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Did Valium kill my cat?

This forum is for cat lovers seeking everyday advice and suggestions on health-related issues. Remember, however, that advice on a public forum simply can't be a substitute for proper medical attention. Only your vet can say assuredly what is best for your cat.

  
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Terrence

465884
 
 
Purred: Thu Jan 25, '07 7:43pm PST 
Dear Fellow Friends of Cats,

I just joined Catster, and this is my first post. It seems like the kind of community where my cats and I will feel at home - I already received several welcoming emails. Unfortunately, I was almost done writing a rather lengthy post when I responded to one of the emails - and lost the entire post. So I'm starting over.

Terrence and Stephen are two 10-year-old cats who were surrendered to the "open door" (i.e., high kill) shelter where I volunteer. They had been there for six weeks when I first saw them, and they were extremely thin and depressed, although they were still responding to attention, cage breaks, tempting food. No one seemed to be aware of what poor condition they were in. I offered to foster them immediately, but the chaos there interfered and by the end of the week the boys were thinner and become jaundiced. I was extremely frustrated - I was trying to avoid fatty liver disease, and now they were showing signs of it. To get them out of there, I finally had to agree to an adopt-for-free arrangement.

They came home with a few days of sub-cu fluids and meds (antibiotics/B12/steroids). They did pretty well for almost 2 weeks - ate sufficient quantity of food (about one 6-oz can per cat per day, plus dry food, plus treats and Nutristat gel), were responsive to attention, had no vomiting or diarrhea. They were also getting milk thistle, amino acids, probiotics, Prozyme, salmon oil, etc to help heal their livers. Terrence hadn't gained any weight after a week, though, so he went back on the fluids/meds for a few days, and gained a 1/4 pound.

The next day, Wed, 17 Jan, he spent most of the day in bed and seemed to not feel well, although he ate pretty well. The following day, Thur, 18 Jan, he was the same, and I called my regular vet, who was unavailable. A B******* hospital (not sure if we're allowed to name names, so I'll disguise it somewhat) near me had an opening, so he had bloodwork there. His liver enzymes were elevated, and the bilirubin was 7.5 (normal range 0.0 to 0.9). They had no evening staff, so the vet recommended the ER vet for IV fluids. I lost my job last year and have a limited income, so this was not a good option financially. We agreed that I would take Terrence home overnight, feed him and give him sub-cu fluids several times, then return him on the next two days for all-day IV fluids at B******* during office hours.

Even though Terrence was eating pretty well, the vet recommended giving him Valium (diazepam, a benzodiazepine) to stimulate his appetite. Terrence got two days of IV fluids, and two doses of Valium. At home, he seemed to do well - he still appeared to be somewhat uncomfortable and needed to rest a lot, but was eating and responsive to affection. I added a/d to his regimen to boost the calories, and offered him plain cooked chicken with broth, which he ate enthusiastically.

B******* was closed on Sunday and Monday, so the plan was to continue with subcu fluids, then return Terrence to the hospital on Tues, 23 Jan for more IV fluids and bloodwork. I asked the vet for a Valium scrip to help encourage Terrence's appetite. Before I could give it to him, however, I found some alarming information. I was continuing to research treatment for FHL, when I found a veterinary website that specifically warned against giving diazepam to cats with liver disease - it could cause further liver damage, even liver failure! I was very disturbed by this, especially when I searched and found a few other sites with similar warnings. So I never opened the package from the pharmacy - that stuff wasn't going near Terrence's still-traumatized liver.

On Sunday, 21 Jan, Terrence was okay - loved eating that chicken, but still kind of tired. Even though Terrence and Stephen were used to living with other cats and Terrence was very sociable, I hadn't given them alot of exposure to my other cats, partly because I needed to monitor T and S's food intake, litterbox, etc. But Terrence seemed to perk up a bit when I gave him a break from his room and he got to see the other cats more - I decided to start giving him more time with the others as I thought it would help his recovery.

Unfortunately, things went very bad that night. He was back in his room, having just eaten and sitting up in his bed looking happy and alert. Something went wrong with his paws - he couldn't use them. I tried to help him up, but he couldn't stand. He lay down, voided his bladder and bowels, and started having a seizure - it lasted about 15 minutes. Then he was calm and quiet for about half an hour - he seemed conscious, and his breathing and heartbeat seemed normal. Then another seizure started, although it was less intense. He was growling, and I could hear his stomach gurgling. I was afraid this was the end, but also afraid that he might need help to die. I went to get the directions to the ER vet, and when I returned my husband told me that Terrence had gasped a couple of times, then was still.

I have been through dozens of losses - people and pets, and many of them quite traumatic - but this just hit me exceptionally hard. I was prepared at first to lose both these boys if they couldn't recover from their neglect. But after two weeks of progress, I had started to hope and expect that they would be well.

