3/3 Binx AMPS 77, +2 92, +4 92

[Briana + Binx]

Last post

We had our appointment with the internist today. I decided not to fast Binx and thank goodness, there was absolutely no need... which frustrates me.

I started the appointment hopeful and excited, especially once I found out the doctor herself once had a diabetic, acro kitty. She seemed knowledgeable and like she’s kept up with research/knew about all acro treatments but ultimately, it all feels like a big waste of time.

My frustrations:
- She seemed very forceful with telling me 0.25 unit changes (even at lower doses) is not a real thing. Repeated it multiple times and even seemed like 0.5 wasn't all that necessary. Tried to push me to switch to a pen and said syringes aren't accurate enough... even though apparently 0.25 units doesn't make a difference, so why should minor syringe differences have an impact.
- She suggested treating his hyperthyroidism above all it seems, as she suggested forgoing the medication path and trying him on a new vet thyroid diet (since his values were low enough it might make the difference alone). When I asked about carb content she said I shouldn’t focus on that since with acro now, his insulin needs have changed. She then went on to say that her cat was up to 26 units twice daily, so we shouldn't focus on diet... even after I mentioned Binx is carb sensitive. I checked the carb content of the thyroid food after... 34%!! It was at this point I stopped taking anything too seriously and realized we weren't going to get what we needed from the appointment.
- She pushed vet food in general, saying that otherwise it's unregulated and varies too much. When I mentioned trying to get him onto a low pho food(for his kidneys), she said it's not necessary with CKD S2 but it has no negative impacts, so it's up to me. Also up to me if I don't want to switch him to vet food (which I don't).
- She basically recommended treating his acro with diabetes control and cited that Cabergoline only saw diabetic improvements in 25% of cats (I think the paper Wendy sent me saw 35% remission, but ECID and I am not looking for that outcome with Binx anyways)... and we didn't even really touch on SRT, as she seemed to joke it's inaccessible and only available in one place in the province (which I already knew from Wendy).

She did say Binx looked in good condition and that his diabetes and health seem to be under good control. His liver may be slightly enlarged but no other obvious signs of acro/other issues. I did also ask her to source Cabergoline and provide a cost, so I will be getting that on my own insistance.

Ultimately, it seems I will making decision on his course of treatment myself (and with the help of this community). So my plan is to start him on his hyperthyroid treatment (pills, not food). Recheck his blood work in 3 weeks time, thyroid and kidney values. After that, I will consider when to start Cabergoline depending on availability and cost. I will also continue with his transition to a low pho diet, and I will not be switching him to a vet prescribed diet.

I'm so frustrated with the whole experience. The time I spent, the money I spent. I should've realized when they asked me to fast him that this was going to be a generic consult, with no consideration for what Binx specifically.

Sorry for the rant. Thanks all for listening. Hope everyone is having a more positive Tuesday

 

[Staci & Ivy]

Last post

We had our appointment with the internist today. I decided not to fast Binx and thank goodness, there was absolutely no need... which frustrates me.

I started the appointment hopeful and excited, especially once I found out the doctor herself once had a diabetic, acro kitty. She seemed knowledgeable and like she’s kept up with research/knew about all acro treatments but ultimately, it all feels like a big waste of time.

