Fortune earned a reduction to 2.5u with that drop <50 today.
Second, with TR we shoot 50 and above as long as the CG is able to monitor him and has plenty of test strips, karo/honey/MC/HC foods.
Click to expand...

So we are back (way back) up to 378. He did have a (unknown brand or type) HC food at the vet, and we fed him rabbit when we got home, so it's not surprising. I feel a lot more comfortable giving him the juice tonight - we will of course keep checking! According to TR it says we reduce immediately only if he under 40 - would the 44 BG reading count since it's within the 20% margin? Or do we hold the 2.75IU and see if he stays low? My biggest concern is that he goes hypo at night when we are unaware!
 
He did earn a decrease for dropping under 50. It was from the 2.75 dose. The depot was causing the drop even though you shot a reduced dose. So the dose going forward is 2.5. Congrats. He’s bouncing so if you want to shoot the 2.75 tonight you can and reduce to 2.5 in the morning.
 
Thank you so much! I think we will go with the new dose (2.5) since it seems like there are fewer risks with dosing down than dosing up too fast. Unbelievably grateful for the input!! :bighug:

What might be causing the bounce? Delayed reaction to the new dose?
 
I wanted to get you an answer so didn’t read your whole thread until just now. I sorry you had such a bad experience today. The bounce is die to dropping to 44 and possibly lower from not eating. It’s his body’s way of protecting him since he was so low. It can take up to 6 cycles to clear.

I never shot through a bounce either but sometimes doing so leads to a shorter bounce.

It makes no sense to keep him around 350 as that’s above renal threshold. :banghead: I bet he isn’t familiar with human meters and a pet meter reads higher but that is still likely above renal threshold. She is definitely not the vet for you. :bighug:
 
tiffmaxee said:
It makes no sense to keep him around 350 as that’s above renal threshold. :banghead: I bet he isn’t familiar with human meters and a pet meter reads higher but that is still likely above renal threshold. She is definitely not the vet for you. :bighug:
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It was quite a traumatic visit, for both Fortune and his keepers. She wrote the most condescending progress note I have ever seen for a cat, it ranks with what I normally see with doctors practicing human medicine, unfortunately.

"The body takes approximately 7-10 days to equilibrate to a new insulin dosage and as such, daily monitoring of blood glucose curves is not recommended and frequent dose adjustments are similarly not recommended. Every clinician approaches diabetes mellitus differently; I personally will start a dose, monitor clinical signs at home and only check a blood glucose if there are concerns for hypoglycemia, and then schedule a blood glucose curve after 10-14 days. The curve is then interpreted alongside the clinical picture. We evaluate appetite, thirst and urination, and weight, alongside the numbers to make an overall interpretation. The numbers are never interpreted in a vacuum. Fortune's prior insulin administration is a bit difficult to interpret today. As such, we recommend starting fresh to some extent. His blood glucose was severely low today, so we recommended skipping his evening dose. If his blood glucose levels are greater than 250 mg/dL tomorrow morning, he may receive 2 units of glargine. From that point, 2 units every 12 hours would be recommended until a blood glucose curve could be performed at the 10-14 day mark. We would then interpret those numbers alongside Fortune's overall picture."

SN: She isn't familiar with our administration, nor has she reviewed any of our data/curves. ANYWAY...

Butters & Lyla said:
I don't think anyone has given you the link to this post on Feline Pain Scales...it will help you learn how to judge when Fortune is in pain. Worth a read when you have time. It has really helped me become better able to tell when Butters, who also has chronic pancreatitis, is in pain.
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Thank you so much! What do you normally do for pain with Butters? My sister has CP, if only it only hurt when she was having a flare up. UGH. UGH. UGH! Would an IM doc help with treatment/pain management?
 
Ooof I reviewed the pain scales. I'm pretty sure he is in pain. He is eating well, drinking, going to the bathroom, and lovey, but no purr, squinty eyes, head forward and looking pathetic :(:arghh:
 
If you were not testing you would have missed the drop to 44. I know lots here give reduced doses for appointments but the very rare times I had to fast Max my vet had me skip. He almost never had me fast him, even for ultrasounds or blood tests. And who needs them to do a curve when it can be done at home and not be elevated due to stress at the vet. That’s just a way to make extra money. The only curve Max had by my vet was after his first dose of Lantus. He never suggested one. I emailed the spreadsheet to him every few weeks. If I forgot he would remind me.
 
tiffmaxee said:
I know lots here give reduced doses for appointments but the very rare times I had to fast Max my vet had me skip.
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We skipped the dose for the vet appt two weeks ago so I was scarred after seeing him go to the 500s! The vet clinic told us to give him his regular dose but keep him fasted "just in case." Well, because of this wonderful site and folks on it we knew to give a reduced dose!

