12/4 Cinco PMPS 153 +3 94

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Tricia Cinco(GA) & Harvey

Tricia Cinco(GA) & Harvey

Member Since 2011
First, sorry I was MIA yesterday. It was a very long, stressful day and I did not have the energy to type it all up. I am at UCD now with Harvey for his evaluation and biopsy, and I forgot to grab Cinco's numbers before I left. I will edit the post and subject line with them when I get home. His spreadsheet is up to date through last night.

I had my first big disppointing experience with UCD yesterday. They are NOT fans of the tight regulation protocol. :sad: The vet that saw Cinco did not want to give me a script for insulin until she gets his BW results today. She'd never heard of using a pen and I had to explain to her how we do it. When I pointed out one of the benefits was cost savings because they contain less, the student said they could sell me one or two ML at a time. I told her I was not comfortable with that, as Lantus is fairly sensitive and you don't want to "dispense" it. She assured me it would be okay. During our discussion, she referred to the "five hours"of study they did on diabetes. :roll: She kept saying "in dogs and cats". I had to clamp my jaw shut to keep from shouting at the poor thing. I think she could tell I was not impressed, as she seemed to get more and more nervous the whole time I dealt with her. I never thought I was intimidating!

The vet wants Cinco seen by an Internist to come up with a plan to manage his diabetes. She consulted with one, and that IM said that she was very concerned about the frequency of Cinco's "hyperglicemic and hypoglicemic episodes". She said I was risking causing him to become insulin resistant and talked about the symogy effect. Sorry, I don't have the summary with me. I'll quote from it when I get home, but I wanted to get something up now as I knew people might be wondering what was going on with us. Apparently, they don't want him going under 100, as that is dangerous. :roll: :YMSIGH: The student wanted to do a fructosamine test, and I resisted, so she went and consulted with the IM again and came back and said the IM wanted me to reduce Cinco's dose to .75 units to even him out, wait two weeks, because that's how long it takes for him to adjust to the new dose, and then do a curve at home and send her the numbers. I'm starting to think my old vet was a better option! I thought a teaching hospital would be more up to speed on treatment protocols. I'm really not sure where to go from here. I'm just hoping I get that script. Do you think there's any point in trying to convince these people that I am not harming my cat by following the TR protocol? I was going to find the sticky on coverting your vet to see if that would help me. I was just so physically and emotionally exhausted last night that I couldn't think straight. The student was very nice, but very slow and didn't have a lot of self confidence. We were there for over two and a half hours. Cinco was pretty stressed and hit the stinky pinkies at PMPS, but came way down and even gave me some blue numbers later.

Minka came through her first chemo treatment really well. The Oncologist was pleased because she had actually gained a couple of ounces since her last weigh in. :D She ate her breakfast with just a little prompting this morning, although she did spit up a very small amount prior to breakfast. She seems to feel fine. Mark is home, so he's keeping an eye on her.

The IM just came in and went over options for Harvey. They are going to do an ultrasound and a couple of blood tests, including the Specfpl (or whatever it is) to rule out pancreatitis. Then they'll determine whether to do a scope, do a surgical biopsy, or if he just needs a special diet. I'm coming back at 6:00 pm.

So that's all for now. Sorry if this doesn't make a lot of sense. I didn't get much sleep last night and I'm kinda fried. :dizcat

Sending healing vines to all in need and hugs to all their beans. :YMHUG: Prayers continue for Amy's DF, Lyresa's DF, Lisa's DF and Elise's DM.
 
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Re: 12/4 Cinco UCD Visit Results

(((Tricia))) what a day! :YMHUG: :YMHUG: :YMHUG: Here's the link to your previous condo, so you don't have to hunt for it: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=129362

This is for that vet and the student. angry(2)_cat If it was me, I'd smile nicely, listen to their suggestions, get the script for pens, then find another vet. Once you have a script you have time. Are there other vets at UCD you could see? I've seen different views between vets at the same clinic. You know Cinco way better than they do, know how he responds to insulin, and you're doing a great job with him. I don't know if I'd try to convert a vet to TR, but it's worth trying to convert them to continuing to let you do what you are doing so well. Neko's regular vet doesn't agree with everything I do (raw food, insulin choice - they normally prescribe Caninsulin :roll:) but she doesn't argue success and works with me.