I'm looking for solace and understanding from a community that I know can offer it, but the main thing I need right now is information. After Terrence died, I got back online and started looking for more FHL information, especially about the use of diazepam. I am horrified by what I've found - reference upon reference that either warns to use extreme caution with this drug in cats with liver disease, or recommends not using it at all, due to the risk of liver failure. At first I was looking for FHL/diazepam research - then I just looked for citations about diazepam and cats in general - they ALMOST ALL warned about not giving this drug to cats with liver disease!

It wasn't even necessary - Terrence was eating on his own pretty well, and I was starting to use a feeding syringe to get the a/d into him. It wasn't like we were desperate to get this cat to eat and diazepam was the only option. And it wasn't - we could have used cyproheptadine with no risk to his liver.

I can't understand what this vet was thinking. He didn't seem to have a lot of experience with FHL, although he did do some research and even gave me some Denosyl (SAM-e) that another patient had donated when their pet had died. I know he and his staff were sincerely interested in helping Terrence; they were very nice. But to miss such a crucial, basic point - the contraindications about diazepam have been widely published in the veterinary literature for years - this isn't obscure, this isn't new. Why didn't this vet know this?

Yes, I know that I can't prove that the diazepam is what killed Terrence. He was a sick little kitty, and things could have still gone wrong. But he was stable all weekend, his appetite and alertness were both improving on Sunday when he suddenly crashed. That's what will make this so much harder to come to terms with - that the drug may have killed him, and that I will never know for sure if it did.

I know the usual response to this kind of situation is to remind me of what a good thing I did, how Terrence and Stephen didn't die in the shelter, that they knew the love and nurturing of a warm and safe home for over two weeks. Those things are all true, and they do and will provide me with some comfort. But I'm in the just-been-hit-by-a-bazooka stage of early grief, and right now, most of what I'm feeling is raw pain. I need acknowledgement of the pain more than anything else right now. One thing I've learned through lots of losses is that it's not a good idea to start a sentence with "at least" when you're ministering to the bereaved.

The diazepam's role in Terrence's death isn't the main issue - the main problem is the vet prescribing it - it was dangerously reckless. Either he didn't know the risks, which is inexcusable, or he misunderstood them - and he didn't advise me of the risks so that I could make an informed decision. Has anyone ever had a similar problem with a medical error? Even if Terrence were still alive and was doing better, I would NOT be taking him back to that vet, and I WOULD be filing some sort of complaint.

That's what I need guidance on. I can write a detailed chronology (yes, even more detailed than this very long post), and provide a page of references to the Merck Manual, and veterinary journals and proceedings. There are attorneys for malpractice even for animals, but I have experience with human medical error, too. Unless you can PROVE a connection between bad care and bad outcome, you don't have a case. But I need to know who should receive my letter - the practice, the corporate headquarters, and state veterinary orgs - I'm not sure how to proceed.

Feedback from anyone who's had a similar heartbreak would be helpful. So would confirmation of my research from anyone who's a medical professional - it would make me feel like I'm on stronger ground - even if all I can do with it is file a complaint. A few weeks ago, I was the only advocate that sweet little Terrence had - his only voice. Not that he is gone, my role as his advocate isn't over - I still need to speak on his behalf.

Oh, yes, Stephen is still sick, although not as sick as Terrence was. He's missing his brother, so that has set him back a little. Advice on successful treatment for FHL would also be most welcome.

Jeannine
A Friend to Cats
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Athena (In- Memory)

Purrs and Love

moderator
 
 
Purred: Thu Jan 25, '07 11:36pm PST 
So sorry to read Terrance's story. For support of a broken heart, you came to the right place because Catsters know and understand your loss.

I would suggest that anyone responding at length to your medical questions do so through the more private pmail.

Arthur (Miss- You!- '93-'09)

Bucket of Fuzz

moderator
 
 
Purred: Fri Jan 26, '07 12:21am PST 
My family and I are so sorry to hear about Terrence!! We'll send purrs for Stephen's recovery and for your healing from this tragedy!

We don't have any first-hand experience with FHL, but I know that diazepam is very commonly used as an appetite stimulant. I looked around the 'net and found some info on diazepam and Hepatic Lipidosis.

http://www.vetinfo.com/chepatic.html#appetite

The page has a lot of other info on the disorder, too.

Athena's right, you came to the right place for support from other cat lovers. We're her for you!

*PURRS*
hug


Jefke

- The Mice Slayer
 
 
Purred: Fri Jan 26, '07 5:49am PST 
I'm very sad about Terrence's story, unfortunately I can't help you because neither me or my mommie has experience with valium. But I am purring very very very very very hard for you!
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Phoebe

I'm Fusky! (I'm- furry and I'm- husky!)
 
