Too Much

Last week I saw a cat in sad shape.  He'd lost a LOT of weight - 6 lbs off a formerly 18 lbs cat.  He was ravenous and drinking lots of water.  Worst of all was his fur coat - it was falling out in huge clumps, revealing thin, dandruffy skin under the orangey fluff.  He was friendly but looked terrible.

"He always loses some fur in the spring," the owner told me, "But I went out of town for a couple weeks and I came back to him looking like this!"  My techs were pretty concerned.  "What do you think is wrong with him?" two of them asked me.  Could be diabetes, hyperthyroidism, inflammatory bowel disease, intestinal lymphosarcoma... any number of things.  But my money was on diabetes based on his symptoms.  I even watched him walk around the room to see if he had diabetic neuropathy.  I sent blood and urine to the lab.

His results the next day confirmed Diabetes.  I called the owner, explaining the basics.  I asked her for a pharmacy so that I could call a prescription of insulin and needles in for her cat, and asked her to bring the prescription and the cat for an appointment later that day so we could go over insulin administration.  "Can I bring my children?  My son is 10, I think it would be good for him to learn so he can help me," she said.  Of course, I encouraged her to bring her kids to learn more about what was happening with their cat.

At the time of the appointment, I went into the room to find the happy cat on the table.  Also sitting on the table was a 6 year old girl looking at me with solemn eyes, and a chubby 10 year old boy who was avoiding all eye contact.  He really looked like he didn't want to be there.  Nevertheless, I think this stuff is cool, and started enthusiastically describing how insulin is the hormone, the thing that gets glucose into the cells, and without it the cells feel like they are starving.  That's why their cat was losing weight and hungry all the time.  Now he needed injections of this hormone that his pancreas was no longer producing.

"I'll give the first injection of insulin, then you can practice with a syringe of saline," I told the mom.  This is the standard training scenario to get owners familiar with giving little injections to their cats.  The needles are super tiny, so that the pet usually never feels it.  In fact, many cats seem to associate the injections with feeling better, and I recommend people give them at meal times so the cat is distracted anyway.  It is serious stuff, though, and overdosing on insulin can be rapidly fatal.

"Here's how you pull up two units," I demonstrated.

"Honey, you need to watch this," the mom said to her son.

"Mom, I don't want to," the boy softly whined, and suddenly tears coursed down his cheeks.

"You need to do this when I am out of town," mom said firmly.

"Mom, I can't..." he said.  His little sister looked at him, and tears welled up in her eyes, too.  He punched her, hard, on the knee.

Woah.  I give injections all day to animals, but I remember how nervous I was the first time.  Now I'd rather give an injection than a pill to a cat, but I don't want to force an unwilling little boy to give a "painful shot" to his sweet pet.  As mom continued to tell her son that he needed to do this, that remember its a small needle he probably won't feel, it will make him feel better, he'll die without it...  all I could think of was the large number of ADULTS that balk at giving their pets shots upon hearing the diagnosis of diabetes.  This was too much to put on this poor kid.

"You know, giving these shots is a big responsibility," I said.  "It needs to be done by an adult.  You said his grandparents will be staying with the kids when you're gone, and maybe they can be the ones to do it.  We can train them if they'd like.  We also have staff members who will come to your house and administer medications.  As a last resort, we also have diabetic patients who board with us, and we give them their injections here.  If he wants to help you, that's great, but its too much to trust to a kid."

"Oh, okay!" mom said, seeming flustered.  Then I demonstrated the insulin injection.  Mom had a turn with the saline; she did fine.  Then she asked her son if he wanted to try.

He seemed like he did.  So, I gave him a syringe of saline, repeated the steps of tenting the skin, burying the needle, then pushing the plunger.  He tented the skin, poked in the needle.  Then the cat shifted his weight, and the boy nervously bobbled his hand, the needle came out.  No big deal, but then he lost it.   He started crying and did not want to try again.  I thought over all he did great, but felt terrible for helping put him in this scary situation with needles.

Again, I offered to mom to have a technician come out to give the injections or board the cat, and repeated it was too much for a child.  "Oh no, I'm sure their grandparents can do it.  They are not old.  They are actually pretty young!" she cackled.  I walked them up front and scheduled a recheck in 5-7 days.  I hope that she heard me when I talked about how dangerous and immediately life threatening hypoglycemia can be, and that this is too much to entrust to a child.