Switching Vets - Questions to Ask?

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Kim&Buddy

Kim&Buddy

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Hi everyone,

I'm getting ready to switch vets for Buddy to get better treatment for and management of his diabetes. Thanks to the help of wonderful ladies on this forum, I've found one that is about 15 minutes from home. I want to go in there armed with appropriate questions because I know so much more now (thank you everyone!!!). Can you please see if I've forgotten anything and if so, suggest additional questions? These are in no particular order at this point.

1) View on home testing? Current vet never once mentioned it to me. It was something I took upon myself after learning from the extensive experience of people in this forum.

2) View on Relion vs. Alpha Trak glucometers? Current vet says Relion runs low because it's not made for animals. Based on the knowledge of you all, I think this may not be the case. Or if there is a difference, it is within an acceptable level.

3) Willingness to switch to insulin (Lantus). Current vet says she prescribed glipizide because she thought Buddy's diabetes may be transient (steroid induced and then gone when the steroid was out of his system) and was worried about hypo. She never told me about home testing. Still does not want to put him on insulin. When I mentioned studies about glip causing long-term damage she said she was not familiar with them.

3) Do they board? If so, special needs cats? Will they test first before administering insulin?

4) How frequent will visits need to be in the beginning when the switch to insulin is made?

5) Will they treat me as a partner in Buddy's health plan instead of a nuisance? Will they educate me so that I can be independent yet still do what's best for Buddy?

Kim
 
Here are more questions to ask: http://gorbzilla.com/decisions_decisions.htm

There's a list of published veterinary articles/studies that promote hometesting here: http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=2509 Your vet can probably get full access to the journals to read the entire articles/studies. There is also VIN.com, a veterinary only web site, where your vet can read up on the latest diabetes treatments and get advice from other vets and those in the veterinary field.

Here is the Rand study on using Lantus for cats: http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf

4) How frequent will visits need to be in the beginning when the switch to insulin is made?
Click to expand...

You don't need to take your cat to the vet for monitoring during an insulin change. If you are hometesting, you can do this at home yourself and get the help of FDMB. Of couse, you should keep your vet in the loop to what's going on with the bg numbers and stuff :smile:

3) Do they board? If so, special needs cats? Will they test first before administering insulin?
Click to expand...
Some vets will do medical boarding. Some pet boarding places will aslo accept pets with special needs. The cost may be slightly more than regular boarding. Be sure to ask if there is qualified trained employees who will properly give the medicine and if they know how to spot a potential reaction to the medicine and how emergencies are handled.

The vet techs at your vet's office may do pet sitting on the side. Ask the next time you go :smile: That way you don't have to board your cat. Or there may be a FDMB who lives in your area and may be able to help if you need to go on a trip.
 
Re: boarding

On the boarding issue, most vets do have some kind of boarding service. When Cedric was dx'd last year, it was 2 weeks before my sister's college graduation in Boulder, CO. I had plans to go there for 3 days, then return and stay at Animal Kingdom Lodge with some friends for another 4 days of "vacation." Cedric was scheduled to stay at Best Friends at WDW the entire time. Once he was dx'd they said he could stay there, but they would not give him insulin. As a result, Cedric boarded at the vet while I was in CO (plus an extra day, since they wouldn't let me pick him up on a Sunday when they were "closed") then I moved him to Best Friends where I was able to come twice a day to give him his injection. They had a fridge there to keep his vial (which I kept in the box). Cedric has also boarded at Happy Paws, whihc is on East Colonial, near Waterford Lakes. They apparently have someone who knows how to administer insulin, but they won't accept the responsibilty for giving injections.

As Squeem3 mentioned, some vet techs do pet sitting as well. I had asked KSAC if they had a pet sitting service they recommended, since I will be going away for about 1 1/2 weeks at christmas. I have 2 cats now and felt that pet sitting would be cheaper. I am also concered with how Dallas (the stray I rescued) would react to staying at a kennel. One of the techs at my vet does have a pet sitting business and she lives in Maitland/Casselberry area. She charges $25 for 1 visit and $45 for 2....which was more than I wanted to spend, but I look at it as someone with vet experience will be taking care of my boys, and if the time comes where Cedric needs to go back on insulin, Lindsay knows exactly how to test and shoot.

Before asking my vet for referrals, I had emailed 2 pet sitting services in our area and asked if they had experience with FD. The Pet Nanny never answered me, period. That email was sent thru their web site, so either their web site has a glitch or they ignored me. The response I got from Auntie Lori's Pet Sitting about testing and insulin was this:
I have several clients with diabetic animals that I have to give insulin shots to. I have never had to check blood glucose levels before. I also have clients whose pets require various medications on a regular basis as well as cats in renal failure that require subQ fluids when I come.
I want to say she was $30 per day for 2 visits, but she had a lousey attitude - web site said references available but when i asked for them, she was reluctant. She also was annoyed that I have spam blocker on the email address I have had since 2002....

