Rimadyl Toxicity – I wish I weren’t an expert…

… but I am.

Billy’s first exposure to Rimadyl was just over a year ago and was my fault – I left a bottle with about 10 of Jasmine’s chewable tablets on the counter after feeding time. Billy exploited the opportunity and as a result, he spent 3 days in the hospital for preventative diuresis. We were lucky and he walked away unscathed. After that, we made significant changes to the way we store the Rimadyl to avoid another accidental exposure.

We starting storing the dog food and medications on top of the fridge, with confidence that they were out of Billy’s reach. The meds we keep up there are in stainless steel water bottles with heavy screw tops. We thought that was safe – who wouldn’t? That strategy has worked fine for over a year, but it turns out that Billy’s determination far exceeds anything we could have imagined.

Day Zero: The Disaster Unfolds (Mon, 10/10/11)

At 6:00am on Monday morning, I flew to Salt Lake City for a 5-day conference, leaving Rich at home with the dogs. Sometime around noon, Billy managed to get access to the top of the fridge (there’s no counter or stool nearby, he must have just scaled the front somehow) and knocked nearly everything off onto the floor. He then took the stainless steel container of Rimadyl outside, unscrewed the top, and ate them all. I had recently refilled Jasmine’s prescription so there were around 150 tablets, an unimaginable overdose by any standards.

I chose to avoid the actual calculations until I was sure he was going to survive, but I have now determined that his exposure was ~425mg/kg. Therapeutic dosage is 4.4mg/kg, and the literature talks about renal concerns beginning at 40mg/kg. In other words, his overdose was massive – 100x therapeutic and 10x toxic.

Rich discovered the disaster around 1:30pm and had Billy at PetCare by 2pm. They began aggressive treatment immediately, which involves vomiting, activated charcoal, IV fluids for the kidneys, and meds to protect the liver and the GI tract. He somehow managed to survive the night and I flew home from Utah first thing Tuesday morning.

Days 1 to 5: To Hell and Back (Tues 10/11/11 – Sat, 10/15/11)

The vomiting subsided within a couple of days but he remained nauseous and had very little appetite. His kidneys had paid a price but appeared to have to have stabilized. Because of the massive amount he got, they opted to keep him on the fluids for an extra couple of days as a precaution. Our new concern at this point was the liver, which started to go south on Wednesday. His ALT (liver enzyme) rose dramatically from 62 on Tuesday (which is WNL) to 126 on Wed (way above NL), then 400 on Thurs. If the ALT had continued to rise at that rate into the 1000 range, we would expect acute (and potentially irreversible) liver failure to not be far behind. But it seemed to stabilize in the 400-450 range. His bilirubin (which causes jaundice) remained elevated, but was also unchanged between Wed and Thurs, which suggested it may have plateaued as well. He was definitely yellow, but his eyes seemed a little better on Thursday – I thought it might be my imagination, but the nurse said the same thing.

His clinical presentation has also improved. He began eating Thursday morning, and shows more and more real interest in food (rather than just humoring me by taking something out of my hand). By Friday morning he was seeking out the morsels that I tossed on the floor, that night he was catching them in mid-air, and on Saturday morning he actually offered simple behaviors, like sit and close. He will engage with a toy when I toss it and find the squeaker, but only once or twice. We go on short walks in the parking lot and he trots with his tail wagging, at least for a few steps at a time – he obviously fatigues very quickly and we’re keeping our visits short so he can rest.

Our schedule this week has been simple: visit at noon because that’s when they run the blood tests, stress all afternoon and evening, visit before bedtime, then try to sleep at night. The 24-hour wait between blood draws is excruciating, but we’re encouraged by the small clinical improvements we’re starting to see each time we visit. In fact, today for the first time, he tried to follow us out of the visiting room rather than going back to his cage with the nurse.

Day 7: More Signs of Hope (Mon, 10/17/11)

Saturday night’s visit was quite uplifting. His attitude had improved even from the morning and we got a glimpse of the Border Collie we know and love – catching his toy in mid-air, snatching it off the ground and shaking it, even a little light tugging, and bringing it back for more. His appetite is obviously improving, as is his willingness to “work” for food. On Sunday, the nurse was pleased to report that he was eating rice and chicken out of a bowl (“like a dog”) instead of only out of her hand. And the fact that he was interested in that sort of bland-ish food was also an improvement because we had previously only been able to entice him with “junk food” (the Dr’s term) like hot dogs, string cheese, and green tripe treats.

