Suggestions on how to handle the Vet???

[all4mymarine]

Ahhhhh!! I think I'm up against a Vet who has completely different ideas than me!! She thinks 220 is a "normal" value for a cat and when Lucky is at 120, it's too low. She's going to freak when she sees the 60's and 90's on his SS because she wants to see it. She won't do his dental till he's "regulated" and regulated means in the 200's. I don't consider that regulated but whatever. She said they put a cat on 1u and that's where they stay for months. Really??!! She said that different Vets have different people have different ideas about this and I said, yes, I feel completely different about it and she said, no, I mean Vets (meaning not the general public).

Any ideas on how to handle a Vet that has these ideas? Any good reading materials to print to show her? Anything? LOL I seriously think she's going to freak. I don't want to do things her way though. I'm not increasing his dose that much. She doesn't agree with tight regulation. If tight regulation will keep Lucky in normal healthy BG #'s then that's what we'll do!!!

Help!

 

[Ginny & Alex]

I don't have any idea b/c the 3 vets I've talked to over the last few weeks all agree that anything under 250 is OK--even the internist at the ER.

 

[Kelly & Oscar]

The numbers she is giving you are the good and safe numbers for if the bean isn't hometesting. Lower than that is dangerous if you don't test actually. There are a few new articles from vets on advocating hometesting and they detail why. Also, you should print out the lantus protocols developed by the Queensland University Veterinary school which details the numbers to raise a dose and the numbers to lower a dose by. I personally had a similar conversation with my "specialist" a few months ago. I told her that I can't expect Oscar to go into remission with non-diabetic numbers if he never sees those numbers. Basically - the numbers you want me to keep him at will keep him on insulin indefinitely and that is not my goal. Hope this helps :YMHUG:

 

[all4mymarine]

The numbers she is giving you are the good and safe numbers for if the bean isn't hometesting. Lower than that is dangerous if you don't test actually. There are a few new articles from vets on advocating hometesting and they detail why. Also, you should print out the lantus protocols developed by the Queensland University Veterinary school which details the numbers to raise a dose and the numbers to lower a dose by. I personally had a similar conversation with my "specialist" a few months ago. I told her that I can't expect Oscar to go into remission with non-diabetic numbers if he never sees those numbers. Basically - the numbers you want me to keep him at will keep him on insulin indefinitely and that is not my goal. Hope this helps :YMHUG:

Yes, I agree with the safe #'s if not home testing, but they know that I AM home testing. She sent me home with print outs about it (even though I had already found this board and knew about it all already ) and tried telling me that the Alphatrack or whatever it is was better than home monitors because it was specific to animals. I told her, that's okay, I'll take my chances with the Aviva.

The Vet tech was relaying info through the Vet today and she told me that they get scared when owners change doses on their own and that BG's in the 100's could be dangerous because they could go hypo. I told her that I would NEVER shoot if the PS was less too low and that the goal was to see 100's around the nadir and that wasn't dangerous at all. Is there a protocol somewhere for ProZinc that I could print out? Are there different dosing protocols? Is it low and slow and the Tilly protocol? I guess I've got some reading to do tonight on dosing and protocol....just need point in the right direction maybe. I'll go check out the Health Links and see if I can find some good stuff.

I don't have any idea b/c the 3 vets I've talked to over the last few weeks all agree that anything under 250 is OK--even the internist at the ER.

Wow. I just don't see that as being safe and healthy! My civvie's BG was 68!

 

[Joanna & Bix (GA)]

That sounds about par for what vets learn in vet school from what I can tell (I'm pretty sure they all read the same book, lol, and it is NOT up to date on diabetes!).

I found it easiest to just present things to my vet rather than actually asking for their take. Their job is to give you advice, so if there is any sense that you are asking for advice, they are going to give it to you - and for the average vet, that means you will come back here and be torn over what to do since we will all shoot down what they told you. :mrgreen:

So for me once I realized that I simply had to pick a route and go with it (and that route was not going to be my vet, who I love, but who has enough on her plate not to have to debate the finer points of BG#s with me on a daily basis), things got a lot easier. I just gave my vet an edited version of the SS whenever I wanted to give her an update, and continued to consult with her on other health issues. But the diabetes I just announced "Bix is doing great - here are his blue numbers" or whatever, and left it at that. When we were having a bad week, she didn't get an update until things improved. ;-)

If you can educate her, more power to you - I didn't have the energy for that for the most part, but some have some great success stories with getting their vets to learn a new way of looking at things.

As for the dental, I don't know why she wants to wait til he is regulated, did she say why? Doesn't that seem backwards? But in any case his numbers are pretty good, so you could tell her he is mostly regulated, right? and you think it's time (assuming you want to get the dental done).

