Really upset - Simmie ok but problems with vet

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LydetteSimmie (Iceman)

LydetteSimmie (Iceman)

Member Since 2014
Please be patient with me as I go through my concerns. I should hear back from the veterinary practice where we board Simmie and I have to have my wits about me. I need your advice.

We left last Thursday for vacation, 8/14 and picked up Simmie and his nemesis, Murphy, today. Our bill was astronomical! One of the reasons is that even though our kitty vet said they weren't big on home testing that if we wanted to have spot checks done they could do it. I had no idea they would charge us $42 for each test! With my meter, lancets, Neosporin, and strips! Supposedly they tested pre-shot though according to their log they 'weren't able to get blood' a few times and I wasn't charged.

While we were away our kitty vet was also on vacation so we had to talk to another vet there that we know. He called to say, on the 15th, that they did a Fructosamine test on Simmie and he was at a whopping 529! I said it was probably due to the stress of just being there but he recommended that we up his insulin to 3.5 units though I just recently (a few days earlier) increased his units to 3. I said that unless they tested regularly I didn't think it was a good idea and to please look at my chart for Simmie before increasing (since they are not there at night to watch the furbabies and I was concerned that he might drop and go hypo). HE said that there was a big difference between home testing and Fructosamine testing so I shouldn't be concerned...FIRST QUESTION: What is the big difference between home testing and the Fructosamine test?

Anyway, we decided to wait until Simmie came home before I increased his insulin.

Well. we went to pick up our 'kids' a little while ago. I saw our bill, almost had a seizure, and saw a testing log for Simmie in our folder. I asked the receptionist if they used my equipment and supplies to test Simmie. She said yes. I asked her for a copy of the testing log and she gave it to me.

When I came home I decided to match the test numbers from the meter memory with the log file from the vet. Guess what, 5 tests that were 'logged' were not in my meter memory. I also counted the strips (I had given them a brand new bottle of 50) and only 3 were missing. I am beside myself and have a call into the vet to talk to the one who I spoke to on the 15th about the Fructosamine test and increasing the insulin. He will call me in about an hour.

Q - I think the techs lied to the vets. I don't think they did the spot checks. I think they were shown how to do it once or twice and then the techs decided it was too much trouble and just didn't do them. I looked at Simmie's ears and I do not see any new pokes. When I spoke to the vet on the 15th I told him that I didn't think the techs knew how to 'home test' and he assured me that they knew how to do it though when I saw a bunch of them when I dropped our kids off I asked them about it and they all said they had never done it.

HELP! I am going to try and lead the vet down the road of telling the truth when he phones by just asking questions at first. What do you think? I am very upset about this. This is one of the most reputable practices in our area. Do you think they have other testing equipment (besides using needles for Fructosamine and curves) that could explain the missing numbers on my RelionPrime?
 
I am going to speculate on this. But I would bet they used their own so called meter Alphatrak that all vet practices use that is calibrated for animal use only.
They will usually try to get you purchase it saying that human meters don`t work on cats which is not true. The strips for these meters if I am not mistaken are really expensive, about $1.00 each, yes that's right 1.00 per strip.
So perhaps that's what could have happened.

Terri
 
I thought so too. But, 3 readings were done on my meter...why change meters? This vet called me about 15 minutes ago and when I asked him what type of meter they used he said "oh, I think it is an accutrak" which is not the alphatrak for animals.

What do you think about the idea of a Fructosamine test vs. home testing? He had really discounted the home testing concept saying the two are completely different.

I also just got a reimbursement of $91.00! He said that they were charging the same amount for spot checking as they charge for doing curves.

I have to decide if we are going to move to another vet really soon as we are going to go on another long weekend in a week and 1/2. I have to say, Simmie looks great and has a wonderful attitude. They really do love him at the practice. I don't know what to do. I want to do what is best for Simmie but I don't want to be scammed either.

Hugs,
L
 
hi.
I would ask any vet not to do a fruct test...
because you monitor.... and have a chart..... you have the best idea of how Simmie is doing....
remember there is 20% meter variance....
you aren't really worried about perfect accuracy of his numbers.... you are watching the trends....

none of us pay for them to do their own test because we don't value it....
and it's not accurate either.... after all, kitty is stressed.....


I've heard of some vets charging $30 or $35 .... but your vet is the highest I've ever heard.

so ouch....


secondly,
I am wondering myself why you would increase to 3.5 u..... from 3.0

you have a blue there..... since increasing....
Imho, I'd increase only to 3.25 for that reason.... give it a chance....
 
