7/24 Lucky AMPS 360 PMPS 72 Vet Questions?

[Luckyducky]

Hi everybody! I'm writing in with Lucky's numbers for today, and an update on his wobbly legs/visit to the vet. Here's his spreadsheet, as well as his numbers for today:

Readings for 7/24
AMPS 360
+9 103
+11 66
PMPS 72
+1 87

Lucky had a low PMPS (listed as +11 on the chart), and when I measured again at +15 he had a reading of 72. I assumed it meant his numbers were rising again so I gave him his PM shot after the reading. I thought I should mention it in case I made a mistake (I wasn't exactly sure how much of an increase would have been okay for going ahead with the shot).

As for the vet visit today: I mentioned in a previous post that Lucky's back legs were wobbly, and that I was going to bring him in to the vet if it hadn't improved by yesterday. Well, his legs did and didn't improve (last night they seemed better since he was able to run up the stairs, but this morning he was limping up the stairs again), so I erred on the side of caution and decided to bring him in to see the vet today.

It was a new vet this time, and while some of the information he told me sounded correct from what I've learned in the past few months, some of it I wasn't so sure about, and was hoping some of you might be able to give some perspective on.

First, the information I thought sounded right:

• 1. The doctor said that he figured Lucky's leg problem was likely neuropathy based on all of the symptoms he was seeing. He pinched into Lucky's foot/leg (I don't recall which) and Lucky flinched/kicked, which the doctor said was a sign that the nerves in his legs seemed fine. When he watched Lucky walk across the floor, though, he noticed that his foot placement seemed uncertain, and he figured it was a sign that his neural messages weren't properly reaching his legs, and that Lucky was mostly guessing from experience where his feet were supposed to go. He ordered blood work to check for other conditions, and I'll know the results in the next two days. Lucky seemed otherwise in good spirits at the vet's office (active, curious, purring, cleaning, etc.).
  
  2. The vet also found that Lucky's teeth are apparently a real mess, worse than the worst grading on his charts. :sad: The doctor mentioned that bad dental health can contribute to problems with regulation, and he placed Lucky on a liquid antibiotic called ClindoCure, since it appeared Lucky's gums were inflamed/infected. I think I really need to buckle down to clean his teeth daily now, because the doctor was convinced that Lucky needs some of his teeth removed (he explained that since Lucky isn't regulated yet he can't undergo anesthesia, so the procedure has to wait).

And here's the information I wasn't so sure about:

• 1. I got a strange impression that the vet might not be familiar with Lantus (the vet tech asked me how to spell it, and the doctor didn't say anything about it when it came up in our conversation). The vet instead said that if I wanted to get Lucky off of insulin in the future I would want to switch to using PZI once Lucky starts getting better regulated with the Lantus. Is that right? I actually don't know much about PZI, but I remember reading that Lantus was very good at helping cats get off of insulin, so I was kind of surprised. That said, Lantus doesn't seem to have been working too well for Lucky so far, and I wonder if switching to PZI might be a good idea given his inconsistent readings so far.
  
  2. When I explained to the vet that I was feeding Lucky the Fancy Feasts classics brand of canned food, he decided to prescribe Purina DM, saying that it was more nutritionally balanced for diabetic cats. I remember reading that the DM brand wasn't so good because it mostly has liver in it, but I was wondering if anyone had any experience or resources that say anything different.

Any help or insight you all can give regarding this experience is really appreciated. Part of me wants to trust vets, but another part also can't help thinking that they run a business, and so I have a hard time shaking off the doubt.

 

[Sienne and Gabby (GA)]

There are a couple of issues.

Dental: No matter how well you brush Lucky's teeth and despite being on an antibiotic, if Lucky's got problems that require an extraction, the antibiotics and brushing will not fix the situation. Gabby has had several dentals, the first of which she was not well regulated. It has never been an issue for my vet. The vet situation is a catch-22: dental problems interfere with getting a cat regulated but the vet won't do a dental until your cat is regulated. I'd suggest getting a consultation with a veterinary dentist.

Lantus vs. PZI: The vet likes PZI. The vet is also not current with the literature. Lantus did better at getting cats into remission than PZI when the two types of insulin were tested head to head. The journal article is attached.


Food: Vets love to recommend prescription food. If they sell it to you, they make a lot of money. They also typically get their training about nutrition from the sales rep that stop by their office to promote their products. Nutrition is probably one lecture in vet school. It's not just the issue that DM contains liver. It's primary ingredients (excluding vitamins and minerals) are: Liver, poultry by-products, meat by-products, water sufficient for processing, chicken, salmon, oat fiber, salmon meal. This food is primarily by-products. Compare this with Fancy Feast Chicken Classic ingredients: Chicken, chicken broth, liver, meat by-products, fish, poultry by-products. DM is a poor quality food -- largely by-products. You get better quality for less money and Fancy Feast is lower in carbs (although the DM is only 7%).

If the leg problem is neuropathy, Zobaline is a form of methyl B-12 that is formulated for diabetic cats. I think it's available through Amazon.

 

[Luckyducky]

As always, thank you so much for your insight and perspective Sienne. I've got to say, it's discouraging to hear that daily brushing and antibiotics aren't likely to affect/improve teeth that appear to require an extraction. I very well may get a consultation with a veterinary dentist in the coming weeks, but I have to get some other personal affairs in order first.

And thanks so much for the article comparing Lantus, PZI and Lente, it really clarifies the issue directly and clear as day. I thought the vet's insistence on PZI sounded strange, and I was getting a vibe that he was anxious to gain my confidence with an assertive disposition, but that he also didn't have an up-to-date understanding of the feline diabetes landscape. If it comes up again in future visits I'll make sure to show him the article, as it may change his perspective on PZI and improve his understanding of glargine.

