Newly diagnosed: Recommended vet near Concord, MA?

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Sam and S'mores

Sam and S'mores

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My ~6yr old male (S'mores) is in emergency care now. He's never had any issues since we adopted him 2yrs ago. We took him in b/c he suddenly stopped eating or drinking mid morning yesterday, and basically did not move for the following 24hrs. Right now, I really don't know much more than he was DKA and "has diabetes", and they are stablizing him now. I don't have any numbers for anything. My wife and I are both scientists, so a few hours around this (awesome) forum has me at least a bit up the learning curve, and with a long list of questions, but the one I want help with first is: Who has a vet nearby to recommend who will be supportive, even helpful, with following aTight Regulation Protocol?
While I'm at it, does anyone have a boarding place or a cat sitter to recommend? I have a family vacation coming very soon, and with 2 little kids, vacations are not optional...
 
you might want to put what you are looking for in a subject title.
however, welcome and glad you found us.
there is plenty to get ready for that we can help you with.
would you like to start...before kitty get's home?
Lori
 
There is so much to ask, I'm not sure what the right subject should be! (suggestions are welcome)
I do want to be ready when he gets home, but I am mentally still in an information gathering mode to make the right decisions, and very nervious until I get him back.
 
http://binkyspage.tripod.com/canfood.html
this is a list of all the canned foods known to cats. you'll see the carb count. i like the idea of 7 carbs and under...many folks go with 10 carbs and under.
you choose.
copy the old and new list and take it to the market and stock up.
this will be your new food.
the vet may try to sell you some diabetic dry food.
garbage.
truly.
wet food only. if you need explanations just ask.
 
Probably the most important thing you can do for Smores is to learn to test his blood sugar at home.
One of our members demonstrates how we do this beautifully in this video
http://www.youtube.com/watch?v=_zE12-4fVn8
It may or may not be this easy the first time around....but we all find it becomes rather routine and easy.
The importance of learning and practicing this is key in helping Smores.
If you would like a Newbie Kit see the link below. It contains everything you need to get started...plus Smores will enjoy (I hope) the toy or 2 that is in there for him.
Lori
 
Thanks. I have to put the kids to bed, but I'll post more later.

Here's what I've learned so far:
1. Wet low carb cat food: (Cat likes Whiskas Purrfectly Fish pouches already, which seems to be good, and reasonably priced to boot)
2. Get a glucose meter and learn how to do ear pricks (This looks like the hard part)
3. Pick an insulin (now we're in religious teritory! But people seem to have voted for Lantus with their feet, based on the number of postings)
4. Follow the Tight Regulation Protocol (check, scientists can read protocols, and we like tracking things) (this almost sounds like fun)
5. Hope he goes OTJ some day

I am fine with ignoring the vet, I would just prefer to actually work with the vet if possible
 
Buy some Ketostix (ketones only) or KetoDiastix (ketones and glucose). You will use them to test his urine for ketones......DKA can be deadly so hopefully he is at a 24/7 ER clinic with everything being monitored.
 
Hello, and welcome aboard!

I am new hear myself and do not know if any of the members live near you to give you recommendations or not. If not, as I found out, it pays to "shop around". I believe you have the right idea with your closing sentence:

I am fine with ignoring the vet, I would just prefer to actually work with the vet if possible
Click to expand...

Yet I would like to take it a step farther, that it is also important that the vet works with you too, keeping S'mores' best interest in mind. In my search for a vet for my cat, Casey, after she was diagnosed, I found that many were close minded and not really open to go beyond the "cookie cutter" protocol. With so, what they prescribed one cat is what they prescribe for all. Others were more flexible with the insulin, yet dead set against home testing.

Armed with what I learned on this website and do diligence, I did found a vet I could work with because she works with me concerning Casey's well being.

You will find lots of support and good advice here!

Roberta
and Casey
 
Hi, welcome. This is the best place in the world to be for owners of a diabetic cat. Seriously you are in good hands here. I live in Swampscott - no where near you - so I don't have a referral. Is your cat at a referral hospital? How is he doing?

I second Lantus. My cat Boomer (GA) and my Mom's cat Francis both were able to go OTJ in about 3-4 months on Lantus....it's an incredible insulin for cats.

I'd go to WalMart and get a ReliOn meter and strips. The expensive part is the strips, not the meter and the ReliOn strips are very cheap.