 

[Joanna & Bix (GA)]

This is the closest I have ever found to a protocol: http://www.uq.edu.au/ccah/docs/diabetesinfo/link2.pdf

It is for a different insulin that I don't think exists anymore, it's out of date, and the dosing is way out of date (1u changes, etc.), but I think it still has some good info, and a decent framework on how to view the different BG ranges.

According to this, for instance, nadirs in the greens are good.

The doctor is well-respected, and has more up-to-date info on Lantus, she seems to have more or less ditched PZI from what I can tell. If anyone is game, you could email her and ask her what her thinking is on ProZinc and does she have a protocol she can recommend for your vet. I'm pretty sure she knows of the board here, I know some of the more experienced have certainly been in touch with her in the past. It would certainly be interesting to get her take, if it isn't already published somewhere (I couldn't quite get their website to work right, so I'm not sure what else might be out there).

 

[all4mymarine]

I found it easiest to just present things to my vet rather than actually asking for their take. Their job is to give you advice, so if there is any sense that you are asking for advice, they are going to give it to you - and for the average vet, that means you will come back here and be torn over what to do since we will all shoot down what they told you. :mrgreen:

I never asked for her advice LOL The vet tech was shoving it down my throat even when I told her I disagreed with it and tried to make me feel like my info was wrong and unimportant because I wasn't a Vet. She told me that Lucky could go hypo if he got down to the 100's. I reassured her that I knew what hypo #'s were and that I new what to do in case that happened but I try very hard to prevent that in the first place by testing and knowing what Lucky can handle and by backing off when I need to.

So for me once I realized that I simply had to pick a route and go with it (and that route was not going to be my vet, who I love, but who has enough on her plate not to have to debate the finer points of BG#s with me on a daily basis), things got a lot easier. I just gave my vet an edited version of the SS whenever I wanted to give her an update, and continued to consult with her on other health issues. But the diabetes I just announced "Bix is doing great - here are his blue numbers" or whatever, and left it at that. When we were having a bad week, she didn't get an update until things improved. ;-)

I was thinking of editing the SS to print, so I'm glad you told me you do this LOL! She wants #'s in the yellows! BUT, if she looks at the SS, a lot of the blues and some of the greens come from the dosage she wanted me to keep Lucky on for MONTHS. The dose changes I have done have been warranted and I need to stick to my guns.

If you can educate her, more power to you - I didn't have the energy for that for the most part, but some have some great success stories with getting their vets to learn a new way of looking at things.

As for the dental, I don't know why she wants to wait til he is regulated, did she say why? Doesn't that seem backwards? But in any case his numbers are pretty good, so you could tell her he is mostly regulated, right? and you think it's time (assuming you want to get the dental done).

I don't think I'm going to try to educate her (too much hehe). I may print something out about good feline BG's to show her but that will probably be about it. If it weren't for him needing the dental, I wouldn't have even had to talk to her...at least until I needed a new vial of insulin. She wants Lucky to be "healthy" and regulated before undergoing anything stressful. I told the Vet tech (who was relaying what the Vet was saying) that I was pretty sure that Lucky was NOT going to be regulated till he had this dental. Then she told me that she had to actually see Lucky before she'd let him have the dental. She wants to make sure he's healthy. He looks better than he has in years! He's gained weight and his coat is sooo soft and smooth and shedding has decreased by at least 90%.

Anyways, I just want her to say he's okay for the dental and let me go on my way. I'm just worried how she's going to react to the SS and I need at least a little info to defend myself!

 

[all4mymarine]

Thanks for the link, by the way! I'll check it out here in a bit after I get my cranky kids to bed! I wish I had more time to prepare myself but she wanted to see him tomorrow.

 

[Carl & Polly & Bob (GA)]

You can edit the SS like you plan on doing. I'd test Lucky just before leaving the house, so you know where he's at. Is he stressed by vet visits? If so, he'll be higher there. I just have a feeling the vet is going to do a BG test once you get there, and if Lucky comes up really low, you might catch hell. How screwed up is that???

Also, go to the FDMB FAQ, and print out section 6 (all about regulation). I think I would ask the vet or the tech or whomever is giving you the most trouble "What exactly is my goal here? Shouldn't I be trying for the best possible outcome? Wouldn't that be remission?" If the vet is content with a cat living in the 200s and thinks that's good enough, well isn't that screwed up? They're basically telling you that you shouldn't try to get Lucky past diabetes, just get him to a point where you have no choice but to continue testing and shooting for the rest of his life. Granted, that might be as far as Lucky gets with the disease, but you (and we) don't believe that, and I'm sure your ultimate goal is for him to one day be DB free.

