PDA

View Full Version : Action Plan--Do You Have One?


We Hope
03-26-2008, 10:20 PM
Whether your dog is newly diagnosed or not, working with your vet to develop an action plan for your dog can help ease some of the problems you might face when dealing with diabetes. Talking with your vet about some of these common situations will help you feel more confident in dealing with them if they arise. In this way, you have the input of your vet and how he/she would like you to handle a given situation should it happen.

Pet Diabetes.net has some good ones here:

http://www.petdiabetes.net/questions/questions.html

johanna
03-27-2008, 01:17 PM
From reading so many diabetic posts over the past 16 months I have come to realize a large percentage of vets do not have a lot of Diabetes experience...
When Killian was first DX he was rushed from my vets office to the emergency hospital......
And in the months to follow.... Every time something major happened with him It was almost guaranteed to happen on a holiday or after hours for my vet....
And his phone machine would say if you have a emergency problem go to the emergency hospital...
Over these months I have had more visits to the emergency hospital then to my vets office.....
The expense of this goes without mention .... There fore sights as this one are so necessary....
I have learned so much....I still have mountains yet to learn.... but I am trying and Killian is making sure that when this is is all said and done,
I will know how to care for a diabetic dog....
I have since found a new Emergency Hospital.. ( although not so close)
They also have a much greater understanding of Diabetes and its treatment...
It was at that hospital that Killians last adventure took us.... Pancreatitis Attack....And this hospital was wonderful for the 5 nights he was there and all the follow up visits after.....

k9diabetes
03-27-2008, 02:05 PM
The ONLY good thing about an emergency vet visit is it does give you an opportunity to establish a relationship with an emergency facility.

When Chris was first diagnosed, the vets in the practice rotated being on call so emergencies involved paging them and meeting them at the clinic. We did that the night Chris was diagnosed with diabetes. It was nice for him to be seen at his regular clinic by vets we knew. But seems like few, if any, vets here do that anymore.

Probably in part because Sacramento has quite a few 24 hour hospitals. We have been to the one closest to home a couple of times and one of Chris' specialists is there so it's comforting to be able to go to a place we know fairly well. Through a bit of coincidence, Chris holds a special place in the hospital owner's heart!

Already knowing what your emergency medical resource is helps when a crisis arrives.

Even better, drop by sometime when you don't need their services and just check it out so you know where it is, how to get there, and what the atmosphere is like.

I think We Hope's action plan is aimed toward having the discussions with your vet before the crisis occurs so you make sure you know what to do when it occurs.

My husband and I were just talking about the young vet who saw Chris the night he was diagnosed with diabetes. For whatever reason, she handed us prescriptions for his food and insulin and gave us a dose as we were on our way out.... I had to ask her to give me a refresher course on how to fill the syringe and give the injection as it had been quite a few years since I'd given them to my cat. No discussion of hypoglycemia or advice to keep syrup handy. No discussion of monitoring at home for ketones. No ensuring I knew how to give the injection properly, to make sure he ate first. Even if she knew that I had a diabetic before, I would have much preferred to at least be offered a refresher course.

I have over the years of managing Chris myself developed some guidelines for action based specifically on him. Like giving a snack if his blood sugar is only slight low and giving glucose if it's below 70. Those are things you can talk over with your vet so you agree on a plan. I know Chris thoroughly by now and have established responses to various problems that come up.

I know, for example, that he can use 1/3 of his normal insulin dose without food so if he won't eat I automatically know how much insulin I can give him.

If your current vet can't help you, try to find another. Some people have wound up working with a distant internal medicine specialist who monitors the case with infrequent visits and telephone and email consults and has the local vet do simple tests like blood draws, so that's another option. Marianne's Pebbles is being handled this way and Kay's Bo was also when his chronic diarrhea wasn't being addressed by local vets.

If you're stuck with a vet who can't help you, then it's important to learn how to use all of the various tools available yourself (plus view your abilities with a healthy dose of skepticism!).

Good places to start are the pages associated with this forum (http://www.k9diabetes.com) (which will be expanding in the future to cover more topics and links), the pet diabetes wiki (http://petdiabetes.wikicities.com/wiki/Main_Page), and petdiabetes.org (http://www.petdiabetes.org/contents.htm). Once you get to the point where you understand the effective duration of various insulins, how to read curves, what constitutes high and low glycemic foods, what can drive high blood sugar, you can start to manage a food and insulin regimen yourself if that's your only option.

I think having a working relationship with a veterinarian is a goal worth working hard at.

Sometimes it's just a matter of sitting down one on one with a good vet and getting to the point where you are both on the same page as far as treatment and monitoring. A good vet will want what's best for your pet and be willing to explore options and new information. They don't have to know everything there is to know about diabetes - they just have to care about your pet and be a good compassionate doctor who works with you...

Haven't read it yet, but my issue of Your Dog newsletter has an article titled "Owners must feel part of the treatment team."

Sometimes you really have to find another vet cuz the current one is unwilling to work with you.

We have switched Chris twice since his diagnosis.

First to get his treatment taken more seriously and because the clinic was so chaotic at that time that we couldn't get good care.

And then later, when he was stable, we changed because I didn't feel like the clinic/vet and I were a very good match.

