Multiple Myeloma

[leslks@aol.com]

I need to know about Alkeran dosage for a cat. Seems this is a rare disease in cats. Not much is known about whether or not this med can be given to a cat. PLEASE advise.

[Mona]

Well, my mother died from this disease, it is an extremely fast cancer which travels all over the body in the blood.

Is your cat being treated for this now. I would not give any medication which is not prescribed or known by your vet.

http://www.accessdata.fda.gov/scripts/c ... n,%20L-PAM

PLEASE be warned about the side affects such as bleeding and bone marrow suppression. Read the above warning for this drug.I have not heard of this drug for cats, Traci can offer more advice.

Mona, Honeybun and Chloe

[leslks@aol.com]

Blondie was supposed to be given 1/4 tab (of a 2mg pill) every other day.
The third dose was accidently doubled. He died an hour or so later. No one knows for sure what else took place. The hosp. has no record for that day and the necropsy results are lost. Blondie had blood on his mouth. The vet said he probably bit his tongue. I don't buy any of it!
The vet board is looking into this. They think the only problem is the records. I think Alkeran is probably not the thing to have given.

[Traci]

Lynda....I sent information to Jane last night for you...if you haven't recieved it yet, here is your info..

As for the Alkeran (otherwise known as Melphalan), the following
is the recommended dosing amount:

0.1-0.2 mg/kg/day, orally, for 7-10 days, then repeat every three weeks.

Keep in mind that the lowest dose is 0.1 mg/kg/day for cats.

As with any chemotherapeutic
agent, caution must always be used when dosing and administering,
because of course they are cytotoxic, and can leave serious side
effects or life-threatening anemia/neutropenia.

[Mona]

Lynda_

I am very sorry for the loss of BLondie. IT is very odd that no records were located for that day at the hospital.

I do hope you can get a more definitive answer and have some closure.


Mona, HOneybun and Chloe

[leslks@aol.com]

Traci,
Jane just called me and forwarded your answer to me.
Blondie weighed 9 lbs according to the first hosp. I took him to.
The emergency hosp. used that weight. I don't see where they weighed him again.
Jane thinks the dose was correct but I am not clear. I don't do metric so could you please clarify for me?
.5 every other day? You show it should have been given daily. He got two doses. The third one was doubled. There are no records for that day.
He had blood on his mouth. The necropsy results conveniently disappeared.
Could the vet have made a terrible mistake?
Thank you.

[leslks@aol.com]

Mona,
Thank you for your prompt reply this morning.
I am sorry for the loss of your Mother.
Blondie was one of my Mother's two cats. He died 7 months after I lost her.
I know something went wrong with his care. He was in the hospital 9 days.

[Traci]

I don't do metric so could you please clarify for me?
.5 every other day? You show it should have been given daily. He got two doses. The third one was doubled.

If your kitty weighed 9 lbs, then the lowest loading dose per day would be .40 mg total for each day (of a 2 mg tablet). The highest possible loading dose for your kitty could have been up to .81 mg per day (this is based on the 0.1-0.2 mg/kg/day formulary for alkeran use in cats), but only the vet was qualified to dose at either the lowest or highest, based on the condition, CBC, degree of immunosuppression.

I mentioned every day dosing because that is the recommendation based on the formulary for alkeran. If your vet wanted an every-other-day dose, he may have felt kitty's platelets were low at that point and didn't want to risk an every day dose. You really need to find out about that day's events, and especially get a record of the last CBC that was done for your kitty, so that you can determine if his platelets were low, or if he might have been suffering mild neutropenia. Was he on a combination chemo protocol, or was alkeran the only chemotherapeutic agent used for his treatment?

If the vet somehow doubled the 1/4 tablet, that would make it 1 full mg, which exceeds the recommended dose for that day.

Was the doubled dose the cause of death? Possibly, but I am not qualified to make that assumption, without the health records to show the amount given for that day, without vitals recorded to monitor kitty prior to the alkeran given, and vitals taken/observed after, a CBC or hematocrit report, and without the necropsy results, it's impossible to determine.

Is it possible that the vet is still waiting for a pathology report? Oftentimes, we must send samples to the lab for comfirmation, this could take up to 7 business days, so if it's been longer than that, I would be for getting your state veterinary board on the case, but first, confirm the recommended dosing amounts from another vet you trust, so that it is made clear on whether or not the last dose was potentially lethal or not.

