On October 10, 2007, we brought our cat, Blue, to XXXX Veterinary Clinic because of a limp. He saw Dr. XXXX, who prescribed Rimadyl 25 mg to be given 1 tablet a day until gone (14 tablets). No warnings of any kind about Rimadyl were given us by Dr. XXXX, neither written or verbal. We were given no information on any danger associated with this medicine. No Client information sheet, required by the Center for Veterinary Medicine of the Food and Drug Administration, for the purpose of communicating important risk information to clients and that is given to a veterinarian by a prescription drug manufacturer so that owners of an animal are provided with vital product safety information including precautions, contraindications, signs of a possible adverse reaction, and steps to take in the event of an adverse reaction to the prescription drug, was given to us.
Blue also received his rabies shot and FDRC booster at this time.
Blue was still limping and had now developed congestion, so he saw Dr. XX on October 29, 2007 and was prescribed Clavamox drops 15ml. He was given a Vitamin b-12 1000mcg/ml injection and penicillin. We were to give him 2ml twice a day for 14 days.
On November 10th, Blue was worse, so he went back to XXXX Veterinary Clinic, and was prescribed Cyproheptadine ½ every 12 hours for 10 days.
November 20, Blue was still not better, so we decided to take him to a different Vet to seek a second opinion. The new Veterinarian called over to XXXX Veterinary Clinic to have his records sent over, and were told they had not seen Blue in 3 years. That was untrue, they had seen Blue 3 times in the past month. I brought along a list of the medications Blue had been taking, and immediately I was asked why Blue was taking Rimadyl, which is fatal for cats.
For the next 2 months, we spent in excess of $1560.00 desperately seeking an answer to Blue’s issues. Blue had the following procedures done to discover why his liver enzymes were abnormal: x-rays, ultrasound, chemistry profiles, hospitalizations, injections, urinalysis, IV Catheterization, Electrolyte profiles, intensive care treatment and ultimately, cremation. Blue died on February 6th.
We sent a letter to Dr. XXXX asking him to review his records on Blue, and contact us regarding this situation, specifically about the prescribing of Rimadyl, which is not approved for feline use in the US. Dr. XXXX called and spoke to me on March 3rd. He said although Rimadyl is not approved for use in the US, it is used in other countries, so he was standing behind the prescribing of Rimadyl to Blue and would feel comfortable continuing to do so.
I am searching for information on the use of Rimadyl for cats. If there is any information you can give me, I would greatly appreciate it.
Rimadyl death
Re: Rimadyl death
I don't know anything about Rimadyl, but I did want to say that I am very sorry about Blue.
Re: Rimadyl death
First, I am so very very sorry about your loss... 
How old was he?
Did he have any other underlying health condition?
When was his last vet exam/bloodwork evaluation BEFORE you took him in to be evaluated for the limp?
What was the vet's assumption as to the cause of the limp?
BEFORE he prescribed the rimadyl, did he suggest/advise a full bloodwork profile? If so, was this done, or did you decline?
What was Blue's weight at the time of this exam?
Had the rimadyl been given for the full 14 days as prescribed by the first vet? At any time, did he tell you to bring Blue back in for testing his bloodwork (particularly for monitoring kidney and liver enzymes)? Did he tell you this should be done at the end of the course of the rimadyl?
The IV fluid therapy and hospitalization, for what, specifically, was this for? What was the vet attempting to treat? What symptoms? Did he suspect liver failure or something else? Were the various types of liver disease ruled out? (i.e., hepatic lipidosis, cholangiohepatitis, etc)
His comments, to me, indicate he is not practicing good medicine. First, you should know that many vets will use a mediciation intended for something, for something else, (extrapolating or off-label use), and most vets are conscientious about this as long as they refer to literature, case histories, and valid information on the product. But, it sounds like this vet feels he is exonerated for merely having his opinion and relying on past case histories that may (or may not have) been effective. When a vet does use a medication off-label, it is incumbent upon them to discuss with the client the reasoning, the contraindications if any, and to discuss the medication in full with the client, to obtain consent! If he truly did not discuss this medication with you, did not ask to obtain your consent, then he is both negligent and liable. The onus is truly upon him to determine if the rimadyl was the cause of the problems and subsequent death. If he is trying to absolve his involvement in this matter, then you may have due recourse to sue. You would have to be fully prepared for that, however, and seek legal counsel.
I'd advise that if you do contemplate seeking legal counsel, get ALL copies of Blue's records from this vet. Obtain ALL copies of Blue's records from the new vet as well, and include any written comments by that vet if possible. You can try asking the new vet to report this case to Pfizer Animal Health regarding the rimadyl's use in a cat, but it is ultimately the responsibility of the first vet to do so. You should call him or speak to him in person and request he report this case/incident to Pfizer, and you should request a followup from both he and Pfizer (if possible). Do not threaten legal action unless and until you've recieved ALL copies of Blue's records first, and do NOT indicate to the vet you intend to persue this matter or sue. Get the facts, records first, seek legal counsel when that has been achieved.
The difficult part is your part in proving the rimadyl was the ultimate cause of death, and having ruled out other underlying health problems having the potential of causing the health problems. Without a necropsy or sufficient findings of bloodwork, fluids or tissue samples, this can be a difficult process. The new vet may be able to help with that, but both sets of records need to be combined and reviwed for any clear indications the rimadyl may have been the cause.