This afternoon, we got good news from his first urinalysis – no urinary casts. These casts, if present, are positive indicators of kidney tubular damage. Absence doesn’t necessarily mean no damage, but it’s still very encouraging. He’s also not spilling protein into his urine. Plus his bilirubin level has dropped significantly and he’s noticeably less jaundiced today. Liver and kidney blood values still not what we’d like them to be, but he continues to eat and play and his stamina is improving. And my friend Sarah is quick to remind me (after her first-hand experience with Rav’s acute failure of both liver and kidneys as a puppy), “look at the dog, not the numbers”.

Following the good results from the urinalysis, they started tapering his fluids in anticipation of sending him home soon.

Day 8: Homecoming! (Tues, 10/18/11)

I’m beyond thrilled to report that 8 days after admission, Billy is home from the hospital! I picked him up on my way home from work and here we are.

Clinically, he’s getting better every day. Today when I visited him at lunchtime, he ran full-speed across the parking lot to chase a squirrel on top of the fence. He obviously has some reconditioning to do after 8 days of lying around in a cage (and more recently a 5’x5′ “room”), but I’m sure that will come back quickly once he’s released to run freely on the back hill. I’m keeping him confined for a day or two while we re-introduce him and Zack, and also I’m going to be a lot more compulsive about daily mushroom checks. It’s that time of year, and even a small insult that wouldn’t normally be a problem could be real trouble now.

Long-Term Prognosis

Chemically and medically, we definitely have some fallout. His liver numbers are far from perfect, but the Dr. is optimistic that those will recover over time – the liver is very resilient and can regenerate. However, his kidneys have almost certainly sustained some level of permanent damage and we’ll probably have to manage chronic kidney disease throughout his lifetime. Based on his current chemistry, he’s labeled as Stage 2 (out of 4).

Next steps include nutritional research and consultation, guidance from an internist (preferably one who understands what it is that we do), and careful monitoring of blood work and hydration.

How do we protect him in the future?

We may not be able to. Dietary indiscretion is no joke, and neither is his drive to exploit vulnerabilities. We can’t put him in a bubble, so all we can do is continue to make adjustments and hope for the best.

We started by buying a new storage cabinet, which now houses all of the food, medications, and garbage containers. It includes a shelf at about the right height that now serves as our food and medication prep center (instead of the kitchen counter).  The cabinet doors have hasp loops that will always be secured with a carabiner, and we have fabricated a nylon crossbar that inserts into the door handles for further security when we’re not here. And finally, the cabinet will be secured to the wall so he can’t pull it over.

I am sticking with the metal stainless steel water bottles, but I have purchased smaller 12-oz ones and will only store a limited number of meds (i.e. less toxic overdose potential) in the cabinet. The remainder will be stored safely somewhere else.

The other significant change is that Jasmine no longer gets tasty chewable Rimadyl tablets. I replenished her prescription with boring caplets. She won’t mind because she still likes Pill Pockets, which I buy by the case anyway, and which are also now secured in the new cabinet.

Soap Box: Don’t buy chewable Rimadyl

On the day Billy went to the hospital, there were three other dogs admitted for Rimadyl toxicity. One of them got it from its owner’s purse after having just been prescribed it therapeutically that day. Four dogs in one day in one hospital? Something is definitely wrong with this picture, and what’s wrong is packaging a toxic medication as a tasty treat.

Finally, I can breathe again

Last Monday night when I was alone in my hotel in Utah, I was certain I was going to lose my boy and I grieved. And my mood on Thursday night, after his liver went south, was equally dark or maybe even worse because I had let my guard down. But now he’s home, he’s hungry, he’s back to his happy playful joyful self, and he has no activity restrictions. I fully expect him to return to his agility training soon and hopefully he’ll lead a relatively normal life.

Life is good!

Please read the two updates – The Journey from Hell to Healthy, and Life is Good.

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25 Responses to Rimadyl Toxicity – I wish I weren’t an expert…

  1. tajmutthall says:

    Wow, Holly. That dog has amazing drive and perseverance–both to Get What He Wants and to survive. What a story. Another case of truth really is stranger than fiction. I understand what you went through–having had Jake in emergency care for something he had eaten and thinking he was going to die. All the what-ifs and why-didn’t-Is and just the misery.

    I’ve usually left my dogs’ meds in a plastic pill container on the counter and have never had a problem with 6 different dogs, even the one counter surfer. But your experience (and that of Joe/Natalie’s Riley) should make me think harder about this.

    I’m so glad he’s home.

