how to educate a vet without alienating?

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KarenAmelia

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I'm afraid I may be alienating my vet. Practically everything I've learned on this site, he disagrees with. For example:
- He does not think ketone testing is worth doing ,because he says DKA is a horrible condition and you'd know it when you see it.
-He poopoohs the notion that Terra isn't feeling well when, after being accustomed to BG s in the 400s/500s range, she goes down to 200s (as happened yesterday and she clearly didn't feel well.)
- He doesn't think that feeding has any effect on BG levels.
-He thinks Terra is a very unusual cat to be so erratic in her response to the Lantus (the spreadsheets of many cats here indicates that this is not so unusual.) He says most cats become regulated in short order.
-Initially he didn't want me to try and switch from dry food, saying we should regulate Terra first.

Etc. I could tell he was skeptical about the value of my learning anything from an Internet site. He's a good, down to earth, somewhat old-fashioned vet that I really value, and I hate to undermine our working relationship. On the good side: he does house calls and is very practical, not going for hi-tech medical care, which suits me.

Hard to work with someone who isn't willing to have learning go both ways...anyone know FD savvy vets in Cincinnati? I may have to work with someone else for this particular pet.
 
Here is some professional info from the Convert A Vet thread:

http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=2509

These articles are vet written and researched, not by the "weirdos on the internet".

Although it sounds like your vet is pretty set in his ways and disagrees with all the current information on feline diabetes. In general, I think if a vet is not up to date but willing to listen and work with his client, the relationship may be worth saving.

Many people just agree to disagree about the diabetes part while continuing to use the vet for other issues. He isn't there when you shoot; he isn't there when you feed. It would be fun to bring your spreadsheet in when your kitty is off insulin - something many people here have been able to do.

Jenny and Sue are listed as being in Cincinnati. You might send her a PM and ask if she has a good vet.
 
Other than printing out vet research papers in the convert-a-vet page, I'm not sure you can convert someone who is so set in his ways. Although at the very least a vet should understand how carbs affect bgs. If you can find a more open minded vet, though, I think that might be your best bet. That's quite a list of denial.
 
Back your decisions with research from published journal articles whenever possible and make it as easy as possible for your vet to get this information- give him copy of the relevant article and highlight/summarize the points that are relevant to the particular decision you are making. Ideally you can come to a working agreement with your vet and help get him up to speed on current research- it will help his next diabetes patient!

On the food issue, there is some evidence that typical meals have little to no impact on short term BG levels, http://jfm.sagepub.com/content/1/4/241.abstract, however there is definitely evidence to support low carb diets as a tool against diabetes http://jfm.sagepub.com/content/8/2/73.abstract or http://cp.vetlearn.com/Media/PublicationsArticle/VTX_02_03_238.pdf.

I'd also caution against viewing the spreadsheets of cats here as 'typical'. They are not a random sampling of Lantus users, and I'd suggest that owners of 'problem' kitties are more likely to post spreadsheets and seek aid. My own sample size of 1, I haven't bothered to put up a spreadsheet as my guy is doing groovy- since about the 3 week mark he's been pretty much below 120 and I don't feel much to need to ask for help with that (I'll get around to it at some point to add another data point to this site). I'm sure I'm not alone in that sentiment amongst well regulated cat owners.
 
All good suggestions. Brian, I'd be curious to see how your cat responded in the first weeks and how you regulated the doses. But then, Terra is an older cat and may well have been diabetic for quite some time before it got diagnosed.
 
Some vets cannot be educated, so you need to decide if you want to keep this vet or not first.

There are many things for which we need a vet, things we can't do ourselves. We can't do dentals or send blood for testing and then prescribe meds. We can't do Xrays or ultrasounds, and we can't set broken bones, operate, or diagnose many illnesses.

So, if you feel your vet is good for the above sort of things, is good with your cat, and has benefits like house calls, then stick with the vet and just do your own thing that relates to diabetes.

