Friday, May 23, 2008

What to do?

I'm a little aggravated by a phone conversation I just had with my vet's office. Maybe my expectations are too high ... well, let me lay out the situation so you can judge for yourself.

The Basics:

Isabella is diabetic. Isabella has a recurrent vaccine-associated fibrosarcoma which seems to make her limp. Isabella's vet (Dr. H) prescribed metacam, an NSAID, for pain. This drug can be quite hard on kitty kidneys, so she first did a blood test to verify that Isabella's kidney function looked OK, and then asked that I bring her back in for another blood test after two weeks on the drug to make sure that things weren't going south. So far so good.

Four days later:

Isabella got sick. I stopped the metacam (in case that was the cause) and took her to the vet for fluid-fluffing, etc. This time I saw Dr. S (for the first time) who a) said don't bother wit the metacam, and b) very, very strongly encouraged surgery - repeatedly if necessary - for her tumor. (We can take it out every 4-6 months for quite a while.) These two docs clearly have very different approaches. That's OK - it's good to get a variety of viewpoints. I'm not a fan of the serial-surgery idea, though.

Two more weeks:

Isabella is feeling and acting all perky and normal again, so I decide to re-start the metacam for a couple reasons: 1) she's still limping, and 2) there's some discussion among some vets that anti-inflammatory meds might slow tumor progression. Hey - that's worth a shot! So I start it up again, which also starts the clock ticking on Dr. H's request for a blood test after two weeks on the med.

And another two weeks:

Ding! Time for a blood test. We scamper over to the vet for the blood draw (no appointment necessary!). When I get there, I say I need a blood test because she's on metacam. Blank looks from the front office staff. To check her kidney values, I further explain. Oh! OK - that's a full blood panel, and $90. (Yikes!!! I sure hope I don't have to do this every two weeks.) The cat is whisked away and her blood is letted (can I say it like that?) and I'm told to call tomorrow for results. While I was waiting I noticed that they had a new associate listed on the business cards - Dr. M.


I call for the blood results and am told the doctor will call me back. When the call finally comes, it's the new associate - Dr. M. (Sigh - where's Dr. H???) The call goes something like this:

Dr. M: Hi It's Dr. M from the Cat Hospital. I'm calling about Isabella's blood test results. I'm concerned - her blood sugar is quite high.
Me: Well, she's diabetic.
Dr. M: Yes, I read the chart and saw that. Is she on insulin?
Me: Yes - she's on PZI; has been for two years. (which is no doubt in the chart...)
Dr. M: She doesn't seem to be regulated.
Me: Sigh. No, she's never been regulated. It's a challenge.
Dr. M: Feline diabetes is a tricky disease...
Me (hoping to get to the point): The reason for the blood test is that she's on metacam. Do her kidney values look OK?
Dr. M: Oh yes, everything looks good. Kidney and liver functions seem fine.

(we discuss a bit about how often to re-test, after I explain WHY she's on the metacam and how much she's getting - which is also in the chart.)

Dr. M (coming back around to her agenda): We might need to adjust her insulin dose.
Me: I test her blood sugar and mess with the dose. I've never been able to regulate her. Do you have any experience with other insulins, like Lantus?
Dr. M: Yes - Lantus is a good insulin. The problem with human insulins is that we're at the mercy of the market. Several human insulins that worked well for cats have been pulled off the market. So we like to stay with veterinary insulin.

(At this point I resisted the urge to point out that veterinary insulins are just as subject to market pressure as anything - wasn't PZI completely unavailable for years? Didn't Idexx just announce that they're not going to make it anymore??)

Me: Since she's been so hard to regulate I've been thinking about a change, but then the fibrosarcoma came up, and I can't decide if it's worth messing around with.
Dr. M: If everything's been done with PZI, Lantus would be the next thing to try.
Me: Well, I'll think about it some more. And I'll bring Isabella in for another blood test in three months.

That was it. On the plus side - there's obviously another vet in the practice who's quite interested in diabetes. And she's heard of Lantus (yay!). On the down side -- hello!! Did you read the chart???

I know they're very busy. I know she probably had a stack of callbacks she wanted to get through on a Friday night. But really - next time, start out with the reason for the test (metacam / kidney values) and then move on to your other agenda.

I think I'll talk to Dr. H about Lantus. What have I got to lose?

Wednesday, May 14, 2008

Just Call Me Nancy Drew

I solved a couple mysteries over the past couple days. First was The Messy Wall Mystery. The second was The Riddle of the Rotund Kitty.

