Last week I deferred my desire to rant against various bureaucracies — both governmental and industrial; I’m an equal opportunity ranter — that were keeping Frankie and his diabetes drugs apart in order to provide some background, which I did here.
The Search for Insulin Begins
This brings us to about three weeks ago when I put up a note on Facebook:
Damn. I just found out that Vetsulin/Caninsulin is out of stock in Canada — where I’d been ordering it since emergency supplies in the U.S. were discontinued. I’m devastated at the thought of getting Frankie regulated on another diabetes medication, especially since my vet wasn’t very encouraging about the success he’s had with switching other dogs over.
Karen of DoggieStylish.com suggested that some Canadian pharmacies that don’t ship to the US have might have supplies — and was generous enough to offer to mail them to me. Sure enough, I was able to order three bottles from the pharmacy she referred me to without a problem.
This was on a Thursday. Karen picked up the Caninsulin two days later, on Saturday, and said she would mail it on Monday. I was leaving town the following Thursday, so we opted for two-day mail for $80 — as opposed to overnight for $130 — so that the Caninsulin would arrive on Wednesday, a day before I was to leave town.
If the shipping seems crazy expensive it was worth it for me to have the perishable insulin arrive in two days rather than the five to 10 that the Canadian pharmacies that ship to the U.S. cite. And the Canadian pharmacy that Karen recommended charged HALF of what I was charged in the U.S. and at the other Canadian pharmacy ($27 vs $54 or $60 per bottle). So I ended up spending about the same amount of money for three bottles — less if you add the $15 the other pharmacy charged for the slow boat shipping.
At this point I wasn’t concerned about replenishing my supply of Caninsulin; I still had more than a month’s worth. I was just worried about getting a medication that wouldn’t work because it had been subjected to heat and excessive jostling.
On Tuesday, I began tracking the package on line. I’ve done this before and kind of like watching the progress of my purchases as they wend their way to me.
Not this time.
First, the Caninsulin wouldn’t clear U.S. customs. Then the package was passed along to the FDA in Louisville, KY, where, in spite of being clearly marked as fragile and perishable, it sat and sat. I began to hate Louisville — which, pre-mailing, I considered a fine city with excellent bourbon — as the place where the package was going to live permanently.
It was still in Louisville Thursday morning, when I had to leave for Scottsdale.
But I wasn’t just tracking the package. I was calling UPS regularly to find out what the options were once it became clear that it might not be delivered while I was still in Tucson. Perhaps I could change the delivery address to that of a friend who would be home? Maybe it could be held at the UPS office in Tucson until I could retrieve it on my return, on Friday afternoon?
What I didn’t want was for the drug to be driven around in a truck that is not temperature controlled all day when it could not be delivered.
One person told me that they had to “attempt” delivery once to the designated address before any changes — including an instruction that the package could be held at the UPS facility — could be made. I asked to speak to a supervisor to discuss why this was the case. It was bad enough that the package wasn’t going to be delivered in the designated two days. I understood that UPS had no control over customs or the FDA (which actually require two much longer and separate rants). But why, for $80, could I not get the delivery — or nondelivery — that I requested?
The supervisor I got was extremely nice. She said that, in fact, supervisors could authorize changes in delivery specification, but not until the package was released for delivery. She suggested I keep tracking on line and then call in again.
This was Wednesday evening.
Thursday morning when the package still wasn’t released by the FDA and I had to leave, I phoned again and asked to speak to a supervisor to explain that I was leaving town and would be on the road a good part of the time and wouldn’t be able to track the package regularly and wanted to make sure the package would not be delivered to my home while I was away. This supervisor totally disowned what the other supervisor had told me. She reiterated that delivery had to be attempted because “that’s in our contract.”
Just so you know, for the most part I was very polite. I understand that people who answer the phones are not the ones who create the policy. But the notion that there was a stealth supervisor policy that some supervisors know about and some don’t was making my head explode. I did raise my voice a little at the second supervisor. It makes no sense not to be able to change the mode/place of delivery when the timely schedule of delivery you paid for is no longer in effect. Who is being served by that policy? Certainly not the customer.
The Delivery. If You Can Call It That
I checked online for the package one time on Thursday afternoon before I left for the book signing. It was still in Louisville. I didn’t want to ruin an event that I was nervous and excited about so I finally decided to let go and stop thinking about it. I managed so successfully that I went out for breakfast with friends the next morning and didn’t check online again until I was almost ready to drive back to Tucson. It was at 11:30am on Friday.
You can imagine how shocked I was to read on the tracking statement that the package had been left outside, on my front porch, two hours earlier! It was an aberrant 85 degrees in Scottsdale and slated to go up to 95, which meant it was probably only a little cooler in Tucson.
You call dropping a package off without requiring a signature for verification “attempted delivery”? After I’ve called at least 10 times to explain the situation, that I am not going to be home and do not want the package being subjected to physical conditions that could further endanger it? WTF??
In a panic, I started calling friends who live close to my house and who might be able to pick up the package quickly. One answered, but was out of town; two didn’t answer at all. I was about to begin throwing my net out to friends who lived farther from my house when Gabe, who not only lives close to me but has my key, phoned me back and told me not to worry, he would get the package inside and refrigerate the contents.
I got home, looked inside at one of the bottles, and the solution looked okay; according to what I’ve read, if the insulin is ruined, it looks clumpy. Gabe told me that the package had been in the shade. And I saw that Karen had packed it very well.
Still, I had to wonder about the next time, since there’s clearly no guarantee of two-day — or sensible — delivery. And here’s where things get even stranger. As I’ve explained, I was fixated on getting Vetsulin/Caninsulin because it was the product that Frankie responded to most successfully when he was first diagnosed with diabetes. Even though there were problems with the formulation, I was reluctant to switch over because he continues to respond well to this insulin and his blood sugar continues to be under control.
But as I was preparing to write this post, I went on line to research the latest data on switchovers, thinking that, even if the drug is not discontinued worldwide, there’s a limit to how much stress I can take — stress that I no doubt pass along to Frankie, who saw me hunched over the phone, pacing around the hotel room, and otherwise being upset. That’s when I found Dr. Carol’s Naturally Healthy Pet Blog’s post on the original Vetsulin recall.
Among other things, Dr. Carol says:
Vetsulin, the “special” insulin, labeled for pets… is actually Porcine Zinc Insulin, which is referred to as PZI. PZI is insulin derived from pigs, and in the past was used for people that are diabetics. Human diabetics use various types of insulin, for example NPH insulin, available at most pharmacies for less than $20.00 dollars a bottle.
PZI is no longer commercially available because today modern technology develops human insulin from DNA, rather than pigs. Since the PZI or pig based insulin is considered to be inferior to DNA based insulin, people don’t use it and Intervet/Schering Plough apparently grabbed the rights and labeled it for dogs and cats.
Now, I’m not taking this article as gospel although it upset me mightily when I first read it. Vetsulin had been billed as being effective because it was more similar to canine physiology than human insulin — which made sense. Or did it? Suddenly, I started wondering if I’d been duped by a drug company into believing that an inferior product that been repackaged for pets was superior. It wouldn’t be the first time.
I said I’m not taking this article as gospel because there are many dubious things about it. Among other things, it suggests that owners: “Get a prescription from your vet for NPH insulin,” and then “Verify the correct dosage of NPH insulin with your vet.” As easy as that? I don’t think so.