I truly hope this was not a case of negligence, but it is not a good sign when no records are produced, no necropsy report, and I am assuming no verbal communication between you and this vet. If such is the case, I'd be hiring an attorney ASAP.

My heart goes out to you, Lynda, this is indeed a frustrating situation.....(((HUGS)))

[leslks@aol.com]

Traci,
This happened June 13, 2000. It has finally come up for review at the Vet Board. We were there Oct. 7 and 15. With your info. I am hopeful they will find a violation. Currently they are only going to send a letter of concern for the missing records. I know that is not enough. The vet initially called an hour after we got home. I couldn't talk so she told Larry nothing was found except Myeloma. He told her I would want to know everything when I was able to deal with it. From then on she could never find what she did with necropsy results. Also no records for the last day. I knew there was something wrong there. Another of my cats, T.W., was also a patient of hers. When there was talk that she may go back east, I told her to be sure to let me know. She said she would but was going to stay here. When I called for an appt. I was told she moved. Then I knew she was hiding something in Blondie's case.
Why tell me to get an atty.? Depending on the outcomen with the Board, I will ask for a refund. The hosp. administrator is easy to deal with and had already told me to wait and see what the bd. says. I had told him I should have gotten a refund at the time. Right now I just want her to be held accountable if she did wrong.
Can you tell me how you know the facts about dosages for this? Do you treat cats with this disease?
Thank you again for the help. It can make a difference.

[Traci]

Traci,
This happened June 13, 2000. It has finally come up for review at the Vet Board.

It is just NOW coming to review? Do you know if this particular vet has any other complaints against her? (I would think an attorney can find that out for you)

Currently they are only going to send a letter of concern for the missing records.

A letter of concern.....this could mean of investigative nature, or inquiry for copy of the records. Again, an attorney could probably get more information for you.

I only suggest an attorney in the event you are seeking legal recourse against the vet (as in, suing for veterinary malpractice). Unfortunately, in veterinary malpractice suits, the red tape is long and frustrating, as most courts still view a pet as no more than if you purchased a purebred and wanted a refund of your purchase price. On the up side, some states are trying to change laws and opt for 'gaurdianship', and adapting more legal recourse options for owners who feel malpractice was the cause of a pet's death. I truly do not know if this applies to you, because it is ultimately up to the board to investigate the matter to find if any discrepencies or blatant act of negligence was done.

From then on she could never find what she did with necropsy results. Also no records for the last day. I knew there was something wrong there.

Poor record keeping indeed is wrong and unethical. There should be a full record of your kitty's health history, from beginning to end. And if the entire staff couldn't find a necropsy report somewhere in the clinic, there is something definately wrong. Yes, occasionally, records get lost, but they always usually show up sometime or another (misplaced in another file, left in the lab or in a vet's drawer in their desk, you get the idea)

Depending on the outcomen with the Board, I will ask for a refund. The hosp. administrator is easy to deal with and had already told me to wait and see what the bd. says. I had told him I should have gotten a refund at the time. Right now I just want her to be held accountable if she did wrong.

I tend to agree with you. However, is the female vet the only vet who attended your kitty and treated her? Were any other vets treating your kitty, and was any mention made of the hospital administrator interviewing all staff members on that particular day, particularly the head technician or other tech or assistant assisting your vet on the day of the incident? I find it implausible that this vet was alone when she last treated your kitty, surely there was a tech assisting her or other staff members involved in kitty's care and treatment...it's up to the hospital administrator to get those questions answered.

Can you tell me how you know the facts about dosages for this? Do you treat cats with this disease?

I'm a veterinary technician, it's my job to know formularies and how they are applied in treatment. Chemotherapeutic agents must be handled carefully, for the safety of the pet as well as the clinician administering the chemo. There are various precautions that must be taken into consideration before administering any chemo agent, including knowledge of the condition being treated, hematocrit and chemical profiles, knowledge of the drug and it's contraindications, critical monitoring of the patient before, during and after administrating the drug, and followup care and treatment to determine the response to treatment or if there are complications that need to be addressed.

Having said that, all of the above should have been accurately recorded in kitty's health chart every single day of treatment.

I'm assuming you were told that a double-dose of the alkeran was administered by the vet, but who exactly told you this, the vet responsible or someone else? And, if it was someone else, were they actually told that by the vet responsible? Did anyone (and who) tell you that the possible cause of death was indeed the double dose, or was the question left up in the air, as in...a complication that was unrelated to the drug? (again, it's up to the hospital administrator to answer those questions and be available to the board to offer the same information)