kinds of drugs and its side effects

Dog Departure Derangement Syndrome

DSM-5_CoverI know I’ve sounded calm, even accepting, about my departure plans for Frankie. And much of the time I am. Operation Spoil Frankie has been a nice diversion.

But then there are the times when the facade breaks open and I realize that a) I’m still in a form of denial and b) I have gone down some crazy lanes.

Breaking Up Is Hard To Do

It hadn’t occurred to me that saying goodbye to Frankie would also involve saying good-bye to his vet, Dr. E — maybe not forever, but it’s an end to a particular relationship that was very meaningful.

Worse, it was done by voice mail. And I’m convinced that T-Mobile, which has been playing fast and loose with my messages, will delete this series.

I’d finally gotten up the nerve to call Dr. E and ask him whether he thought Frankie could be helpful in medical research; it’s something I wanted to know yet dreaded asking. After a couple of rounds of phone tag, I got a message from Dr. E that said, in essence, that he knows of no medical programs. The message also included these words of farewell: “You’ve taken such good care of Frankie. Say good-bye to him for me.”

I lost it  — and still sob, every time I think of it, including now.

I felt like I was losing a dear friend, a vital and gentle guide to the ways of Frankie, my first dog. I have no doubt that the farewell was heartfelt, that Dr. E genuinely cares for his long-time patients. (And yes, I will write him a note when the deed is done and tell him how much he meant to me.)

But it wasn’t only that. Once your beloved vet says good-bye to your pet, and approves of your decision to let go, there’s no turning back.

I suppose there’s one part of my decision to postpone the inevitable until November 1 that has denial as its source. Maybe the hospice vet was wrong, I’ve been thinking. She saw Frankie at his worst, having woken him up from a deep sleep in mid-morning. He’s far perkier in the evening these days.

And Frankie’s junk food diet —  the cat food and franks I’ve been giving him to spoil him instead of organic no-grain kibble and plain chicken — seems to have made him more alert. Maybe it was his boring low fat diet that got him depressed, giving him no reason to get up in the morning?

Oh, so you expected rational?

“You’ve Taken Such Good Care of Frankie”

That praise, coming from Dr. E, means a lot to me.

Dr. E. is the third medical professional who has said words to that effect. The first was the eye specialist who said that Frankie’s vision was surprisingly good considering how long he’s had diabetes; she attributed it to my care. The second was the hospice vet who said that it was unusual to find a diabetic dog who was still relatively healthy after five years of living with the condition.

Friends, real and virtual — yes, that means you, gentle readers — have said similar things.

It’s too bad I don’t believe it.

None of you have a clue about what goes on behind the scenes… the times I’ve forgotten to refill Frankie’s water bowl for at least an hour, when I’ve made him ride with me in the car without soothing music, stood too long chatting on the trail with friends who have a dog that made Frankie nervous…

But the prime exhibit of my lack of  caretaking skills: I’m convinced that if  I hadn’t allowed Frankie to take steroids for two weeks when he injured his back 5 years ago, he wouldn’t have gotten diabetes in the first place. And if I was really a good caretaker, I wouldn’t have allowed him on the couch or on my bed, so he wouldn’t have injured his back jumping off high places to begin with.

In other words, if only I had second guessed Dr. E.,  who prescribed the steroids, or prevented Frankie from behaving like a dog, I might have deserved the kudos I’m now getting.

Bottom line:  If I was a really good caretaker, I wouldn’t be saying good-bye to Frankie. I would be able keep him alive — and of sound body and mind — indefinitely.

Delusions of grandeur alternating with deep feelings of inadequacy: Is there a formal name for Dog Departure Derangement Syndrome in the DSM-5?

Update: You all are the nicest, most supportive readers a blogger could hope for — I thank you for all these comments. But as I explain in my next post, although I have moments of doubt (and derangement), I was exaggerating here for effect. Most of the time I know I’ve done the best that I can for Frankie, that I don’t have super powers.

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Laparoscopic Spay: Less Pain, Except on the Wallet

This article is a version of one that originally appeared in Your Dog, the newsletter of The Cummings School of Veterinary Medicine at Tufts University. You will be seeing several more of these articles in the coming weeks, as Will My Dog Hate Me moves towards its final days.

