Sable (our “quadpawd?”)
So, this post is about Sable, our 2-year old baby who is a 50 pound 3/4 pit bull, 1/4 lab mix. She is a real wiggle worm. I was looking for some advice and thought that with everyone’s experiences here, someone may have a recommendation or two.
Here’s the story:
When we first adopted her from an “accidental” backyard litter in Michigan, we noticed her hair was starting to fall out and her skin was irritated. We took her into our vet (actually our vet came to us as we had a mobile vet who showed up in a big motor home that’d been converted into a mobile vet clinic complete with microscope, x-ray machine, and most of the other stuff you’d find in a regular vet office) and the vet determined Sable had demodex mange based on the skin scraping she inspected under a microscope. She prescribed “off-the-label” use of ivermection and provided us with proper dosage information. For those of you who don’t know, ivermection is a cattle dewormer which is typically injected into the cattle. With dogs, it’s given orally at a dosage that’s gradually stepped up over time to ensure no neurological issues develop. It is worth mentioning here that ivermectin often causes issues with herding breeds due to the often present MDR1 (Multi Drug Resistant 1) gene which leads to normal dosages being toxic for the animal in question.
Back to the story… at the time she was diagnosed, she probably weighed 10 pounds or less. I don’t remember exactly how much she weighed, but it wasn’t much. Regardless, she tolerated the ivermectin without any issue and the symptoms of her demodex mange cleared up and all was well.
Fast forward to a couple of weeks ago. What appeared to us to be similar symptoms started showing up again. We called to make an appointment with our vet and learned that our usual practitioner was out of town at a conference for the next several days so I asked to make an appointment with someone else as Sable had become VERY itchy – to the point she was chewing herself raw – hair off, scabs forming, bloody paws, etc. They set us up to see another provider shortly thereafter. We had already started her on Benadryl in hopes of alleviating the incessant itching.
The new provider did a skin scraping and said she didn’t see any demodex mites on Sable and suggested antibiotics for a few days and ivermectin at that point if it didn’t clear up. We were able to rule out sarcoptic mange, scabies, and fleas since none of our other dogs are itchy, nor are we. I asked her if there would be any disadvantage to beginning the ivermectin right away since we all agreed that the symptoms did present as demodex mange, even though none were seen on the scraping. She said there weren’t any concerns and provided us with a chart that showed how many cc’s to give orally per 10 pounds of body weight. Since Sable weighs 52 pounds, we were told to give her 5x the amount shown on the chart. We talked about whether or not we dilute the ivermectin in something else (cherry syrup, vegetable oil, etc.) and we told her we hadn’t in the past, we just squirted it on her food and she gobbled it down. The vet said that’s very uncommon since the ivermectin is known to have an unpleasant flavor and she commented on what a good girl Sable is to eat it without giving us any trouble. She suggested continuing the Benadryl at this point. Our initial appointment was last Monday, July 28th. We began the antibiotics that night, continued with the Benadryl and started the first step of the ivermectin treatment the next day – Tuesday, July 29th.
We continued on the same course of treatment for the coming days until Sunday, August 3rd. That morning, we woke-up, fed the dogs and took off to run errands for a couple of hours. When we returned, we noticed Sable was acting very unusually – super wobbly, HUGE pupils and doing weird stuff like running into walls, pushing her nose up against immobile objects and almost seeming blind. She wasn’t at all her usual wiggly self. I called our regular clinic (who has Sunday hours) and they didn’t have any availability so we rushed to the emergency vet. Upon discussion with them, they determined it was ivermectin toxicity and advised the best course of action would be to empty her stomach using activated charcoal and pump IV fluids for the next 12+ hours. They admitted her and we went home sad and concerned. The next morning they called and said we could come pick her up and that they trusted she was stable. They advised us her liver enzymes were out of whack and that she needed to take a liver supplement
We picked her up, brought her home and she was still almost in a comatose state – very non-responsive to our voices and even to poking at her or gently shaking her about. I called the emergency vet back and talked about her symptoms. They advised we could bring her back if we were genuinely concerned. At this point I started scouring the internet where I learned a few very important things. Thankfully she was interested when there was food around, when she’d fallen into these deep sleeps, she would eventually wake her up with a medium amount of effort on our part, she was breathing without any noticeable issues and her body temperature seemed normal. These are all good signs when it comes to ivermectin toxicity.
