Mimi update - listen to what this vet told me about testing, etc. :(

https://www.felinediabetes.com/FDMB...fter-now-not-please-read.234144/#post-2619883


So the vet called today and said all of Mimis blood work is good except her pancreas levels are elevated which could mean shes having a flare up of pancreatitis. Then he told me that he believes pancreatitis is linked to the gut or having IBS? I thought pancreatitis was always treated with an antibiotic?
@Critter Mom
@Sienne and Gabby (GA)
@Marje and Gracie

He also began to ask what my goal was in testing mimi so much- and I said "increase her chances of remission". so he told me that in all his 27 years of being a vet if a cat was going to go into remission it would be the first few months and majorly because of a diet change... ??? He said after that they have it for life and I shouldn't be testing her so much, that he's content with her numbers being in the 200s that he considers that controlled and anything lower he says risks them going hypo (like what on earth is he saying)- he owns the practice so he's the head vet there. its a very popular well known vet clinic too- all 5 star reviews everywhere.. He then told me he's not into the idea of me giving mimi raw formula because of salmonella, etc and he compared it to us eating raw meat- its not good. I then asked "but they're carnivores and we arent- don't they have an entirely different digestive tract?" He said "no they aren't that different from us".. WTF IS HAPPENING ...
He also doesn't use Lantus as his first defense for cats, he uses vetsulin (which is what they started Mimi on and she ended up going DKA)

So, I just bit my tongue and let him speak just thinking- ok so he wants me to stop testing her so much that its stressing her out and totally unnecessary (he didnt mention if PS testing was still ok but Im guessing he would say don't bother) That as long as her numbers are in the 200s shes regulated- and he also told me that he's certain she will NOT ever go into remission that most cats start out type 2 but go into type 1...let me repeat that- CATS WILL ONLY GO INTO REMISSION IN THE FIRST FEW MONTHS according to this vet. He has NEVER seen them go after that.

PLEASE LEAVE YOUR COMMENTS AND OPINIONS!!! Time to find a new vet??


So one thing I did go home with was sub q liquids that they want me to administer once a day for the next few days, give her Mirtazapine to stimulate her appetite, and he doesn't use Zofran (Ondansetron) only Cerenia, and doesn't want to give her an antibiotic at this time, he wants to see if this makes her feel better (which I like that conservative approach)

Mimi seems to be feeling better- Im holding off on her regular raw formula, and just feeding her her favorites like turkey slices, sardines, and some roasted chicken I got. Ill try the canned formula I have too- its by Daves- called "the cats meow" I think its like 7 with carbs.

If Mimi had some kind of IBS wouldn't it show in her poop? She used to always have runny poop until I switched to raw formula- since then shes been solid every time and exactly what its supposed to look like (if you look up what its supposed to look like online lol)

Thanks for listening!

@Wendy&Neko

@tiffmaxee

@carfurby

 

He doesnt HAVE to know you test...just sayin

 

right but just the fact that he believes its unnecessary- its because he believes cats will only go into remission in the first few months after diagnosis and its because of diet change more than anything. Obviously I know thats not true cause I see on here otherwise but, like why does he think that!

 

We've heard that before perhaps all "these" vets went to the same school lol

 

Hold on for more replies I'm sure there will be some choice words.

 

I'm a zoologist, not a vet, but I can tell you that cat anatomy and physiology is way different from humans:

• Cats will go blind if they don't get taurine - we humans can synthesise it from other amino acids
• Many things that are edible and even healthful to humans, e.g. garlic, are poisonous to cats
• Carnivores have short guts so that meat passes through quickly and doesn't have time to go bad - we have longer guts for absorbing maximum nutrients from plant foods, and don't actually need meat at all*
• Cats metabolise insulin twice as fast as humans, which is why they need injecting twice a day

I can't advise you on whether to get another vet or not, but it sounds like you're better informed about FD than he is!


* I cut meat and most dairy out of my diet two years ago and have been a lot healthier for it

 

He's right though! A cat that isn't going to be diet controlled has no hope going into remission if he's their vet.

My vet gave the same spiel to me. 20 years as a vet, only one cat ever in remission and that cat had better numbers than mine, blah blah blah ...