There are numerous reasons why the FDA will not license/approve particular medications for use in cats and why vets must follow those recommendations. Cats cannot metabolize many medications, and those marketed for dogs should always be avoided, unless there is sufficient research to indicate safety in cats, at recommended, proven, safe doses. This vet's comments about it's efficacy and use in other countries is completely moot, they obviously do not have as strict standards as the US, medicine is practiced quite differently between them. The vet also knows that manufacturers are very careful to label medications for use, as it regards different countries.
I'm really appalled at his comments, and his disregard to your inquiries, and especially his practice, if he is giving rimadyl to other client's cats without their consent, he needs to be reported, montiored by the state veterinary board, possibly put on probation or license suspended or revoked. Rimadyl is not approved for use in cats, period, and the manufacturer clearly indicates to vets to obtain client consent.
The vet knew there were other, more safer medications he could have prescribed.
General information:
http://www.veterinarypartner.com/Conten ... &A=623&S=0
Rimadyl prescribing information:
http://www.rimadyl.com/display.asp?coun ... CN&sec=660
How old was he?
Did he have any other underlying health condition?
When was his last vet exam/bloodwork evaluation BEFORE you took him in to be evaluated for the limp?
What was the vet's assumption as to the cause of the limp?
BEFORE he prescribed the rimadyl, did he suggest/advise a full bloodwork profile? If so, was this done, or did you decline?
What was Blue's weight at the time of this exam?
Very unprofessional and neglectful on his part, particularly after all the information and information available on the drug.Blue wrote:No warnings of any kind about Rimadyl were given us by Dr. XXXX, neither written or verbal. We were given no information on any danger associated with this medicine. No Client information sheet
This, I think, was bad practice on his part. First, he gives rimadyl, an NSAID, then two vaccinations, he should have waited to give vaccinations after the course of the rimadyl, since all of these things combined were quite an insult in one day.Blue also received his rabies shot and FDRC booster at this time.
Do you mean respiratory congestion? How soon after the first vet visit did he develop congestion? This also applies to the remaining limp, did you not notice any improvement within a few days? Did the vet listen to Blue's heart and lungs? Did he offer an xray? If so, was it done then, or did you decline?Blue was still limping and had now developed congestion, so he saw Dr. XX on October 29, 2007 and was prescribed Clavamox drops 15ml. He was given a Vitamin b-12 1000mcg/ml injection and penicillin. We were to give him 2ml twice a day for 14 days.
Worse, how? Was the congestion worse? Or? What other symptoms were developing?On November 10th, Blue was worse, so he went back to XXXX Veterinary Clinic, and was prescribed Cyproheptadine ½ every 12 hours for 10 days.
Who told the new vet about the records? If a receptionist, that's an error on her part, not necessarily the vet. However, if the vet told the new vet he hadn't seen Blue in 3 years, then that is quite different.The new Veterinarian called over to XXXX Veterinary Clinic to have his records sent over, and were told they had not seen Blue in 3 years. That was untrue, they had seen Blue 3 times in the past month.
I'm assuming this was all done with the new vet? When was the liver enzyme levels detected? The day you first saw the new vet, or later? Did the vet rule out underlying health problems as opposed to the rimadyl, or did the vet suspect the liver enzymes were in relation to the rimadyl? Which enzymes were out of range? Were any other chemical enzymes abnormal? How did the vet treat this once determining the liver enzymes were abnormal? What injections were given?For the next 2 months, we spent in excess of $1560.00 desperately seeking an answer to Blue’s issues. Blue had the following procedures done to discover why his liver enzymes were abnormal: x-rays, ultrasound, chemistry profiles, hospitalizations, injections, urinalysis, IV Catheterization, Electrolyte profiles, intensive care treatment and ultimately, cremation. Blue died on February 6th.
Had the rimadyl been given for the full 14 days as prescribed by the first vet? At any time, did he tell you to bring Blue back in for testing his bloodwork (particularly for monitoring kidney and liver enzymes)? Did he tell you this should be done at the end of the course of the rimadyl?
The IV fluid therapy and hospitalization, for what, specifically, was this for? What was the vet attempting to treat? What symptoms? Did he suspect liver failure or something else? Were the various types of liver disease ruled out? (i.e., hepatic lipidosis, cholangiohepatitis, etc)
When was the letter sent, what time frame between the time it was sent and when he called you?We sent a letter to Dr. XXXX asking him to review his records on Blue, and contact us regarding this situation, specifically about the prescribing of Rimadyl, which is not approved for feline use in the US. Dr. XXXX called and spoke to me on March 3rd. He said although Rimadyl is not approved for use in the US, it is used in other countries, so he was standing behind the prescribing of Rimadyl to Blue and would feel comfortable continuing to do so.
