Enter our Cockatoo, Parrot & Animal Jewellery on-line shop

Part 2

Hopefully if you are reading this page you will already be familiar with Part 1 of this account of the death of my Lesser Sulphur Crested Cockatoo and my quest to find some answers as to why he was administered an injection of the non-steroidal anti-inflammatory drug (NSAID), Rimadyl (a highly controversial drug) by a bird vet back in May 2005.

In case you have not already read Part I, here is the link to it:

Bird Vet Administers Rimadyl to Lesser Sulphur Crested Cockatoo - Part 1

The Lesser Sulphur Crested Cockatoo is a CITES Appendix 1 listed species, see below:

Lesser Sulphur Crested Cockatoos

All information on this page and in Part I is factual, true and can be verified by the official letters I have received from the RCVS and from the vet in question himself.

If anyone is wondering why I am going to the bother of publishing this case on the internet, it is because I am incensed at the conclusion arrived at by the RCVS Preliminary Investigation Committee, their lack of reasoning and justification for their decision, and last but not least because of an article they published in the November 2005 issue of RCVS News. On page 9 of that publication there is an article "Use of Unauthorised Off label Medicines - Informed Consent". This article is part of the Chairman's Report to Council and reads as follows:

"The second complaint reported concerned the treatment of a cockatoo with Rimadyl without the client's prior informed consent. The client formulated the complaint based upon the drug's datasheet and internet information, which indicated that Rimadyl is not authorised for use in psittacines.

The PI Committee commented that very few medicines were authorised for use in avian species but considered the veterinary surgeon had provided a confident and well referenced defence to the complaint.

The Committee commented that the only professional conduct issue in this case focused on the perceived lack of informed consent. However, the PI Committee took the view that this did not amount to serious professional misconduct and decided the complaint should be closed with advice issued to the veterinary surgeon that when using off label medicines the client should be made fully aware of the principles of "cascade" in order that they are in a position to give informed consent. In an avian practice, for example, this may be elaborated by way of a consent form.

I would like to make it absolutely clear, my complaint was not about the fact an unauthorised drug was used - I am fully aware that that there are few medicines specifically authorised for avian use.

Neither is my complaint based solely upon the fact that Rimadyl was administered without my knowledge or consent - even though that in itself is a departure from the RCVS guide to professional conduct when dealing with unlicensed medicines. So what is my grouse with the vet in question and the RCVS you may be asking? Let me explain.

My initial question to the vet and subsequently to the Professional Conduct Department of the RCVS: Why was Rimadyl the drug of choice in this case? In my opinion this was an INAPPROPRIATE choice of drug and I have repeatedly asked them to explain to me why it was administered to my cockatoo - to date [10 January 2006] this question has not been answered.

CASCADE

The Chairman's article mentions the "principles of the cascade". Perhaps many of you reading this page will be unaware of 'cascade' and what it actually refers to. Here is the definition of 'cascade' taken from the RCVS website.

According to current EU and UK law and published Guidelines & Codes of Practice of the RCVS, if no medicinal product authorised for use in the UK exists for a condition in a particular species, in order to avoid unacceptable suffering veterinary surgeons may exercise their clinical judgement by resorting to the 'Cascade' whereby they select in this order:

· A product authorised for the same condition in another species or a different condition in the same species (off label use).

· A medicine authorised in the UK for human use, or

· A medicine made up on a one off basis - a 'veterinary special' - by a veterinary surgeon or other authorised person. If in doubt veterinary surgeons should consult the Veterinary Medicines Directorate.

A product 'authorised for the same condition in another species' is the important point here. Rimadyl is authorised for canine species - but is it authorised for the condition gastroenteritis?

I think you will find that the answer to that question is a resounding 'no'.

According to Pfizer's data sheet "Rimadyl is indicated for the relief of pain and inflammation associated with osteoarthritis and for the control of postoperative pain associated with soft tissue and orthopaedic surgeries in dogs".

My cockatoo did not have osteoarthritis nor had he undergone any surgeries. It appears to me that the rules of cascade are being manipulated here. The rules clearly state same condition in another species or a different condition in the same species; nowhere does it say different condition in a different species.

I maintain my arguement that the criteria for resorting to 'Cascade' were not met in this case, and hence the vet was working outside the relevant laws and guidelines by administering Rimadyl to my cockatoo with suspected enteritis.

Pfizer's product insert for Rimadyl clearly states that Rimadyl is a NSAID and that like all others in that class, adverse reactions may occur with its use. It also says that the most frequent reported effects have been GASTROINTESTINAL signs.

I therefore repeat my question to the RCVS, please explain to me the justification for administering a NSAID when treating gastroenteritis when the most common adverse reactions to NSAIDs are gastrointestinal. Is that not tantamount to throwing paraffin on a fire? All my attempts to get answers from the RCVS Professional Conduct Department have been futile so far.

To our shop Select Parrot Cages at the Cheapest prices on-line.

GASTROENTERITIS

I think most people will already know that the most common cause of bacterial gastroenteritis is food poisoning, and given the fact that the vet and I had agreed that my cockatoo's problem was probably caused by something he had eaten, I therefore (wrongly) assumed that the vet would be treating him for bacterial gastroenteritis (as opposed to viral gastroenteritis*). It was on that premise that I believed the injection given to my cockatoo was an antibiotic. I knew that the antibiotic, Baytril, is licensed for use in birds and so I had no reason to expect the vet to request my written consent for the injection, whereas an injection of an unlicensed medicine would have required written consent (according to the RCVS code of conduct).

