whew, well that was an interesting vet visit! Different woman from last time, mostly I guess I liked her but once again, there was a bit of resistance regarding the home testing w/ human meters and the protocol.
short of things, first things first;
His weight had increased a bit since last visit in March to 8.9 lbs. Good
normal temp
she checked his ears and feared mites, but turned out just a mild bacterial infection. I need to use T8 Keto flush wash to clean them 1x a week, and administer Tresaderm drops 2x a day 12 hrs. apart for 2 wks. (another of his 'came with' and somewhat chronic problem, bad ears!)
she did know about acromegaly, and that is somewhat underdiagnosed and was not averse to testing for it at some point, but wants to rule out other things first. as she put it, not all diabetic cats have acromegaly, but all acromegalitic cats have diabetes! Same with the IAA.
Did draw blood and will do a CBC and what she called a pancreatic snap (now can't remember what that is exactly). Also mentioned possibility in future of pancreatic ultrasound? Because he had some blood work done not that long ago, not rechecking thyroid at this time. Last time a urinalysis was done, which had shown a slightly elevated WBC, but they didn't do a full culture, so they're doing that this time.
they currently do NOT have dental xray capability but are in the process of adding that (she is basically the head of this effort) she couldn't promise exactly when equipment will be in place, but hoped within 2-3 months. She does think he needs a dental, mentioning trouble around one of his top molars, but she wants to get his BG in better shape before doing it, and felt it could wait a bit.
She is very uncomfortable w/ the 6.25 dose right now, considering he was at 3.5 when he was last in on Mar 16. I tried to explain the steady increases via the protocol but she was a little hard to convince of this. She did admit that some cats do need more but she seemed a bit reluctant to think he was a likely IAA candidate. Her argument about the increases was that they were happening too aggressively, and that a given dose should be held for weeks, not days, or the body and organs don't have time to adjust properly. I tried to discuss the depot/shed with her, and she was kind of aware of it, but i could totally sense reluctance on her part to fully embrace all of this. She was skeptical of basing dosing on nadirs especially because of the meter variance and maybe not having enough tests. I showed her my spreadsheet so I don't know how she could think i am not testing enough! I noted that scans of the protocol were in my chart and that if she had a chance it might be good for her to look it over more carefully... guess we'll see...! Always that little bit of getting their back up "we study this in vet school and know all about diabetes"... Sigh. I explained i wasn't in anyway challenging or diminishing her knowledge...
I also tried to explain about the meter variance b/n human and alpha track, and that i am fully aware of the 20% variance on a human meter. She said the manuf. want human readings to read lower, so people pay more attention? So, she really felt that some of his greens in the 50s-60s were scary dangerous because of that 20% variance. I tried to explain that i was carefully monitoring him and that he showed no signs of distress and I was using food to help keep him up etc., as well as the 'feeding the curve' concept. She felt that is more a human diabetic strategy...
also, because my lantus is 5 mo. old (well, not exactly, I got it on Jan 26, so it's really more like 3.5 mos.), but she heard Jan and now it's May, so she thinks 5 mos. She strongly suggested getting a new vial but doesn't want me to go with 6.25 on a new vial. She suggested 4.0 units and ultimately did say "it's up to you of course but....".. Personally, i did have my concerns that perhaps the lantus was degrading since it is getting old. I know others get 6 mo. out of theirs and she was aware of that sometimes as well, but I can't say it hasn't been in my mind that part of why he's losing a bit of momentum could be older lantus...
So, I'm waiting for blood work results tomorrow, and the urine culture is 3-5 days wait unfortunately. This was an expensive visit, and then a new vial of lantus on top of it is really going to hurt. I called around again and it has gone up already since i last got it in Jan. For those who may not know, you can get it at CostCo even if you are not a member there. They currently had the best price of 5 places I called in town. I could go w/ the Marks canadian pharmacy too I suppose, but that's at least another week before I get it most likely.
I'm running out of time to pick up a vial this evening and wonder what others think about me waiting until I get all the test results back before worrying about getting the new vial (probably 3-5 days as I said). She is going to call me tomorrow w/ blood test results.
my head is spinning once again, and though I tried to be prepared and logical in my presentation of information, it still felt a bit like a uphill battle to override her skepticism about "Using the internet" to get knowledge. Sigh. I really wish they would just spend some time on the forum themselves to get an idea of the depth and breadth of knowledge on there. I guess overall she was glad I'm a strong advocate for my kitty and I do get the impression that we can work together. This is so exhausting though!
Oren was a brave little patient as usual and seems no worse for wear on his part.
I feel your exhaustion. I'm very lucky with Vyktors vet, he wasn't sold on how I was treating Vyktor's diabetes to start off with (they had never used lantus) but he did watch and at least realise that it wasn't unsafe and left me to it. He's very impressed with the results we had and now he does listen to my ideas on things and goes off to research them himself 