His comments, to me, indicate he is not practicing good medicine. First, you should know that many vets will use a mediciation intended for something, for something else, (extrapolating or off-label use), and most vets are conscientious about this as long as they refer to literature, case histories, and valid information on the product. But, it sounds like this vet feels he is exonerated for merely having his opinion and relying on past case histories that may (or may not have) been effective. When a vet does use a medication off-label, it is incumbent upon them to discuss with the client the reasoning, the contraindications if any, and to discuss the medication in full with the client, to obtain consent! If he truly did not discuss this medication with you, did not ask to obtain your consent, then he is both negligent and liable. The onus is truly upon him to determine if the rimadyl was the cause of the problems and subsequent death. If he is trying to absolve his involvement in this matter, then you may have due recourse to sue. You would have to be fully prepared for that, however, and seek legal counsel.
I'd advise that if you do contemplate seeking legal counsel, get ALL copies of Blue's records from this vet. Obtain ALL copies of Blue's records from the new vet as well, and include any written comments by that vet if possible. You can try asking the new vet to report this case to Pfizer Animal Health regarding the rimadyl's use in a cat, but it is ultimately the responsibility of the first vet to do so. You should call him or speak to him in person and request he report this case/incident to Pfizer, and you should request a followup from both he and Pfizer (if possible). Do not threaten legal action unless and until you've recieved ALL copies of Blue's records first, and do NOT indicate to the vet you intend to persue this matter or sue. Get the facts, records first, seek legal counsel when that has been achieved.
The difficult part is your part in proving the rimadyl was the ultimate cause of death, and having ruled out other underlying health problems having the potential of causing the health problems. Without a necropsy or sufficient findings of bloodwork, fluids or tissue samples, this can be a difficult process. The new vet may be able to help with that, but both sets of records need to be combined and reviwed for any clear indications the rimadyl may have been the cause.
There are numerous reasons why the FDA will not license/approve particular medications for use in cats and why vets must follow those recommendations. Cats cannot metabolize many medications, and those marketed for dogs should always be avoided, unless there is sufficient research to indicate safety in cats, at recommended, proven, safe doses. This vet's comments about it's efficacy and use in other countries is completely moot, they obviously do not have as strict standards as the US, medicine is practiced quite differently between them. The vet also knows that manufacturers are very careful to label medications for use, as it regards different countries.
I'm really appalled at his comments, and his disregard to your inquiries, and especially his practice, if he is giving rimadyl to other client's cats without their consent, he needs to be reported, montiored by the state veterinary board, possibly put on probation or license suspended or revoked. Rimadyl is not approved for use in cats, period, and the manufacturer clearly indicates to vets to obtain client consent.
The vet knew there were other, more safer medications he could have prescribed.
I am searching for information on the use of Rimadyl for cats. If there is any information you can give me, I would greatly appreciate it.
General information:
http://www.veterinarypartner.com/Conten ... &A=623&S=0
Rimadyl prescribing information:
http://www.rimadyl.com/display.asp?coun ... CN&sec=660
..........Traci
Re: Rimadyl death
Traci wrote:First, I am so very very sorry about your loss...
How old was he?
Blue was 7 years old.
Did he have any other underlying health condition?
None that we were aware of.
When was his last vet exam/bloodwork evaluation BEFORE you took him in to be evaluated for the limp?
His last vet exam was 10/02/06. He had no bloodwork done at that time.
What was the vet's assumption as to the cause of the limp?
She didn't know. We thought it may have been from roughhousing with his Westie companion.
BEFORE he prescribed the rimadyl, did he suggest/advise a full bloodwork profile? If so, was this done, or did you decline?
This was not suggested.What was Blue's weight at the time of this exam?
Blue's weight was 23.12
Very unprofessional and neglectful on his part, particularly after all the information and information available on the drug.Blue wrote:No warnings of any kind about Rimadyl were given us by Dr. XXXX, neither written or verbal. We were given no information on any danger associated with this medicine. No Client information sheet
This, I think, was bad practice on his part. First, he gives rimadyl, an NSAID, then two vaccinations, he should have waited to give vaccinations after the course of the rimadyl, since all of these things combined were quite an insult in one day.Blue also received his rabies shot and FDRC booster at this time.
Do you mean respiratory congestion? How soon after the first vet visit did he develop congestion? This also applies to the remaining limp, did you not notice any improvement within a few days? Did the vet listen to Blue's heart and lungs? Did he offer an xray? If so, was it done then, or did you decline?Blue was still limping and had now developed congestion, so he saw Dr. XX on October 29, 2007 and was prescribed Clavamox drops 15ml. He was given a Vitamin b-12 1000mcg/ml injection and penicillin. We were to give him 2ml twice a day for 14 days.
The congestion developed in the next week to week and a half. His limp did not appear to be getting bettter in that time.
We were not offered x-rays.
The vet did a physical exam and Blue's weight was down to 21 pounds. His temp. was 103. He was given Clavamox 2ML by mouth twice a day for 14 days. Penicillin, Vit B12 1000mcg/ml.
Worse, how? Was the congestion worse? Or? What other symptoms were developing?On November 10th, Blue was worse, so he went back to XXXX Veterinary Clinic, and was prescribed Cyproheptadine ½ every 12 hours for 10 days.
The congestion was worse. His limp was about the same. The vet gave him cyproheptadine 1/2 tablet by mouth every 12 hours. He also ordered a CBC and Chemistry profile.