My frustrations:
- She seemed very forceful with telling me 0.25 unit changes (even at lower doses) is not a real thing. Repeated it multiple times and even seemed like 0.5 wasn't all that necessary. Tried to push me to switch to a pen and said syringes aren't accurate enough... even though apparently 0.25 units doesn't make a difference, so why should minor syringe differences have an impact.
- She suggested treating his hyperthyroidism above all it seems, as she suggested forgoing the medication path and trying him on a new vet thyroid diet (since his values were low enough it might make the difference alone). When I asked about carb content she said I shouldn’t focus on that since with acro now, his insulin needs have changed. She then went on to say that her cat was up to 26 units twice daily, so we shouldn't focus on diet... even after I mentioned Binx is carb sensitive. I checked the carb content of the thyroid food after... 34%!! It was at this point I stopped taking anything too seriously and realized we weren't going to get what we needed from the appointment.
- She pushed vet food in general, saying that otherwise it's unregulated and varies too much. When I mentioned trying to get him onto a low pho food(for his kidneys), she said it's not necessary with CKD S2 but it has no negative impacts, so it's up to me. Also up to me if I don't want to switch him to vet food (which I don't).
- She basically recommended treating his acro with diabetes control and cited that Cabergoline only saw diabetic improvements in 25% of cats (I think the paper Wendy sent me saw 35% remission, but ECID and I am not looking for that outcome with Binx anyways)... and we didn't even really touch on SRT, as she seemed to joke it's inaccessible and only available in one place in the province (which I already knew from Wendy).

She did say Binx looked in good condition and that his diabetes and health seem to be under good control. His liver may be slightly enlarged but no other obvious signs of acro/other issues. I did also ask her to source Cabergoline and provide a cost, so I will be getting that on my own insistance.

Ultimately, it seems I will making decision on his course of treatment myself (and with the help of this community). So my plan is to start him on his hyperthyroid treatment (pills, not food). Recheck his blood work in 3 weeks time, thyroid and kidney values. After that, I will consider when to start Cabergoline depending on availability and cost. I will also continue with his transition to a low pho diet, and I will not be switching him to a vet prescribed diet.

I'm so frustrated with the whole experience. The time I spent, the money I spent. I should've realized when they asked me to fast him that this was going to be a generic consult, with no consideration for what Binx specifically.

Sorry for the rant. Thanks all for listening. Hope everyone is having a more positive Tuesday

Oh Briana, I am so sorry it was so disappointing. What a big bummer

I would also be taking the same approach and not even think about the vet diet, being so high carb and the advice to just ignore the diabetes seems crazy.

And there's no way I would give higher dose increases than .25 units.

A previous vet of mine wanted me to do 1 unit increases (and suggested no testing was necessary), I was a newbie and knew nothing.
It all "felt wrong" to me and it led me to researching and finding this website (thank God!)

I think there's something about knowing our own cat and intuition of what is best for them.
Even if it's eliminating the things you just can't live with and taking some suggestions into consideration.

Did she even discuss I131 treatment for hyperthyroid?
I can't even imagine why they wanted Binx fasted....why?
So glad you didn't do that!

Sending you both lots of hugs, I know you need them

 

[Briana + Binx]

Oh Briana, I am so sorry it was so disappointing. What a big bummer

I would also be taking the same approach and not even think about the vet diet, being so high carb and the advice to just ignore the diabetes seems crazy.

And there's no way I would give higher dose increases than .25 units.

A previous vet of mine wanted me to do 1 unit increases (and suggested no testing was necessary), I was a newbie and knew nothing.
It all "felt wrong" to me and it led me to researching and finding this website (thank God!)

I think there's something about knowing our own cat and intuition of what is best for them.
Even if it's eliminating the things you just can't live with and taking some suggestions into consideration.

Did she even discuss I131 treatment for hyperthyroid?
I can't even imagine why they wanted Binx fasted....why?
So glad you didn't do that!

Sending you both lots of hugs, I know you need them

Thanks, Staci

Can't believe you were previously told to increase by 1 unit, with no testing... crazy. I guess that little voice in our head leads a lot of us here and I'm glad there's a place for us to find when we do go searching.

The fasting request is definitely a generic comment for all that come to see one of their internist. I get that a lot of people go to run diagnostics and get unanswered questions answered... but that wasn't the case for us and I wish they took some time to understand that before making the request.

She briefly mentioned I131 treatment but said we'd want to try other treatment first, see how he responds, before diving into that... this was what I thought as well, but she didn't go into further detail there and I felt so checked out that I stopped pushing follow-up questions.