  2. Sarah says:

    So glad Billy is home. Very well written. I lived this nightmare 10 years ago with Rav to a toxic mushroom. I won’t go into details but she was not supposed to live more less compete in agility & get 8th place at Nationals. She wore a box muzzle for her 1st year because I was ao afraid of her eating a mushroom again. Twice I have been @ other people house & my dogs got mice posion just sitting on the ground in piles on the floor! Only on a Sunday out of town & no ER vets. I hope people understand why I am neurotic about asking if people have snail bait, rat poison, xylitol gum or candy if I am at their house or if they have it in their purse. I love my no worry bubble that Sharon Harper makes. In canada & back east that said highest toxic
    mushroom growth in years. So lesson learned:
    Don’t buy flavored chewable rx
    Keep locked up
    Dont buy xylitol in any products
    Make sure not in friends purses @ your house
    If dogs are @ friends house always ask if they have mouse,snail bait or any other poisons out.
    Dont judge someone when you see a bubble on their dogs head. You never know what they have been through.

  3. Julie says:

    Happy to read that Billy is on the road to full recovery. What a close call!

  4. Joanne says:

    I saw your article on the kidney list. We just lost our cattle dog/sherp mix 2 months ago. She had kidney disease for 2 1/2 years. We started holistic care after 5 months with Accupuncture , herbs and rehab along with western traditional care. At the beginning she was given 3 to 6 months to live. We credit her longer life because if the blending of holistic and Western care.
    Our dog got ahold of 2 cups of Orejin kibble that we fill pushed her into kidney failure. Before she was raw feed/ organic kibble.
    She was healthy her whole life before becoming ill doing agility, Flyball, swimming, etc.

    The holistic approach was key in keep our dog as strong as possible. She was 14 3/4 years old when she passed.

    Hope there is a holistic vet near you that could offer herbs and Accupuncture to help your dog.
    We have 2 BC, active (flyball & agility) and understand your concerns.

  5. Karen Oneil says:

    I’m glad to hear your boy is on the road to recovery! My young female is obsessed with chocolate & coffee. She has scaled furniture I thought wasn’t possible, ripped open containers, etc. I tell people it really does make them sick and can easily kill. The second time I spent a scary night in the ER with her, 3 others were fighting for their lives. It makes me crazy when people causually tell me about a dog who ate chocolate and had no problems. They were LUCKY but also the damage can be silent and cumulative until that dog finally eats it one to many times! We are also extremely careful now. Mostly I just don’t have it in the house!

  6. Lloyda says:

    I am so glad for Billy’s will to live & prevail and for your persistence in his care. Rosie can’t have Rimadyl at all as it causes stomach upset & bloody diarrhea so I ask for something else when she needs that type of med. The warning on chewables and medication storage has given me lots to think about. Thank you and I will share this with non-agility people too.

    Sarah – where can we get the bubble head coverings. I think those are brilliant esp here in foxtail heaven.

  7. EllenC says:

    What a nightmare. I’m glad that Billy has pulled through this inadvertent suicide attempt and I’m sorry that you are likely to be paying for this financially and emotionally for a while. Know that you are doing everything you can to prevent him from doing damage to himself and don’t beat yourself up about it (easy to say, difficult to do.)

  8. halters says:

    I’m so sorry you went through this! I just found this on a search. My dogs are both in the hospital right now because of a Rimadyl overdose. One of them is a lab mix and the other is a purebreed german shepherd. Our lab takes Rimadyl for arthritis, and I just refilled her 60 count bottle last week Friday. My husband woke up this morning to find the bottle on the floor with teeth marks in the bottle, but no pills anywhere to be found. We rushed both girls to the vets to induce vommiting but nothing. So, they are being hosptialized and given charcoal. We have no idea if one or both of them got into the pills, so its a wait and see right now. I’m glad you were able to see your dog while he was in the hospital. Our vet told me today that he’d prefer we not go to see them until we know who is sick because the stress could be worse on them. We’ll know tomorrow if liver and/or kidney enzymes go up. Your story gives me hope that they may pull out of this. I’m so devastated leaving them thinking I’ll never see them again. 😦

  9. hardcore says:

    I am so glad Billy is home. I had my dog (vizsla) overdose on rimadyl also. Luckily he had no side effects, probably because we made him drink some hydrogen peroxide. We were luck because:
    A. He had just eaten
    B. We fed him hydrogen peroxide almost immediatly.

    He is fine, but he does this dangerous stuff all the time, like being hit by a car, breaking his tail, bit in the face while he was a puppy, jumping out windows, and doing a really weird thing where he shook uncontrollably, yet he didn’t seem to notice.

    i am glad Billy is ok though!

  10. talbert says:

    I am so glad Billy is okay and thank you for making me rethink where we keep our dogs meds.

    My dog bianca ate zeus rimadyl today along with his antiobotic. Stole it from the chest freezer and chewed the tops off. I didn’t even realize she could reach reach. We were thankful for severl reason…1) there was a very small amount of rimadyl in the container as the meds were only for an infected anal gland 2) I happended to come home from work on lunch and found saw the bottle withing hours 3) whatever combination she ate she started throwing up while I was one the phone with the vet.