Question - does Lucky absolutely need the dental at this point in time? Is he having dental problems that are contributing to his illness (infection or whatever)? If their attitude isn't going to change, and he's not going to be able to have the dental done by them unless you follow their instructions, then I'm thinking postpone the dental, and see if you can find a different vet - one that is more supportive of your efforts with Lucky. I'm more of a "get the vet to go along with the dance" person, but it doesn't sound like these people are supportive of what you're doing at all.

I just don't understand how they can be comfortable leaving a patient in a condition where his BG is basically twice as high as a non-diabetic cat, and somehow that is okay. I mean, do civie cats go hypo when their BG is below 100?

Carl

 

[Terri&Kit]

What is it with vet techs this week? Lol. Someone else had a vet tech friend that told them that if they didn't have the money to have the vet board the cat and get it regulated that they should just put it down.

I switched vets right at the beginning of Kit being diagnosed and my new vet pretty much went along with what I wanted. She listened, gave suggestions, and was extremely surprised that I had already been home testing for a week before I went there. She said only ONE of her other patients home test. She gave me her email address to email numbers once in a while, gave me insulin and said call if you have any questions. I would have to agree with Carl that you may want to consider finding another vet. If they give you any problems tomorrow, ask for copies of your kitty's test results and go on a vet hunt for someone with experience with FD. Then point your current vet to this site and DARE him/her to come here and say tight regulation isn't a good idea.

I've only been here a short time, but I have learned a LOT (including how not to panic! Ok, so I'm still working on that part ). If you have a vet that doesn't want to do whatever he/she can to get your kitty OTJ, it's because of 1)They don't know what they are talking about or 2)If kitty goes off the juice, vet doesn't get any more money. That may be a little cynical, but if you think about it, it's true. Vet should be looking out for what is best for your kitty, and if he/she isn't, time to find a new vet. Now IF you really like your vet, I think you should go for it and print off everything on this site and hand it to vet. A good vet will be interested in learning.

Take a peek at this http://gorbzilla.com/decisions_decisions.htm

 

[all4mymarine]

You can edit the SS like you plan on doing. I'd test Lucky just before leaving the house, so you know where he's at. Is he stressed by vet visits? If so, he'll be higher there. I just have a feeling the vet is going to do a BG test once you get there, and if Lucky comes up really low, you might catch hell. How screwed up is that???

I have to give Lucky his insulin right before we leave the house, so no worries about his BG being too low!

Also, go to the FDMB FAQ, and print out section 6 (all about regulation). I think I would ask the vet or the tech or whomever is giving you the most trouble "What exactly is my goal here? Shouldn't I be trying for the best possible outcome? Wouldn't that be remission?" If the vet is content with a cat living in the 200s and thinks that's good enough, well isn't that screwed up? They're basically telling you that you shouldn't try to get Lucky past diabetes, just get him to a point where you have no choice but to continue testing and shooting for the rest of his life. Granted, that might be as far as Lucky gets with the disease, but you (and we) don't believe that, and I'm sure your ultimate goal is for him to one day be DB free.

Thanks for letting me know where to look, I'll check that out tonight. Yes, I plan on letting them know my goal is remission and I can't do that if I'm not allowed to get his #'s into a non diabetic range. She even told me in the beginning that some cats go into remission. I don't know how any of her patients would be able to do this following her protocol! I'll give her the benefit of the doubt for now until I see her tomorrow and we can talk some more. She may agree with me once she sees how often I test and his results.

Question - does Lucky absolutely need the dental at this point in time? Is he having dental problems that are contributing to his illness (infection or whatever)? If their attitude isn't going to change, and he's not going to be able to have the dental done by them unless you follow their instructions, then I'm thinking postpone the dental, and see if you can find a different vet - one that is more supportive of your efforts with Lucky. I'm more of a "get the vet to go along with the dance" person, but it doesn't sound like these people are supportive of what you're doing at all.

Lucky has bad teeth. His gums were infected mid June and he was on Clavamox for 2 weeks. He had teeth removed in '08. I checked his gums the other day and they are really red and inflamed. It's time. This vet wants to be involved, I can tell, and that's great but if she doesn't agree with what I think, then we are going to have a prob.

I just don't understand how they can be comfortable leaving a patient in a condition where his BG is basically twice as high as a non-diabetic cat, and somehow that is okay. I mean, do civie cats go hypo when their BG is below 100?

I don't understand either!!! I even brought up the fact that I tested my civvie and she was at 68. The vet tech said it's okay for non diabetics but it's dangerous for a diabetic. Something about a pocket of insulin bringing #'s down all of the sudden and quickly and could be bad if they are low to begin with?? I don't know, didn't understand that part.
Carl