 

[Tim & Pookey]

Gosh, I’m sorry Briana. I’ve felt that before too when you hear something that you know is just wrong or generic high-level advice and you just check out. That pushed me away from my previous vet, like they didn’t consider my actual situation and cat at the time.

Your plan sounds reasonable to me. I’m sure it’s frustrating to feel alone too in the decision making. You know we’re all here to talk and help anytime.

 

[Jessica & Indy]

My vet also tried to get me to do whole unit increase and decrease the first time Indy was diagnosed. I have since learned better. Indy is on such a small dose, I couldn't imagine what would happen if I tried to more than double his dose....like wow. That vet appt sounds ridiculously frustrating. I'm so sorry you went through that.

 

[Allie & Gen]

Huh, I find it rather weird that they have a generic requirement/request for fasting! The scheduler for the internist I'm going to see later this month was very clear about the first appointment being a consultation only (I made a point of asking, as I was hoping I could make an appointment for a biopsy right away, but they won't do that without a separate appointment to see Gen first - this seems to be standard with specialists around here even if one's own vet has already recommended a particular procedure).

I can relate to a lot of what you're saying after recent appointments. I am so confused about why so many vets are so insistent about "vet food" - I really don't buy that it's likely just about commissions, laziness, etc. For some vets, maybe, but mine keeps up with research, listens to me, and clearly cares far too much about animals to try to "sell" me on a given brand just for the selling's sake. (She has rescued ... so many difficult-case animals herself.) But she was still recommending I give him prescription single-source protein foods which are 30-40% carbs for his IBD trial.

She said that sometimes you have to focus on one condition even if it's worse for another one, at least temporarily, which it kind of sounds like this specialist was gesturing towards as well. This is something I understand as potentially medically necessary at times - for humans, too. But in Gen's case I found so many options that wouldn't have required such a dramatic tradeoff! They just apparently weren't options she felt were trustworthy. She generally goes along with my judgement on things like this, but her concerns about the severity of Gen's symptoms made her push hard - she clearly has faith in the preparation protocols that these "vet" food companies use. I'm not finding the evidence to back it up, but I also don't think she's being lazy or failing to use critical thinking. I feel like I'm missing something.

Sorry for all the unrelated blather about Gen's individual circumstances, but in brief: there's a huge disconnect between attitudes towards "vet" foods and I don't think I adequately understand it! And that drives me nuts.

While I have a hard time writing off my vet's recommendations, though, I must say, this specialist has some weird ideas about insulin dosing. We've all seen the difference .25u or .5u can make. That would really affect my ability to trust her, all on its own, especially if she wouldn't listen.

Anyway, you know Binx best! I'm sorry it was such an unsatisfying experience overall. You know we're here to support you while you figure out how to proceed.

 

[Albert & Xander]

I'm sorry to hear about the experience! I've had that experience with vets, as well as with HUMAN doctors all the time. They know a great deal and have years of experience, but aren't infallible and need double-checking.
Even with my current new vet which I love, there have been suggestions that I don't agree with such as a low-fat higher carb rx diet for pancreatitis. I think your current plan sounds reasonable, and its totally acceptable to trust your own well-founded research over authority. I've had to do so with Xander's diabetes in the beginning (with this site saving Xander).
You put in a great deal of time researching what is best for Binx and will no doubt end up making the best choices for him

 

[Briana + Binx]

Gosh, I’m sorry Briana. I’ve felt that before too when you hear something that you know is just wrong or generic high-level advice and you just check out. That pushed me away from my previous vet, like they didn’t consider my actual situation and cat at the time.

Your plan sounds reasonable to me. I’m sure it’s frustrating to feel alone too in the decision making. You know we’re all here to talk and help anytime.

Thanks, Tim I hate that we've all experienced the same thing.

While the decision ultimately falls on me now, I'm lucky to feel so supported by everyone here that it's not so lonely in the end. I know we've all felt that way at some point, which is a better communal feeling to have.

