Vet visit on Wed.: tips?

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jldnvjld

jldnvjld

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I'm taking Junga to the vet on Wed. for the first consultation after his diagnosis on 10/22. My goals for the visit:

Prescription renewal for the syringes
Prescription renewal for the Cortisoothe shampoo
Weigh Junga; I think he might have gained weight; I'd rather he didn't -- he's a butterball
Blood draw to repeat tests on kidney and liver values. His lab values were all messed up at diagnosis
He's got a limp; it doesn't seem to be bothering him much, but I'd just as soon the vet looks at it.

I have some trepidation about this visit. Here's a recap of my vet stories:
When I first took Junga in to check for diabetes, Dr. D. was in and diagnosed FD. Dr. D. told me to switch Junga to a low-carb, meat-based wet-food diet and referred me to catinfo.org and veterinary partner for info on Feline Diabetes. He prescribed Lantus, and encouraged me to try home testing. He said he'd want to repeat some of Junga's lab tests when he was more stable.

On 11/1 I took Junga in for a scheduled in-office glucose curve. Dr. D. was out; Dr. C. did the curve -- without administration of insulin. She called me in the evening and told me she liked Junga's rather flat curve and to continue with Lantus once a day. I told her I wanted to give Junga the insulin twice a day, and after quite a bit of discussion, she said 'ok.' She said Junga was really, really stressed out by the in-office glucose curve, and so suggested I do curves at home weekly and bring him in in a month for a fructosamine test.

Last week I called and asked to make an appt. with Dr. D. for the repeat lab tests, and for a fructosamine test if he wanted do it. He relayed back that Junga needed an in-office glucose curve, not a fructosamine test. I mumbled something along the lines of, 'oh; maybe next week.' and didn't make an appt.

After thinking it over a bit, I made an appt. with Dr. C. for Wed., asking for a repeat of Junga's lab tests (require fasting) and the fructosamine (does not require fasting, but is okay if he is fasting). I have no idea how this will go; unlike Dr. D., Dr. C. favors dry foods and doesn't seem all that familiar with glargine dosing. On the other hand, I didn't see the point in an in-office glucose curve. And I do need a refill on the syringe prescription. I will be bringing in my spreadsheet. Any suggestions on how to handle this?

J.
[SS values for yesterday are missing; they're on a sheet of paper and I'll add them this evening.]
 
There's no need for them to do curves if you're doing them at home... I wasted a lot of money on that back in the day; throwing a handful of twenty dollar bills out the window would have been as effective.

I learned how to hometest via the folks on this site. It is a lot less stressful to you and your cat, and your values will be accurate - at the vet's office they are NOT accurate since there's a certain amount of "vet stress" with every animal. On top of being a waste of your time and money, what's the point if you're not getting a real read in the cat's actual environment?
 
I don't see the value of a fructosamine test if you are regularly testing at home. It gives you an average of bg levels over the past few weeks. You have that on your spreadsheet. As I am sure you have read, we don't see the value of curves at the vet. They are usually comprised by stress levels and tend to read higher than at home.

Are you sure you need a prescription for syringes?

You are between a rock and a hard place. One vet says one thing and the other vet says another, and neither really fit with what you think will work. I think I would take a stand: What my cat needs is a blood test and to have his leg looked out. I am dealing with the diabetes at home, with daily hometesting and diet. I will be glad to share my spreadsheet with you.

BTW, the spreadsheet looks fantastic. Your kitty is almost off the juice. How can they argue with success?
 
Sorry - but just re-read your post again - why would you need a fructosamine assay if you already know where your numbers have been for the past few weeks? That test isn't necessary for you at this point, as you've been aware of what your numbers have been for the past several weeks. I believe fructosamine tests are given at diagnosis only...
That said, I'd say the only thing you need from your vet are your prescriptions/refills. Looks like your cat really wants to go OTJ... nice!
 
Well, I would suggest skipping the fructosamine -- waste of money since you are home testing.

I would try to make an appt with Dr. D for bloodwork / office visit, and explain (bring in) that you are doing glucose curves at home because Junga gets stressed out at the clinic.

Inquire about diabetic neuropathy -- that -might- be what is causing Junga's limp.

We give Methyl B-12 vitamin to help with neuropathy, if that is what is going on. (can be crushed and mixed in the food and given daily for a long period of time)

Try ordering syringes from http://www.hocks.com -- you may not need a prescription. I like these:
http://hocks.com/hocks-healthcare/hocks ... 40030.html
 
I left out a detail in my previous letter: I faxed my spreadsheet with a cover letter describing current dosage to Dr. D. I was hoping he'd call, but he didn't.
You bring up a good point about the fructosamine test; perhaps we'll skip it.

Re: neuropathy -- Junga's limp is with his right front leg. He's not walking on his hock/wrist; he just bobbles when he walks, more when he trots (trotting is more frequent these days than it used to be.) He doesn't seem to mind me messing with his leg (or legs, for that matter), so I am not sure what hurts, if anything. I had thought this wasn't neuropathy, since it's a front leg. But it still could be? If it's neuropathy, will it improve on its own, given Junga's BGs are pretty good these days?

Where do you get the methyl b-12, and what dosage do you use?

Dr. D. told me that in Nev. I need a prescription for the syringes, but not the insulin, but that he writes scrips for both as it reduces arguments at the pharmacy. I honestly think the pharmacy tech told me the opposite. I have a pharmacist in the family -- I'll ask her.

Thank you all for the input.

J.

Phoebe_Tiggy_NortonGA said:
Well, I would suggest skipping the fructosamine -- waste of money since you are home testing.

I would try to make an appt with Dr. D for bloodwork / office visit, and explain (bring in) that you are doing glucose curves at home because Junga gets stressed out at the clinic.

Inquire about diabetic neuropathy -- that -might- be what is causing Junga's limp.

We give Methyl B-12 vitamin to help with neuropathy, if that is what is going on. (can be crushed and mixed in the food and given daily for a long period of time)

Try ordering syringes from http://www.hocks.com -- you may not need a prescription. I like these:
http://hocks.com/hocks-healthcare/hocks ... 40030.html
Click to expand...
 
My pharmacist relative doesn't work at a retail pharmacy -- she says to call a retail pharmacy and ask about buying syringes.

That said, I still need the vet for bloodwork (liver, kidneys), for the cortisone shampoo, and to check out Junga's front-leg limp. I have my spreadsheet ready to go, plus an article on tight control (the Australian one that talks about human and the Alphatrack meter, since Dr. C. had asked me questions about meters), and some snippets from Vet Partner, hit with a highlighter. I don't know if any of this will be of interest to her. We'll see. A co-worker recommends a cats-only practice should my long-time vets and I come to a crossroads. That's a thought, but it's a much farther drive, and will immensely complicate things as Junga gets older and presumably sicker.

Send good thoughts for tomorrow morning!

J.
 
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