Good luck with your new vet! love the photo of Buddy btw.
 
There is no reason for you to make expensive regular visits to the vet because of the diabetes.
I really don't view the condition as being sick in a way that needs vet visits.

If you are giving insulin and monitoring at home, and the cat is NOT sick, why go to the vet?
What will happen at that vet visit? Draw a single blood to test for BG? It will likely be a number skewed by stress. Draw blood to have a fructosamine test done? That result is the same as you can get from your own meter as it's just an average of the last few weeks, so get that average from your meter.

Maybe word the vet question in an open ended fashion.. What reasons are vet visits needed, in your opinion, for my cat?

I know that many will give you questions to ask, but try to take a few moments to list 6 questions that are unique to YOUR cat. What are some of your concerns? Some habit that bothers you? Morning vomit? Style of eating? Position of sleeping? Stuff that matter to you, and you will then get a good feel how the vet is addressing what matters most to you.

I took my list all printed out, even gave my vet a copy of my questions. I took a pen and wrote down answers, and if I got an answer that brought another question to mind, I asked it as well.

Aside from the questions, if you are taking your cat with you, I took mine when I went for the consult as price was no diff with or without the cat, watch how your cat interacts with the vet...I loved our new vet just by seeing how he handled my cat and how my cat reacted... the interaction was very telling.
 
I just wanted to comment on the Relion vs. Alphatrak meters--the Relion does run lower than the Alphatrak, by about 30 points. That's because the Alphatrak is calibrated for feline blood, where the Relion is calibrated for human blood. However, that in no way reduces the efficacy of the meter. You just change your point of reference. For example, numbers below 50 would be considered low on the Relion, where numbers below 80 would be considered low on the Alphatrak. Dosing protocols are written based on human meters since that's what most people use. Here's the Lantus/Levemir protocol--you'll see the first section is written for human meters, and there is a second section that is the same protocol, but written for pet meters: http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf.

The reason why most people use human meters is because the Alphatrak meters are pricy and you can only buy strips online or at the vet. Vets make $ off the alphatrak, so they do have an interest in getting you to use it.

Bandit has only ever gone to the vet for his regular 6 month checkups--he never has had any visits/testing because of his diabetes. When he was on insulin, I'd have a 15 minute meeting over the phone with the vet once a month where she would get online and look at his spreadsheet (linked in my signature), and she'd give me his opinion on his numbers and how I was dosing him. Since I was using a protocol, she mostly looked at his numbers and said that everything looked good and I was doing a great job. I think those meetings were for her peace of mind, not mine--she wanted to make sure I was following the protocol correctly and not doing crazy things with the dose. She also would answer any little side questions I had--usually about weight loss, food, hairballs, etc.

When I switched vets, I went in and said, listen, here's all the research that supports the treatment plan I have Bandit on. This is how I treat his diabetes, and I need a vet who will is willing to work with me so that he has the best possible chances at remission. She was thrilled that I had done so much research on my own, and even ended up changing some of their recommendations for their other diabetic cats based on Bandit's treatment. To me, that's a good vet--they don't have to know everything, but just be open to working with you, trust that you both have your cat's best interests at heart, and be willing to learn along with you.
 
Gayle Shadoe & Oliver said:
I know that many will give you questions to ask, but try to take a few moments to list 6 questions that are unique to YOUR cat. What are some of your concerns? Some habit that bothers you? Morning vomit? Style of eating? Position of sleeping? Stuff that matter to you, and you will then get a good feel how the vet is addressing what matters most to you.

I took my list all printed out, even gave my vet a copy of my questions. I took a pen and wrote down answers, and if I got an answer that brought another question to mind, I asked it as well.
Click to expand...

Thanks for the suggestion about questions unique to Buddy. He has been acting differently the last couple of months and it would be nice to know if it could be the diabetes, him being a senior, and/or something else. I can trace his behavioral changes starting in January when he developed a severe URI that took over two months to go away which eventually led to a steroid injection that I'm convinced triggered his diabetes (seeing as he had no symptoms prior to the shot). All I know is that my sun loving, bedtime cuddler has become partial to dark rooms/shaded areas and prefers limited contact. He no longer sits on his table catching rays/looking out at the world and no longer sleeps with me at night. He won't even come into my room during the night even though he's been upstairs to use the litter box. I now am down to three quality hours a night with him - the time between me getting home and going to bed. If I don't get to sit with him during that window of time, I won't get to snuggle up again until the next day. It's breaking my heart, especially if these changes are because he doesn't feel well!

I also like the suggestion of bringing in a written list. I think it's a good sign that when I called, the woman who answered the phone seemed pleased I had some knowledge about the disease and what areas I'd like to discuss regarding Buddy's treatment. Of course, I'll give FMDB all the credit seeing as you all have been giving me a crash course on diabetes! :-D

I'll tell you, this has been one heck of an emotional journey!
 