I'm much happier with the new vet and clinic, which makes visits more pleasant, for me at least. I think he's a good doctor AND a kind and compassionate person. He knows I want details, details, details and cheerfully provides them. And he doesn't hesitate to suggest a referral to specialist for more intensive care, such as sending us to a neurologist when Chris had his MIA. The symptoms weren't consistent with one diagnosis and he felt someone with neurological expertise should take a look.

If nothing else, you can work down the checklist yourself and make sure you have a confident answer to all of the questions. If you don't, research the topic until you feel comfortable choosing a plan of action for those possible events.

That way, you know your dog will never have one of the crises on the list.... s/he'll find some other way to start a panic!! :)

Natalie

We Hope
03-27-2008, 03:19 PM
That's EXACTLY what I'm referring to--being able to go over questions you have with a good vet so you are prepared to handle some common problems which might come your way with diabetes.

We did "What If" a lot when Lucky was diagnosed. If there was something I was concerned about how I should handle, these were the questions I asked. There were a lot of things I asked about which we never faced, but I felt good about knowing what the answers were in case I might need them.

We had one non-diabetes related problem when both of my guys were out of town, so it meant taking Lucky to a nearby hospital. The visit was a disaster because not only were they not well-versed about diabetes, they were trying to diagnose him as having Canine Cognitive Disorder. The push was on for taking a blood panel to put him on Anipryl. I was already annoyed that they tested only urine for glucose. I knew they'd never seen a vial of pork insulin before by the way they were looking at it. It was suggested that he be hospitalized there and force fed also. Had I thought I needed to do that to get him to eat, I would have gone to our practice and the techs and I would have done that--not have it done in a place where they basically knew very little to nothing about his history with anything.

So we came home and I mentally went over some of my "What Ifs", doing what I thought either of mine would advise if they'd been in town. I got him eating easily by using a little baby food; by dinner time, he was eager to have the canned W/D without anything added. I'd made an appointment for us for the first day one of my guys was back--the other place claimed he "might" have a UTI--they couldn't confirm this even with taking urine.

When we came in two days later, Lucky was "Mr. Poor Baby who'd been through a lot". :) He did not have a UTI. We decided both of us needed Anipryl more than Lucky because he didn't have Canine Cognitive Disorder any more than he had a UTI. I was told by both that I handled this situation just as they would have advised me to do--the new "house rule" was that only one could be out of town from now on. :)

Without that Action Plan, I might not have been prepared to properly handle things for Lucky. It helped me know that I was doing the right thing for him and also that what the other hospital was suggesting was not.

eyelostit
03-27-2008, 11:58 PM
Its good if you can find a vet with knowledge, but one vet had told me it would take a lot of patience on my part, yes it did and I am over that, (the shots, feedings, insulin etc) what she did not tell me was that i could home cook, and kept wanting me to use the Purina DCO which was not working.

2nd vet who I like, isn't that knowlegeable, as when Niki was there for a curve, all they told me was it seems the insulin quits working after 8 hours, and told me nothing else.

So as I have viewed the boards over the years I told Niki's diabetes into my own hands, and I think thats why she is still here 5 yrs with diabetes now.

Seems the only vets in my area are not that knowledgeable, I'd have to travel to Ohio State stay overnight 2 nites and drive back, that would not work, being with doing curves doing other foods etc or differnent insulins is not enough time to warrant this.

My vet did not want Niki to have the Vetsulin or the pork insulin, nor did she want me to get any fast acting, I just think alot of vets don't want to deal with this, or only understand it to a degree, they just say feed and give insulin at 12 hrs. like that is normal for all dogs.

I was never told what a rebound it, most of what i learned was from the boards and the "Dog's diets and Diseases" books.

johanna
03-28-2008, 12:14 AM
I have to agree with Deloris.....
Every place is different and In California I think there more aggressive with there treatment as in any Metropolitan area....
In smaller area's Its just not the same......
As you know Im always asking questions... Some turn out to be dumb.... but I ask any way.... Pride is gone when it comes to keeping Killian alive....
The point Im trying to make is that on the boards.... Im the dumb one....
At my Vets office Im the smart girl in the dumb row !!!!!
Here's the really scary part........
Some one who knows me also uses the same vet as me.......
At her last visit she asked about me to my vet.....
My vet replied " That woman knows more about diabetes then I do"
SCARY>>>>>>>>>>>>>:eek:!!!!!

eyelostit
03-28-2008, 01:00 AM
You certainly do, they don't research it, I think they are more involved in giving shots or handling emergencies or giving nail trims, they just don't answer questions, when you get an answer like some dogs do good with DB and some don't. I think to myself "Because you don't know and don't care to know doctor"

k9diabetes
06-19-2008, 02:12 PM
Also bringing this forward.

Debbie & Apollo
06-19-2008, 02:44 PM
We have moved recently and finding a Vet that we liked and one that Apollo felt safe with was a challenge.

Everything mentioned already is SO TRUE and is excellent information.

I would like to add:
If you feel like there is a lack of information/understanding we as the owner must become proactive.
I had no problem switiching Vets. Ask for recommendations, I went to neighbor garage sales and looked for dog owners to see where they took their babies. I then spoke to the vet -- Be polite but if they are offended.... well he's my baby!

Debbie & Apollo