I’ll continue to mention this countdown so you can’t say I didn’t warn you.

***

Tested on Humans (though not the spaying, per se)

Following upon the heels of its success in human medicine, laparoscopic surgery — performed using instruments with optical devices — is becoming increasingly popular in veterinary practices. Its benefits for pain reduction and recovery speed are evident in such common procedures as canine spaying, with the greatest benefits seen in larger dogs.

Surgical specialist Rob McCarthy, DVM, at Cummings School of Veterinary Medicine at Tufts University, has seen the number of laparoscopic spays increase exponentially in the past five years. “Because they now know about laparoscopy in humans, more and more dog owners are expressing interest in this method of spaying as they learn about its availability,” he says.

Still, Dr. McCarthy estimates that fewer than 5% of all practices in New England currently offer laparoscopic surgery, in part because of the expense of the equipment and in part because of the difficulty of getting veterinary surgeons trained in traditional methods to feel comfortable with the new technique.

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If laparoscopic neutering is a good option for female dogs, why is it not available for males? Put simply: Because female reproductive organs are internal, and male reproductive organs are external. Dr. McCarthy explains: “The way laparoscopic procedures work is that you need a space in order to see what you’re doing. Think of it as working inside a balloon as opposed to working in a closed dark box. In the abdomen, where the ovaries and uterus are located, you are able to inflate the space with carbon dioxide.”

In contrast, with a normal descended testicle, there is no space you can distend in order to perform the surgery. Or, to be more precise, it could be done — in humans, thyroids are removed by distending the tissues in the neck — but it’s not worth the trouble because removing the testicles is not a very invasive surgery to begin with, requiring an incision that’s only a few centimeters long.

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How does laparoscopy work?

With an “open” procedure, as traditional surgeries are called, the surgeon makes a large incision in the abdomen in order to remove the reproductive organs. With laparoscopic spay, a small incision is made just behind the umbilicus (belly button), and a long optical surgical instrument is inserted. After the first ovary is located, another small incision is made to the front and side of it. The ovary is grabbed through this opening, pushed against the body wall and held there with a suture while the blood vessels are fused together and severed. After the first ovary is removed, the process is repeated on the other side. Read More »

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I’m My Dog’s Seeing-Eye Person

Frankie’s eyesight is failing, though I’m not sure to what extent. Although they’re not completely obscured, his lenses look cloudy. I’ve also noticed that Frankie is hesitant to jump off things as low as the mattress on the floor where we sleep. (Yes, when he had back problems years ago, I opted to put my bed on the floor rather than train Frankie not to jump up it. That’s for my sake as much as for his; I like waking up next to my little furry buddy).

He seems a bit more uncertain in general,  a little more irritable.

This encroaching sight limitation — ok, blindness — comes as no great surprise. Frankie is about 13 and he’s had diabetes for more than four and a half years. Cataracts are a side effect of both age and diabetes; sometimes they are the first sign of the disease, in fact.

There’s a possible solution to the problem: Cataract surgery. It’s a fairly simple procedure, and I thought maybe I could have it done as the same time as I had Frankie’s teeth cleaned, because putting him under anesthesia twice didn’t seem like a great idea at his age.

But when I called the veterinary specialist to get a quote on the price for cataract surgery and to find out about the possibility of having Frankie’s teeth cleaned at the same time, I got a nix on the dual procedures. Eye surgeons don’t want bacteria from the teeth migrating up while they’re trying to create a sterile environment. Which makes sense.

And then I got the sticker shock: It would cost about $4,000 to do both eyes. Not so simple, budget-wise. I can’t afford it. I can barely afford the teeth cleaning, about $600, but I know Frankie’s health and comfort are at stake when it comes to dental work. The eyesight issue is not so clear cut.

I’m deeply conflicted. There’s a part of me — the rational one — that knows this is more about me than about Frankie, about not wanting to accept that my once bright-eyed, perky pup is getting old. I imagine that when he seems distressed and wants something from me that he can’t express that he’s upset over his eyesight, that he wants me to make it come back.

Project much?

Of course he could also have early stage dementia, which cataract surgery wouldn’t improve. He would simply see where he is wandering better.

Then there’s the morbid superstition that if I were to go into debt –or I should say more debt — for  eye surgery, Frankie would immediately contract a fatal disease, leaving me broke as well as bereft.