IMHO, no vet will be as good or helpful as the folks here who do this every day and have life experience. Go check out the Lantus section of this board to see how it works. You'll get plenty of daily help and input.

Best of LUCK!!! Let us know how S'mores is doing.
 
I am in MA and newbie as well and just started home testing. You might want to talk to Dr Lori Kreidberg at Metrowest Mobile Vet. She supports home testing. We just started trying to regulate and I don't have a lot of details on all of it but you could speak with her and see if you feel it's a good match. If you need any help around the home testing , let me know.

Thanks.
Elizabeth and Munchie
 
Hi and welcome,

I'm in MA, but down on the South Shore. I don't know anyone in the Concord area. My recommendation is you look for a couple of multi-vet practices in your area with hours that work for you. There is a list of Veterinarians in MA through the MA vet association. Then call, and basically interview them.

Find out what kind of experience they have with Feline diabetes. (Keep in mind, treatment is quite different from dogs). What insulin do they recommend? (Lantus is my preference for my 5 diabetic cats) Will they use your log of home tests for assisting with dosing? Are they ok with commercial low carb wet food? How about raw food? What about emergency care?

Basically, if the vet encourages you to take control of feline diabetes, they will lose income initially. But, the cat will live longer and need annual visits and blood monitoring for other reasons for years to come.

Good luck with S'mores. If I can help with anything else, let me know.

Claudia
 
Thank you all for the help and kind words. Here's the update:
I went to visit S'mores this morning. He's doing better (still very weak), and it was nice to be able to give him some hugs. He is on a continuous drip still with BG in the low 200's, and his ketones are down to 50. It looks like he got a bladder infection which sent him over the edge into DKA. His BG was ~350 on admission, and his ketones were 150. Fortunately, it looks like his Kidneys and Liver are just fine!!!

The vet seems knowledgable, but certainly not expert on FD. She did recommend Lantus, so I did not have to fight that. She had no idea about using the pens, but was happy to write me a prescription for it anyway. She is also in favor of home monitoring, and they teach how as part of their sign-out. She does not seem to know much about tight regulation. I plan to get her some of the primary source literature.

They are feeding him Hill M/D Wet, which seems to be OK based on the Janet & Binky's page, and they say he likes it.

They are planning to move him to a low dose of Lantus after they get his BG <200 on the drip, hopefully tonight or tomorrow morning.

I went out and started buying stuff! I have Lantus pens, small insulin syringes (with 1/2 unit marks), and a sharps container. I am planning on the Relion Micro, but I have to get over to Walmart for that. I want to have my meter when they show me how.
I also have to get lancets, but it sounds like there is not much consensus on the best choice there. I'll have to see what works
I also need to get Ketone strips.
I also need more food!

I almost feel like I'm on top of things! I'm sure that will all change as soon as we get him back...
 
You've done an incredible job! Good for you.
The pens are simply a smaller container for the insulin. It holds less and it's easier to travel with in a plastic pen. You still stick the needle into the end and draw up the insulin as you would with a vial.
When you buy tour monitor sometimes you can get a kit with a lancet in it. I don't think there's a "bad" lancet, they all are sililar. There are different gauge needles for the lancet and fatter ones tend to make the ear bleed easier.
You also should make a rice sock to microwave. You use this to warm the ear so it bleeds easier for you. Cold ears don't bleed well. Just get a small sock, put some rice (maybe a half cup or so) in it and tie the end. You can also use the sock when you do the blood test to have something to "push against"- you'll see what I mean when you do it. if you watch a video of a cat getting tested it'll show what I am talking about.
Another suggestion is to keep the food list so you'll have other food options available when and if your cat stops eating the vet food. They seem to do this (stop liking it). Plus the vet food is expensive. Why feed that when you don't need to?
 
sams said:
They are feeding him Hill M/D Wet, which seems to be OK based on the Janet & Binky's page, and they say he likes it.
Click to expand...

Hills M/D Wet is still a bit too high in carbs for a diabetic cat. The only prescription food that has a good carb content for a diabetic cat is Purina DM. However, it's expensive and is about the same quality as Friskies or Special Kitty (which both make several different low carb options), so there's really no point in purchasing prescription food at all. I wouldn't let the vet send you home with the Hills M/D--if you feel more comfortable with a prescription diet make sure it's the DM. It's easier if you start from the beginning with a low carb diet (at least under 10% carbs, but ideally under 8% since many cats (like my own) are sensitive and will still give you high numbers with 8-10% carbs.