Who told the new vet about the records? If a receptionist, that's an error on her part, not necessarily the vet. However, if the vet told the new vet he hadn't seen Blue in 3 years, then that is quite different.The new Veterinarian called over to XXXX Veterinary Clinic to have his records sent over, and were told they had not seen Blue in 3 years. That was untrue, they had seen Blue 3 times in the past month.
I believe it was the receptionist. I didn't pursue it at that time.
I'm assuming this was all done with the new vet?For the next 2 months, we spent in excess of $1560.00 desperately seeking an answer to Blue’s issues. Blue had the following procedures done to discover why his liver enzymes were abnormal: x-rays, ultrasound, chemistry profiles, hospitalizations, injections, urinalysis, IV Catheterization, Electrolyte profiles, intensive care treatment and ultimately, cremation. Blue died on February 6th.
Yes, it was done at the new vet.
When was the liver enzyme levels detected?
The day you first saw the new vet, or later?
The following values are the three panels they did. The first number was 11/20/07, the second number is 11/21/07 and the third numbers were done on 2/01/08
Bun 28.0 26.0 37.0
crea 1.4 1.3 1.2
phos 6.5 5.6 5.2
T.P. 7.3 7.0 6.1
Alb 2.3 2.1 2.3
Total bili 0.1 0.2 4.3
Alkaline phos 77.0 66.0 649.0
ALT (Sgpt) 24.0 22.0 135.0
AST (sgot)______ 85.0 80.0
Chol 135.0 160.0 101.0
Calcium___ 8.8 7.5
Sodium 153.0 149.0 145.0
Chloride 116.0 108.0 102.0
A/G Ratio___ .4 .6
BUN/Crest ratio___ 20.0 32.0
Glob 5.0 4.9 3.6
Lipase___ 121.0 130.0
Amylase___ 886.0 1110.0
Triglyc___ 159.0 324.0
CPK___ 1790.0 607.0
Mag ___ 1.7 2.4
Hemoglobin___ 10.8 10.7
WBC 40.46K/microL 43.2 21.1
RBC 6.92M/microL 6.11 7.17
MCV50.2 55.0 42.0
MCH 16.52 17.7 14.9
MCHC 32.9 32.4 35.7
Platelet count___ 269.0 301.0
Platelet est.___ Adequate adequate
Neutrophils 36.41/microL 40176.0 14770.0
Bands___ 0.0 0.0
Lymphocytes 1.19K/microL 1296.0 5275.0
Monocytes 1.63K/microL 1296.0 844.0
EOS 1.0KmicroL 432.0 211.0
Baso .25 K/microL 0.0 0,0
Blood parasites___none none
I have to run right now, but I will be back to answer the rest of the questions.
Did the vet rule out underlying health problems as opposed to the rimadyl, or did the vet suspect the liver enzymes were in relation to the rimadyl? Which enzymes were out of range? Were any other chemical enzymes abnormal? How did the vet treat this once determining the liver enzymes were abnormal? What injections were given?
Had the rimadyl been given for the full 14 days as prescribed by the first vet? At any time, did he tell you to bring Blue back in for testing his bloodwork (particularly for monitoring kidney and liver enzymes)? Did he tell you this should be done at the end of the course of the rimadyl?
The IV fluid therapy and hospitalization, for what, specifically, was this for? What was the vet attempting to treat? What symptoms? Did he suspect liver failure or something else? Were the various types of liver disease ruled out? (i.e., hepatic lipidosis, cholangiohepatitis, etc)
When was the letter sent, what time frame between the time it was sent and when he called you?We sent a letter to Dr. XXXX asking him to review his records on Blue, and contact us regarding this situation, specifically about the prescribing of Rimadyl, which is not approved for feline use in the US. Dr. XXXX called and spoke to me on March 3rd. He said although Rimadyl is not approved for use in the US, it is used in other countries, so he was standing behind the prescribing of Rimadyl to Blue and would feel comfortable continuing to do so.
His comments, to me, indicate he is not practicing good medicine. First, you should know that many vets will use a mediciation intended for something, for something else, (extrapolating or off-label use), and most vets are conscientious about this as long as they refer to literature, case histories, and valid information on the product. But, it sounds like this vet feels he is exonerated for merely having his opinion and relying on past case histories that may (or may not have) been effective. When a vet does use a medication off-label, it is incumbent upon them to discuss with the client the reasoning, the contraindications if any, and to discuss the medication in full with the client, to obtain consent! If he truly did not discuss this medication with you, did not ask to obtain your consent, then he is both negligent and liable. The onus is truly upon him to determine if the rimadyl was the cause of the problems and subsequent death. If he is trying to absolve his involvement in this matter, then you may have due recourse to sue. You would have to be fully prepared for that, however, and seek legal counsel.
I'd advise that if you do contemplate seeking legal counsel, get ALL copies of Blue's records from this vet. Obtain ALL copies of Blue's records from the new vet as well, and include any written comments by that vet if possible. You can try asking the new vet to report this case to Pfizer Animal Health regarding the rimadyl's use in a cat, but it is ultimately the responsibility of the first vet to do so. You should call him or speak to him in person and request he report this case/incident to Pfizer, and you should request a followup from both he and Pfizer (if possible). Do not threaten legal action unless and until you've recieved ALL copies of Blue's records first, and do NOT indicate to the vet you intend to persue this matter or sue. Get the facts, records first, seek legal counsel when that has been achieved.