But maybe you’re wondering about Frankie’s quality of life, as opposed to the state of my mental health.

Aside from the bouts of seeming to have some indeterminate need I can’t meet — maybe an existential crisis? — he seems fine. He’s still chasing his squeaky carrot, though he doesn’t run with it as far as he used to. He finds his way outside to his favorite bathroom spots in the yard, no problem. I’m far more likely to trip over him when he gets under my feet than he is to bump into anything.

And he’s never been interested in wandering when we go on walks. He’s always happy to trot along behind me on the leash. And that’s not changed.

He also continues to stare at me to psych me out.

Still, I’m trying to clear the floor of obstacles — stray shoes in the living room and bedroom, papers and books on the floor of my office. This is not a bad thing to do under any circumstances (as I said, I’m more likely to trip over stuff than Frankie is).  And I’m trying to stay rational and not let guilt blind me to the fact that I can’t control every aspect of my dog’s aging, but that I will continue to guide him and cater to his comfort as best I can.

Has anyone else dealt with vision loss in a dog or cat? Who had more trouble coping — you or your pet?

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Vaccinating Your Dog, Part 2: Risk Assessment

Last week I gave a basic overview of vaccinations, including a discussion of why dogs need them. I made the distinction between core vaccines (those that every dog needs for public health reasons, including rabies, which is required by law) and noncore, which should be administered depending on a dog’s particular circumstances — exposure to other dogs, for example, or geographical location. The American Animal Hospital Association (AAHA)  recommends that noncore vaccines be given whenever the risk of the disease is high enough to override the risk of vaccination.

Here I pick up with a discussion of “the risk of vaccination” part of that equation.

***

Adverse Reactions

Very few dogs — less than ½ of 1% — have adverse reactions to vaccination. And most of those reactions are mild. But if your dog falls into a high-risk category (see the “Is Your Dog at Risk?” box) or you prefer to err on the side of caution, there are strategies that can help mitigate any potential problems.

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A very large, comprehensive study — 1,226,159 dogs vaccinated with 3,439,576 doses of vaccine at 360 veterinary hospitals — conducted in 2005 determined that the dogs at greatest risk of having an adverse reaction to immunizations were young adult, small-breed, neutered dogs who received multiple vaccinations during a single office visit. (The results of this study can be found in JAVMA — Journal of the American Veterinary Medical Association — Vol. 227, No. 7, October 1, 2005; I would attach a pdf if I knew how.)

Most reactions fell into the following categories: swelling of the face and eye area (31%); raised, itchy areas (21%); generalized itching (15%); vomiting (10 %); swelling, inflammation, or soreness of the vaccination site (8 %); fever, lethargy, and lack of appetite (5.5%).  Most dogs were successfully treated with an antihistamine and/or glucocorticoid (steroid that reduces inflammation).

Small breeds. The larger the dog, the lower the risk of a reaction. Here’s why, and it’s a shocker: The manufacturers’ recommended dose for vaccines are not adjusted for body weight, in contrast to doses of almost all other veterinary pharmaceuticals.

Within the small breed category, the dogs most likely to experience symptoms after vaccination were dachshunds, pugs, Boston terriers, miniature pinschers and Chihuahuas. A genetic predisposition to allergies likely plays a role in this response because, in general, small mixed breeds had far fewer bad reactions to vaccination.

Multiple vaccinations:  The risk of a reaction increased as the number of vaccine doses administered per office visit increased, especially with small dogs. Each additional vaccine increased the likelihood of reaction by 27% in dogs that weighed less than 22 pounds and 12% in dogs larger than 22 pounds.

Neutered dogs: Both male (27%) and female (38%)  neutered dogs were more likely to have a reaction than sexually intact dogs.

Young adults: Dogs of approximately 1 to 3 years old had the greatest number of   adverse reactions, which is probably related to the fact that most boosters for puppy vaccinations are administered during this age span. Dogs older than 8 years experienced the fewest side effects.