You see, as Isabella has dropped weight over the past year, the formerly slim Casey has plumped up like a Ball Park frank. (New nickname: Rotundo.) I've cut his food ration and given the extra to Isabella to no avail - she's still scrawny and he looks ready to burst.

On top of that, the wall by Isabella's bowl is flecked with bits of food. And the floor is gross. Casey's area is neat and tidy. I clean up after Isabella but soon it's all icky again. I normally fill their bowls and leave them be, so I had no idea what went on in there while they ate. But since I'm really getting concerned about Casey's weight, I decided to sit down and watch. What I saw made me understand why I've got a fat cat and a big mess. Here's the routine:

The bowls are full and both kitties dive in with gusto. Casey is like a hoover. He can polish off his ration in under a minute. He devours every bit and then licks the sides and bottom of the bowl spotless. Isabella, on the other hand, is very diligent but slower. Much, much slower. Once Casey is done with his meal, he sidles up close to Isabella. Her face is in deep, leaving little room ... but there's just enough space for a little white paw to sneak in and flip! a hunk of food out. Some lands on the floor. Some hits the wall. Some is still on the little white paw. The stolen bits are gobbled up and the little white paw goes sneaking in again and again, Isabella paying no attention at all to the intrusion.

Eventually, Isabella steps back to take a breather. Never mind that she's been eating for ten minutes, there's still at least a third of her meal left in the bowl. This is the moment Casey's been waiting for. As Isabella rests and licks her lips, Casey dives in and polishes off what's left.

Yikes - it's laundry room larceny going on right under my nose. Casey is a thief and he leaves a huge trail of evidence. He's clearly addicted, so it's up to me to put a stop to the pilfering.

I'm now the food monitor. I serve up the meal, and sit down on the step and watch. Casey knows darn well he's not supposed to steal and watching him trying to resist is hilarious. He sits by me, but his attention is on Isabella. Soon, he s t r e t c h e s out his neck toward her bowl. Then a paw. Like I won't notice! I drag him back. When Isabella takes her break, Casey makes a dive for the goods, but I snatch up the bowl until she's ready to eat again.

I'm not thrilled about this new routine. I suppose I could separate them, but I dread the drama that would accompany such a change. So I'll just play cop until my little furry thief is reformed. Or forever - whichever comes first.

Saturday, May 3, 2008

Talk the Talk

Like many things, feline diabetes comes with its own lingo - words and phrases that might be confusing to strangers but make diabetic cat owners nod knowingly or laugh out loud. I've taken a stab at compiling a list of these words along with definitions. Did I miss anything?

Baileys scale: A guide to how many shots of Baileys Irish Cream it will take to cope with the cat's antics, ranging from one shot for a normal day to the whole bottle - for those times when... well, you can read it yourself. (A tip of the hat to Jenn, who devised the scale, and to Chris, who taught all of us that there is no apostrophe in Baileys.)

BAM!: Straight-in injection method used with short needles. No "tenting" of the cat's skin - just a direct stab-and-go.

Bean: Human being / cat owner. The cat's having a good day; her bean, on the other hand, is a wreck.

BGPs: Short for Big Girl Panties. A phrase used to encourage owners to stop being scared about making a change to their cat's therapy - more insulin, less insulin, new insulin ... whatever. Put on the BGPs and raise his dose.

Cauliflower ear: The dreaded result of poking the cat in the ear too many times. There are no actual documented cases of cauliflower ear; it's just one more thing for diabetic cat owner to torture themselves about.

Fur shot: Insulin injection that somehow ends up on the outside of the cat rather than on the inside. Grrrrrrrr.

Gusher: An ear poke that hits directly on the vein producing a nearly unstoppable flow of blood. Especially messy when cat shakes its head or runs freely around the house, trailing blood in its wake.

Honeymoon: The much hoped-for revival of the insulin-producing capabilities of the kitty's pancreas, eliminating the need for injected insulin. Can be elusive, and signs of the cat packing its bags for a honeymoon trip are spoken of in whispers with liberal application of anti-jinx. AKA "da fallz:"

Insulate: To inject insulin. Isabella's blood glucose was 237, so I insulated her with 1.6 units.

Kitty crack: Dry food. Much craved by many diabetic cats to a degree that mimics an illicit street drug.

Shoot the cat: Give insulin injection. As in: I've gotta get going; it's time to shoot the cat. Usually gets a double-take from outsiders.

Tunarita: Low carb drink for diabetic cats, used for celebrating low blood sugars (fictitious, of course). As in: Tunaritas all around! Isabella is at 93 today.

Vampire Club: A members-only organization for diabetic cat owners who have successfully gotten blood from their cat for a blood glucose test.