4/15 Jack: 267@amps, 215@+2- insulin resistance tests update

Jack & Mopem'sMom

Jack & Mopem'sMom

Member Since 2020
Last post: https://www.felinediabetes.com/FDMB/threads/4-12-jack-281-amps-increased-to-10-5u.288710/

I took the weekend off from life because I wasn't feeling well and I just don't have anything good to say. I'm praying that Jack shows some action today or tomorrow on this dose. He generally waits until day 4 or 5 of an increase to do something, so maybe today is the day.

I never got a phone call from the vet, which is really upsetting, since I wanted to DISCUSS things, and found an email in my inbox last night that was apparently came in at 9:30pm Saturday night. I've pasted the main part of the email below; any thoughts/feedback would be greatly appreciated, especially regarding the internal med specialist recommendation- anyone have one they like that they work with or know anything about the clinic she is recommending? Also, cliff notes version of the fructosamine test? Thanks in advance--hope everyone has a good week and all the kitties surf safely!

"[Techs] will call you near the end of the week. Our charges usually would be double MSU's fee to us; industry standard is double to triple the MSU fees. This is to cover staff time in sample prep and packaging, and cover doctor time in researching and discussing results.

I do recommend adding a fructosamine level, also. This probably should be done through Antech due to shipping time. I definitely agree that we need to assess his insulin dose; a cat his size should usually do well with up to 8 units glargine , and he's taking more than that. There is also referral to Eastern PA Vet Referral in Allentown, or the internal medicine specialist of your choice, for further assessment if needed. The references I've found on glargine say that the main concern for the diabetic cat is how he is feeling: is he PU/ PD? are his energy levels good? If he's feeling great that is our goal, even if his numbers are not at textbook normal levels"
 
Morning Christine,I hope you're feeling better now.
I hope Jack starts to work the dose.
Glad you heard from the vet. Hopefully an experienced member will come along and comment on the vets e mail :bighug::bighug::bighug::cat:
 
Sorry - rant coming next. Double or triple the costs?!!!!! Seriously? That is not "industry standard". They charge for the blood draw, shipping, and MSU fees. There is not a lot of extra work beyond what they do to ship blood to Antech or Idexx. MSU can send them the mailer making it super easy. Charging for a vet to "research"?? Seriously, why should you be paying for a vet's education? OK - rant off.

I hope the vet is testing both IGF-1 and IAA? I would seriously skip the fructosame. The back half of the PM cycle is a little light on tests, but I don't see evidence you are missing a bunch of diving.

You might want to post in the Feline Health forum, asking for IM vets in the Eastern PA area.

Dose - it's time to forget the 0.25 unit changes. From 5 units to 10 units it's usually 0.5 unit changes but 0.25 if tweaking a dose with some green. Over 1 unit it's 1 unit changes if no green, 0.5 if there is some. Think of the increase as a percent of total dose.
 
Oh My.
I am seriously concerned about this vet. Not only did they not respond to you promptly, this cost thing is very strange.
Maybe to get a second opinion? I think @Wendy&Neko's suggestion to ask around is a good one.
Sorry you were feeling under the weather. Hope you have rested and started to feel better! :bighug::bighug::bighug:
 
Oh Christine, I am so sorry they are so disappointing and dismissive. I totally understand how you feel. It just makes our job so much harder when they just seem like they don't really care.
The vets in my area are also way overpriced as well. It's so insane.
Sending you s big hug for support. I get why you needed a mental health break over the weekend (same here).
Hoping Jack gives a good response to the increase and stays safe:bighug::bighug::bighug:
 
Wendy&Neko said:
Sorry - rant coming next. Double or triple the costs?!!!!! Seriously? That is not "industry standard". They charge for the blood draw, shipping, and MSU fees. There is not a lot of extra work beyond what they do to ship blood to Antech or Idexx. MSU can send them the mailer making it super easy. Charging for a vet to "research"?? Seriously, why should you be paying for a vet's education? OK - rant off.

I hope the vet is testing both IGF-1 and IAA? I would seriously skip the fructosame. The back half of the PM cycle is a little light on tests, but I don't see evidence you are missing a bunch of diving.

You might want to post in the Feline Health forum, asking for IM vets in the Eastern PA area.