Why bother with an IM vetty visit? It's just another charge. When Neko got her acro diagnosis, my vet wanted me to go to an IM vet for a diagnosis and treatment plan. Well, I knew the diagnosis and knew the treatment better than they did. Saved myself $250 too. Ask the vet if they've heard about glucose toxicity if they go on about lowering the dose to "level him out".

Good news on Minka eating - sending tons of healing vines for her and hoping for success from the chemo. Paws crossed here for Harvey too.
 
Re: 12/4 Cinco UCD Visit Results

Grrrr! I bet the student "forgot" that you are using a human meter and the numbers would be higher on the Alpha or at the lab!! I missed that the part about Harvey now being diabetic. Is that for sure or are you going to try diet changes first? :YMHUG: :YMHUG: You are amazing!!
 
Re: 12/4 Cinco UCD Visit Results

Let me know when you want the likes to my posts to Marje on Somogyi. When you're less fried, I'm happy to provide you with the info on shy this has absolutely no relevance for humans or cats. (You can always ask the vet for the research on Somogyi using Lantus. There isn't any)

Not all IM docs know anything about diabetes. In humans, IM covers a lot of ground. There are general IM docs and then there are specialists. I'm betting this wasn't an endocrinologist you were talking to. I guess you should be happy they didn't suggest you switch to N.

Why do you need an IM vet for Cinco's FD?

Oh, BTW, the drug manufacturer will not guarantee the insulin if it's repackaged. So much for what the vet student knows!
 
Re: 12/4 Cinco UCD Visit Results

((((((Tricia Minka,Cinco, Harvey and Sasha))))) Big hugs to you, sorry you had all that BS to put up with yesterday!!! (sorry it is just frustrating to think about!!! ) Is there a local vet that can write the script for Cinco's Lantus pens? Can you choose which vet you see at UCD- preferably one who isn't pushing antiquated information? Sending tons and tons of prayers and healing vines to all of you- Remember, you CAN be intimidating and in charge of that vet student and the others- they work for you not the other way around!

Elise, I could be wrong, don't think Harvey has FD- I think Tricia just wanted to get a Rx for Solostar pens rather than the vial.
 
Re: 12/4 Cinco UCD Visit Results

Tricia :YMHUG: :YMHUG: :YMHUG: :YMHUG: :YMHUG: I'd say you have plenty of reasons for needing to chill, don't worry about not posting.I think you might be right about going bak to your old vet. Would there e a problem at that clinic about getting the Rx for pens?

On the other hand, you could print out all the info on FD, Symogi, bouncing, insulin resistance, food lists, TR, using Lantus, etc, here and on Dr. Lisa's sight and give it to the intern as a reading assignment. I bet it would take her a lot more than 5 hours to get through! :lol: :lol: Pick your battles though, you have too much on your plate to need more hassles now.

I guess i missed Hrvey's FD Dx too. I thought they were speculating on IBD.
 
Re: 12/4 Cinco UCD Visit Results

Ugh, sorry to hear about the very frustrating vet!!! angry(2)_cat It is so weird to me that more vets don't study TR and do more research on it. It's fascinating stuff! I hope you can find a vet who is more open-minded and can respect that you know what you are doing. We have been through 3 vets since Billie's diagnosis, and it took that many for me to find one I really like.

I'm so glad Minka did well with her first treatment and glad to hear that she gained a bit of weight! Sending more vines to her and Harvey, and Cinco and Sasha too, and hugs to you. :YMHUG: :YMHUG:
 
Re: 12/4 Cinco UCD Visit Results

I'm sorry about your bad experience with the UCD vet. I hope you can find another vet at UCD that is more understanding and knowledgeable.

I'm glad Minka's treatment went well. I hope things go well with Harvey's tests and you can figure out what is going on with him.

Sending prayers and hugs.
 
Re: 12/4 Cinco AMPS 202 +2.5 165 +8 134 UCD Visit Results

THANK YOU ALL for your support. Just a quick drive by - got home and had a bite to eat, spent some time with the kitties, and now I've got to head back to UCD to find out what's up with Harvey.

Sorry if I gave the wrong impression somewhere. Harvey has NOT been diagnosed with FD (thank God!). The confusion is probably because he is seeing an IM about his bowel/intestinal issues.

The procedure for dealing with FD at UCD is that an IM is assigned to you to "manage" it for you. That's why we are supposed to take Cinco to one. I will definitely get the links from you, Sienne, before that appointment (if I make it), and will ask the questions you and Wendy posed. I also plan to ask if I can talk to Dr. Nelson, who is considered an expert on FD, or ask what Dr. Nelson says about TR.

