8/25 FCC vet email

Acadaca

Acadaca

Member Since 2021
Thank you for the OTJ party and all the help. I hope everyone and everycat find themselves well today.

I sent FCC's spreadsheet to the vet since I thought it would be good for his records. He wanted to know what the results of the curve were when we first started, but we didn't sent him the info then because it was fairly obvious that he wasn't going to get behind our general strategy. Below is his response. Do I need to be concerned about any of it?? Also, if you don't want to call him Field Commander Cohen that's fair, but at least use FCC. Field is unnaceptable.



"I hope this email finds you and Field Commander Cohen well. Thank you so much for the update on his blood glucose values.

Unfortunately, based on those readings I am not able to give any recommendation in regards to insulin. The insulin dosage was changed periodically (every 5-7 days). Those changes will create a non-reliable blood glucose curve values. I usually recommend to maintain a dose for two weeks before a blood glucose reading. Any dose adjustment should be consulted with a veterinarian first. Then reassess the dose by doing the blood glucose curve (8 hours long).

I can see that Field is not receiving any more insulin currently. Those last values were more towards the low range of what we want to see. I would be recommending to see Field for some blood work (fructosamine). Fructosamine concentration is a marker of the mean blood glucose concentrations during the preceding 2 weeks. With this information I will have a better clinical picture in regards of the current status of diabetes.

I will recommend to monitor Field for any lethargy, vomiting, decrease appetite, drunk like behavior (incoordination). These are signs of hypoglycemia (low blood glucose). If any of these are seen, I will highly advice Field be seen by a veterinarian.

Please do not hesitate to contact me if you have any questions or concerns"
 
Oh my! I was hoping to read well done! Your vet clearly doesn’t know about TR and FCC would have gone hypo if you waited 2 weeks to change the dose. Kind of in insistent in advice as says he was low and yet wanted you to wait two weeks to change the dose. He’s not going to be hypo without insulin. I had to go back to make sure it didn’t say hyper! Do you like your vet other than when it comes the fd? If not I would look for a new one. If you do then continue to monitor as we suggest and after a few months of being under 100 you could get a fructosamine. What do you think?
 
tiffmaxee said:
Oh my! I was hoping to read well done! Your vet clearly doesn’t know about TR and FCC would have gone hypo if you waited 2 weeks to change the dose. Kind of in insistent in advice as says he was low and yet wanted you to wait two weeks to change the dose. He’s not going to be hypo without insulin. I had to go back to make sure it didn’t say hyper! Do you like your vet other than when it comes the fd? If not I would look for a new one. If you do then continue to monitor as we suggest and after a few months of being under 100 you could get a fructosamine. What do you think?
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I didn't expect well done. I actually thought I might get a bit of a lecture. When I found this site I knew I wanted to follow the protocols on here and follow all of the wisdom that has been passed down. I do understands that vets can't be experts in everything. I don't have much of an opinion of him one way or the other. I didn't get to see him when it came to FCC because of covid and I think I went there once with Typewriter. It has mostly been a matter of convenience since they've had decent reviews and are a couple blocks away (I don't drive). A new vet has opened up that is just as close and I do know that I can get FCC a ride to a different vet if need be.

If I monitor always and watch out for any changes in health do I even need to get a fructosamine test? FCC hates going to the vet. I don't want to do anything that compromises his health, but I'm not sure how useful a vet is in this situation? I know things can change quickly.

Thank you!
 
The fructosamine test is for the vet. It won't tell you anything that you don't already know. I always decline the fructosamine because I have a spreadsheet of numbers that will say the same thing as an expensive blood test. Sorry that this doctor has put a damper on an otherwise joyous time for you and FCC. He needs to read up in his endocrinology textbook on what it means to go off of insulin!
 
Wow! Just wow!

Wonder what he will say about a spreadsheet like Simba or Jaxon where they were in their 30s and 40s? Bring them for an immediate dextrose drip? Does he not know that you can't have hypoglycemia when not on insulin.

I agree with Katherine, the fructosamine test is a waste of money and unnecessary trauma for FCC...I mean Field! :rolleyes:

Look for a new vet if this one keeps this up.
 
You have real time info on his bg. The only reason I said you could do a fructosamine was if you really liked your vet and needed to see him. Otherwise there’s absolutely no reason for one. I agree with Katherine. Max had one curve and one fructosamine over the three years. The curve was after his first shot at the vet’s office. The fructosamine was because my vet thought Max might be in remission. He wasn’t.
 
Would be interesting to find out how many cats this vet has treated that have actually gone OTJ. Very few would be my guess.:rolleyes: Just follow the instruction that were posted as part of the OTJ trial instructions for post trial.

As for the fructosamine test, I always ask myself with vet suggested tests, what would I do differently the results. If the answer is "nothing" as it would be in FCC's case, I decline.
 
I'm happy to hear that the concensus is that I don't need to worry about the vet until I need a vet. I will definitely be checking into the new one that just opened up. Really hard to get in as a new patient with covid at the moment, but if Field Commander Cohen doesn't need to go in right now it doesn't matter.

I have no interest in subjecting him to anything that isn't necessary. I would like the reason for him to be grumpy to be me poking him without purpose rather than someone else. Don't get me wrong, the poking taking place on here is very purposeful. I just like to harass the cat.

I'm very comfortable following all the guidelines of the forum. I just wanted to make sure that I wasn't missing anything. I would imagine this vet hasn't had a ton of experience with FD. Although he is the same vet who tried to tell me that not only did I need a prescription for Lantus, but that I also needed to go to a specific pharmacy. Despite all this, I swear he's not as sketchy as it sounds.
 