I hasten to add, at the time of taking my cockatoo to the vet's surgery, he was only mildly unwell - he was still eating and drinking, could fly and just appeared slightly subdued and quieter than normal. He was not displaying the classic symptoms of gastroenteritis, e.g. vomiting and diarrhoea. The vomiting started about 15 minutes after the Rimadyl injection.

Gastroenteritis can also occur from ingesting chemical toxins e.g. from water contaminated with lead, mercury, cadmium or even arsenic. However, it seems unlikely that my cockatoo would have ingested contaminated water - he was given water from the same source as all my other birds - and they most certainly were not ill. The post mortem reports states that there was "no sign of foreign body" in the gut contents. I would also rule out the possibility of viral gastroenteritis based on the fact that it is highly contagious - surely at least some of my other birds would have caught it had it been a viral form?

CORRECT DOSAGE?

With regard to the dosage of Rimadyl administered to my cockatoo, we have some differences as to what the manufacturer's recommended dosage states and the amount actually administered by the vet. Furthermore, there is a difference between the vet's version of the dosage (based on bodyweight) and the version given by the RCVS Preliminary Investigation Committee (based on metabolic rate) in their defence of the vet.

The RCVS Guide to Professional Conduct clearly states that medical products should be "used at the manufacturer's recommended dosage".

I would like to bring your attention to a document entitled Freedom of Information Summary regarding Rimadyl Injectable [Pfizer Inc. - New York - 3 March 2003]

This document states that Rimadyl Injectable is "for the relief of pain and inflammation associated with osteoarthritis in dogs at a dose of 1mg/lb of bodyweight twice daily". Page 3 of that document also states that each millilitre of the solution contains 50mg of Rimadyl.

The dosage of 1mg/lb of bodyweight is also stated on Pfizer's data sheet that accompanies Rimadyl and must therefore be the source of data available to the vet on which he based his 'extrapolation' for the dosage to be administered to my cockatoo.

N.B. Pfizer specifically base their dosage calculation on BODYWEIGHT (not metabolic rate)

On 6 May 2005 when the vet injected my cockatoo with Rimadyl he did not weigh him first and could therefore only have guessed his actual weight. The post mortem weight of my cockatoo is given as 266 grams which is the weight I have used in my following calculation to determine the correct dosage of Rimadyl Injectable:-

Convert body weight from grams to pounds :-

266 x 0.002205 = 0.58653lbs

Therefore correct dose at 1mg per pound of bodyweight would be 0.58mg (just over half a milligram).

The vet administered 0.03ml

0.03ml x 50mg = 1.5mg injected (almost three times the recommended dose in one injection).

Even if my cockatoo had lost a little weight between the time of the injection and his death (22 hours) as a result of not eating, that still would not account for the difference between a dose of 0.5mg and 1.5mg.

If the vet's primary concern had been the welfare of my cockatoo then why would he administer a triple dose of an unlicensed and controversial drug? How can he still be so adamant that there was no risk involved when he was injecting three times the manufacturer's recommended dosage?

I wish to point out that it would be impossible for the vet to accurately guess the weight of my cockatoo, and as I have already said, he did not weigh him. The size and weight of Lesser Sulphur Crested Cockatoos varies quite a lot due to hybridisation of the sub species in aviculture, adult LSC cockatoos can vary in weight from 300 grams to 350 grams.

The symptoms experienced by my cockatoo very soon after the Rimadyl injection, e.g. pounding heartbeat, vomiting and seizures are all consistent with the known symptoms of NSAID overdose.

In a letter I received from the Professional Conduct Department of the RCVS dated 21 October 2005, I was informed by them that "It was also indicated that you had calculated the dose rate of the drug linked to the weight of the animal; however, the Committee agreed that the dose rate was more closely linked to the metabolic rate of the particular species and it was concluded that the use of Rimadyl did not contribute to your parrot's death."

So if the RCVS are claiming the (triple) dosage administered to my cockatoo was based on metabolic rate, then that isn't in keeping with the manufacturer's recommendations, is it? Therefore it is not in keeping with the RCVS guidelines either.

The metabolic rate of any animal is the number of kilocalories used per kilogram of bodyweight per hour and varies according to activity level. I would like to know how the RCVS Preliminary Investigation Committee (or the vet) could calculate the metabolic rate of my cockatoo without knowing his bodyweight? As I have already pointed out - the vet did not weigh my cockatoo before the injection and there is no standard weight for a Lesser Sulphur Crested Cockatoo due to hybridisation in the sub species.

There is still a lot more to be written on this subject and I will be publishing Part 3 on this website soon.

Meanwhile some further reading if you are interested:

The BBC's 'Action Network' has some very interesting articles written by disgruntled clients of veterinary surgeons. There is one about veterinary surgeon, Mr Laurence Swift who "has got the full support of his governing body the Royal College of Veterinary Surgeons, although he has had to face three Disciplinary Charges and numerous Preliminary Investigations. They think his methods are unorthodox, but very acceptable."

Who is protecting our animals by David Baines

There is another written by Janet Mahoney of the Action Group Against The Conduct Department of The Royal College of Veterinary Surgeons.

An article in The Telegraph by Quentin Letts : The Royal College of Veterinary Surgeons has been accused of running a cosy, secretive "closed shop" which tolerates serial malpractice by "Harold Shipmans of the vet world".
Vets accused of appalling cruelty [The Telegraph - 01/03/2003]

Action Group against the RCVS

Please note, we appreciate that there are thousands of good and caring vets in our country, but they are being let down by their governing body

.