I'm in tears. I love all of you. Without you, I would be lost.

Thank you.

I would like even more opinions on this issue as I have to start my search (I did find one vet that I have planned to visit) for another practice to care for my babies.

Simmie is so happy to have us home. You should see him. He is so magnificent!

Love
Lydette
 
Lydette,

I would look for a bonded petsitter to come in and give Simmie his shots. Maybe do an internet search. I know that's what some of the members do here.
It would be less stressful for him and you as well.

Terri
 
I don't know if there is really a difference between the fruct. test and home testing, but I think the fruct. test is a waste of money and time if you home test. Home testing gives you more accurate information and Simmie is not stressed by being at the vet. I would hesitate to increase the dose again just because of one number the vet saw, especially if you recently increased. The dosing should be based on the nadir, not the highest number the vet saw.

It's hard to tell whether the vet techs did all of the tests. Some may have been done without your meter. My vet doesn't use a meter when they do tests. They draw blood from a vein and run it through some kind of machine to get a reading.

If you are going to consider using this vet to board the next time, you might want to lower the dose a little since they may not be testing as much as you would. Then you can get back on track when Simmie is back home with you.
 
(((Lydette))) what a frustrating experience with the vet. :YMHUG: Way to undo all the relaxing you got done on your vacation. :-x I hope you find a replacement vet for the next trip. But good news that Simmie is doing well.

As to the fructosamine, I found an interesting description on the Caninsulin website. By definition
A single fructosamine measurement indicates the average glucose concentration over the previous 2-3 weeks,
Click to expand...
. More telling if you scroll to the bottom of the page is a section describing the advantages and limitations of a fructosamine:
Unable to detect short-term or transient abnormalities in the blood glucose concentration, e.g. hypoglycaemia
Click to expand...
In other words, the fructosamine gives you an average value over 2-3 weeks, but no way of telling you if that means the blood sugar has been around 220 the entire time, or varied from 400 to 40. Only spot testing will tell you if there have been hypo episodes. And we dose Lantus based on the nadir. The fructosamine doesn't tell you what the nadir has been.

My own vet uses a OneTouch in their office and she's found it gives results close to the lab results. The "accutrack" might have been an accucheck which is also a commonly used meter. Not all vets use the AlphaTrak.

As to dose, let's get a couple days of data of the current dose (3.0), uninfluenced by stress, and figure out where to go from there. It'll probably be to 3.25 but it's good to judge that on recent data.
 
Perhaps you could employ one of the more experienced vet techs to come to your house to care for Simmie, give him his tests and his shots, etc. You could teach the tech how to test to make sure that she/he does it correctly. You could make sure that the tech uses your meter, strips, syringes. You could pay the tech on a daily basis, rather than by how many tests and shots are given.

Another thought: is it possible to take Simmie with you on your next vacation?

Good luck!

Ella & Rusty

p.s. If you employ someone to come in, you should lower Simmie's dose to keep him safe. Presumably a tech would only be testing at PS times and therefore you would not know what Simmie's nadirs are.
 
A fructosamine test is, like Wendy said, the average BG over a 2 - 3 week period. It's the equivalent test to a hemoglobin A1c in humans. When you are home testing, there is no need to get an "average" since you have your own test data that if you really wanted to, you could average. In fact, many meters will give you an average number.

If this were my regular vet, I would take the, "I'm really confused." approach. I'd explain how you did exactly what you told the vet -- you went over how to use your meter and you brought ample supplies. Then point out the number of strips is at odds with the number of tests as is the data in your meter. And, you just don't know what to think. I'd also point out that it would have been very helpful if they had given you the cost for testing. (I also think that $42 is an exorbitant amount. When I was living in Chicago and using a very expensive, cat-only practice, they would charge $25 for a test.) You might call around and some local practices what they would charge for testing if you were boarding your cat with them.

FWiW, you might want to call the vet school at OSU. There is a well-respected feline vet there, Tony Buffington. He might be able to recommend a vet in your area.
 
Wow Lydette, I can see why you were so upset! :shock: My vet(s) all 3 of them said a fructosamine was a waste of money! And they don't even use the Alpha Trak, they use One Touch. I haven't asked yet how much they will charge me for doing spot checks if I board Tiger there, but wow, you sure paid a lot! :shock: I hope your vet has some answers for you soon! If not, I would be looking for a new clinic!
 