And sure enough (much to my chagrin, looking back) the vet was the one that sold to me the can of Purina DM. Your comparison of the ingredients was very insightful, and I also happened to find an article that corroborates your post (albeit with the dry food variety) and notes that the food was apparently made prescription-only by the manufacturers as a marketing decision, and not a medical board. The next time I talk to the vet I'll have to ask him specifically why he wanted me to use Purina DM vs. Fancy Feast classics --- I'd hate to be in a position where his credibility would seem undermined, but on the same token I'd like to know if he actually had any valid reasoning that might not be easily noticeable (and if not, whether he's a worthwhile vet to keep).

I've also never heard of Zobaline before, but I'll be sure to check it out and see. Lucky's walking doesn't seem much improved since yesterday (though his numbers have gotten much better of late), so it would be great if Zobaline helped to improve any potential neuropathy he might be suffering.

Again, thanks so much for your help and guidance Sienne, it really is a blessing. If anyone else has any insight to provide as well it would be much appreciated, otherwise thanks again and I'll be back in a few days to report on Lucky's next set of readings.

 

[Sienne and Gabby (GA)]

One way to not step on the vet's toes too badly is to simply tell him you tried the DM and because it's higher in carbs than Fancy Feast, you noticed a change in Lucky's numbers. You can even tell him that the 2 - 3% increase in carbs made a difference. To be honest, I had a similar discussion with my vet when Gabby was first diagnosed. Once she was comfortable that I understood that regulating carbs was important for Gabby's health, she backed off on the food issue. I simply told her I could buy a better quality food that was lower in carbs and in price than the prescription food she had suggested. (You can buy a human grade cat food, like Wellness, at a lower cost than the prescription stuff. I also returned a few cases of the canned food. Or, simply tell the vet that Lucky won't eat the DM. It will neatly sidestep any further discussion.

If you end up getting the Zobaline, don't expect an overnight change. It can take a couple of months to notice a difference.

 

[Vyktors Mum]

My vet tried to insist on DM too. He gave up when I took in the food I was feeding and compared the ingredients with the DM and I asked him which one he thought contained only products suitable for cats :lol:

If you want to see what a difference a dental can make to trying to get a cat regulated check out Vyktor's ss...

 

[tortie58]

I got the Zobaline Methylcobalamin B12 from www.ilifelink.com
Rosy has been taking one tablet per day since April. She was pretty bad at that time, barely walking on her rear hocks. It just came all of a sudden.
Some improvements since then still need to take it. I didnt notice too much improvement but my DB, who saw her once in awhile said Rosy's walking much better than before.

 

[Luckyducky]

@Sienne: Thanks for the advice, dealing tactfully with vets is something I can always use help with. By a stroke of 'luck' , Lucky actually stopped eating the DM food after the 2nd time of feeding it to him (he snubbed it, and ate the Fancy Feast when I gave it to him instead), so I was able to tell the doctor that he didn't like it. I still need to ask the doctor about Zobaline though, so we'll see how that goes.

@Vyktor's Mum: I looked at your SS, and was super-surprised by Vyktor's amazing improvement only a few weeks after his dental. It encouraged me to go forward with a full cleaning for Lucky this coming Tuesday (more on that in a second), so thanks very much for letting me know your experience.

@Tortie58: Thanks to you too for letting me know your experience with Zobaline, it helps to put its long-term nature into perspective. Recently Lucky seems to be walking less than normal, and I'd really start to worry if he wound up walking on his hocks too, but we'll see. I hope Rosy gets better with time too, it must be really difficult to see her in that kind of condition. :sad: I hope her walking returns to normal soon.

Lucky Vet Update: The doctor called me yesterday and let me know that Lucky's blood tests came out just fine. But strangely enough, in the same phone call he addressed all of the problems I mentioned in my first post. He first mentioned that, given all the tests so far and Lucky's poor regulation, he figured the best bet to address Lucky's diabetes was to go forward with a full dental. I agreed with him, and Lucky will be getting his teeth worked on this coming Tuesday (I hope it works out!)

The vet also addressed the Purina DM, which doubly surprised me. When I mentioned that Lucky didn't seem to like eating it, he asked if I happened to know the carb content of the Fancy Feast, and that so long as it was low carbs it was fine by him (and he mentioned that he recommended Purina DM mostly because it was the dietary brand he was most familiar with).

Finally, the vet addressed the Lantus vs. PZI. He seemed to tone down his previous emphasis for switching over to PZI, and made it more clear that it would be best to see how the dental goes and to try and get Lucky regulated on the Lantus first. He mentioned that different cats can react to different insulins differently, and that if Lantus didn't work out in the long term it might be a good idea to switch over to PZI.

I was really glad for all of his clarifications and the less resolute disposition, though the subtle change in tone and the addressing of each of my "worry points" makes me wonder if he might have discovered this thread. :!: I had given him a copy of Lucky's SS and he was very surprised at the chart's complexity (the designer of the spreadsheets really has an amazingly organized design-sense) along with the amount of data that had been collected the past few months, and when I mentioned the Tight Regulation protocol he said he wasn't familiar with it, so I wonder if the combination might have made him curious enough to go online and do some research. In any case, if he did go online to get a better/more current understanding of the feline diabetes community, that's a thumbs up in my book (though it does make me a bit self-conscious :lol: ).

 

[Sienne and Gabby (GA)]

It sounds like your vet is curious! You may want to share this paper that discusses the TR protocol (and is from a vet journal) and the research outcomes of the clinical trial with your vet. I sent it to my vet. (She got a very quizzical look from me when she started to tell me about the TR protocol some months later. I had to remind her I sent her the paper.)