I am writing from my mother’s bedroom in Connecticut. Three years ago, my mom fell down the stairs and broke her hip. She had already been experiencing memory loss and dementia, but the injury and ensuing surgery exacerbated these dramatically. She initially fought her way back to walking with a walker, but eventually age and the condition doctors call “senile degeneration of the brain” took their toll. In July, we began getting hospice support. She hasn’t been able to get out of bed for six months. On the other hand, she can still feed herself, and usually knows who I am.
This week, the social worker informed us my mother may be too stable to qualify for extending her hospice care. Um, she’s 100 years old — literally, can’t get out of bed, and has dementia, but apparently Medicare no longer finds this sufficient. “But what do we do if she suddenly goes into respiratory distress or has some other crisis in the middle of the night requiring palliative care?” I asked. Our main goal is to keep her home and pain-free until the end — not have EMTs drag her to a hospital. Which brings me to today’s topic.
Home emergency care. We can’t provide for every scenario, but there are two common conditions affecting dogs and cats that warrant owners having emergency medications at home: diabetes and seizures.
Take Honey, the diabetic dog, and Sweetie, the diabetic cat. Both get daily insulin injections. The two main urgent complications with diabetes are blood sugar too high, or blood sugar too low. Elevated blood glucose, technically called hyperglycemia, occurs when Honey doesn’t get enough insulin. It can lead to a life-threatening condition called diabetic ketoacidosis. Signs may include excessive drinking and urination, loss of appetite, vomiting, diarrhea, dehydration, belly pain, mental dullness, weakness, and severe depression. This isn’t something you can address at home. Period. You need to get to your veterinarian immediately.
Too low blood sugar, known as hypoglycemia, is a more common complication. It can occur if Sweetie gets too much insulin, doesn’t eat enough, or if other stressors result in imbalance in glucose regulation. Signs can include weakness, incoordination, staggering, acting “drunk,” vomiting, panting, seizures, loss of consciousness, and eventually death. The emergency home remedy is simple: Sugar — ideally a liquid glucose source like corn syrup, commonly known by the brand name Karo, used in cooking. If Sweetie shows mild signs of hypoglycemia, first try feeding his regular cat food. If he eats and symptoms resolve, you’re all set, though you should check with your veterinarian about adjusting his insulin dose before his next injection. If, however, Sweetie doesn’t eat voluntarily, or if his symptoms are more marked or persistent, squirt a small amount of corn syrup slowly into his mouth. Only do this if he is alert enough to swallow safely. Don’t force it, or he could aspirate it, and this will just make things worse. Instead, rub it on his gums. His body can actually absorb the glucose right through his mucous membranes.
Another situation warranting having rescue medications at home is if you have a dog with a history of seizures. There are many types of seizures, but we’re talking about classic “tonic-clonic” convulsions — the kind seen on doctor shows on television. The patient loses consciousness, falls over, becomes stiff, then moves their limbs like they’re running or shaking violently. There are many causes; toxins, infections, tumors. But if we can’t find any underlying explanation, and if the dog fits other criteria, we call it primary epilepsy, generally thought to be genetic. We expect these individuals to have seizures periodically, but don’t always start them on daily anticonvulsants right away. Some epileptic dogs have only a few minor seizures a year, and those getting daily antiseizure drugs may still have occasional episodes. The worry is that seizures can suddenly become more frequent or severe.
Forty years ago, we told people if a dog had more than three seizures in 24 hours, or one seizure lasting more than five minutes, to get to an emergency vet, no matter if it was 2 am. Then, maybe 20 years ago, we started giving owners of epileptic dogs doses of liquid diazepam they could administer rectally at home if needed in an emergency. We would draw up the proper dose in a syringe, replace the needle with a little enema nozzle, and advise owners to store it securely. Since you can’t give oral medication to an animal actively convulsing, rectal administration was a safe alternative, and the drug was absorbed rapidly this way. But eventually we learned there was another problem: If these syringes were stored too long, the plastic absorbed the active ingredient out of the liquid, leaving a much less effective medication. So then we taught owners how to draw up a fresh dose with a needle and syringe from a glass vial right when their dog was having a seizure, then remove the needle and substitute a rectal cannula. But this was hard for people during a crisis, and even without these issues, studies showed diazepam wasn’t always very effective.
Nowadays midazolam is often the drug of choice for home seizure rescue. It is more effective, and can be given intranasally, i.e. squirting up the nose. I prefer to prescribe it as a stable nasal gel from a compounding pharmacy, dispensed in individual dose syringes with nasal adapters. Easy to administer, reasonable shell life, greater efficacy. Unlike Karo syrup for diabetics, diazepam and midazolam are controlled drugs, and must be prescribed by licensed medical professionals. The same is true for many medications we would ideally have on hand for my mother’s comfort, should 24/7 hospice care cease to be available. For now, they have extended her approval 60 days, which gives me time to talk with her doctor and explore options. It’s a strange system when taking such good care of one’s elderly parent can result in no longer being able to get the necessary support.