If you go the commercial food route, there are many, many options. Here's a link to the chart listing the carb content of many types of cat food: http://binkyspage.tripod.com/canfood.html. It really depends on your budget. Like I said, Special Kitty and Friskies are very inexpensive and have low carb flavors. Fancy Feast is a good mid-range food that is very popular here. Here's a link to the low carb, grain-free flavors: http://felinediabetes.com/glutenfree.htm. If you looking for a higher quality food without byproducts, Merricks, EVO, and Wellness all have many low carb flavors. You'll want to limit fish to once or twice a week because of the mercury content, and the tendency of cats to become addicted to them.

It sounds to me you have a good vet who's informed and willing to work with you. I've attached a copy of the Roomp/Rand article concerning Lantus and tight regulation to give to your vet. You'll also want to give your vet a copy of the protocol you'll be using: http://felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf

When I switched vets, they were prescribing Prozinc for all of their cats, and Bandit was on Lantus. I handed my new vet a copy of the protocol, the Roomp/Rand article, and told her this was how we were dosing Bandit so I would appreciate if she would look over the materials so that I could ask for advice. She did, and pretty soon they started all their new patients on Lantus and recommended tight regulation via home testing. My spreadsheet with Bandit's data is a google doc, so I just added my vet to it so she could view and we would do consults with his data over the phone.

Here's a link to the spreadsheet instructions if you want to get started with that http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207&start=0. No reason to reinvent the wheel in tracking your data, imho. :-)
 

Attachments

Thank you for the study pdf. I wanted to send the primary source to the vet, which should help. I see that the study used <10% for carbs and the M/D is too high. I'll get a selection of either Friskies, Fancy Feast or 9-lives. It looks like the chart is getting pretty stale, and product names keep changing, but all of those vendors have good data for their products online now, so I can figure out which ones are <<10%. They all seem to be about the same price, so I'm not sure if there is a reason to favor any one of them.
 
The problem with figuring it out on your own is that you have to call each company and get the as-fed values for each flavor. I believe Wellness is the only brand that posts their as-fed values online. You can't determine the content from the guaranteed analysis on labels and web sites since they are in minimums and maximums, which makes calculating content inaccurate.

However, if a food is grain free, it's likely under 8% carbs. Just stay away from anything that has rice, wheat germ, wheat gluten, corn syrup, corn starch, soy in the ingredients at all, or a vegetable as one of the first ingredients (very small amounts of vegetables are ok).

Some companies, like Wellness and Merrick, state on the front of the cans if the food is grain free or low glycemic. Others, like Friskies or Whiskas, don't volunteer this information and you have to check the ingredients. Formulas do change over time, but Janet and Binky's list is still a useful tool because the large majority of the low carb foods have not had drastic changes to their ingredients which would cause the carb content to change significantly.

You want to favor foods that don't have liver or byproducts as the first ingredient--liver is ok to feed but it's high in vitamin d and a which is not good for your cat in large amounts. Byproducts are going to be less nutritious than muscle meats, but they aren't going to hurt anything in smaller amounts.

Fancy Feast is popular because it's not too expensive and many cats love it. It also has a lower liver content in most flavors than Friskies or 9-Lives. Some cats get sick of liver and will not eat it after a while (but some don't ever have a problem eating it). If you have a local independent pet food store, you can get large 13oz cans of the higher end foods (that don't have byproducts like EVO 95% and Wellness) for about the same price you'll pay for Fancy Feast. Both brands have store finders on their website that tell you where it's sold close to you.
 
She does not seem to know much about tight regulation. I plan to get her some of the primary source literature.
Click to expand...

Have you found your way to the Lantus support link? I found a great deal of information from this sticky: (Board index < Insulin Support Group < Lantus) "STICKY: LANTUS & LEVEMIR - NEW TO THE GROUP? PLEASE READ..." (I do not know how to link things on this site yet) It covers a wide spectrum of what ever you would want to know about working with Lantus including links to expand to greater detail about many of the topics, including "Tight Regulation Protocal".

I am a newbie just starting w/Lantus too and find myself refering to that sticky time and again.

Hope this is helpful, and I am glad to hear that S'mores is getting better!!

Roberta
and Casey
 
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