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There’s little you can do about most of the risk factors noted here — you can’t change your dog’s size or age or un-neuter him — but you can control how many vaccines you have your vet administer at a time. This requires spending additional money on individual office visits, but with an at risk dog it’s likely worth the investment in your peace of mind. Read More »

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Vaccinating Your Dog, Part 1: The Basics

The story of an adverse canine vaccination reaction detailed in recent weeks in my friend Roxanne Hawn’s Champion of My Heart blog inspired me to go back to a piece I wrote for Your Dog newsletter in late 2010. It’s long, so I broke it into two parts. Part 1 puts the larger issues of vaccination in context, while Part 2 discusses what can go wrong — and how to try to prevent it .

Why Vaccinate?

Vaccinations are not only essential to the health of your dog. By preventing the spread of dangerous, highly contagious diseases, they’re also key to the health of the canine community. But one size doesn’t fit all. The type and frequency of vaccines that dogs receive need to be tailored to their individual, ever shifting, circumstances.

Linda Ross, DVM, ACVIM at Cummings School of Veterinary Medicine at Tufts University, stresses the need to discuss vaccination with your veterinarian. “Beyond the vaccines that are generally recommended for all dogs, there are others that depend on where you live, whether you put your dog in a kennel, go to the dog park, etc.,” she says. “A vet who is familiar with your dog’s routine and medical history can help you decide what’s best for your pet at different life stages.”

Vaccination is the introduction — usually by injection but sometimes nasally or transdermally (by direct application to the skin) — of killed or deactivated organisms in order to provide immunity against the diseases they cause.

The vaccines in widespread use fall into two general categories: the core group, recommended for dogs across the board, and the noncore, which are prescribed based on a dog’s individual circumstances.

Core Vaccines

Core vaccines protect against diseases that are common in North America, that are particularly dangerous and difficult to treat, and that are very easily transmitted. The American Animal Hospital Association (AAHA) Canine Vaccination Guidelines includes in this group distemper, which often causes seizures and spinal cord damage; parvovirus, resulting in severe vomiting and diarrhea; adenovirus, an upper respiratory illness (the vaccine also helps prevent canine hepatitis); and rabies, as dire as depicted in horror films  but usually more quickly fatal than plot requirements dictate Read More »

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Diseases of the Dog’s Anal Area

Trying To Squeeze InLet’s face it: Dog owners spend a lot of time discussing dog butts and what emerges from them. Puppy bums lend themselves to lots of joking. But this article, adapted from one I wrote for Your Dog, the Tufts University veterinary school newsletter, deals with some medical problems that are no laughing matter.

That doesn’t mean I was going to put in graphic disease photos. Dog butts are cute and funny.

***

Diseases of the anal area occur frequently in dogs, from those that are easily prevented and resolved to others that are unpredictable and persistent. Although owners might prefer not to think about or investigate this part of their dog’s anatomy, anal diseases naturally benefit from early diagnosis and treatment.

Luckily, symptoms are generally easy to spot.

“It’s worthwhile to know what normal looks like in this area, so it can be checked periodically,” says surgical specialist John Berg, DVM, at Cummings School of Veterinary Medicine at Tufts University. “Owners of older dogs, especially those whose tails cover the anal region, need to be especially vigilant.” Frequently encountered diseases include anal sac impaction, perianal fistulas, and perineal hernias, discussed here.

Anal Sac Impaction

The most common problem, one particularly affecting small and overweight dogs, is impaction of the anal sacs. Located beneath the skin and anal sphincter muscles at the 4 and 8 o’clock positions, these organs are lined by cells that produce a malodorous, oily brownish fluid. It’s usually discharged in small quantities when feces pass through the rectum and squeeze the sacs.

“We don’t know for certain why the sacs are there or why the fluid is produced,” Dr. Berg says. “It’s theorized that the fluid may lubricate the stool and make it easier for the dog to defecate.” Read More »

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Do Dogs Need Professional Teeth Cleanings? Yes!

Maybe you’ve seen a sign for “Teeth cleaning without anesthesia” in your groomer’s shop or on a pet store bulletin board. And you’ve wondered: Would your dog benefit from some quick tartar removal, free from the perceived dangers — and costs — of a professional cleaning under anesthesia at a veterinarian’s office?

“Definitely not,” says Jean Joo, DVM, a veterinary dentist at Tufts Veterinary Emergency Treatment & Specialties in Walpole, Mass. She stresses that the hazards of such services far outweigh any superficial cosmetic benefits. “Not only do these types of cleanings fail to prevent periodontal disease, which takes place below the gum line,” Dr. Joo says, “but they create a false sense of security in the owner because the teeth look clean.”