You don't need permission to buy ketostix and test for ketones, so who cares if the vet says don't bother. I have to wonder about a vet who thinks that waiting until an animal is horribly ill, rather than test to catch the start of the illness, is an iffy kind of vet to me.

You don't need permission to home test your cat, and I worry about vets who think you don't need to test.... I guess they don't know that human diabetics would never dream of NOT testing, so what makes animals less important for caution?

You are using a good insulin, so just continue testing urine for ketones and blood for BG numbers, recording all in your ss. Later on, when you are in the nicely regulated zone, you can take your ss to the vet and say see?

Until then, just go along as you have been doing, and you do not need to do what the vet dictates.
Remember it's YOUR cat and YOUR money; the vet is to be servicing you, not ordering you.
 
KarenAmelia said:
All good suggestions. Brian, I'd be curious to see how your cat responded in the first weeks and how you regulated the doses. But then, Terra is an older cat and may well have been diabetic for quite some time before it got diagnosed.
Click to expand...

Done and started a thread on my boy so as not to derail you here with more info on his particulars for comparison http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=61961.

Edit-futzed the link above
 
When Squeak was first diagnosed, my vet and I eventually disagreed on a few things, but she respected my desire to be involve, to learn and to provide input. Fast forward to now, 9 years later, and we still have this relationship only its even better. She knows I'll research everything and will have thoughts on what to do. But she also knows that I respect her degree and her experience.

When I look at your description of your vet, I see two things. First, I see a vet who is ver cavalier with your cat's health. Second, I see a vet who is not willing to respect your input. So to me, there is little room for the team work that you require to successfully treat this disease as well as your pet's overall health. But it is up to you to determine what you need in your relationship with your vet.

Good luck!!!!
 
You seem to have three choices:

1. Talk to your vet. Tell him that you are interested in being pro-active with your cat's treatment. Explain that you plan on testing for ketones, testing blood glucose before each shot at minimum, and feeding low-carb foods. Ask him if he is willing to work with you even though he doesn't think these things are necessary. You can use the human child analogy - no parent would give their child insulin without testing first.

2. Go ahead and do it all without discussing it with him. You don't need his permission to do any of this.

3. Find a new vet.

I always say it's better to work with a vet you respect and like, if at all possible, especially one you have a long established relationship with. I suggest running if they say "it's my way or nothing." I don't accept arrogance from any of my doctors! They have to be willing to listen and give sound reasons for their treatment.
 
This is parts of my vet experience

I don't do all the vets says. First there are so many different vets at the hospital we go to, not to mention the amount of nurses, who is really the ones taking care of the kitties and doing the hard work :-) So we've seen many different vets there and their different nurses, all seem to have their own opinion.

Simba got diabetes in 2006 and at first the hospital wasn't for home testing, so I came in with Simba once a week for a day curve. He went into remission after 2-3 months.

Then when the diabetes came back in 2007, the hospital had changed their way and was now for home testing, and even gave me the gluco meter for free. I was petrified because I had never home tested before and I didn't understand what the letters HI ment on the gluco meter for instance. And they wanted me to do curves and report. When I finally asked what this HI ment, the Intensive Care manager vet said it ment it was so high glucose that the meter couldn't read it ..... and I had been getting a lot of that HI's ....

When it came to food though, they were not so enlightened, so Simba was still on high carb dry food and that is what kept him in those HI's. But the same Intensive Care manager vet wasn't enlightened about foods, so since Simba seemed to not respond to the insulin, they first changed our then Insulatard insulin to Lantus, which was new for them then. But that changed nothing for Simba's HI's. It was still the food. So the same Intensive Care manager vet then said Simba could have Cushings disease .... and instead of enlightening himself about foods, he prescribed a medication called Acarbose ....

And this Acarbose was my introduction here on this site when I came on in January 2008, and I immideatly got some memorable responses from vet dr Lisa, and vet tech JoJo, and others about how ILLOGICAL it was with this Acarbose :-) and that I should drop the dry food instead .... because that what was the problem was.

So I stopped with the Acarbose, and changed to wet food, and voila Simba did not have Cushings :-) That was in 2008 and oh it is such a long story with the different vets at that hospital.

