Did a misdiagnosis kill my dog?

Cassie the Corgi is not dead yet, but it’s pretty clear that sooner or later the adrenal gland dysfunction that has afflicted her since I took her to MarvelVet to treat a cough will carry her away.

I’ve suspected for some time that the medications he gave her made her sicker — a lot sicker — than she was. The combination of prednisone and fluconozale, as it develops, is contraindicated: the makers of prednisone specifically say not to give the drug in the presence of a fungal infection, which is what Valley fever is. When combined with prednisone, fluconozale can interfere with adrenal gland function. Fluconozale has a variety of baleful side effects, all of which appeared in the dog. By the time I unilaterally took her off the drug, it apparently was too late to save her from those effects.

Yesterday out of curiosity I looked into the question of whether adrenal tumors and dysfunction could result from an infectious agent. She does sleep on my bed, and as a matter of fact I’ve been feeling fairly shitty of late, myself. Yes, I find, that is possible, but it sure as hell isn’t likely.

However, what should I stumble across at Science Direct but this interesting statement:

It is noteworthy that a major category of antifungal medications, the azoles, can adversely affect adrenal function presumably via liver cytochrome P450-mediated interactions. In particular, the inhibition of CYP3A4 (the most abundant cytochrome P450 in humans) significantly impacts steroid catabolism.¹³³ The most potent antifungal that inhibits the P450 system is ketoconazole (an azole that currently is infrequently used in the USA and Europe), but adrenal insufficiency can occur during the administration of other azoles.134, 135, 136, 137 Additional important inhibitors of the P450 system include antibacterials (such as macrolides and isoniazid) and antiviral agents (such as ritonavir and delavirdine). Hence, clinicians should carefully consider the potential risks associated with the use of an azole or other medications that affect glandular function in patients at risk for, or with suspected or proven, adrenal dysfunction.

SON of a bitch!

This pretty much fits the bill. New Vet remarked that her liver is somewhat enlarged. And yes, Cassie surely IS “at risk for, or with suspected or proven, adrenal dysfunction.” She’s at risk for two reasons:

1. She’s an elderly dog.
2. Pembroke corgis are genetically presdisposed to adrenal sarcomas.

And then of course we have number 3: evidence of an adrenal mass seen in an abdominal ultrasound.

Okay. It’s probably unreasonable to expect a vet with a busy urban practice to be aware of an obscure study that appeared in 2014. BUT… Putting her on a powerful drug with nasty side-effects in the absence of proof that the dog had the disease for which the drug was intended? Not a good idea. The Valley fever test came back negative, which is not proof that his shoot-from-the-hip guess was wrong. But…if we’d waited four weeks and then tested her again, it probably would have shown positive if she really had VF. Which, in my opinion and in the ever-so-much-better-educated opinion of New Vet, she does not. Even if she did, a more conservative approach wouldn’t have harmed her significantly.

She no doubt did have the adrenal tumor. But like most such growths in aging dogs, it was asymptomatic and probably would have remained so until she died of something else. Now, though, we learn that the fluconozale very likely activated or aggravated a condition that was quiescent.

So in fact what we have here is an iatrogenic ailment that almost certainly will kill the dog within the next few weeks.

I don’t even know how to say how furious this makes me. Poor little Cassie! She was a healthy, active, middle-aged dog one day; a week later she was an elderly, sick dog.

Is it possible to sue a vet for malpractice?