 

[Briana + Binx]

Huh, I find it rather weird that they have a generic requirement/request for fasting! The scheduler for the internist I'm going to see later this month was very clear about the first appointment being a consultation only (I made a point of asking, as I was hoping I could make an appointment for a biopsy right away, but they won't do that without a separate appointment to see Gen first - this seems to be standard with specialists around here even if one's own vet has already recommended a particular procedure).

I can relate to a lot of what you're saying after recent appointments. I am so confused about why so many vets are so insistent about "vet food" - I really don't buy that it's likely just about commissions, laziness, etc. For some vets, maybe, but mine keeps up with research, listens to me, and clearly cares far too much about animals to try to "sell" me on a given brand just for the selling's sake. (She has rescued ... so many difficult-case animals herself.) But she was still recommending I give him prescription single-source protein foods which are 30-40% carbs for his IBD trial.

She said that sometimes you have to focus on one condition even if it's worse for another one, at least temporarily, which it kind of sounds like this specialist was gesturing towards as well. This is something I understand as potentially medically necessary at times - for humans, too. But in Gen's case I found so many options that wouldn't have required such a dramatic tradeoff! They just apparently weren't options she felt were trustworthy. She generally goes along with my judgement on things like this, but her concerns about the severity of Gen's symptoms made her push hard - she clearly has faith in the preparation protocols that these "vet" food companies use. I'm not finding the evidence to back it up, but I also don't think she's being lazy or failing to use critical thinking. I feel like I'm missing something.

Sorry for all the unrelated blather about Gen's individual circumstances, but in brief: there's a huge disconnect between attitudes towards "vet" foods and I don't think I adequately understand it! And that drives me nuts.

While I have a hard time writing off my vet's recommendations, though, I must say, this specialist has some weird ideas about insulin dosing. We've all seen the difference .25u or .5u can make. That would really affect my ability to trust her, all on its own, especially if she wouldn't listen.

Anyway, you know Binx best! I'm sorry it was such an unsatisfying experience overall. You know we're here to support you while you figure out how to proceed.

Thank you, Allie! Please don't apologize, it's actually incredibly helpful to hear your experience - to know about what's happening with Gen and also how your appointments are structured. It's too bad they wouldn't let you get the biopsy right away... all we want is for the case to be understood and the appointments to be planned accordingly, which I guess I can see why a consult first would work but your case is different.

The vet food also confuses me. Especially for what she said for Binx, because his thyroid values are still pretty low so it seemed dramatic to ignore the diabetic requirements in favour of the less severe condition... and that could also be treated through other means. She mentioned her friend worked on the formula for the thyroid food, which made a little suspicious too. Generally I could see the benefit of a vet food, I started Binx on one and it was fine, but for access and cost reasons, it just made more sense to switch. And honestly, it works. Why try to change something that works!

Like you said too, if you've found options that can work for both the IBD and diabetes, aren't they worth the shot? Understandable your vet may be wary of them, because they probably are less regulated than vet food, but if the combo options work, wouldn't that be great! I so hope that they do, btw.

Appreciate the support and kind words. Lucky to have this group

 

[Briana + Binx]

My vet also tried to get me to do whole unit increase and decrease the first time Indy was diagnosed. I have since learned better. Indy is on such a small dose, I couldn't imagine what would happen if I tried to more than double his dose....like wow. That vet appt sounds ridiculously frustrating. I'm so sorry you went through that.

Thanks, Jessica It would be crazy if you had to up Indy to 2 units!! Can't believe so many people have gotten that direction.

 

[Briana + Binx]

I'm sorry to hear about the experience! I've had that experience with vets, as well as with HUMAN doctors all the time. They know a great deal and have years of experience, but aren't infallible and need double-checking.
Even with my current new vet which I love, there have been suggestions that I don't agree with such as a low-fat higher carb rx diet for pancreatitis. I think your current plan sounds reasonable, and its totally acceptable to trust your own well-founded research over authority. I've had to do so with Xander's diabetes in the beginning (with this site saving Xander).
You put in a great deal of time researching what is best for Binx and will no doubt end up making the best choices for him

Thanks, Albert This site saved Binx too, it's incredible.