Wendy&Neko said:
Not sketchy, in experienced. My vet was more used to dogs on insulin, but willing to learn. Aces on CKD, so she was a keeper and we learned together.
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Learning together is always a good thing. Sending me to a specific pharmacy was puzzling especially since it was far, but I don't think it was nefarious.

I am hoping I will find a vet that is close and open to me managing FCC's condition. I'm hoping even more that we don't have a reason to go to the vet for some time.
 
Ok, so I sent Pearl's vet her ss yesterday night for records, because she had been snippy (a bit) with me on the phone when I told her Pearl is currently trialing OTJ. If I could recall the message I would.This vet KNOWS me so well and how I am a researcher and medically experienced blah blah blah, but has been zero supportive about home testing etc. She was upset, and I really hope she can see reason when she looks at the BG spreadsheet. Aside from Pearl's FD journey, we have been on the same page about everything (perhaps she and your vet could be best buddies maybe).

Well done, both you and FCC!! I wish your vet could have said this.
 
Margaret (and Pearl) said:
Ok, so I sent Pearl's vet her ss yesterday night for records, because she had been snippy (a bit) with me on the phone when I told her Pearl is currently trialing OTJ. If I could recall the message I would.This vet KNOWS me so well and how I am a researcher and medically experienced blah blah blah, but has been zero supportive about home testing etc. She was upset, and I really hope she can see reason when she looks at the BG spreadsheet. Aside from Pearl's FD journey, we have been on the same page about everything (perhaps she and your vet could be best buddies maybe).

Well done, both you and FCC!! I wish your vet could have said this.
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Haha. Thank you. Your trial looks good so far. I'm just thankful I found this site and didn't follow his 2 units of Lantus then a curve ad infinitum. We are all definitely doing what is best for our kitties.

Suzanne & Darcy said:
No way your kitty can hypo when not receiving insulin. Don’t worry. Well done you! Don’t waste money on Fructosamine test
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I appreciate that. I don't think FCC wants to go back to the vet any more than I do so I think we'll just stick around here unless something goes awry with his health.

Hoping all the wonderful people on here and their kitties are fighting the good fight and doing well.
 
Congrats on the OTJ trial. Fingers crossed that FCC likes it and stays that way!

Based on the concern with lower numbers and the statements about watching for hypoglycemia, I’m wondering whether your vet isn’t completely familiar with the reference ranges that are applicable when using a human glucometer on a cat. It’s possible they’re used to “normal” being stated as 70-120 (ish), such as they see on lab work. It would follow that lower numbers could raise a red flag. I don’t agree with the other guidance about dosing and so forth, but many vets just don’t understand the nuances of FD or even that there are folks like us who are willing to put in the time/effort/expense to truly manage the disease as well as we do.

Just for the sake of being comprehensive, I’d like to clarify that it *is* technically possible for a cat who isn’t receiving insulin shots to go hypo BUT only under very specific and typically rare circumstances (such as when the cat has an insulinoma—a type of pancreatic tumor that’s uncommon in cats). I cringe when I see absolutes such as “it can’t happen,” and remember an older member quietly pointing out the exceptions in my early days on the board. The reality, though, is that barring some rare medical issue/disease, you shouldn’t have to worry about hypoglycemia as long as you’re not giving exogenous insulin shots.
 
JL and Chip said:
you shouldn’t have to worry about hypoglycemia as long as you’re not giving exogenous insulin shots.
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Agreed, provided there have been no insulin shots for a while. I've also seen the "can't go hypo" statement when someone skips just one shot. Unfortunately, the depot will still be around influencing what happens. As an extreme example, but a real one, look at Scooter's SS for Feb 19, 2014. Scooter's caregiver removed dry food from the house, she had thought he wasn't able to get into it. He proved her wrong by dropping below 50 14 hours after his last shot. :eek: Yes, that was 5.5 units to OTJ in one step.:woot: And a really long day and a half. Lantus (and Levemir) hypos can go on for hours.
 
Acadaca said:
Unfortunately, based on those readings I am not able to give any recommendation in regards to insulin.
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The vet should have stopped talking after making this comment.

It's sad to see that unfortunately many vets just don't know a thing about feline diabetes. I had that experience myself - had I listened to my first vet when Luci was diagnosed, she would not be with us today. His recommendation was for euthanasia. I chose a different path and Luci is here with us nearly four years later - fat and sassy - and yes, she's still on insulin - but she's happy and healthy otherwise. It's no big deal supporting a beloved pet for the rest of her life who has a chronic illness.

This vet could clearly use some time off to catch up on the literature - and if not, should just nicely say, I have NO experience treating feline diabetes - here's a recommendation for someone who has had more experience with it.

Thank goodness you found this group and have been able to support FCC correctly and now you're getting the rewards of your intelligent efforts! CONGRATULATIONS!!! Job well done!!:bighug::bighug::bighug::D:D:D
 
Thank you everyone for your replies, support, and information. I appreciate it and it is helpful as always. I want to reply to everyone, but I realize that would make a really long post.

I agree that I am very fortunate to have found this group. I wish that the vet would ask where I was getting all the information and help from because I think it would be wonderful if the link could be passed along with his next sugar kitty diagnosis. I read the room though and figured that wouldn't fly. I am not sure he read my email too carefully because I did mention that I was using a human meter and knew that they produce lower numbers. I find that the most helpful people are the ones who don't always think they have the answers. I might be being unfair to him though and it could just be that he's really busy and honestly didn't want to say anything without seeing FCC again. In the end it doesn't matter because FCC is still doing great and I am still going to try and keep learning. He will obviously be off to the vet if he needs to go, but for now that's not an issue.

The amount of posting, thought, time, and guidance on here is a testament to how many of you love not just your kitties, but all kitties.
 
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