|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.
A Friend to Cats
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