This was just a bad situation all around.  I responded to the original post
on this a couple of months back.  It is easy to sit back and take potshots
in hindsight on a case like this.  The cat may have fared better if a couple
simple things had happened:

In house bloodwork.  Sending the blood to an outside lab was not a bad
thing, regardless of the distance to the lab.  The samples are all Fed-Exed
and the results faxed back, so the lab could have been in Zimbabwe for all
we care.  The results were still back in plenty of time.  Actually, sending
it out at 4pm or so and getting results back the next morning is as good as
it gets for an outside lab.  The benefit of an outside lab is that you get
more information for the same or often less cost than in house.  In house
bloodwork would have told you right away that you needed to check the urine.
In a non-cooperative cat like this, hopefully you were able to get some
while it was anesthetized, otherwise you've got to re-anesthetize him.  As
it stood the cat was at home, and not at the clinic and needed to come back
to have a urinalysis done.

Recheck exam.  So the next morning Elle calls and says the cat is much
worse.  She should have been instructed by the staff to bring the cat in
asap, or the staff should have told the vet right then, and s/he instructed
Elle to bring cat back asap.  I don't know what actually happened, but those
are questions that come to mind.  Supportive care and additional bloodwork
may have helped at that stage.  Also, after the first dose of insulin was
given and the cat's weakness was reported to the veterinarian, a recheck
should have been urged by the veterinarian.

Another question that comes to mind is how do we know this cat had
ketoacidosis anyway?  We don't even know that the cat had diabetes.  A
single blood glucose of 363-ish on a cranky cat is hardly diagnositic.  It's
possible the cat didn't even have diabetes and giving insulin to an already
sick cat caused fatal hypoglycemia.  Another possibility is that anesthesia
in a sick and possibly dehydrated, hypovolemic cat caused a serious enough
drop in blood pressure to result in acute renal failure due to hypoxia.  You
can come up with several plausible scenarios.  In over ten years as a
veterinarian, I have seen many cats with similar symptoms and completely
normal bloodwork.  Even in the cases with moderate glucose elevations such
as this, a significant portion of those are due to stress alone.

Diabetes, and especially diabetic ketoacidosis, in an un-cooperative,
aggressive cat is a veterinarian's nightmare.  The stress response makes
doing an accurate glucose curve next to impossible.  DKA usually requires
repeated blood draws and administration of regular insulin hourly or every
few hours.  On a cat with a temperment such as this, treatment is a
challenge to say the least.  So even if it did turn out to be DKA, treatment
would have been no picnic.

I actually like it when clients look stuff up on the internet.  Heck, I
often give them the website addresses myself.  I don't mind if clients
question what steps we're taking or not taking.  That said, I don't have
much tolerance for snide, condescending, intimidating, suspicious, or
superior attitudes from clients or anyone else.  We are all human beings
doing the best we can.  Be respectful of me, and I'll be respectful of you.
I have noticed that when clients try to self diagnose on the internet, they
suffer from tunnel vision.  They lack the perspective that veterinary school
and years of practice provide.  They focus on a few possibilities without
realizing it may be something entirely different.  That's not to say they
aren't right sometimes.

Finally, please do remember that your veterinarian does see many patients
everyday.  Sometimes we are juggling several sick patients at the same time.
It's not easy, and it takes a lot of diligence to make sure that mistakes
don't happen.  We also deal with many different types of clients.  I think
that gets forgotten on this board.  Posters seem to think that most of our
clients are like them.  The vast majority are not.  They are not well
educated on the various health concerns of their pet, they don't want to do
everything humanly possible, regardless of cost to save their pet, etc.
Part of my job is to figure out, under often emotional circumstances, what
level of care the client wants.  It can be difficult to shift gears from
people that are reluctant to have basic care done to working with someone
that will spare no expense.  By all means, pay attention to what your
veterinarian is doing or not doing and ask questions.  After all, you are
both on the same side.

No one should ever "blindly" trust **anyone** else's advice. If things don't
make sense or aren't improving, get another opinion, ask more pointed
questions. or do your own research.  I would hope for nothing less from my
clients.  Stating that seeing the vet now without "becoming informed" may be
fatal to your cat is irresponsible.  Spending time looking up potentially
mis-guided information on the internet while your cat is sick at home may
also be fatal to your cat.  There is no perfect solution.

MK DVM

Really.  The words have different meanings.  D-I-C-T-I-O-N-A-R-Y.

I was setting up *why* we should be our own advocates and not trust
them to be.  I don't think they SHOULD.

f.ck off, Philip.