#1 – Sable had been given several doses of ivermectin that were WAY TOO HIGH for her body size. Upon further investigation, I was able to determine the dosage chart we were given from the vet assumed we were diluting the ivermection at a ratio of approximately 1:10. Remember I said we were supposed to step-up the dosage over the course of time to get to the full dose after more than a week? Well, on the first day, she received a dosage that was almost double the full recommended dosage. Meaning, the full dosage she should have received after 10+ days is 0.7 cc’s, but she received 1.25 cc’s on the first day, more the second and third day, and by the fourth and fifth day, she was receiving 3.5 cc’s once per day. Again, the MAX dose for a 50 pound dog is 0.7 cc’s. That’s obviously an unacceptably HUGE difference.
#2 – Ivermectin has a half-life of 48-72 hours.
#3 – The symptoms of ivermectin toxicity can take weeks to go away, but they typically resolve themselves as long as the dogs makes it through the rough “overdose” period.
Over the last few days, she has gotten better – at least as far as the ivermectin toxicity symptoms are concerned; she’s still ridiculously itchy – her eyes seem to be returning to normal, her wobbliness is pretty much gone and I haven’t seen her leaning nose first into the wall at all. Last night, she seemed fine all day but then around 8 pm she fell into a deep sleep and had similar symptoms as far as not responding very much to being called, moved, poked, etc. As I write this, she’s sleeping again, but opens her eyes about half-way when I call to her.
So, my questions to you are whether or not any of you have had any experience with being given instructions to give your dog / cat a potentially fatal amount of a medication? How did you handle it with the vet who made the error? Does it seem reasonable to ask them to refund the $80 I paid them for the visit as well as the $550 we had to pay the emergency vet and any associated future costs?
Separately, anyone have any ideas as to what might be causing her itchiness? At this point, with being able to rule out scabies, fleas, and pretty much any other bug with the amount of ivermectin she’s had and the fact that none of the rest of us are itchy, I’m thinking it might be allergies, but then wonder why the Benadryl wouldn’t be helping?
We have a follow-up appointment with our primary vet tomorrow, at the same clinic where we received the bad instructions. I did inform them of the issue and what caused and provided specific numbers / dosages. The poor receptionist sounded as though she wasn’t really sure how to handle it. I was very kind to her, and will be to the medical director when I see him tomorrow, but ultimately want to be sure this never happens to anyone else, and would like to recover the added expense this has caused. We are already on a tight budget and with Sebastian’s recent visits, our budget is stretched even tighter than usual.
Advice or thoughts on any of the issues would be appreciated.
<<Geez, what a long post!>>
9 comments so far
3:06 am - 8-7-2014
Wow. I was so glued to your post, and am SO glad that things turned out OK with Sable. How scary! I would be a total mess.
First, I would definitely go over this with the medical director and your vet. That mistake could have cost your dog her life. You sound like you are very rational and calm, and this is GOOD, it will get you very far with your complaint to the clinic. Keep a good head on your shoulders and I’ll bet they would be willing to work with you on at least the costs. It would be crazy for them not to.
Meanwhile, to address her itchiness….I read somewhere that skin issues are the number one reason for vet visits these days. Consider getting a referral to a vet teaching hospital that has a dermatology specialist on board, and if you can’t find that, then a private practice vet dermatologist.
But honestly though, they’ll probably put her through a lot of crazy, expensive testing and trial and error. If you want, visit a holistic-minded vet instead; their approaches encompass the whole body, not just trying to fix the symptoms. I have a friend with a Sheltie that had horrible skin problems; she went holistic and the dog is doing great. If this type of practitioner is an option, why not give it a try?
Good luck, keep us posted OK?
3:57 pm - 8-7-2014
Thanks, Jerry. I will definitely discuss this with our primary vet during our appointment this afternoon and will be on the look-out for an appropriate dermatology specialist and/or holistic provider. We did try switching up her food to that which Sebastian eats to see if that might help (a fish based protein versus a beef based protein) but that hasn’t made a noticeable different at all. You hit the nail on the head when you said they’d likely put her through lots of tests at a pretty high expense to maybe find a problem, which is exactly my concern. Of course, if the tests are necessary we will have them done – that’s our style – but I don’t see any sense in having them done blindly to *hopefully* find something.
I’m trying to remain very calm and rational as I learned long ago it leads to better results. I’ll be bringing in all of the paperwork from both our initial visit to their clinic as well as from the emergency vet clinic to provide documentation of everything that was involved as well as all associated costs. I’ll update you all again later tonight.
3:32 am - 8-7-2014
Good grief, what an ordeal. I’m with Jerry on finding a holistic vet. My vet is great but when my dog had gastritis and vomiting she gave her Prilosec and tried to help her symptoms. On my own I researched her symptoms and felt her problems were diet related. I slowly switched her diet to no grain and a different kind of protein and she immediately got better. She even had bloody stools, that was how sick she was. Then my sister’s cow dog started itching and developed lumps all over. The same vet didn’t know what was wrong and suggested biopsy. Before my sister did all that I suggested changing her diet and guess what, her lumps went away. Dogs also can be allergic to their environment, weeds, grass, etc. Unfortunately our traditional vets don’t have experience in these fields so they go with what they know which could be way more complicated than it really is. Good luck on you and Sable’s problems.