DH was really busy today and didn't test while I was gone. :YMSIGH: When I asked, he was sure he had and even went through the meter looking for the reading! :roll: If you want something done (right).....

Gotta run. Will post more later. Hugs to you all for being so wonderful to me us! :YMHUG: :YMHUG: :YMHUG:
 
Re: 12/4 Cinco UCD Visit Results

Many vines for you and the kitties. Big hugs too. Very disappointing about the vet student, probably just parroting what she heard in class. I just love the knowledge and experience in LantusLand. Don't you wish Wendy or Sienne could go with you? :-D We are thankful every day for finding this place.
Liz
 
Re: 12/4 Cinco UCD Visit Results

This is an excerpt in response to an IM vet giving Marje a hard time shortly after she joined LL (12/14/2010):
The topic of Somogyi came up some time before you joined the Board. Both Jill and I did a lot of lit searching. I have access to both a medical and veterinary library system. For a theory that has so many people convinced that it is a factor in human as well as in feline diabetes, there is an amazingly small amount of research on the topic. The earliest paper by Michael Somogyi, is from the 1930s and was not published in a widely recognized medical journal (i.e., it was in the Weekly Bulletin of the St. Louis Medical Society). Note that this was a report based on 5 human subjects and urine glucose, not blood glucose was measured. More recent reports note that Somogyi's observations have not been reliably reproduced under controlled conditions.

Gale said:
Although some patients had a very rapid fluctuation from hypoglycaemia to hyperglycaemia, we found no evidence that changes in counterregulatory hormone levels were responsible.The preceding interval of hypoglycemia was often prolonged, which implied defective homeostasis, and the difference between the patients with apparent rebound and those without could not be explained in terms of circulating levels of cortisol, growth hormone, or glucagon. Other workers have noted very variable changes in growth-hormone and cortisol levels after acute hypoglycsemia in unstable diabetics. We did not measure catecholamines and cannot rule out the possibility that they were partly responsible for the difference between our groups. However, the evidence presented here suggests that free insulin is the major factor involved.
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The bold is mine. It points out that there is no evidence for what the vet is suggesting about "stress" hormones (i.e., cortisol).

In addition to the dearth of empirical research, there is even less that pertains to cats and none that addresses Somogyi phenomenon in the use of Lantus. Given that the presence of Somogyi is believed to be associated with doses that are raised in too large of an increment, it is surprising that this IM vet would not be an enthusiastic supporter of the Queensland/Rand tight regulation protocol. (FYI - there is another TR protocol and the vet may have assumed this was the one you were referring to.)

This is a link to info on Chronic Somogyi Rebound on Wiki. I would draw your attention to the section on Controversy:
Although this theory is well known among clinicians and individuals with diabetes, there is little scientific evidence to support it. Clinical studies indicate that a high fasting glucose in the morning is more likely because the insulin given on the previous evening fails to last long enough.[5] Recent studies using continuous glucose monitoring show that a high glucose in the morning is not preceded by a low glucose during the night.[6] Furthermore, many individuals with hypoglycemic episodes during the night fail to wake due to a failure of release of epinephrine during nocturnal hypoglycemia.[7] Thus, Somogyi's theory is not assured and may be refuted.
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This information pertains to humans, not cats. However, the phenomenon was based on humans and extrapolated to felines so I'm going to presume the issues with the paucity as well as quality of the research are the same.

If this were me, I would ask the IM vet for more information.
  • I would want her to provide you with the research/empirical studies that she was referring to so you can do some reading and better understand what she thinks is going on with Gracie. (Personally, if there is research out there, I would very much appreciate seeing it because I can't find it and I'm pretty good at doing lit searches.)
  • I would ask to see research documenting Somogyi in cats on Lantus.
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The links that were in another of the 2010 threads are to the "old" board and can't be recovered. I don't know if Marje copied them.

You might want to take a look at this link to Medscape on Somogyi. It's referring to humans and notes that if Somogyi exists, it's rare. Further, they note that increasing insulin has little effect with Somogyi (vs. bouncing) -- we rarely see this to be the case since once a bounce clears, raising the dose is usually effective. The other point the article makes is that Somogyi can be confused with dawn phenomenon (at least in humans).

If the IM vet can provide you with research citations, I have access to a pretty impressive veterinary library -- OSU is one of the top vet schools in the country. I can get pretty much anything he suggests would be worth reading. However, what I suspect will happen is that he won't recommend reading RESEARCH articles and that's really what's needed is research based data. IMHO, Somogyi is something that's been perpetuated in the literature with very little evidence to support it especially with the newer, longer-acting types of insulin.
 
