Dispensing medical advice/direction

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NancyJac

NancyJac

Member Since 2013
I am still very new to this board and I have gotten some extremely useful information, helpful tips, and wonderful support when I felt totally overwhelmed. However, I had also received what is undoubtedly medical advice and directions overriding the advice and directions of my DVM (who happens to also be the President of the American Association of Feline Practitioners). I am very uncomfortable with that, not only for myself, but for other newly diagnosed or struggling diabetic cat guardians who might be more vulnerable to taking unprofessional medical advice. I don't think directing someone to change the dosage prescribed by their veterinarian who has examined, tested, and diagnosed their cat is appropriate and could cause great harm. I sure that every one means well, but even so I don't know you, you don't know me, more importantly you don't know my cat, and even if you are a DVM, you are dispensing treatment directions, sometimes based on nothing more than a single data point.

I am very happy to have found this forum and am grateful for the wonderful suggestions and information provided, but very uncomfortable with the dispensing of uncredentialed medical advice specific cat already under veterinary care.
 
I agree with you in principle. However, some new caretakers have posted here with totally inappropriate dose/insulin. I recall one vet perscribed Humalog, a very fast-acting insulin and R insulin, als a fast acting insulin. I also recall very high starting doses like 5 or 10 units. Vet directions like that are dangerous to the cats.
 
I'm sure that type of thing does happen from time to time, and suggesting that the caretaker might have misunderstood and recommending she clarify with her vet is appropriate. Arbitrarily telling her to change the dose from 5 units to 1 unit, or whatever is inappropriate.
 
I understand where you're coming from and why you may feel uncomfortable receiving dosing advice over the internet from complete strangers.There is a sticky at the top of this board called Suggestions for Advice Givers that is worth a read-through that goes into detail what responsibilities we take on when assisting each other.

The big difference here is that we're dealing with the day-to-day management of diabetes, which requires dosage changes and tweaks, the same as human diabetics need to adjust their doses, usually without their doctor's oversight. There are human diabetes boards that are similar to what we do here. And humans even have the added benefit of having a diabetes specialist for a doctor vs. a general practitioner (which, in most cases, is what we get when it comes to vets). Short of living with your endocrinologist or your vet (or leaving your cat at the vet's indefinitely), there is no real way to manage this disease on a daily basis without outside help.

Part of the reason this board exists is to provide that outside help. Everything here is peer-reviewed and many of us have been dancing this Sugar Dance for years, some with multiple cats. If someone tells you something that might be potentially dangerous, there are dozens of others who will immediately chime in and warn of the danger...even if that "someone" is the vet. The greatest vet in the universe is still human and can make mistakes. Cats are known to be unpredictable and can do things that the vet wouldn't be able to account for. Maybe the vet is uncommunicative and you need a response before the next shot time and they still haven't called you back. Maybe the vet is prescribing the wrong type of insulin because they're not up-to-date on the latest research. Maybe the vet is prescribing the wrong dose because they're used to working with an older insulin. Maybe the vet is simply a "bad" vet and they need to be fired.

There are a lot of potentials and possibilities when it comes chronic, life-long illnesses that even the best vets can't keep up with on a daily basis and that is where this board steps in. I've been active on this board since October and I have seen more than my share of vets overdosing cats to hypoglycemic levels and telling people to still give 5u when the cat's BG level is at 60. Curves at the vet are notoriously inaccurate because stress hyperglycemia can spike the BGs up by 100-200 points or more, so the deciding dose based on those numbers is usually too high. I have sat through many a hypo watch with a new member who overdosed their cat per their vet's instructions and there are many members who have joined here because they were getting tired of weekly or monthly hypo visits to the ER and felt there was a better way of managing this disease instead of blindly trusting their vet. That, to me, is the cause of the greatest harm.

My personal experience is that my own vet was willing to learn right along with me and loves seeing the positive results and wishes more of his diabetic cat owners would follow suit. In fact, many people's vets on here are supportive of this site because they can see the difference in our kitties and there are numerous members who have joined here at the encouragement of their vet. In 10 months, I have not yet seen a single cat end up in a hypoglycemic coma (or worse) from following the dosing advice given here. We raise and lower doses by .25u to .5u at a time. Most vets raise by whole units. We strongly advocate home-testing so you can tell how the dose is working. Most vets don't even mention home-testing as an option. We tell new users to never shoot a pre-shot under 200. Vets who don't advocate home-testing are having the owners shooting at anything. If there is an emergency or a crisis or we don't feel the cat is safe, we tell the owner to take the cat immediately to the vet. We even help chip in on the vet bills if the cost might be a problem.