Julia & Bandit said:
I just wanted to comment on the Relion vs. Alphatrak meters--the Relion does run lower than the Alphatrak, by about 30 points. That's because the Alphatrak is calibrated for feline blood, where the Relion is calibrated for human blood. However, that in no way reduces the efficacy of the meter. You just change your point of reference. For example, numbers below 50 would be considered low on the Relion, where numbers below 80 would be considered low on the Alphatrak. Dosing protocols are written based on human meters since that's what most people use. Here's the Lantus/Levemir protocol--you'll see the first section is written for human meters, and there is a second section that is the same protocol, but written for pet meters: http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf.
Click to expand...

That's an excellent point about dosing protocols being written based on human meters. I never thought about it from that perspective before.
 
Hello Kim,
I too am facing a new vetbean for my sugar girl this Saturday. I have 3 girls and the other 2 have already had their visits. Now, it is her turn. She is in remission for almost 1 yr., but it is time for dental for her. Has been 4 yrs - eeeks. But before I switched to vet #4, I called and visited with the office for over 30 min. about my sugar girl. I explained to them that since her first curve, 1 yr ago, she has not even been back to a vet at all. I also informed them that I was on this forum, home test and raw feed. If they had a problem with any of those issues, I would not be bringing any of my family to see them.
They (office girls) seemed ok with all of the above and I took my smallest of the family to see him, now the oldest to see him and so far, it has been great.

I just did not want to put them thru yet another vet that would not listen to my concerns, know that I was VERY involved in all areas of meds, treatments, etc. and that I would have to approve all they suggested before they just 'did' something to them.

As for our visit Saturday, I have already sent her file to them along with my spreadsheet. Our main issues with this visit is to see what they will be doing during our future dental. What meds? etc. Then I will bring that information back to my favorite place HERE and get advice! I have found that is the best for me and my girls. :smile:

Good luck with the new visit...hold your ground and hopefully all will be well!

Sending furry hugs and well wishes your way!
 
OK, I have to ask a dumb question. What exactly is meant by "curve"? Does that mean you test pre-shot AM, post-shot 6 hours, pre shot PM?
 
Kim&Buddy said:
OK, I have to ask a dumb question. What exactly is meant by "curve"? Does that mean you test pre-shot AM, post-shot 6 hours, pre shot PM?
Click to expand...
How to do a Curve
Example of a typical curve:
+0 - PreShot number.
+1 – Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 – Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.


Look at any of the spreadsheets and you will see the test numbers of others.
If you were to plot these test numbers on graph, you would see how the numbers change, or 'curve', and it gives you an idea how the insulin and the dose you are giving are working, or not working.
 
When most of us do a curve, we test every 2 hours for a 12 hour insulin cycle. Some days you might also want to get a "mini-curve", which is testing every 3 hours for a 12 hour cycle. I did a full curve with Bandit once a week.
 
Once a week would be doable on a Saturday or Sunday. I'm assuming you switch back and forth between ears because you're doing so much testing?

Actually, yet another question (sorry!). Does it matter if I use predominantly one ear? I don't want to cause bruising or do any harm. I try to change the location of the poke so it's on different spots, but there's only so much room to work with in an ear.
 
I will add that Bean will NOT bleed on her right ear??? dont know why and of course that is the easiest ear for momma to get. But, I am not alone, lot of folks here have the same issue. However, if they would both bleed, I would switch.
BTW, there is never ever too many questions here!
;-)
 
You've gotten great advice already... just want to add some things I asked my long-time vet:

How many other diabetic cats are you currently treating/have you treated?

Which insulins do your other patients use?

What is your typical starting dose?

What is the average amt of insulin your clients use?

Have you had any/many cats to go into remission? If so, how long were they on insulin? Did they stay in remission? How long? Did any have a relapse?

What foods do you recommend for your diabetic clients? Are you open to ...

...and then if there are any specific questions to your cat... ie: I have a high-dose cat who continues to stay in the 300-400s most of the time. What would you recommend that I change to bring his/her numbers down?


You've already hit the nail on the head... you need your vet to be a partner WITH you in treating your baby. Your gut will give you a good indication if the vet is a good fit, but it helps to have the questions and know the answers that you'd LIKE to hear, before you go in.

Good luck! BTW - Grayson only bleeds in his right ear!

Lu-Ann
 
Thanks Lu-Ann! Thanks also for letting me know about the one ear bleed. Attempted his right ear this morning and it did not want to bleed. Left ear - no problem. Yeesh, their bodies sure are finicky!!
 
Kim & Sweet Buddy,
Welcome to fd, right? Just when I think I know my girls and everything about them, they switch it up. I think they meet while I am gone and then secretly laugh when they throw that curve ball! :lol:
 
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