Penny
4:08 pm - 8-7-2014
Thanks for the suggestions, Penny. We did switch Sable’s food once we brought her back from the emergency vet. She’s now eating a fish based protein versus a beef based protein but it hasn’t seemed to help quite yet – she’s been on the fish based food since Monday with no improvement yet. I don’t think the food is grain-free though so perhaps that’d be a good thing to try. I have definitely heard that grains cause trouble for some dogs. I’ll let you know if that works out!
3:16 pm - 8-7-2014
I also was glued to your post. This is ABSOLUTELY something that should never have happened! The on l y reason sweet Sable is here with you today is because of your advocacy! I’m just sitting here shaking my head in disbelief…literally!
This is such valuable information you have shared on so many levels.These blogs go up and down so fast, I wish more could see this.Maybe a post under Ask a Vet with a title of “warning about ivermectin”
And by all means you should be reimbursed for every single penny cent as a result of this horrible error on the vet’s part! Inexcusable! I would even ask for a written response as to what steps were taken to ensure this never happens again and what actions were taken with that vet! Who knows how many times this may.have happened before, and even with different meds and improper doses and unsuspecting owners .ever had a clue why their dogs got sick and passed away.
THANK YOU GAIN for taking the time to share.this.
And all the hugs in the world to Sable and sweet Sebastian too…and save some for you!
Sally and Happy Hannah and Merry Myrtle too!
PS. I have a senior adoptee shelter dog who is almost driven insane with the same itchy skin you describe…this is the first summer I’ve had her. As much as I hate to do it, the only.thing.that.helps is the dreaded.steroid shot and then follow up with small doses of prednisone. As she is a senior and I adopted her to get her out of shelter so whatever time she had left she could be loved and happy it makes going the steroid route a little easier.
If you find anyth i ng holistic that works, let me know!
3:52 pm - 8-7-2014
Great idea on asking for a written response on what steps the clinic will be taking to ensure this never happens to anyone else again. I worked in Medical Professional Liability for about 10 years and am well versed on medication errors. I realize everyone involved is human and errors can be made, but this was terrifying and horrible on so many levels. Sable is such a sweet girl and should never have had to go through this experience. I can’t even imagine what was happening in her little head as she was having these symptoms.
3:44 pm - 8-7-2014
THANK YOU ALL for your responses. I appreciate the support and the suggestions. We have our follow-up with our “usual” vet today and a meeting to discuss the issues with the Medical Director at the clinic as well. I will update you all on what transpires tonight after work. Fingers crossed that they are accommodating to my request for reimbursement and that this NEVER happens to anyone else. My husband and I both still feel horrible that this happened even though we didn’t know we were doing anything other than what was right based on the information received from the woman we met with last Monday. Thankfully Sable is still improving from the neurological symptoms. Talk about scary!
8:26 pm - 8-7-2014
Wow…I’m just sitting here totally shocked by how close your family came to losing Sable. I’ve learned through my experience with Leland that as a pet owner you really have to do a lot of research of animal health issues to be a strong advocate for proper medical care. It’s so discouraging that the people we entrust with our animal’s health care can make a mistake that has the potential to cost them their life. I’m just shaking my head at this.
So onto my suggestion as a possible avenue to explore with the itchiness. Because Leland had a lot of health issues appear after his surgeries (thyroid problem, autoimmune disorder, and at the end we suspected issues with kidney/urinary tract) I have read a lot of articles trying to figure out why this happened to our boy. Through my readings regarding autoimmune there are disorders that affect the skin. I’ve also been reading articles on how over-vaccinations of our pets are leading into autoimmune disorders and thyroid issues. I don’t have the articles here with me now but I will come back and post the links to the articles that I have looked at.
I didn’t go to school to be a vet but after Leland I feel like I have to be just as knowledgeable to ensure my new family member (Lucian) doesn’t suffer the same problems down the road.
Sahana and her Angel Leland
1:45 pm - 8-8-2014
Here are the links to some of the articles I have read regarding over-vaccination. There’s a lot of info you can check out.
http://www.whole-dog-journal.com/issues/13_8/features/Annual-Pet-Vaccinations_20036-1.html
http://www.knowbetterpetfood.com/are_we_vaccinating_too_much
http://www.canismajor.com/dog/autoimmn.html
http://www.petwelfarealliance.org/why-over-vaccinating-is-a-problem.html
Sahana and her Angel Leland