At the end of the day, you're the one holding the syringe. If you don't feel comfortable listening to the dosing advice, feel free to ignore it or discuss it or question it or ask for a second opinion from other members or even your own vet. Every single one of us is here because of our cats. Many of us came here because we weren't seeing the results we wanted and we knew there were better options out there. The help I received here when I first started out saved Michelangelo's life and now I'm simply paying it forward. :-D
 
I agree with Larry. I do not give dosing advise. Many times people are given a starting dose by their vet and they start their cats on a low carb diet and the vet says come back in 2 weeks. Their cat's sugar starts to come down on a low carb diet and that cat is given the same dose of insulin they were started with and that cat goes hypo. I have seen that happen here. Many vets do a glucose curve in their office. Many times a cat's glucose will be higher at the vet due to stress and those cats are ordered a higher dose of insulin based on that curve when if a curve done at home may show lower numbers. Home testing is the key. Many vets do not even offer this to their clients. I do agree that people should be careful about giving advise. Every cat is different. I believe that many people share personal experiences and what has worked for their cats. Not all vets are very comfortable with dosing insulin. I'm lucky that I have a great vet. She is also a cat doctor. You must also keep in mind that there are members here that are financially strapped. Not everyone can keep going back to the vet. I feel for people who are trying to help their sick cat and can't really afford this expense but they try to do the best that they can. I'm sure someone may chime in but I do believe there are some stickys about giving advise.
 
However, I had also received what is undoubtedly medical advice and directions overriding the advice and directions of my DVM (who happens to also be the President of the American Association of Feline Practitioners).
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Nobody here is an "expert" on feline diabetes. Unfortunately, that is true of most vets as well. I considered my vet to be an incredible person, extremely professional, and extremely willing to work with me. If that were not the case, she wouldn't still be my vet. But she isn't, nor does she consider herself to be, a Feline Diabetes expert. She told me that she sees, on average, about 3 new FD cases per year. So in her career, she's seen about 100 of them. "We" get more new members than that in a year's time. And the overwhelming majority of the "new cats" that come here aren't under the care of a vet who knows anything close to what my vet knows. Or if they do, then the advice they have given the caregivers who join the board don't reflect that they know much about feline diabetes.

Most cats come here without the benefit of what has been proven over the last decade or more to be the best way to manage feline diabetes:

1 - low carb, not dry food, diet.
2 - proper insulin that has been proven time and again to work best for cats - Lantus, Levemir, or Prozinc
3 - regular home testing which is used to evaluate the appropriate and SAFE dose based on daily data collection.

Your vet gave you a good insulin.
Your vet prescribed a safe and logical dose of Lantus that agrees with the standards published by the AAHA guidelines.
Even though Purina DM is a good choice of food, as it is low-carb, as you already realize, you can use less expensive brands that are just as low-carb, and just as high quality.
In other words, your vet seems to be one of the "good ones", and you should consider yourself very fortunate.

Your vet is completely wrong about the meter, and telling you that a human meter isn't good enough or accurate enough to manage the condition. But two out of three isn't bad. ;-)

I read the line I quoted above, and went back and re-read your other thread, the one you started when you first posted here. I don't see the "medical advice and directions overriding your vet's advice or directions, though. What is it that you felt was troubling?

I am not sure what exactly the "President of the American Association of Feline Practitioners" means, or how one becomes that. I'm sure it means he's pretty special. But it doesn't guarantee that he's an expert on feline diabetes. I'm certainly not an FD "expert", but I am 100% certain that I have spent more hours reading and studying up on feline diabetes over the past two years than your vet, or any other vet has (Unless they are actually experts who specialize in feline diabetes). So have many of the people who post here and offer suggestions when they see "vet advice" that for many reasons is "not quite right".

People here usually don't just dispense advise arbitrarily. If someone suggests that a new caregiver drop the dose from 5u to 1u, as your example stated, I think it's usually accompanied by questions as to how the vet came up with a starting dose of 5u to begin with? A dose of that magnitude is contrary to logic and to published guidelines unless something else is a factor at the time of diagnosis. Asking if something else went into that dose advice is normally a part of it. And that is because our number one priority here is safety. A 5u starting dose, absent further complications to make that dose logical is just unsafe and irresponsible advice, whether it comes from a DVM or not. If you see a case like that, what you will usually see after that is that the advice came from a vet who really didn't know what he was doing. In a "best case scenario", the vet comes to realize that, and the next cat(s) they diagnose benefit from what people learn here. We also usually encourage new members to share what "we" tell them with their vets, and for that reason. So that future diabetes cases benefit.

If you do see specific cases where you feel that arbitrary or dangerous advice is given by someone on this board, please bring it to the attention of one or more of the board's moderators. You can report the thread in question, or you can send a PM to one of the moderators. It doesn't happen often, but it does happen. And the wonderful lady, Rebecca, who founded this board and up until recently administrated it, was very adamant that the people who advise here are not "experts" and should follow certain guidelines when giving advice. The current administrator and the moderators feel the same way.
 