I probably should email the sheet to the vet, we had sent it when we first started, and he knows we are tracking. I'm not sure he is aware we have been changing the dose on our own, and I don't need another lecture after the lovely vet visit today.

The only time my vet recommended a curve was after we were repeatedly expressing concern that his diabetes is causing symptoms and he consulted with a different IM. That's what prompted me to find this site because I was not comfortable leaving him unattended for 6-8 hours :)

We aren't going to stop testing until he is at a good dose. We are happy to do whatever it takes to help Fortune!!
 
RachelG said:
Ooof I reviewed the pain scales. I'm pretty sure he is in pain. He is eating well, drinking, going to the bathroom, and lovey, but no purr, squinty eyes, head forward and looking pathetic :(:arghh:
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Awwww. Poor Fortune. Butters will also almost always eat well even when she looks to be in pain. My primary care vet gave me buprenorphine for her for pain. The Internal Medicine vet gave me gabapentin for her for pain. I think buprenorphine works really well for cats, at least from what I have seen on the board. Butters seemed to respond better to the gabapentin, but she was probably underdosed on the buprenorphine.

An IM vet but also the primary care vet should be able to help you with pain meds/management/treatment for Fortune. Butters' primary care vet gave me a good supply of buprenorphine for her pain and gabapentin so I could decide what to use, as well as appy stimulant, and anti-nausea meds so at the first sign of any pancreatitis symptoms I can treat her.
 
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Sorry you had one of those IM vets. :rolleyes: You diagnose a cat with early stage CKD and you want to keep the blood sugar above renal threshold? :mad: Paws crossed you find another and better (a low bar) IM vet.

Good luck with the new dose.
 
Red & Rover (GA) said:
Did the vet give you anything for the pancreatitis?
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No, they told me that pain is not experienced with chronic pancreatitis, only acute. :banghead:

Suzanne Williams said:
Do you have labs on him to see what “mild” CKD is?
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Sorry I missed this! I put his labs for November and December 2020 in this spreadsheet - they didn't do any new lab work today. I highlighted in red what is high based on the performing labs numbers.

Wendy&Neko said:
Sorry you had one of those IM vets. :rolleyes: You diagnose a cat with early stage CKD and you want to keep the blood sugar above renal threshold? :mad: Paws crossed you find another and better (a low bar) IM vet.
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FR! It reminds me back in 2016 when we were looking for a new PCP. The one we have now has an amazing bedside manner, communicates over email, and is wonderful with the kitties! He seems to "by the book" for everything and of course not very well informed on FD and now the SCL, so I'm torn on whether we keep seeing him, especially since he is a bit far. I was happy to keep dragging Fortune to him when I thought he was getting the best care. It's so hard out there for complex patients! I would know, I'm one, too, lol.
 
I am so sorry, how frustrating!

I got similar from my first vet "no you don't need to change food, no need to test at home, bring him in for curves and fructosamine, just want to keep him around 350"....as he's peeing and pooping all over the house, hiding, not grooming, and going through 2 bowls of a water a day.

It looks like you got a few good references, but just adding that I actually joined and asked some neighborhood mom's groups on Facebook for recommendations for new vet.
 
FrostD said:
It looks like you got a few good references, but just adding that I actually joined and asked some neighborhood mom's groups on Facebook for recommendations for new vet.
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That's a great idea! Thank you! It's hard with a complex kitty finding solid recommendations, but it definitely cannot hurt! Appreciate it!
 
Butters & Lyla said:
An IM vet but also the primary care vet should be able to help you with pain meds/management/treatment for Fortune.
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I'm going to email his primary, but in the meantime was thinking about giving him CBD oil. We occasionally give it to our boys, but not when Fortune is not eating well (so not lately lol). But I'm thinking it might help with the pain. Trying to figure out if its HC!
 
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