The results can be devastating. “I had a toy poodle come in with clean, white teeth,” Dr. Joo says. “The groomer scaled her teeth every month, and they had almost no calculus at all. However, when I examined the dog under anesthesia, I saw that her teeth were in terrible shape, many of them loose and diseased. I ended up extracting 16 of them.”

What Happens Under the Gums Stays Under the Gums

Calculus, commonly called tartar, is the hardened form of plaque, the bacteria-laden material that naturally forms on and between teeth. It’s easy to chip tartar off the upper part, or crown, of the tooth — which is why it can be done without anesthesia — but that’s not where problems occur. Read More »

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Unnatural Naturals: A Tale of Pet Perversion

A bit of quackery?

Yesterday I made the case — or posed the possibility of a case — for natural remedies for pet health problems. Today I’d like to discuss my personal experience with their dark side.

Ok, so it’s not really dark, just funny peculiar.

Denial is a river in Tucson, too

When Frankie was first diagnosed with diabetes, it took quite a long time to get his blood sugar regulated. I was at my wit’s end and, at the same time as I was adjusting doses of insulin and paying for glucose curves at my traditional veterinarian, I decided to consult a holistic vet. The practice had been highly recommended by a friend who swore — and still does — by the acupuncture treatments her dog received there to relieve hip pain.

My experience was somewhat different than my friend’s. Read More »

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Herbal Remedies for Pets: First, Do No Harm

Does your medicine chest look like this?

My Drug Problem (No, Not That Kind)

When it comes to medications, conventional and alternative, I’m profoundly conflicted.  I’m suspicious of the medical establishment, especially of its encouraging people to take drugs and then more drugs to counteract their side effects. But I have no problem taking over-the-counter pain meds, allergy pills and antacids, as well as prescription drugs on a temporary basis.

I’m even more suspicious of natural supplements and remedies. I remember deadly L-tryptophan in 1989 — about 1500 people disabled, and some 37 deaths — and various contaminated products from China. And even aside from taints, I don’t always believe in their effectiveness. My doctor prescribed Vitamin D, for example. I took it for a while, and then decided it was dumb since I live in the land of sunshine.

Turns out, it was being over-prescribed.

That said, although I no longer take any vitamins or other supplements, I know when I start developing joint pain, I’m going to turn to glucosamine and chondroitin before I opt for steroids.

Of Drugs and Dogs

I try to be even more careful with Frankie, whose body weight can’t absorb mistakes — and who can’t articulate the drugs’ effects very well. In some cases, it’s obvious:  Flower essences like Rescue Remedy do nothing to calm Frankie’s car fears. But would something natural have helped his back pain, obviating the need for corticosteroids, which may have hastened the onset of his diabetes? I’ll never know.

My reason for ruminating about this issue now is the Animal Cafe interview that Dr. Lorie Huston did this week with Dr. Joel Murphy, who is responsible for formulating the remedies in the Renew Life pet care line.

Some background

Dr. Murphy, whose veterinary specialty is the treatment of birds, has been interested in holistic medicine along with traditional medicine since 1983, when he went to the Amazon to see how parrots might respond to their natural diets. There he became interested in nutraceuticals — a term I had to look up.  According to Wikipedia, it refers to a food or food product that purports to provide health and medical benefits, including the prevention and treatment of disease. 

I’m afraid that, in relation to pets, the word that nutraceuticals brings to mind is neuticles. Which is distracting. Read More »

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A Close Call — and a Change of Medical Course

Healer -- or deadly weapon?

Thank heavens for sinus headaches.

I never thought I’d have a reason to say that, but a nagging pain in my head combined with a friend’s fatigue may have saved Frankie’s life.

Frankie’s insulin problems: Some background

I’ve written about this many times before, so I’ll just recap.

Frankie’s diabetes had been well regulated on a canine-oriented insulin called Vetsulin. Then Vetsulin was taken off the U.S. market and I started mail-ordering the equivalent drug directly from a Canadian pharmacy — until there was a run on the pharmacy’s supplies. With the help of the ever-generous Karen Friesecke of Doggie Stylish, I was able to nab the saved-for-Canadian-dogs supplies, though getting the fragile drug through the mail via UPS was nerve wracking, not to mention expensive.