I still go there though, even if we still disagree and I ask questions and come with ideas that I have learned here. They saved Simba's life in 2007 and are otherwise prompt when I come in in emergency with either of Gustav and Simba, or the baby girls, or baby boys. They are a fully equipped high tech 24/7 hospital and only 15 minutes away even if it feels like hours to get there when an emergency. They take DKA seriously, they take pancreatitis seriously, they take hypos seriously, they take tube feeding asap seriously, and a lot more they take seriously.


Hope this helped to make up your mind about your vet and just didn't confuse you more!
 
Most of the advice points to doing what I think is right and not trying to educate the vet. That's okay with me. I was just worried that I might seem somehow negligent to others here if I use this forum for all my guidance. THought that it might seem irresponsible not to consult with my vet but rather to ask the main questions here. But the truth is that I have already gotten way more valuable info here than through my vet, who just gave me the insulin with a very minimal training on how to shoot, and left me alone - didn't even check in for the next week to see how things were going. I think that is dangerous. Lucky I found this website.
 
KarenAmelia said:
Most of the advice points to doing what I think is right and not trying to educate the vet. That's okay with me. I was just worried that I might seem somehow negligent to others here if I use this forum for all my guidance. THought that it might seem irresponsible not to consult with my vet but rather to ask the main questions here. But the truth is that I have already gotten way more valuable info here than through my vet, who just gave me the insulin with a very minimal training on how to shoot, and left me alone - didn't even check in for the next week to see how things were going. I think that is dangerous. Lucky I found this website.
Click to expand...

You still need a vet, but just maybe not that vet.
 
KarenAmelia said:
Most of the advice points to doing what I think is right and not trying to educate the vet. That's okay with me. I was just worried that I might seem somehow negligent to others here if I use this forum for all my guidance. THought that it might seem irresponsible not to consult with my vet but rather to ask the main questions here. But the truth is that I have already gotten way more valuable info here than through my vet, who just gave me the insulin with a very minimal training on how to shoot, and left me alone - didn't even check in for the next week to see how things were going. I think that is dangerous. Lucky I found this website.
Click to expand...
We are NOT advocating you stop consulting a vet!

You need your vet (or a new one) and ideally you want one who is on your side. Testing, food changes, are all home actions and not really up to a vet in the first place. It would be nice if they approved, but not necessary. They are really just good basic home care. We are all willing to help you with problems, even suggesting insulin dosages, based on testing information and behavior but we are not vets and you should not use our advice as a replacement for your vet. Please try to work with yours or find a new one you can deal with!
 
Correct, you absolutely require a vet. There may be a few things that you decide to do based on info you receive here, but you require a team. There are people who have to go it completely alone, without a vet, but that is rare and usually is when they are in a small town with no reasonable options.
 
Hi I am running off to work so this is going to be short.

Years ago, my Spader was diagnosed with FD and then CRF. I listened to what the real people had to say here and on CRF sites but respected the white coat. They were skeptical at first but eventually changed their minds. One night, Spader was headed to a hypo. It was late and very stormy outside. Yolanda, from New Zealand walked me through it on the board. I told the vet about it the next day and presented her with the values and then all of the vets started to ask about home testing.

If someone here didn't tell me to check his bp when he was diagnosed with CRF, I never would have known to ask. He was put on meds which helped.

Anyhow, they eventually changed the way that they worked with both diseases and also refer people to me to show them how to home test.

Thanks to this board and some patient vets, I had four extra years with Spader before he passed away.
 
My advice is pretty simple. Print this out and share it with him, then ask for a time to discuss it once he's read it. Read it yourself, highlight certain points like high protein/low carb diet, starting dose, etc. and bring your points to the discussion. Most vets are not used to owners taking such an interest in treatment, many see owners who will PTS sooner than go to this amount of effort.

He should respect this standard of care, but may not know about it. He just sounds not very up-to-date on current standards, especially regarding diet and insulin management of Lantus.

http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf
 
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