I don't know. In the past year I have found that vets very often give incorrect directions. Things that could potentially kill an animal. Not just diabetes, a range of diseases. They tend to start too high in dosage. For example my cat Misty was just diagnosed with Hyperthyroid and my vet told me to give her 5mg of Methimazole once a day. But the group I joined said a cat can overdose at that dose and said the starting dose should be 1.25mg either once a day or twice a day. I didn't even consult my vet, I went with their advice because I have learned that vets go too high too fast. And my cat had already started showing signs that it was too high at 3 days of the 5mg. I cut it in half and within a few days she was back to normal.

The people here helped me get my cat into remission in 3 months. I can't prove it but if I had just gone with my vets instructions, I doubt my cat would have ever gone into remission. It doesn't mean my vet wasn't a good vet. But most vets are not diabetic specialists. They too often start a cat at a high dose and they don't tell the human to home test. That is a dead cat waiting to happen. They usually discourage home testing which is one of the stupidest things I have ever heard.

I think you are judging before you actually know what is going on here. This is a life saving forum. Doctors and vets are not always right.
 
I posted here, after lurking for months, because had I continued following the advice my vet gave me, my cat would be dead by now. And after the crisis he had, after months of inadequate care, I found the veterinarians at the DVM to be no better informed, and my cat had a hypoglycemic seizure 9 days ago because they didn't listen when I alerted them that his insulin dosage needed to be reduced. They were all nice people. Some of them teach at the universities here. But they don't know a great deal about treating feline diabetes. Thankfully, I overrode their advice, and took the advice here, and my cat's BG numbers are coming down. I hate to think of how alone and helpless to help my cat I'd still be had we hadn't come here.
 
ok, after this post I am going to drop out of this discussion even though I was the one that initiated it. My final thoughts that I would like to convey are strictly my personal opinions about my experience with this forum.

My first post was to introduce myself and my newly diagnosed cat Hairy and asked for some tips on testing. I got a lot of great tips and information and just general support that was very helpful. But after those initial responses I felt like I was being interrogated. What type of insulin was he on, what dosage, what diet, etc. All I wanted to know was how to get a drop of blood out of his ear. I have cared for cats all of my life, both personally and professionally. I guess I have been fortunate up to now in that none of those 100s of cats were diabetic. So in part because of that, because I did have a lot of prior experience in feline care, just not with diabetes, I was already pretty stressed out, overwhelmed and feeling pretty crappy about myself that I couldn't seem to get a drop of blood out of my cat's ear to test his BG with. I felt like we had made a huge step forward today when we finally able to get one successful test done. But since I posted what I thought was a giant step forward on this forum, I feel like I have been beat about the head and shoulders for not doing 4 times a day everyday.....well DUH. If I could I would, but I can't, at least not yet so mia culpa and get off my ass!

I am sure the intent of all of you is to be helpful. But, try to put that in the context of what is helpful to the first time care giver of a diabetic cat. Berating them about not being able to do enough perfectly enough and overwhelming them with laundry list of things to do and things to by just isn't very helpful.
 
But after those initial responses I felt like I was being interrogated. What type of insulin was he on, what dosage, what diet, etc.
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Without a doubt, people here can be overzealous when meeting and greeting new members. But I hope you realize their motivations are all good? Every single one of us was in your shoes at some point. And although I was able to get blood on my very first try at the vet's office when my vet showed me "how", I wasn't so successful once I got home and tried it. It took a few tries, mostly due to my lancets being too small. But after I bought bigger ones, I never had another problem getting Bob's ears to bleed on demand. "My" experience was pretty much the norm.

And every success that any one of us has achieved, whether it's poking for blood, giving shots, getting a cat to eat good food and ditch the dry-food habit, or ultimately, getting our cats to the point where they go into remission? All those things do is make us want to share our successes with new people. Admittedly, at times we are overwhelming.

Also, you do realize that all those questions, about what type of food, insulin, dosage, etc.... those are all "critical things we need to know" in order to help most effectively? You use Lantus. I've never even seen a vial or pen of Lantus. But I understand how it works. More importantly, I know dozens of people who post regularly who know more about it than I ever will, so asking what type of insulin allows me to figure out "who to ask" if you have a question I can't help with. Dosage? Absolutely need to know. Some cats show up here on 5u based on a single test at the vet saying their BG was "HI". 99.9% of the time, that dose is quickly discovered to be way too high, and has no basis in logic. In many cases, that knowledge has saved cat's lives, and saved caregivers from the guilt of what might have happened had they not reduced the dosage to a sane level. And diet is probably the most important, and easily "fixed" aspects of feline diabetes management. My cat was prescribed Hill's M/D dry food. I might have well have been feeding him Cap'n Crunch. When I found out that low-carb canned food was the "key", I "educated" my vet, switched to Fancy Feast and Friskees, and since then, rather than prescribe Hill's Carbage, my vet directs her new diabetics to Dr. Lisa's list of low carb canned food.