Sorry you've had the same experiences with vets (and human doctors). I'm glad your current vet is more trustworthy and at the same time, you still feel comfortable to advocate for when you disagree and ultimately, make the right choices for Xander. We have to trust ourselves too.

 

[Lisa & Lady Arya Stark 🦋]

Very interesting thread. Why is it that we pay them a small fortune and we get better advice on a voluntary website? Blows my mind! If I hadn’t found you wonderful people Arya would be on 2u (at 3kg!) and not tested prior to shot.
Interestingly I was on cabergoline for ten years… took me having to self diagnose after seeing different GP’s for years who kept just trying to push me on to anti-depressants for my “symptoms” (that they obviously thought were imaginary until I demanded a certain test and they discovered a tumour on my pituitary gland- JUST LIKE I TOLD THEM!! )
Sorry… now I’ve gone off topic and made it all about me! I just find it interesting that they use this drugs for cats.

Great chat… Brianna - we’re keeping our toes and paws crossed and in all honestly I’d never go anywhere near those vet prescription foods like HILLS- they recommend them becaus HILLS sponsors vet schools … Truth about Pet Food - Knowing the truth can save your pet's life

 

[Laurie&Petey]

That sounds terribly frustrating! It's not like your knowledge isn't backed by real science, ugh! I need to make a check up appt for Pete and so dreading it.

️

 

[Mary & Jude]

Briana, I'm so sorry you weren't more supported by the doctor. I think your plan sounds like a good one. You're thinking about which of these illnesses needs to be more closely regulated. And, I would think that his FD is super important, since if you don't try to keep him somewhat regulated, you run the risk of DKA or other damage to his internal organs if he were chronically left in higher numbers. Of course the CKD and thyroid are important as well, but I think your plan to medicate and try the lower Ph foods are good attempts to treat those two (and the higher carbed food isn't!). I wish I knew more about thyroidism vs. FD, especially in light of her favoring treating the thyroid issue as primary over the FD (if I'm understanding what you're saying correctly). I guess her thinking is that you get the thyroid regulated with food and just dump insulin into Binx to keep his numbers somewhat low?? So complicated!! You two will be in my thoughts as you try to make the best decisions for Binx.

 

[Wendy&Neko]

Ugh, sorry about the vet visit. Have you ever read this page: Feline Hyperthyroidism Especially what she says about the Hills special food. I've had a couple people tell me that the sales reps from Hills teach the nutrition class (less than a day) at vet schools. Perhaps that explains a few things.

BTW, if your kitty was at 26 units, we'd be suggesting larger increases like 1-2 units. But Binx is no where near that.

Any chance your local practice vet is interested in learning along with you? Neko's vet had never seen an acro kitty, and after I finally managed to convince her to do the testing, was willing to learn. And very shortly after realized she had another acro in her practice. I declined the consult with the IM vet when Neko's vet first suggested it, I had faith in my vet until Neko got even more complicated.

@Lisa & Lady Arya Stark 🦋 Fascinating to have a human with a pituitary tumour on here. We had one another member years ago, but that was before my time and well before Cabergoline was an option. Many of us have had to really work our vets to get tests done on our cats too.

 

[Briana + Binx]

Very interesting thread. Why is it that we pay them a small fortune and we get better advice on a voluntary website? Blows my mind! If I hadn’t found you wonderful people Arya would be on 2u (at 3kg!) and not tested prior to shot.
Interestingly I was on cabergoline for ten years… took me having to self diagnose after seeing different GP’s for years who kept just trying to push me on to anti-depressants for my “symptoms” (that they obviously thought were imaginary until I demanded a certain test and they discovered a tumour on my pituitary gland- JUST LIKE I TOLD THEM!! )
Sorry… now I’ve gone off topic and made it all about me! I just find it interesting that they use this drugs for cats.