    Thankfully she is at home tonight. We will be back to the vet on monday for blood tests. When I got home I placed zeus’ new meds on the top of the fridge….. they have now been moved into the bathroom in the cabinet where our meds are.

  11. I am so glad your dog survived. I had the most adorable, precious little black and tan, long coated doxie–our Sofie. She was quite the imp, and got into EVERYTHING. My son was visiting with his 120 pound dog She got into my sons bag and swiped the dog’s medicine, went under the bed, chewed off the top and the contents..apparently there were about 10 in the bottle. We had NO idea what she had gotten into, or what was wrong..the vet did everything she could, to save Sofie’s life. She suffered terribly, and died in my arms, about 4 days later (she had just turned 4) It was utterly devastating–

  12. Sad dog owner says:

    My dog is in the hospital tonite with an od if rimadyl she got it off the counter I had no idea it was so dangerous to make it worse she also was already being treated for idiopathic pernicious anemia. So it’s unclear if she will survive this or not

  13. Jane says:

    Mine is in there right now after ingesting 60 100 mg tablets. What a horrible nightmare.

  14. Jenny says:

    My 20lbs dog ingested 14 25mg rimadyl chewable tablets today about 5:00pm. I gave her peroxide to try to get her to vomit which didn’t work. Now it’s 8:17pm and I’m scared to death after reading how dangerous this drug is when overdosed . I live about an hour and 15 minutes from an emergency vet clinic, I don’t know what to do?? Should I take her now to the clinic or wait until first thing in the morning????

    • Nancy says:

      I would recommend taking your pup in. You may not see symptoms until it’s too late. My shepherd got into some pills last August. We rushed her to the vet and they induced vomiting; but the pills were chewable and already ingested. They had to hospitalize her and give charcoal to stop the absorbtion. By that time her kidney and liver enzymes already elivated within a couple hours. It was scary, but she pulled through. Please don’t wait.

    • Holly says:

      I’msorry I didn’t see this sooner. Nancy is right, you definitely should drive to the ER. In fact,I hope you’re already there.

  15. Liz says:

    Thank you for posting your story. My three spaniels were alone for 4 hours this morning, and managed to chew open the childproof bottle I had on the kitchen table, eating 14 75mg pills, Not sure whodunnit but looking at some serious hospital bills. Your story gives me hope that even if one ate them all, they might be OK

    • agilepooch says:

      So sorry to hear this. Maybe they can tell from the vomit who got it, although it dissolves pretty quickly so that might not be possible. What a nightmare, hope they all come through.

  16. cat says:

    *hugs* to everyone who has gone through this. I’m in hell now too, my dog has been in the hospital for 4 days. Everything looks good except his kidneys, his creatnine is hovering at 2.5. 😦

    I’m so devastated, I cant believe I left it in my purse. The kicker? He got a total of 400mg, and he is a 75lb dog, and he still is in liver failure. Its my fault he got it, but a part of me is angry they would make something with such a toxic potential…and worse they make it taste like treats.

    Don’t know if he’ll be okay, hopefully his values will stay stable as they wean him off fluids.

  17. Conni says:

    Thank you!!!!!! I’m away from home & my 2 Goldens ate over 250 chewables with their sitter. They are at CSU Vet Hospital now. I’m freaking out- but your story gives me hope.

  18. Nancy says:

    My 4 year old Minature poodle mix, Cali, was prescribed Rimadyl after experiencing a week of lameness. After 5 doses, she vomited twice and her limping had stopped. So, I stopped the Rimadyl. Despite stopping, the next couple of days Cali seemed to feel bad. She was apathetic and had no appetite. I took her to the vet and we were told that she likely had Leptospirosis even though she was vaccinated. Her liver function tests were very high (ALT 400+). She was admitted to the local specialty hospital for antibiotics and further evaluation. Her Lepto and other tests came back negative. After discharge, the doctors never diagnosed her with Rimadly toxicity. We are positive that that is what she has. She has every sign and symptom related to Rimadly toxicity.
    She was discharged from the hospital 4 days ago, but barely eats anything despite being on an appetite stimulant. She is not the same Cali. She has no energy and rarely wags her tail. Does anyone know when I might expect her appetite to return. I have read that appetite is one of the things that improves the slowest after Rimadly toxicity.

  19. Tanisha says:

    Please tell me it’s not a life sentence for our baby

    • agilepooch says:

      Too many variables to answer that without more information (and I’m not a vet). But I will say my dog’s near-death experience was 5-1/2 years ago and he was labeled a chronic kidney dog. Because he was young, he bounced back and is now competing at the highest local levels of dog agility and went to Nationals last October, the 5th anniversary of his crisis. Read all three segments of my blog post.

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