I'll be frank with you. I lost my little girl in May (16 weeks tomorrow). I can't blame one person because multiple veterinarians screwed up with her care. Now I get to spend every spare moment of idle brain activity thinking about how I lost her and should have changed vets the second they sent her home with pancreatitis saying there was "nothing wrong with her". Didn't check for ketones, didn't give her her insulin. Wouldn't check for pancreatitis, said it was "difficult to test for", I pointed out a SNAP fPL was all she needed and all I got was "well we don't carry them so we could do an x-ray instead to check for obstructions". Didn't even recommend asking around for a vet who carried the test. My vet also said BS like that cerenia and ondansetron cancel each other out, that cerenia was a "pain killer", etc. etc. There were signs before that that she was an inadequate vet, but I just kept doing my own thing, content that the vet wasn't trying to interfere in day-to-day FD life. The issue came when she DID need vet care, and my vet was not up to snuff.

I would find someone new. We're not going to find anyone as educated as the people here unfortunately, but at least find a vet who is knowledgeable on crisis FD issues like DKA, pancreatitis, fatty liver, ketones, etc and takes them seriously. I still remember a kitty someone lost recently - tested at the max for ketones and the vet just shrugged and sent him home on antibiotics. He didn't make it.

I feel like garbage every day thinking about what happened. My daily ritual for the past four months is crying on the way to and from work. If you can avoid it and find someone who's a better fit for Mimi please do.

 

Well of course! Makes total sense! I was wondering why my cats kept inviting all the neighborhood cats over to BBQ! I mean really....a well bred cat would never eat a raw mouse or bird, right?

 

LMAOOOOOO

 

Just on a quick flypast, Rosa, but will try to reply further later on today. I just want to get this out there straight away.

Did the vet run a Snap fPL or Spec fPL as part of the bloodwork? If yes, what result?

Two words: PAIN RELIEF. Where is it?

Pancreatitis is painful. Administering appropriate pain relief (e.g. buprenorphine) helps the cat to feel better and eat better. Also, effective pain management can speed up resolution of the flare.

Here are the IDEXX Pancreatitis Treatment Guidelines. It's a good document to have to hand when discussing treatment options with one's vet. It covers all appropriate treatments and meds used to manage the condition.

Antibiotics are not always necessary. A course of vitamin B12 injections can greatly benefit cats with pancreatitis, and it may help with appetite.

For information, ondansetron and Cerenia work in different ways in the body to control nausea, and can be used in concert if required. If the mirtz and the Cerenia don't get Mimi all the way back to eating normally, I'd suggest revisiting ondansetron with your vet.

As an aside, the branded version of ondansetron, Zofran, is very pricey. Generic ondansetron should be much cheaper (definitely the case in the UK). Our vet was reluctant to prescribe ondansetron for Saoirse and when I asked why, he said it was because Zofran was so expensive and they couldn't get the generic from their wholesaler. While I appreciate my vet trying to look after my wallet (although Saoirse was insured up to the hilt), I appreciate it more when he trys to look after my cat. I persisted with the vet and after a week (A WEEK! ) of giving Saoirse the med he recommended instead - with frell all success - he agreed to give me a written Rx so I could get generic ondansetron (a human drug, Rx can be filled at any pharmacy). Turned her round in about 48 hours. (((Saoirse)))


Mogs
.

 

As long as Mimi continues to have diabetes, which means she is sick, the more I can bring her into the office for tests, meds, antibiotics. It’s sad that most vets best interests is to keep your pet sick so they can continue taking your money. Dammit I really want to become a vet just so I can be the “change” so badly needed.

 

A five star review means nothing and it's gone to his head. Some doctors and vets think they know all there is to know and that's that, unwilling to learn new things and incapable of admitting shortcomings. It's not supposed to be that way.
The meat / diet thing. For a million years cats ate mice and rats but now we "know better" because of clever packaging? Long before big box stores I had two cats that ate pig-slop wet food and Meow-mix. One lived to 17, the other to 23. My wife has the same story. When I've had a bad day sushi is my comfort food.
None of this is medical advice but I will second jt's motion that the vet doesn't have to know you test. It is after all your cat right?

 

Rosa first Mimi is Adorable .... I surprised your Vet did not suggest the food they sell Hills I’m sure they get paid a kick back to sell . When my Vet was checking for pancreatitis they did the SNAL fpl and when looking for a blockage she had an ultrasound done
She had both nausea meds because they both work different . An appetite stimulant is useless with out nausea medication. To not check for Keytones is dangerous to me and it’s really a simple test. They have her right there to give her fluids if she needs them .
I would have been so Frustrated because you know better . Then the. Eat acts like you have no idea what your talking about ughhhhhh

 

Mimi IS a cutiepie!