Dose - it's time to forget the 0.25 unit changes. From 5 units to 10 units it's usually 0.5 unit changes but 0.25 if tweaking a dose with some green. Over 1 unit it's 1 unit changes if no green, 0.5 if there is some. Think of the increase as a percent of total dose.
Click to expand...
Hi Wendy, thanks so much for your input. Yeah, I just can't with the cost estimates--I don't have the energy for the arguments with them anymore. I guess it's the same everywhere. I shoulda become a vet instead of a teacher I guess. We ran both the IGF-1 and the IAA back in July of 2022, about 6 months after he was diagnosed and started insulin. Both came back solidly negative (on my SS under labs if you want to see the numbers) I thought maybe you or another experienced member (I'm sorry I can't remember) had commented a while back that the assay for the IGF-1 had changed, so since he is on so much insulin, there may be value in retesting the IGF-1(not the IAA since once negative, always negative?) and testing for Cushing's (even though there really aren't any symptoms that are 'classic Cushing's') I generally just get his bloodwork done once a year so I was considering scheduling an appointment for a body/coat/teeth condition checkup, a senior blood panel and the fructosamine which should be about $400 and look for the internal medicine specialist to discuss the other tests. I'm not really sure why she wants the fructosamine, I understand it gives an average, without the stress factor of driving the BG up, but since I do test as often as I do, I figured it wouldn't have too much value, but maybe I'll do it anyway. I do slack on testing overnight if he's over 150, I haven't been feeling great the past few months so I try to get sleep when I can. Maybe I'll try to set my clock over this coming weekend to get some more tests in when I can nap during the day (Sat and Sun) I kinda get the feeling the vet doesn't want/can't deal with Jack anymore. I just don't know- I must say I was pretty shocked by the email response. It's not like her.
 
Wendy&Neko said:
Dose - it's time to forget the 0.25 unit changes. From 5 units to 10 units it's usually 0.5 unit changes but 0.25 if tweaking a dose with some green. Over 1 unit it's 1 unit changes if no green, 0.5 if there is some. Think of the increase as a percent of total dose.
Click to expand...
I will go to .5 increases from now on. It just seems like sooo much insulin that I was being cautious. Thanks again for the advice
 
Mikanmama said:
Oh My.
I am seriously concerned about this vet. Not only did they not respond to you promptly, this cost thing is very strange.
Maybe to get a second opinion? I think @Wendy&Neko's suggestion to ask around is a good one.
Sorry you were feeling under the weather. Hope you have rested and started to feel better! :bighug::bighug::bighug:
Click to expand...
Yes, I will post in the forum @Wendy&Neko suggested. I just need to get out of work meetings today----
the cost is one of the reasons I'm so mad about lack of response- it's not like I go to a 'discount vet'---the owner charges a decent amount of money for services and the medicine/lab markups are outrageous. Have been for a while--I remember ranting about it the first time I tested Jack for the IAA & IGF-1
 
You are right, once you've tested for the IAA, you don't need to pay the extra $20 something, or $40 or whatever the vet would charge for that. Did you ever read this post?
MSU VDL testing instructions for IGF-1 and IAA

Yikes on the fructosamine cost! It gives an average over two weeks. That doesn't tell you if he's been flat, or wild swings up and down that average to the same number. Home testing gives you more into. Fructosamine is great if you aren't home testing. This posts lists some of the advantages and limitations of the test: Reference Ranges for Fructosamine Test
 
Sending that dispassionate email instead of calling so you could have a discussion of options coupled with the fact that it took them a month to get that ridiculous email together, tells me they are not interested in having you as a paying client. I wonder if your vet was pressured by the clinic owner.

I'm not clairvoyant, but I see vet shopping in your future.

I'm sending positive supportive vibes for you and Jack so universe delivers a vet who is capable and willing. :bighug:
 
I am sorry you got that email instead of a phone call, that would be so annoying! My vet was always pushing for fructosamine, too, even with all the tests. It almost felt like they are checking boxes and cannot get out of that, sometimes!
I hope you will find a good IM vet that will be able to see the whole cat. Do you have a veterinary school close to you? That might be a good place to start.
 
JLS12 said:
Sending that dispassionate email instead of calling so you could have a discussion of options coupled with the fact that it took them a month to get that ridiculous email together, tells me they are not interested in having you as a paying client. I wonder if your vet was pressured by the clinic owner.

I'm not clairvoyant, but I see vet shopping in your future.

I'm sending positive supportive vibes for you and Jack so universe delivers a vet who is capable and willing. :bighug:
Click to expand...
Sadly, I'm ALWAYS vet shopping- there are just NO good options anywhere- my Mom lives in Queens, NY- she has the same problems- just with a higher price tag. No one gives a :spam: about the animals anymore. :(
 
Wendy&Neko said:
You are right, once you've tested for the IAA, you don't need to pay the extra $20 something, or $40 or whatever the vet would charge for that. Did you ever read this post?
MSU VDL testing instructions for IGF-1 and IAA

Yikes on the fructosamine cost! It gives an average over two weeks. That doesn't tell you if he's been flat, or wild swings up and down that average to the same number. Home testing gives you more into. Fructosamine is great if you aren't home testing. This posts lists some of the advantages and limitations of the test: Reference Ranges for Fructosamine Test
Click to expand...
Thanks for the info here. The fructosamine was quoted at $118; the visit $70, and whatever the senior blood panel costs made up the rest of the $400. I'm going to look into the IM specialist and maybe hold off on the fructosamine test- I can set my clock and get a 24hr curve this weekend and do my own damn average. I think @cecile & bella is probably right about checking boxes and not really knowing how to treat. Thanks again for all of your advice- greatly, greatly appreciated. It's sad that I get more help and conversation from strangers on an internet chat board than a vet clinic I've been going to for over 25 years.
 
You must log in or register to reply here.
Back
Top