So maybe it was too quick to bury you with questions. But all of the questions were asked for good reasons.
 
NancyJac, I had the same experience as you months ago, and I quit, feeling scolded. However, I now see that the people here are right, and I think what might prompt some of the messages that come across as demanding is the urgency that it's crucial to get you testing to know how your cat's body is using insulin, and to give the correct food. There's a window of time for the best remission results.

And you have to factor in that the internet is a flat medium, so we're reading words without the context of tone of voice, body language, and the other somatic clues we get from face-to-face communication, so words may come across as sounding more harsh than they're intended.

As I come to read peoples' profiles, I realize that there are people here who are caring for multiple cats with sometimes wide-ranging health problems. There's people who have gone through multiple surgeries, and who are caring for parents, or other people. People who have long commutes and lots going on with their families. I read the boards and see that these helpers are going through the posts one by one and checking in with everybody to see if we need anything, like a doctor doing the rounds, and then I think I *LOVE* these people, who are making the time for me to do this. So much decency and compassion.

I hope you stick around and see the great benefits to being here. There's lots of us who just say hi every day as well.

Lara
 
One of the reasons I pulled together my signature link of Secondary Monitoring Tools is because sometimes you can't test the blood, and some data - whatever you can observe - is better than no data at all. There is even an older protocol which goes by some of these less precise observations and may be used in a Start Low, Go Slow kind of approach which is cautious precisely because these observations are less quantifiable. You do what you can, as you can.

And yeah, I got the same kind of response when I first started posting. I also had folks stay up with me most of a night because food change and the vet's prescribed dose sent Spitzer's glucose levels plummeting like a rock.
 
NancyJac said:
ok, after this post I am going to drop out of this discussion even though I was the one that initiated it.
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And I thank you for initiating it. In the customer service world, there's a "rule" that for every complaint received, there are another 99 people who don't even bother complaining and simply take their business elsewhere. If we don't know what's broken, how are we to fix it? You've brought up valid concerns that aren't necessarily easily or visibly addressed, but this post you made goes a long way into explaining the whys and hows of what we do here. :thumbup

Carl, maybe we could move this to the Think Tank and/or post a link to it in the "Suggestions for advice givers" sticky?
 
I slapped my hands to keep from posting here yesterday but today, I've changed my mind. If I had followed my vet's dosing advice, I would have killed KT THREE TIMES this month by shooting a full dose into a hypo number.

I like my vet but we both realize that I know WAY more about FD than he does now as I live it daily and have for 2 years. He also didn't support home testing when KT was dx'd...know why? He didn't know HOW! All he was ever taught was to draw vein blood then test which isn't something he would want someone to do at home. NOW he DOES support and suggest home testing. He still prescribes Humulin N mostly but I'm working on that too...he does support our use of Lantus. Know what his FD training is? Sales Reps from Science Diet and Royal Canine foods and the sale rep from Walmart that touts the cheapness of Humulin N at WallyWorld. They fill the vets full of misinformation.....too many believe it.

BIG HUGS!
 
I too almost posted yesterday but held back. I understand being leery of advice from the internet. Here is my take on all this.

I question by vet (and my own doctor). I do not follow blindly. Though I hate the word, I'm proactive. The way to protect your cat (and yourself) is to know as much as you can. The way to learn about Feline Diabetes is to read all you can here. This site has the combined knowledge of hundreds, if not thousands, of people dealing with feline diabetes every day.

Vets (and human doctors) are just people, not gods. I don't bash vets. Hell, my dad was a vet! But some vets have loads of experience with FD, others got one 2 hour class on it at vet school. My vet treats dogs, cats, horses, cows, sheep and more. There is no way she can know everything there is about all of those species, and she readily admits it. When I gave her information from this site, she was thankful. I told her that many vets seemed threatened by their clients using FDMB and thanked her for being so open, she said "I don't know everything. I'm always willing and happy to learn."

The people here care, maybe a little too emphatically sometimes. Some of us have been dealing with this for years. I no longer give dosage advice - it's been over 5 years since Maggie died and most people here use Lantus and I used Levemir. But advice to reduce insulin really doesn't do much harm if there aren't ketones. We have seen too many cats go too low. And people are left to deal with that at home, often with no help from their vets. But we are here. If you looked at the links KPassa posted, scared owners are walked through hypos, often late into the night. Yes, taking advice from people on the internet sounds like a bad idea. But we try to help in an open forum that also has moderators.
 
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