Great chat… Brianna - we’re keeping our toes and paws crossed and in all honestly I’d never go anywhere near those vet prescription foods like HILLS- they recommend them becaus HILLS sponsors vet schools … Truth about Pet Food - Knowing the truth can save your pet's life

And look at her now!! It blows my mind as well, Lisa

Agreed with Wendy, so cool to have a personal human experience here with a pituitary tumor! The human drug needs to be compounded to be used for kitties, but it's been shown to work! Pretty impressive stuff. Sorry you had just as bad an experience with human doctors... we're always having to advocate for what we know to be true!

Thanks for the support, Lisa Interesting read on the pet food too! Ugh, how bad.

 

[Briana + Binx]

That sounds terribly frustrating! It's not like your knowledge isn't backed by real science, ugh! I need to make a check up appt for Pete and so dreading it.

️

Ugh indeed, Laurie!!! Totally understand your dread for booking the appointment too. Hope all is good with Petey though

 

[Briana + Binx]

Briana, I'm so sorry you weren't more supported by the doctor. I think your plan sounds like a good one. You're thinking about which of these illnesses needs to be more closely regulated. And, I would think that his FD is super important, since if you don't try to keep him somewhat regulated, you run the risk of DKA or other damage to his internal organs if he were chronically left in higher numbers. Of course the CKD and thyroid are important as well, but I think your plan to medicate and try the lower Ph foods are good attempts to treat those two (and the higher carbed food isn't!). I wish I knew more about thyroidism vs. FD, especially in light of her favoring treating the thyroid issue as primary over the FD (if I'm understanding what you're saying correctly). I guess her thinking is that you get the thyroid regulated with food and just dump insulin into Binx to keep his numbers somewhat low?? So complicated!! You two will be in my thoughts as you try to make the best decisions for Binx.

Thanks, Mary 100% well said, which needs to be most closely regulated. You definitely understood correctly and I agree, I think she was thinking you can always give more insulin but why do that when I can manage it better with food and then manage the thyroid with medication! 6-7 units already feels like so much when I inject, if I can over those double digits, I'd like to. Of course, if the thyroid medication doesn't work out, then maybe I'd start considering other options... but we must try first!

Appreciate the support, always

 

[Briana + Binx]

Ugh, sorry about the vet visit. Have you ever read this page: Feline Hyperthyroidism Especially what she says about the Hills special food. I've had a couple people tell me that the sales reps from Hills teach the nutrition class (less than a day) at vet schools. Perhaps that explains a few things.

BTW, if your kitty was at 26 units, we'd be suggesting larger increases like 1-2 units. But Binx is no where near that.

Any chance your local practice vet is interested in learning along with you? Neko's vet had never seen an acro kitty, and after I finally managed to convince her to do the testing, was willing to learn. And very shortly after realized she had another acro in her practice. I declined the consult with the IM vet when Neko's vet first suggested it, I had faith in my vet until Neko got even more complicated.

@Lisa & Lady Arya Stark 🦋 Fascinating to have a human with a pituitary tumour on here. We had one another member years ago, but that was before my time and well before Cabergoline was an option. Many of us have had to really work our vets to get tests done on our cats too.

Thanks, Wendy

What a link!!! Thank you for sharing. Wow, just wow. Makes me even more frustrated thinking about how much she talked about this thyroid food.

When she was talking about getting to 26 units, I kept thinking about Neko never getting above 10 units. Her assumption that we will likely be reaching those numbers anyways was bothersome. I know ECID and Neko had SRT and that brought her numbers down for a good period of time... but like you said, Binx is no where near that high amount (and hopefully he doesn't have to get there, anti-jinx).

I do think my local vet would be up to learning along with me. One of the vet techs has a diabetic kitty and had him tested for acro as well, so I know at the very least they're believers. They are also believers in this internist though and we know how that went, but I don't think that would impact their desire to learn and support us through this.

Once I get the Cabergoline info back from the internist, I'm going to speak to my vet about doing everything through them.