Fast forward to this past June. Frankie and I came back from my trip to San Diego and he had two hypoglycemic — low blood sugar — attacks out of the blue, one in the middle of the night, and one after breakfast. This hadn’t happened in years and it’s very scary. It’s not good for high blood sugar to be left untreated, but it takes weeks or months without insulin to lead to serious health effects; skipping an injection or two is no big deal. In contrast, a dip in blood sugar as a result of getting too much insulin can lead to convulsions, coma and even death within a matter of hours.

Although I suspected the problem with the insulin might be a result of my traveling with it and having it degrade, I nevertheless thought it might be time to switch to a more easily obtainable human variety, Humulin, to which  lots of diabetic dogs successfully transitioned after Vetsulin was taken off the market.

A month of anxiety

The vet had suggested I start out with a very small amount — 1 ml as opposed to the 3.5 ml that I’d been giving Frankie of the Caninsulin — and go up from there gradually. By testing Frankie’s urine — a far less accurate measure than blood testing but one that’s worked for me in the past — I raised his insulin in tiny increments over the first few weeks whenever the sugar content tested high. He had his first hypoglycemic attack when I reached 2.5 ml. Luckily I was home and caught it right away; a tablespoon of high sugar Karo syrup and a small meal was an instant cure. Another hypoglycemic incident followed about a week later at a lower level of insulin, at which point I began obsessing about leaving Frankie with a caretaker when I went away for a weekend.

I prepared needles with an even smaller amount of insulin in advance. All was okay, and I began to relax.

Until last Thursday night. Another food writer friend and I had gotten semi-last minute invitations to a tequila dinner at a nice resort.

Good tequila, good food, and good friends are some of my favorite things in the world.

Aside from Frankie.

The near catastrophe

I was looking forward to the event, but Thursday was hectic, with a midday meeting and a sinus headache I couldn’t relax long enough to get rid of. I still wanted to go, though — if tequila wouldn’t cure a headache what would? — but then my friend canceled and the host said maybe we should all convene another time.

I thought of saying I was feeling well enough to come on my own but then thought… nah. It would be a late night and I probably should take it easy because I had a lot to do the next day.

I never thought about a problem with Frankie. His blood sugar had tested high before dinner, so I went up from 1 3/4 ml to just slightly under 2 ml of insulin.

I lay down to watch TV after dinner — something I don’t usually do, i.e., the laying down part — so I didn’t really look at Frankie when he came wandering out of “his” room, though I saw him emerge. He went back in so I figured he was just checking to see if I was there, as he sometimes does. It’s very sweet.

About half an hour later, at 7:15, he came out again and I thought he might need to go out, so I got up — and saw he was staggering and shaking.

I gave him Karo syrup but, for the first time, he was almost too out of it to take it in. And he didn’t try to gobble up the food as he has always done. It took much longer than ever before until he — literally — bounced back and went bounding out of the room.

All I could think about was “What if I had gone to that dinner?” I wouldn’t have been home for another 3 hours, minimum.

I can’t bear to contemplate that, though of course I keep going there, over and over.

The new course of action

I called the vet the next morning.

I had been planning just to make an appointment for a glucose curve which would determine what time of day the sugar levels dropped and for how long — maybe the insulin lasted longer than 12 hours in Frankie, I thought — but when I explained what had been happening, my vet asked, “So can you still get that insulin from Canada?” She said one in ten dogs have trouble making the shift and Frankie seemed to be that one.

I wasn’t happy, needless to say, but I was relieved that I had “permission” not to keep trying something that so clearly wasn’t working. I have half a bottle left of Canadian insulin and I’ve ordered five more, enlisting Karen’s help to get it to me.

I wish that wasn’t the case and that Frankie had been able to make the switch. And I worry that the Canadian supplies will dry up entirely. But I’ll deal with that if I have to.

As anyone who takes care of pets or infants knows, it’s frightening to have the life of a loved one who can’t communicate with you in your hands. It’s doubly scary when the medicine you think you’re administering carefully has the power to do so much harm.

Surely insulin can’t be the only drug that behaves this way, though. I’m interested: Does anyone else deal with this kind of delicate balance in taking care of a pet?

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