The difficult part is your part in proving the rimadyl was the ultimate cause of death, and having ruled out other underlying health problems having the potential of causing the health problems. Without a necropsy or sufficient findings of bloodwork, fluids or tissue samples, this can be a difficult process. The new vet may be able to help with that, but both sets of records need to be combined and reviwed for any clear indications the rimadyl may have been the cause.
There are numerous reasons why the FDA will not license/approve particular medications for use in cats and why vets must follow those recommendations. Cats cannot metabolize many medications, and those marketed for dogs should always be avoided, unless there is sufficient research to indicate safety in cats, at recommended, proven, safe doses. This vet's comments about it's efficacy and use in other countries is completely moot, they obviously do not have as strict standards as the US, medicine is practiced quite differently between them. The vet also knows that manufacturers are very careful to label medications for use, as it regards different countries.
I'm really appalled at his comments, and his disregard to your inquiries, and especially his practice, if he is giving rimadyl to other client's cats without their consent, he needs to be reported, montiored by the state veterinary board, possibly put on probation or license suspended or revoked. Rimadyl is not approved for use in cats, period, and the manufacturer clearly indicates to vets to obtain client consent.
The vet knew there were other, more safer medications he could have prescribed.
I am searching for information on the use of Rimadyl for cats. If there is any information you can give me, I would greatly appreciate it.
General information:
http://www.veterinarypartner.com/Conten ... &A=623&S=0
Rimadyl prescribing information:
http://www.rimadyl.com/display.asp?coun ... CN&sec=660
Re: Rimadyl death
Blue wrote:Traci wrote:First, I am so very very sorry about your loss...
How old was he?
Blue was 7 years old.
Did he have any other underlying health condition?
None that we were aware of.
When was his last vet exam/bloodwork evaluation BEFORE you took him in to be evaluated for the limp?
His last vet exam was 10/02/06. He had no bloodwork done at that time.
What was the vet's assumption as to the cause of the limp?
She didn't know. We thought it may have been from roughhousing with his Westie companion.
BEFORE he prescribed the rimadyl, did he suggest/advise a full bloodwork profile? If so, was this done, or did you decline?
This was not suggested.What was Blue's weight at the time of this exam?
Blue's weight was 23.12
Very unprofessional and neglectful on his part, particularly after all the information and information available on the drug.Blue wrote:No warnings of any kind about Rimadyl were given us by Dr. XXXX, neither written or verbal. We were given no information on any danger associated with this medicine. No Client information sheet
This, I think, was bad practice on his part. First, he gives rimadyl, an NSAID, then two vaccinations, he should have waited to give vaccinations after the course of the rimadyl, since all of these things combined were quite an insult in one day.Blue also received his rabies shot and FDRC booster at this time.
Do you mean respiratory congestion? How soon after the first vet visit did he develop congestion? This also applies to the remaining limp, did you not notice any improvement within a few days? Did the vet listen to Blue's heart and lungs? Did he offer an xray? If so, was it done then, or did you decline?Blue was still limping and had now developed congestion, so he saw Dr. XX on October 29, 2007 and was prescribed Clavamox drops 15ml. He was given a Vitamin b-12 1000mcg/ml injection and penicillin. We were to give him 2ml twice a day for 14 days.
The congestion developed in the next week to week and a half. His limp did not appear to be getting bettter in that time.
We were not offered x-rays.
The vet did a physical exam and Blue's weight was down to 21 pounds. His temp. was 103. He was given Clavamox 2ML by mouth twice a day for 14 days. Penicillin, Vit B12 1000mcg/ml.
Worse, how? Was the congestion worse? Or? What other symptoms were developing?On November 10th, Blue was worse, so he went back to XXXX Veterinary Clinic, and was prescribed Cyproheptadine ½ every 12 hours for 10 days.
The congestion was worse. His limp was about the same. The vet gave him cyproheptadine 1/2 tablet by mouth every 12 hours. He also ordered a CBC and Chemistry profile.
Who told the new vet about the records? If a receptionist, that's an error on her part, not necessarily the vet. However, if the vet told the new vet he hadn't seen Blue in 3 years, then that is quite different.The new Veterinarian called over to XXXX Veterinary Clinic to have his records sent over, and were told they had not seen Blue in 3 years. That was untrue, they had seen Blue 3 times in the past month.
I believe it was the receptionist. I didn't pursue it at that time.
I'm assuming this was all done with the new vet?For the next 2 months, we spent in excess of $1560.00 desperately seeking an answer to Blue’s issues. Blue had the following procedures done to discover why his liver enzymes were abnormal: x-rays, ultrasound, chemistry profiles, hospitalizations, injections, urinalysis, IV Catheterization, Electrolyte profiles, intensive care treatment and ultimately, cremation. Blue died on February 6th.
Yes, it was done at the new vet.
When was the liver enzyme levels detected?
The day you first saw the new vet, or later?
