Don’t Give that Injection

D. E. Larsen, DVM

I looked at the clock, 5:30 in the morning. I have no idea how long the phone has been ringing. I roll over and stretch to lift the receiver.

“Good morning,” I say.

There is an old lady on the line, she sounds frantic, it takes me a couple of minutes to collect my thoughts. I finally sit on the edge of the bed.

“I’m sorry, it is early, and I didn’t catch much of what you said,” I said.

“This is Opal,” the lady said. “I live in Albany and go to a veterinary clinic here. Julie works at this clinic, but she takes her animals to you. Mucho has diabetes, and the doctor here has been having trouble getting him stabilized on a dose of insulin. Julie told me yesterday that this doctor didn’t know what he was doing and that I needed to get Mucho in to see you.”

“I know Julie,” I said. “I am a little surprised that she would suggest that to you.”

“She said the Mucho will die if I don’t get him in to see you right away,” Opal said. “He has been having little seizures all night long. And I am supposed to give him another injection at 6:30.”

“I could probably see Mucho if you have at the clinic at 8:00 this morning,” I said. “But if you are going to bring him to see me, you do not give that injection this morning.”

“But those are the instructions that I have from my doctor here,” Opal said.

“This is what I am telling you, Opal, if you give that injection, I will not see Mucho,” I said. “If you give that injection, you go to see your doctor this morning. And if Mucho has been having seizures all night, you probably better call him before you give that injection.”

“Okay, I will not give the injection, and we will be at your clinic at 8:00,” Opal said. 

“Do you know where we are located?” I asked.

“Yes, Julie gave me directions,” Opal said. 

“Okay, I am going to try to get an hour of sleep, I will see you and Mucho at 8:00.”

Julie was a good client, and we had talked about her situation several times. She knew that she could get her veterinary services at much-reduced fees at the clinic in Albany, but just preferred coming to me. I am sure that she would lose her job if her clinic knew she was actively sending clients to my clinic.

Opal and Bill were waiting in front of the clinic when I arrived at 7:45. They were an older couple in their mid-70s. They were both short and slightly built, some would call them trim. Bill’s hair was thin on top and gray in color, and he had a well-trimmed mustache. Opal’s hair was white. Opal was the commander of the group, Bill followed and carried things.

Mucho was a white poodle, immaculately groomed without a hair out of place. He looked older and somewhat heavier than he should be, but I would stop short of calling him obese.

“Good morning, Doctor,” Opal said as I unlocked the door.

I held the door open as Opal and Mucho entered. Bill took hold of the door and motioned me to go ahead of him.

“It is going to take a few minutes for everyone to get here and set up to see you,” I said. “You can make yourself comfortable, and we will get you looked at as soon as possible. Do you have any records?”

I knew that was a mistake as soon as I said it. Opal pulled out a folder that was an inch thick.

“These are my records,” Opal said. “I didn’t want to ask our doctor for records because I didn’t know if Julie would get in trouble or not.”

I took the folder from Opal. “I will glance through these while we are waiting for the rest of the staff to arrive.”

At about the same time, Ruth came through the door, and Mucho stiffened in Opal’s arms and pull his head back, and then started twitching.

“On second thought, maybe we should take Mucho and get a look at him immediately,” I said.

“He has been doing this for most of the night,” Opal said.

We got Mucho into an exam room and collected a blood sample for a blood glucose level. The test would take a little time.  While we were waiting for the test result, we got an IV catheter in place and started a slow drip of D5W. I was sure that his glucose level was going to be quite low.

Just how low was the question, his blood glucose was 42. Had Opal given the prescribed dose of insulin at 6:30, Mucho would have never made it to Sweet Home.

Talk about an instant cure, with a small dose of 50% glucose, Mucho was up, and wagging is tail.

“That is amazing, Doctor,” Opal said. “What did you give him?”

“I just gave him a little glucose,” I replied. “You see, the insulin dose you have been giving has been too large. It just kept making his blood glucose a little lower each day, then finally, it is too low. So we have to do a couple of things. Number 1, we need to get him through today. And then, number 2, we need to start him back on a low dose of insulin and adjust it slowly every couple of days until we get him where we want his blood level.”

“How will we keep this from happening again?” Opal asked.

“I will do things a little different than your doctor in Albany,” I said. “I go slow, making sure his diet is the same every day, and adjust his insulin dose, so his symptoms are relieved. That means we will adjust his glucose to a level that you and Mucho can live with, not what some book says it should be.”

“That sounds a little complicated,” Opal said. “I want you to know, I won’t leave Mucho here. We will have to do this at home.”

“Except for today, that should be no problem,” I said. “It might mean that you will need to travel back a forth every couple of days, but we can do most of this as an outpatient.”

“You said, except for today,” Opal said.

“We need to keep Mucho for a couple of hours anyway,” I said. “Just to make sure he is not going to have a seizure on your way home. We need to know that he is out from under the insulin dose from last night. You guys could probably go eat breakfast. If you eat slowly and talk to each other a little, that would probably be long enough.”

And so it began. Opal and Mucho were nearly constant clients for a time. That first day went well, and we let Mucho go home without any insulin for a couple of days so we could get a fresh start on stabilizing his dose.

Mucho did prove to be quite a challenge. We ended up having to use a split dose of Regular Insulin and NPH Insulin.  He did very well for many years, giving his insulin every 12 hours, and eliminating all the little goodies from his diet pretty much did the trick.

This entire time, I worried about Julie’s job status. If Opal’s previous veterinarian knew she had sent Opal over here, he would not be happy. The problem was solved in a couple of months when Julie informed me that they had purchased a small farm in upstate New York and would be moving shortly. Things just worked out fine.

Photo Credit: Photo by Goochie Poochie Grooming from Pexels