What a rotten experience for you. So sorry. My vet at first commented that at some point he would want to do a fructosamine test. Since then he saw my spreadsheets and agreed there was no need!!
 
i don't think a fructosamine test is a waste of money, but it provides information that you don't need if you are hometesting. it's appropriate for people who aren't, because it gives a ballpark idea of blood sugar overall, which can suggest how appropriate a dose is.

but . . . when you're following the protocol and hometesting, that gives you up to date information on what's going on in Simmie's body at the very moment you're testing.

my biggest issue would be with a test being performed that i hadn't ok'd, and that i was then billed for it. as a general rule, most vets will tell you in advance what tests they would like to do and you get to ok them. it doesn't sound like that was the case with this situation.

regarding Simmie's dose:
Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Click to expand...

Simmie is new to numbers under 200. he just got to blue nadirs when you increased the dose to 3.0u. i'd hold the dose and give it the 8-10 cycles before increasing.
 
Lydette,

I totally understand your frustration. I've had similar experiences with the vet where I was boarding Cinco. It's a large practice with multiple vets, and I tried repeatedly to get my concerns addressed with the manager, but she never had time to talk to me. I felt trapped, because they are the only facility in the area with staffing 24/7. Even though they didn't follow my instructions, Cinco never came to harm in their care. I am so lucky that the doctors at UC Davis Vet Hospital told me about a former vet tech of theirs that started her own business caring for special needs animals. I boarded Sasha there for a weekend, and she was just wonderful. I'm taking Cinco, Sasha and Minka to her this weekend while my DH and I are going to Reno. She understands the importance of following my instructions and I have total confidence in her. I would like to echo Sienne's advice to contact the vet school at OSU. I'll bet they will have some recommendations for you.

You are right to question what they did, and I hope you are able to get some answers. Stand up to them - you are not some ignorant client. You are educated about FD and how to properly care for your cat. Once they understand that you know as much, if not more than they do about FD, they should respect you more.
 
You're absolutely right to be upset. Besides the question of whether they really did the testing they were supposed to, any reputable vet should have told you in advance what the charges would be, and should not have performed an expensive and unnecessary fructosamine test without getting your approval first. I see they did reduce the charge for the spot checks, but you'd be justified in asking that the charge for the fructosamine test be removed too.
 
I can't add too much more to this discussion since you have already gotten some good advice.

My vet charges $29 for an ear poke using their meter (an Alphatrak.) The Pet ER charges $35. They use an animal calibrated meter as well. In both instances, their meters register significantly higher than my human meter. My vet checked the AlphaTrak against a blood draw and found that the AlphaTrak was almost exactly the same as the blood draw. Bottom line is that the AlphaTrak is probably more accurate for cats than the human meter, but that is irrelevant when you are talking about doing curves and monitoring blood levels. The important thing is to use the same meter for all of your testing. If your vet used your meter sometimes and their meter sometimes, the curve is going to be off by a lot.

The Fructosamine test is good if you are not home testing since it gives an average BG reading for the last 2 - 3 weeks. However, like the AlphaTrak, it is going to give you a reading that is calibrated for cats and. therefore, will be significantly higher than your home testing numbers. My vet charges $100 for a Fructosamine test. If you didn't authorize the test, you certainly shouldn't have to pay for it.

Vacations are a problem when you have cats with health problems. Fortunately, Oliver got OTJ before I went on vacation this year. If he hadn't, I was planning to take him with me to the beach. My sister house and cat sits for me when I am away, but she isn't able to home test or give insulin injections.

If you have to board, a facility that has 24/7 coverage is best. Second best would be a vet facility that, hopefully, would recognize a health emergency if one occurs. If you are boarding somewhere that doesn't have 24/7 coverage or if you have someone who is coming in a couple of times a day to test and shoot, I wouldn't try to follow tight regulation while you are gone. I would give a "safe" dose of insulin and then get back on the tight regulation protocol when you return. (I am a major worrier, so understand that this advice is coming from someone who always follows the "better safe than sorry" path.)
 
My vet's office charges $49 for a ear prick but he did it without charging me for a visit and did it himself. He looked Max over each time. This was before I was home testing and we were trying to regulate him. I once asked if I should not make an appointment and his reply was that he wasn't charging me for an office visit and I should make an appointment.
 
Our sympathy is with you as you navigate through this difficult decision.

We currently work with a supportive vet who doesn't charge for BG tests if we bring in our own supplies. There are two experienced vet techs there who do the testing and shooting, and they'll also come out to the house (for $20 per visit) to give tests, food and shots. We feel so lucky to have them all as our local care team and they're wonderful with Clare.