Re: 12/4 Cinco UCD Visit Results

((((Tricia)))), Just sending some support to you tonight. I hope you were able to get some real answers out of those vets. Sienne really nails it!

Lots of vines for Harvey, Minka, Cinco, and Sasha.
Hugs to you,

Ella & Rusty
 
Re: 12/4 Cinco UCD Visit Results

I am so sorry you're having to deal with this vet about Cinco's FD on top of everything else. Do they not know how long YOU have been taking care of Cinco and his FD, and do they not see how incredibly well he is doing with your care??? It's crazy to tell you that after years of taking care of an FD kitty, you are doing it all wrong and you NEED someone to manage it for you. Argh - I feel your frustration, and am sending some "get some good sense in your head" vines to the staff at UCD on this one!

I'm glad Minka did well with her first round. Continuing to send prayers for all of you!
 
Re: 12/4 Cinco UCD Visit Results

Oh, Tricia. What a hassle. The IM at CSU comes from the same perspective as the student who gave you a hard time. The biggest threat to Polly after SRT, hypoglycemic events. And she'd had access to Polly's spreadsheets knowing that I was a compulsive tester. When I e-mailed about Polly's "headaches" and disorientation several weeks after the SRT, her response, "likely hypoglycemic event. Did you test her?"

I'm sure it's what they're taught. And that's a shame. My local vet, a large animal specialist, has been so supportive. "It looks like what you're doing is working. Keep doing it." He even wrote a script for me to take to Colorado 'cuz I was worried I'd forget Polly's pen in a hotel room along the way. On his day off. Drove it into town and met me at his clinic after hours. I don't laugh at "horse" doctor jokes anymore!

Good lord, you're fighting some difficult diseases, you shouldn't have to fight with the doctors. Just light and prayers and positive thoughts for you, your kitties. They couldn't have a stronger advocate. We've got your back! And LL is with you every step of this most difficult journey. Feel the hugs, the encouragement, the you-go-girl thoughts coming from around the country.

Hugs. Big hugs. To you. To Cinco. To Harvey. To Sasha. To Minka.

Marilyn and Polly
 
Re: 12/4 Cinco UCD Visit Results

adding hugs from me too. i'm sorry you've had such a rotten day. It sounds very stressful. :YMHUG: :YMHUG: :YMHUG: :YMHUG:

I suspect you could teach the people you saw today about FD. I have no doubts that you know more about the management of an FD cat than they do.
 
My mom always told me, if I didn't have something nice to say, to not say anything at all.....so that is all I have to say about the *%()*$#)(% idiots who were giving you a hard time at the clinic


Sending you lots of hugs-n-prayers-n-healing vines for all your fur babies.....glad Minka's first chemo went well and hopefully you have news on Harvey soon. If it is IBD then at least you know that it is something manageable. I will say, when Skooter was diagnosed --- he was about 13 pounds and dropped to about 8 pounds and was vomiting and having diarrhea EVERYWHERE in my apartment at the time. For whatever reason after the surgery -- they ended up taking I think 10 biopsy samples -- it changed drastically. He now throws up every so often, but that is about it. Obviously he was able to put the weight back on....and them some. He got up to 16 pounds at one point and we had to do some work to get him back down to the 13 pound range. I spent the day and night of his surgery steam cleaning all the carpets in the apartment as he had to stay overnight anyways.

I will be sending prayers your way and hope to hear some good news soon on the Harvey front and that the *%()*$#)(% idiots at the clinic stop giving you a hard time, give you your needed script and let you go on your merry way and treat Cinco the way you want to and the way that has been working for a very long time. A little open-mindedness on their part will also be prayed for :)

Sending lots of love-n-hugs to you, the hubby and all da fur babies....
 
Thank you, everyone!!

Sienne, that information is invaluable and I will print it out and refer to it, if not show it to someone. I plan to ask about seeing Dr. Nelson. I don't know if he even sees patients, but I plan to try.

Yes, Liz, I absolutely would LOVE to have either Wendy or Sienne (or both) with me when I talk to the IM. They are both much smarter than I.