The following values are the three panels they did. The first number was 11/20/07, the second number is 11/21/07 and the third numbers were done on 2/01/08
Bun 28.0/ 26.0 / 37.0
crea 1.4 / 1.3 / 1.2
phos 6.5 / 5.6 / 5.2
T.P. 7.3 / 7.0 / 6.1
Alb 2.3 / 2.1/ 2.3
Total bili 0.1 / 0.2 / 4.3
Alkaline phos 77.0 / 66.0 / 649.0
ALT (Sgpt) 24.0 / 22.0 / 135.0
AST (sgot)______ / 85.0 / 80.0
Chol 135.0 / 160.0 / 101.0
Calcium___ /8.8 / 7.5
Sodium 153.0 / 149.0 / 145.0
Chloride 116.0 / 108.0 / 102.0
A/G Ratio___/ .4 / .6
BUN/Crest ratio___ /20.0/ 32.0
Glob 5.0/ 4.9 /3.6
Lipase___ /121.0 / 130.0
Amylase___ /886.0 / 1110.0
Triglyc___ / 159.0 / 324.0
CPK___ /1790.0 / 607.0
Mag ___ /1.7 / 2.4
Hemoglobin___ /10.8/ 10.7
WBC 40.46K/microL /43.2 / 21.1
RBC 6.92M/microL / 6.11 / 7.17
MCV 50.2 /55.0/ 42.0
MCH 16.52/ 17.7 / 14.9
MCHC 32.9 / 32.4 / 35.7
Platelet count___ /269.0 / 301.0
Platelet est.___/ Adequate / adequate
Neutrophils 36.41/microL / 40176.0 / 14770.0
Bands___/ 0.0 / 0.0
Lymphocytes 1.19K/microL / 1296.0/ 5275.0
Monocytes 1.63K/microL / 1296.0 / 844.0
EOS 1.0KmicroL / 432.0 / 211.0
Baso .25 K/microL/ 0.0/ 0.0
Blood parasites___/none / none
/
Did the vet rule out underlying health problems as opposed to the rimadyl, or did the vet suspect the liver enzymes were in relation to the rimadyl?
He didn't say.
Which enzymes were out of range?
The results are posted above.
Were any other chemical enzymes abnormal?
How did the vet treat this once determining the liver enzymes were abnormal? What injections were given?
Had the rimadyl been given for the full 14 days as prescribed by the first vet? Yes.
At any time, did he tell you to bring Blue back in for testing his bloodwork (particularly for monitoring kidney and liver enzymes)? No.
Did he tell you this should be done at the end of the course of the rimadyl?
No.
The IV fluid therapy and hospitalization, for what, specifically, was this for? What was the vet attempting to treat? What symptoms? Did he suspect liver failure or something else? Were the various types of liver disease ruled out? (i.e., hepatic lipidosis, cholangiohepatitis, etc)
His 11/20/07 abdominal ultrasound showed:
the liver and GB appeared normal. The spleen was normal. The left kidney was small (2.2cm long) with moderate-severe decreased corticomedullary definition and mild renal pelvic dilation. The right kidney is 4.62 cm long, has fair corticomedullary definition, no renal pelvic dilation, +/- small areas of mineralization by the diverticula. The urinary bladder is normal. No pancreatic lesions, masses or fluid identified. Intestinal wall thickness is normal where measured.
Assessment:
Left kidney- r/o chronic renal disease +/- pyelonephritis
Right kidney- r/o nephrocalcinosis vs. nonobstructing nephrolith
Low albumin- r/o protein losing entropathy (severe IBD, GI LSA) most common cause vs protein-losing nephropathy, liver disease, other
Bilateral RACL.
Radiographic/laboratory findings: 11/20/07 CBC panel- neutrophils 36410, eos 1000, baso 250, chemistry-NSF. 11/21/07- Antech Alb 2.1, neutrophils- 40176, monos 1296, abd x-rays: left kidney much smaller than right.
Physical exam: QAR, H, pk, 2 sec, EENT- normal fundics OU, PLN-WNL, U/G-M/C, abd- difficult to palpate due to obesity, H/L- difficult to auscult due to purring, eupneic, HR 180/min, difficult to palpate due to obesityu, MSI-obese with severe dorsal muscle wasting, Bilateral RACL.
Recommendations:
-Get voided urine for UA. If proteinuria and inactive sediment, recommend urine protein/creatinine ratio to rule out PLN.
-Continue zeniquin 25mg PO SID for 4-6 weeks in case of occult pyelonephritis.
-a fasted serum B12 and folate may be useful in documenting small intestine disease.
--Continue buprenex PRN for pain. I would NOT use NSAID due to kidney disease, anorexia issues, etc. I would also avoid clavamox since it commonly causes anorexia/ vomiting.
When was the letter sent, what time frame between the time it was sent and when he called you?We sent a letter to Dr. XXXX asking him to review his records on Blue, and contact us regarding this situation, specifically about the prescribing of Rimadyl, which is not approved for feline use in the US. Dr. XXXX called and spoke to me on March 3rd. He said although Rimadyl is not approved for use in the US, it is used in other countries, so he was standing behind the prescribing of Rimadyl to Blue and would feel comfortable continuing to do so.
We sent it March 3rd, and received a return call within days.