That being said, here are some limitations we've noticed as we tried a variety of settings and veterinarians' offices before we decided on staying with this one.

When we initially brought Clare in to her original vet, her primary symptom (that we noticed) was that she'd lost weight and wasn't eating well. The vet did a blood panel and took two x-Rays. She said that something appeared to be pushing Clare's stomach out of position and that there were some granular deposits in her liver, which had irregular borders and was enlarged. Her blood sugar and eosinophils were elevated. She recommended that we take Clare to the specialty clinic 2 hours from here in Appleton, to have an ultrasound and possibly a biopsy of her liver.

In Appleton, they told us that there was no mass there, that her stomach had an undigested bone in it and that's what appeared as the granular spot on the x-Ray, overlaying her liver so that's why it looked like it was in there. They said that her stomach was positioned normally and that probably our vet had thought it should be where a dog's stomach is, which is in a different place. Her liver was a little enlarged but the borders were smooth. The ultrasound showed that her colon wall was thickened in some spots, consistent with parasites. Her liver enzymes were fine but they told us, after another set of labs and urine tests, that Clare was diabetic. She also probably needed to be wormed.

Since then we've been involved with several area vets who weren't at all encouraging home testing or tight regulation. Their approach is to have weekly visits to the office with the blood tests there, along with fructosamine tests every few weeks. Recommended dosage changes are made after getting the results of the fructosamine tests. This approach is perhaps safe for the cat but ties you to the vet for ongoing diagnostic and treatment services and I think is based on the (human-oriented) assumption that diabetes is a permanent condition.

Since Clare was diagnosed, the vets we've connected with have had recommendations (like the specialists training us to roll the Lantus vial before measuring out the insulin, the strict recommendation to never shoot if she's vomitted, or our current vet recommending a different dose for the AM and PM cycles) that appeared to be based on the use of older, non-depot types of insulin.

As a result of all this we've taken on a "buyer beware" attitude in vet land, where professionals seem often to be focused on selling their own high-markup supplies and services, and also seem often to be very competitive toward one another.

We feel so fortunate now that we've found a home here in LL and have also found a local vet who's open enough to at least consider the tight regulation protocol, check the spreadsheet once in awhile, care for Clare from a holistic point of view - checking to see if she''s still gaining weight and looking happy and well - and otherwise pretty much leaving us to do our thing.

Last week, they boarded Clare during the day while we went on a canoe trip - our first day out in awhile. They just had her marked for "observation", fed her, petted her, and the vet techs did one BG test with our glucometer. They charged us less than $20 for the day!

That's as good as it gets here in Central Wisconsin!

Please let us know how this works out.
 
Georgette and Clare said:
Please let us know how this works out.
Click to expand...

I sure will. It is quite a journey searching for a new vet with all of our requirements. But it will be worth it.

Instead of taking one long vacation we thought it would be best to have a few short ones during August and Sept. It was a stupid idea but we did have all kinds of considerations in addition to Simmie. Our dog Buddy has a number of health issues, Murphy the Cat has pancreatitis (which really isn't too much of a problem) and then we have our semi-feral kitty, Princess Kitty Kat who we make stay in the whole time we are away but can't have other beans come into the house during this time as we don't want her to 'escape' while we are gone. She doesn't seem to mind...she gets 3 litter boxes, tons of good food and water and the whole house to herself!

I feel as if I am complaining too much. I think the ideas that have been presented here are great and will try some! Thank you all.
 
Wow! All that for $20. My vet was charging me "just" the $49 to test but skipped the recheck fee of at least $70 I think before I started home testing. When I asked if I should not make an appointment one time his response was that I should make an appointment and that he wasn't charging me for the vet visits. He wanted to see Max each time which is really nice though. He too looks at my ss and was calling me weekly. The last few I sent did not get a call. I'm going to send one this week as we haven't talked in some time.
 
((Lydette)) I don't think you're complaining at all. Shouldn't we be responsible for giving feedback to our vets as we go along? I never liked the term "consumer complaints" because it seems to be a negative. When actually I've found (and did myself) that professionals generally appreciate getting positive comments, market information (for their services) and helpful ideas for being a better advisor, if given with the intent to be supportive.

Maybe my vet's fee was low for the day-boarding because of all the helpful info I've passed on from Lantus Land! She said that the Univ. of Queensland protocol that I got from here was the best she'd seen for treating kitties with diabetes.
 
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