Really, Wendy? You read his papers for fun? I feel very shallow. ;-) I just read the Cat portion of the link you posted. Very interesting. Sounds like he does not subscribe to the TR protocol, but he is closer than the IM that was evaluating Cinco. Here are the comments on the Discharge Instructions I received yesterday:

"While we are impressed with all of the blood glucose checks you have been doing, Lantus is a long-acting insulin that requires a different management style, and the fact that he is becoming both hypoglycemic and hyperglycemic repeatedly is concerning.

We discussed Cinco's case with one of our internal medicine residents. She is concerned about the frequency of Cinco's hypoglycemic episodes. We understand that you are worried that his blood glucose has gone above 300 several times in the last two weeks (no, I'm not - I know why it did that). However, the dips in BG are both potentially dangerous in the short term and harming your ability to control his high numbers. When Cinco becomes hypoglycemic, his body releases multiple hormones to raise his blood glucose and alleviate any immediate danger; this can result in his BG overshooting and becoming high, and the effect can last multiple days. This is called the Symogyi Effect.

Dr. Y (the IM) would like you to reduce his insulin dose to 0.75 units twice daily and perform a blood glucose curve at home in 2 to 3 weeks. You can bring these results with you to your internal medicine appointment. It can take this long for cats to become regulated and settle into a stable pattern after a change in dose. The internists here rely less on tight daily regulation of numbers and more on clinical signs and periodic checks of fructosamine or blood glucose curves."

Elise, you make an excellent point. I wish I had thought to tell them I am using a human meter (they did not ask). That would make a big difference in the "hypo" events they site!

On a much happier note: The IM that saw Harvey today (not the same one that reviewed Cinco's info) was really nice and seemed pretty sharp. They did the ultrasound and blood tests. The BW will be back tomorrow. They "accidentally" did more tests than planned (for which they did not charge me), and she said his BUN was back to normal and Creatinine almost there! :-D She had explained to me earlier that how they obtained the biopsy would depend on where the most thickening of the intestine was. If in the front (duodenum), they could do an endoscopy down this throat. If in the back (ileum), it would be a colonoscopy through the rectum. If in the middle (jejunum), the only way to biopsy it is through surgery. Guess where Harvey's issue is? :roll: Yup, smack in the middle. She said they can do it arthroscopically, but it would still require anesthesia, so they have to do it in an operating room. Because he is not currently exhibiting much in the way of clinical symptoms (he's not throwing up or totally refusing to eat, etc.), it is not considered an emergency, and the surgery likely won't take place until after Christmas. Because it could be just IBD and therefore could be controlled by diet, she wants me to start him on the diet (Hill's Z/D) and we'll see how he does on that. Meanwhile, she'll request a surgery date. If he does well on the diet, she can cancel the surgery, but if he doesn't, or if he refused to eat it, the surgery will proceed. They gave me 12 cans of Hill's Z/D and a 4 lb bag of the dry. When we got home, it was clear he was hungry (no food since midnight, although they did offer Z/D at the hospital and he wouldn't touch it). Dinner time arrived and I served him a nice plate of Z/D and he ate it!!! He even got half-way through seconds! Minka thought his food looked more interesting than hers, so she had some, too! :roll: I didn't offer it to Sasha, but I might, as it is supposed to be for cats that have intestinal issues, and I think chemo patients qualify for that. The only one that can't have it is Cinco, as it is HIGH in carbs. The IM also told me that if he wouldn't eat the Z/D, she would give me instructions for preparing a home-made food for him that would do the same thing. I think that is a very viable alternative, as Harvey likes people food. She discontinued the Metronidazole, as she said it is more for cats with diarrhea.

Sorry for writing a novel. I just wanted to share all the info I have. I REALLY appreciate the feedback and support. :YMHUG:
 
The IM also told me that if he wouldn't eat the Z/D, she would give me instructions for preparing a home-made food for him that would do the same thing.
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I would be willing to hedge a bet that the home made diet will consist of boiled chicken and white rice. Our dog when I was growing up had to go on that diet for a few weeks. She was throwing up and sick and our parents were out of the country -- we didn't think she would make it and the vet had us use that recipe. Low and behold the day they got back, so was fine. Turns out she just missed them :roll: ohmygod_smile

I also have a friend who has a dog that has a lot of intestinal issues and that is her diet. She will spend an afternoon making it in batches and then she freezes it and pulls it out as she needs it. I think she said she can get like a month's worth done in an afternoon. It is a pretty big dog, so I am guessing she eats more than Harvey will :)

Perhaps Harvey's IM could weigh on Cinco if Dr. Nelson is not available?
 
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