His comments, to me, indicate he is not practicing good medicine. First, you should know that many vets will use a mediciation intended for something, for something else, (extrapolating or off-label use), and most vets are conscientious about this as long as they refer to literature, case histories, and valid information on the product. But, it sounds like this vet feels he is exonerated for merely having his opinion and relying on past case histories that may (or may not have) been effective. When a vet does use a medication off-label, it is incumbent upon them to discuss with the client the reasoning, the contraindications if any, and to discuss the medication in full with the client, to obtain consent! If he truly did not discuss this medication with you, did not ask to obtain your consent, then he is both negligent and liable. The onus is truly upon him to determine if the rimadyl was the cause of the problems and subsequent death. If he is trying to absolve his involvement in this matter, then you may have due recourse to sue. You would have to be fully prepared for that, however, and seek legal counsel.
I'd advise that if you do contemplate seeking legal counsel, get ALL copies of Blue's records from this vet. Obtain ALL copies of Blue's records from the new vet as well, and include any written comments by that vet if possible. You can try asking the new vet to report this case to Pfizer Animal Health regarding the rimadyl's use in a cat, but it is ultimately the responsibility of the first vet to do so. You should call him or speak to him in person and request he report this case/incident to Pfizer, and you should request a followup from both he and Pfizer (if possible). Do not threaten legal action unless and until you've recieved ALL copies of Blue's records first, and do NOT indicate to the vet you intend to persue this matter or sue. Get the facts, records first, seek legal counsel when that has been achieved.
The difficult part is your part in proving the rimadyl was the ultimate cause of death, and having ruled out other underlying health problems having the potential of causing the health problems. Without a necropsy or sufficient findings of bloodwork, fluids or tissue samples, this can be a difficult process. The new vet may be able to help with that, but both sets of records need to be combined and reviwed for any clear indications the rimadyl may have been the cause.
There are numerous reasons why the FDA will not license/approve particular medications for use in cats and why vets must follow those recommendations. Cats cannot metabolize many medications, and those marketed for dogs should always be avoided, unless there is sufficient research to indicate safety in cats, at recommended, proven, safe doses. This vet's comments about it's efficacy and use in other countries is completely moot, they obviously do not have as strict standards as the US, medicine is practiced quite differently between them. The vet also knows that manufacturers are very careful to label medications for use, as it regards different countries.
I'm really appalled at his comments, and his disregard to your inquiries, and especially his practice, if he is giving rimadyl to other client's cats without their consent, he needs to be reported, montiored by the state veterinary board, possibly put on probation or license suspended or revoked. Rimadyl is not approved for use in cats, period, and the manufacturer clearly indicates to vets to obtain client consent.
The vet knew there were other, more safer medications he could have prescribed.
I am searching for information on the use of Rimadyl for cats. If there is any information you can give me, I would greatly appreciate it.
General information:
http://www.veterinarypartner.com/Conten ... &A=623&S=0
Rimadyl prescribing information:
http://www.rimadyl.com/display.asp?coun ... CN&sec=660
Re: Rimadyl death
Just looking at the lab results, several of the parameters are all over the place, the last tests may have been quite revealing had the vet known exactly what he/she was looking for.
The problem is narrowing the possible conditions down. Just a basic guess on my part, but a few that may have been considered: heart disease (congestion), acute liver disease (i.e., cholangitis or hepatic lipidosis or biliary obstruction), acute pancreatitis, or hypothyroidism. Renal disease or failure could have been underlying or secondary to a primary condition, particularly if bacterial infection, poor hydration, poor nutrition, stress were all factors. Triaditis could also have been a problem (this is a combination of liver disease, pancreatitis, and IBD, with the latter two usually secondary to liver disease). Any liver, kidney or intestinal infection could have worsened things, considerably. Lastly, diabetes could have been ruled out (via urinalysis and blood glucose testing), and cushings disease. I'm not sure what the vet was referring to with "RACL" but I interpret that as cruciate ligament rupture or sprain, which could have caused enough pain to cause anorexia, leading to liver disease, dehydration, renal problems. Ultimately it sounds like there was an underlying disease condition that exacerbated with secondary health conditions progressing rapidly.
The vet not being able to palpate and hear heart and lung sounds well, should have prompted additional xrays, or checking heart function, looking for inflammation, ascites (fluid) -- which could have occured as a result of infection somewhere.
Whether any of this has any relationship to the rimadyl is anyone's guess. Certainly liver and kidney problems could result as a result of giving this NSAID to a cat (or any other NSAID used inappropriately), but there is a big question of whether there was a reasonable period of time between the initial administration to the worsening of symptoms. Not having bloodwork done prior to the administration of rimadyl was a very bad choice on the part of the first vet, and I'd be taking this up with him. This does not mean the health problems were necessarily caused by rimadyl alone, but if there is ANY indication it was partially responsible, then the vet needs to be approached with this, and someone needs to warn him of it's use in cats (whether that is a collegue or the state veterinary board who governs him).
Now for the big problem. NO bloodwork or prior bloodwork to determine overall health was done prior to 2006, nor was it done immediately preceeding the rimadyl administration. Examinations alone cannot detect underlying disease process, so there is an equal chance there was an underlying health condition that went undetected before the rimadyl was ever given. In a court of law, this would not hold water if you proceeded to sue. Also, without a necropsy and pathologist's review, there is virtually no way to determine if rimadyl caused any of the health problems.