 
Purred: Fri Jan 26, '07 6:42am PST 
Phoebe's Mommy here:

I am also very sorry to hear about Terrence...and you tried so hard to do all of the rights things.
I am sure you will hear from Hunter's and other Mommys who know a lot more about this stuff. I am not trained in vet work, other than my own research.
It SEEMS that valium (just based on what I know about valium) would not have been a direct cause of death. Possibly, though, he needed something else and the vet missed it. I think it would be more likely that the lack of PROPER medication would have killed him rather than the valium itself.

Even good vets can make mistakes...or in the case of Phoebe, some things that I don't really understand. When she was very sick at Christmastime, one vet at her hospital started her on Clindamycin...but the vet I regularly use (and have for almost 19 years) switched her to a combination of Clavamox and Zenequin which really made her turn the corner. A follow up with him four days after the med change showed her doing great. After a little over a week on that combination, though, she began having terrible diarrhea. After researching the two meds, I found out that the Clavamox was the likely cause...but I further found that it appeared that Phoebe was on a DOG dosage...which is DOUBLE the normal cat dosage. It was New Years weekend, she was already doing really well otherwise, so I made an executive decision and stopped the Clavamox. She continued to get better with the remaining course of Zenequin. The vet called at the end of the week to see how she was. I told him what I had done with the meds and he said that I made a good choice. He was also very pleased with her recovery because this illness just seemed to stump everyone. I never questioned the dosage...but I might in the future.

Good luck.
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Hunter

Lazy, Lazy, Lazy
 
 
Purred: Fri Jan 26, '07 9:40am PST 
I would doubt that Valium was the direct cause of death. Although in our Hepatic Lipidosis cases we typically send home Cyproheptadine (if an appetite stimulant is neede3d) it is not uncommon to see patients go home on Valium. There may have been an underlying disease that continued to worsen while Terrence was appearing to improve. It will be hard to determine cause of death without an autopsy (called necropsy in veterinary medicine).
I am so sorry for your loss. You were trying to save this kitty and you gave him a warm, loving home, instead of a jail cell for the last weeks of his life. You can only be commended for that. I hope his brother continues to improve.
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Delyte, Dark- Angel, at- Bridge

Me and my- person, together- against all
 
 
Purred: Fri Jan 26, '07 3:11pm PST 
This is Delyte. My late companion, Peri, was a very nervous and shy kitty, who suffered greatly with separation anxiety. She was home alone while her person was at work, and the dog was outside. She was also pretty obese--16 pounds on a small frame. But at one time in 1992, the vet gave her 2 mg Valium to calm her down. It made her so calm that she was only awake for an hour a day, and our person thought that was awful so she stopped giving them. Nobody said they were an appetite-inducer, which was the last thing she needed at that time in her life. Sadly, when she got older and had severe kidney trouble, no one offered it to her then, even though she only weighed 6 pounds when she died. Medications for cats are definitely a developing science.
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Riley

425784
 
 
Purred: Fri Jan 26, '07 3:33pm PST 
It sounds like Terrance had multiple issues other then liver disease and i know you want a reason for his death--but vets know all the contraindications towards meds/disease...i'm sure it was a low dose--but that's besides the point --do know you opened your heart and home to Terrance and did all you could..but it just seems he was a lot more sick then everyone anticipated.. be proud that you gave Terrance a chance...may he have the sweetest dreams
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Beatrice- (Miss You!- '94-'12)

The very Beast- of all

moderator
 
 
Purred: Fri Jan 26, '07 11:15pm PST 
Hunter and Riley are right--you did the best thing that anyone could possibly have done for Terrence, by giving him a loving home for the rest of his life. There were things that were ouside of your or your vet's control that shortened your time together, but it's the love that mattered most. Terrence was very lucky that you and he found each other.

We're with you in your pain, and purring for Stephen's recovery. Please keep us posted.

*PURR PURRR PURR PURR PURRR PURR!*
hug

♥Mor- gan The- PirateGato

You Gotta Love- Me, I'm a Pirate
 
 
Purred: Sat Jan 27, '07 4:55am PST 
We are so sorry that you were unable to save the Kitty. Mom rescued a kitty named Mucho in September - he was also old and in very very bad shape. Mom and the Doc did everything for him too. He bounced back and and was healthy enough to be neutered and microchipped. They were both so happy! And Mucho was a wonderful loveable kitty - who loved to talk and get kisses and hugs.

A few weeks after his neuter, he stopped eating, lost weight, and went down hill again. His kidneys were failing. Mom and the Doc sent him to heaven - and Mom still misses him.

It is never easy with a situation like this. Both you and the Doctor did everything you could to save the Kittys life. At least he knew love and happiness for even a short time. Many kittys never know that.

As far as the meds - if you read anything that comes with a medicine - human or animal - it will give you tons and tons of things that will scare you. Go on-line and look further and you'll find a thousand horror stories related to that drug. There are times when a Vet will try something a little different - based on the animals symptoms.
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