 

Me again Rosa. I looked at your profile and the medical history of Rosa. It's quite impressive and more than obvious that you care deeply for your cats and along the way someone somewhere has overcharged you. Because there is so much to look at I've picked just a few items to comment on. Keep in mind I'm not a vet and haven't had a diabetic cat for a couple of years. Here goes...
Are there any groups out there for feline UTI and bladder issues?
No forums here but now that it's out there someone else might know. All our boys now eat Royal Canin SO, not a diabetic food, and the constant UTI issues that three of them had are over.
so I thought she might have had a parasite!?
All our boys are indoor cats but two can be trusted to walk around outside for a short distance. One got worms, it spreads easily, they all got dewormed.
gallbladder “sludge”.
I hope you didn't pay too much for that diagnosis. Was this an ultrasound or a guess?
They told me she seemed neurologic, didn’t seem to “see well” and seemed very weak.
The vet thought she might have had either a stroke or swelling of the brain from being rehydrated.
I've been down this road. A brain aneurysm that nearly ruptured, mini-strokes etc. It was only because I could describe what I felt to a neurologist that I got my first of 4 MRI's. Cats can't talk and will put up with a lot of pain without complaining. In anything neurological it could be completely obvious or remain a mystery for years. I've been down that road as well.
and a bill of almost $8,000.
This has to stop before it breaks you emotionally. Love and money aren't the same thing.

 

I’m going to respond to all of this ASAP but real quick- she’s on SUB Q fluids- she got them last night at 7:30 pm - I’ll be at work till at least 9- I’m home till 3:30 today should I try and just give them now or is it too soon?
She also gets her insulin at 9:30- so there’s a chance it will be running into insulin time!

@Critter Mom

@Marje and Gracie

I think I’ve heard you guys talk the most about subq fluids

 

Mimi on the right with her silly little brother Batman

 

It depends. How much fluid does she receive? You also have to physically check that the last subq fluids have been completely absorbed. Check her legs, ankles, and belly feeling for a pouch of fluid. Too much fluid can make the heart work harder. Does Mimi have a history of heart problems?

 

Not me in this instance, Rosa. I've no experience of administering sub-qs. Sorry I can't help with this.


Mogs
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Love it!!!!

 

I agree. Also if you do end up giving insulin around the same time, try to give it in a different area on her body away from the subq. I have given it in the side or towards the back leg. Any place where you can pull up some skin to insert the needle.

 

Rosa, dinner's cooking so I have to make this quick. I did not want to imply there is a limit to how much you or anyone should spend on a cat's health. It's a bad analogy but I've had too many cars that became money pits so that decision was easy.

I've always had the best luck with vets but it's a big industry and some clinics are now part of a chain. Take your cat to the vet inside Walmart, then have a BigMac while the work is done. That's the day I know something is really wrong with the world.
Stay safe, get enough sleep, we will get through this.
Dickson

 

Max had chronic pancreatitis from the age of 12 until he passed at 19. He NEVER was given an antibiotic by my boarded internist. His treatment included at various times ondanssetron, cerenia, bupe, and on rare occasion cyproheptadine for his appetite. His always became inappetent and that was the only symptom he always had. A few times he got sub-q fluids when he had a bad flare.

 

Our vet prescribed an antibiotic one time when Saoirse was going through a flare. I think it was more of a hit 'n' hope than anything else.

.

 

I remember Amy’s vet did give an antibiotic as well. I think it’s used when other things aren’t working as is prednisolone and some perhaps use if they have IBD too but not customary from every article I’ve read. My vet was stingy with antibiotics even when I suspected a kidney infection as he didn’t want an upset tummy or diarrhea inappetence. You want them to work when clearly needed. Kind of the same with humans. Some ask for antibiotics when not needed and cause resistance to them in the future.

 

Just been going through this with the civvie (has a urinary tract infection and she's IRIS stage 3 ). Have a better handle on it now but a fortnight ago things were awful. The antibiotics are making her queasy. Took a couple of goes but managed to get an ondansetron Rx and that's improved matters. (Anti-jinx!)


Mogs
.

 

I've had three hospital stays for pancreatitis. Fluids, odanestron, with the lovely Miss Morphine at my beck and call but no antibiotics.

 

Mogs
.

 

@Red & Rover (GA) So sorry you have had it.

 

Poor baby. I’m glad you got ondansetron.

 

Tried to get me to settle for mirtz alone, and I can understand the reasons, but I wanted ondansetron and cypro (nausea was the much bigger issue and the appy stimulant effect of cypro is much more controllable than mirtz).

(Sorry for the slight frankenthread, Rosa! )


Mogs
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Those were my preferred meds as well, Mogs.