Since the first vet feels he is absolved of any wrong-doing, I guess I would talk to the second vet and get his/her opinion on the matter. That vet must have had some suspicion as to the cause of the health problems, whether it was a primary condition or secondary conditions exacerbating the primary condition. Literature should provide some insight about contraindications for use of rimadyl in cats, the time period that one should expect symptoms or problems could also be researched (by the vet). A consult with Pfizer from the vet could also be done to get this information. If there is any information suggesting rimadyl may have been partially responsible for kitty's health problems and/or death, then I'd contact the state veterinary board and report this to them so they can review and make a decision on how to handle it with the first vet. Ultimately, the first vet should NOT be prescribing this to his feline patients, and the manufacturer does NOT advocate it's use as such!! The state veterinary board could either heavily reprimand him, monitor him, or even take action against him for using a drug like this off-label, and for not having explained the drug and it's risks and contraindications with you. The manufacturer even strongly advises vets who use this drug to disclose all information with clients prior to prescribing it. Pfizer should also be notified of any case where off-label use was done (particularly in cats), so they can keep logs and references and so they can re-label the product to include stronger warnings etc.
Again, I am so very sorry for your loss, I can imagine the pain and heartache you've been through and my heart goes out to you.
The problem is narrowing the possible conditions down. Just a basic guess on my part, but a few that may have been considered: heart disease (congestion), acute liver disease (i.e., cholangitis or hepatic lipidosis or biliary obstruction), acute pancreatitis, or hypothyroidism. Renal disease or failure could have been underlying or secondary to a primary condition, particularly if bacterial infection, poor hydration, poor nutrition, stress were all factors. Triaditis could also have been a problem (this is a combination of liver disease, pancreatitis, and IBD, with the latter two usually secondary to liver disease). Any liver, kidney or intestinal infection could have worsened things, considerably. Lastly, diabetes could have been ruled out (via urinalysis and blood glucose testing), and cushings disease. I'm not sure what the vet was referring to with "RACL" but I interpret that as cruciate ligament rupture or sprain, which could have caused enough pain to cause anorexia, leading to liver disease, dehydration, renal problems. Ultimately it sounds like there was an underlying disease condition that exacerbated with secondary health conditions progressing rapidly.
The vet not being able to palpate and hear heart and lung sounds well, should have prompted additional xrays, or checking heart function, looking for inflammation, ascites (fluid) -- which could have occured as a result of infection somewhere.
Whether any of this has any relationship to the rimadyl is anyone's guess. Certainly liver and kidney problems could result as a result of giving this NSAID to a cat (or any other NSAID used inappropriately), but there is a big question of whether there was a reasonable period of time between the initial administration to the worsening of symptoms. Not having bloodwork done prior to the administration of rimadyl was a very bad choice on the part of the first vet, and I'd be taking this up with him. This does not mean the health problems were necessarily caused by rimadyl alone, but if there is ANY indication it was partially responsible, then the vet needs to be approached with this, and someone needs to warn him of it's use in cats (whether that is a collegue or the state veterinary board who governs him).
Now for the big problem. NO bloodwork or prior bloodwork to determine overall health was done prior to 2006, nor was it done immediately preceeding the rimadyl administration. Examinations alone cannot detect underlying disease process, so there is an equal chance there was an underlying health condition that went undetected before the rimadyl was ever given. In a court of law, this would not hold water if you proceeded to sue. Also, without a necropsy and pathologist's review, there is virtually no way to determine if rimadyl caused any of the health problems.
Since the first vet feels he is absolved of any wrong-doing, I guess I would talk to the second vet and get his/her opinion on the matter. That vet must have had some suspicion as to the cause of the health problems, whether it was a primary condition or secondary conditions exacerbating the primary condition. Literature should provide some insight about contraindications for use of rimadyl in cats, the time period that one should expect symptoms or problems could also be researched (by the vet). A consult with Pfizer from the vet could also be done to get this information. If there is any information suggesting rimadyl may have been partially responsible for kitty's health problems and/or death, then I'd contact the state veterinary board and report this to them so they can review and make a decision on how to handle it with the first vet. Ultimately, the first vet should NOT be prescribing this to his feline patients, and the manufacturer does NOT advocate it's use as such!! The state veterinary board could either heavily reprimand him, monitor him, or even take action against him for using a drug like this off-label, and for not having explained the drug and it's risks and contraindications with you. The manufacturer even strongly advises vets who use this drug to disclose all information with clients prior to prescribing it. Pfizer should also be notified of any case where off-label use was done (particularly in cats), so they can keep logs and references and so they can re-label the product to include stronger warnings etc.
Again, I am so very sorry for your loss, I can imagine the pain and heartache you've been through and my heart goes out to you.
..........Traci
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mamabear
- Formerly mamaof4soon
- Posts: 589
- Joined: Wed Apr 18, 2007 10:39 pm
- Location: The Garden State
Re: Rimadyl death
I agree, call the board. I am so very sorry for the loss of your kitty. I do hope you get the answers you seek and have this dr. at least questioned by the board if nothing else so he can answer to prescribing a medication that we do not give to cats. Maybe since he thinks it's ok in other countries he should move there and practice.
Praying that you get justice in this. Hugs so your heart heals dear one.
Praying that you get justice in this. Hugs so your heart heals dear one.
Almost 7 years in remission from Graves disease and no meds!