Monday, February 18, 2008

New York Vet Rodwell Rillen's "Continuing Misdiagnosis . . constituted a gross deviation from . . . standards."

Kelsey, a 5 1/2 year old Shetland Sheepdog, had started to limp. So Kelsey's owner took her to see Rodwell Rillen at The Animal Hospital of Morris Park in the Bronx.

Rillen told Kelsey's owner that she had a traumatic injury. He prescribed a steroid (dexamethasone), and prozyme, an enzyme supplement. He also noticed a bite or tick mark on the dog. The Findings state that he did not record any dosage for the prozyme.

Rillen gave the owner Chlorhexideine shampoo to use on Kelsey, because of the tick bite.

Within the next few days, the owner gave Kelsey a bath with this shampoo. The owner attested that no shampoo got into Kelsey's mouth, and that the shampoo was thoroughly rinsed off. Kelsey's owner also gaver her the steroid Rillen had provided.

Six days after they originally went to see Rillen, Kelsey stopped eating and drinking and started vomiting. Two days later she brought Kelsey back to Rillen, telling him she had been vomiting and not eating for 3 days. Rillen's recorded that at this visit Kelsey "was depressed and had sunken eyes." In spite of this observation, Rillen did not recommend or offer to hospitalize Kelsey. He did not order any bloodwork, x-rays, or diagnostics for Kelsey to better figure out what was wrong.

Instead, Rillen assumed that Kelsey was experiencing toxic effects of the shampoo he had given her owners, even though the owners had not reported that she ingested any of it.

The regulatory board (in New York, it's the Department of Education -- go figure) noted in its findings that "Even if Kelsey had ingested the Chlorhexidine shampoo, it is not possible that Kelsey could have consumed enough of it to cause the degree of illness that she suffered. Morever, Chlorhexidine would not cause systemic and prolonged illness . . . there was no reasonable basis for diagnosing Kelsey as having Chlorhexidine shampoo toxicity."

The board said that Kelsey's symptoms, instead, could hve been caused by a number of other ailments including liver or kidney disease, pancreatitis, or gastrointestinal infection.

Rillen's "reliance, without investigation, on Chlorhexidine shampoo toxicity as his diagnosis for Kelsey does not make sense."

Yet, Rillen persisted with his non-sensical, unreasonable diagnosis, even when Kesay was brought back 2 days later even worse. This time, she had labored breathing and blood in her stool. Still, Rillen asserted again that all this was because of the shampoo. Finally, he took some diagnostics -- xrays, blood test. He also hospitalized her and gave her fliuds, antibiotics, and atropine, which was presumably to help her breathing.

The board found that the ex-rays showed that Kelsey had a grossly enlarged liver, called hepatomegaly. Yet, Rillen didn't perform any of a number of tests he could have to identify possible causes of her enlarged liver.

In spite of all this, Rillen still maintained that Kelsey was suffering from toxic effects of the shampoo.

Two days later, Kelsey's owner took her to another veterinary hospital, and unfortunately, a few days later she was euthanized.

The Board charged Rillen with "gross negligence, gross incompetence, negligence on more than one occasion, incompetence on more than one occasion" in the case of Kelsey. They cited his misdiagnosis and his failure to perform diagnostic tests.

The board document states that Rillen's "deviation from . . standard of care endangered Kelsey's health and life". Further they said that he "jumped to and stuck with [his diagnosis of shampoo toxicity] dogmatically notwithstanding that, as shown by the record, it is not possible that Kelsey could have consumed enough Chlorhexidine shampoo to cause the degree of systemic and prolonged illness that she suffered."

Many questions remain after reviewing this case. Chief among them: Why did a dog, in the prime of its life, apparently healthy except for a limp for which she was brought into Rillen, become so ill after seeing him that she ultimately had to be euthanized?

I can only hypothesize and conjection from the layperson's perspective but . . . I have to ask -
Why did the dog with the limp develop an enlarged liver?

The answer may be in that tick bite, and perhaps that is why the board mentioned it. One of the first symptoms of lyme disease in dogs is limping, which was the symptom that Kelsey's owners originally brought her in for. (See

Moreover, this article says that Shetland Sheepdogs are one of the breeds most prone to getting sick from Lyme disease: Kelsey was a Shetland Sheepdog.

Hepatomegaly -- enlarged liver -- is also listed as one possible effect of lyme disease (, and in fact, in humans, hepatitis occurs in 15-20% of those with lyme disease (, and ( Hepatitis IS inflammation of the liver.

In any case, it may well be that giving steroids was the worst thing that could have been done for Kelsey. Steroids -- specifically glucocorticoids, the class in which dexamethasone, the drug given to Kelsey belongs -- can cause enlarged liver/hepatomegaly in dogs.

If indeed, it was perhaps lyme disease that Kelsey was suffering from, could she have been saved if she had been appropriately diagnosed, and treated?

This article says: "Fortunately, over ninety percent of dogs treated within the first week of obvious signs of Lyme Disease will respond rapidly to treatment with a tetracycline antibiotic." (

Approximately 2 weeks transpired between the time Kelsey went to Rillen and when she was eventually euthanized. Certainly, if her problem had been diagnosed (whether it was lyme disease or something else), 2 weeks could have made a difference in her outcome.

Seems certain that she didn't get the treatment she needed, and that it may have made all the difference.