Erik update

[cellio]

My vet called this morning with the results from Erik's blood tests. His white-cell count is high (and his temperature was higher than usual but not quite a fever Monday), so I'm to start giving him antibiotics now instead of next week when they'd be due (for the hepatitis). His thyroid number is also, for the first time, unusually high.

Back when he first started losing weight (a few years ago), the vet suspected hyper-thyroidism as the cause. We did bunches of tests and that number was always normal, so after eliminating other possible explanations (some scary), she shrugged and said "idiopathic". Now, suddenly, it's high. Huh? (She has no idea why.) One bit of good news, though: arrhythmia is sometimes a symptom of hyper-thyroidism, so with luck he doesn't really have heart disease.

There are three ways to treat hyper-thyroidism, she said. The first is surgery, which she doesn't recommend because of Erik's other health problems. Having seen the trauma the last surgery put him through, I concur. The second is a radioactive iodine treatment; they inject him with this stuff (once) and somehow, by magic, the radiation finds its way to the damaged thyroid cells and kills them without damaging anything else. There are two problems with this. First, it makes the cat radioactive for some period of time (a week or two?), and while that's true he has to be sequestered in a special facility. So, essentially, I'd have to take him to some place where they do this procedure (she thinks there is now one in western PA; you used to have to go out of state), and then I wouldn't be able to have any contact with him until he's cooled down sufficiently. (And I'm betting that during that time he's not going to get much attention from the staff, since they'd have to suit up to go near him.) Second, they will only do this after a large battery of tests, some expensive, come back ok.

The third option is medication. Both surgery and radiation are one-time permanent solutions, so medication sounds like the last resort, except for two things: first, I suspect (haven't checked with the vet) that factored over the life-expectancy of a 14-year-old cat, the drugs are probably the least-expensive option. Second and the deal-maker, though, is that according to my vet, treating hyper-thyroidism can make Erik's existing liver problems worse. So before we even consider a permanent solution, I want to do something that we can abort if it starts damaging his liver. If that happens, she said, then essentially we'd experiment to find the right balancing point, treating the thyroid as much as possible without harming the liver. Medicine is not boolean; a partial treatment can still help.

If I understood my vet correctly, treating the thyroid problem might also help Erik gain some weight.

These are my notes from our phone conversation; I haven't yet consulted Doctor Google for more background.

Comments

[spiritdancer]

I'd agree with what your vet is saying re: the surgery (although there are some vets out there that prefer surgery over the radioactive iodine, YMMV).

The two places in Columbus where I refer cats for the I-131 treatment (Ohio State and MedVet) both have me treat any patient we're going to send in for treatment for at least 30 days on medication (Tapazole/methimazole) prior to treating with the I-131. You get a baseline on the bloodwork (specifically complete blood count, thyroid, liver, and renal values) before starting the methimazole, and 30 days after starting the meds. (Methimazole, BTW, is available as a generic tablet at most any drugstore for a pretty reasonable price. If you need it in another form, it can be compounded). Why the bloodwork? Sometimes the kidney function in hyperthyroid cats is borderline, and the elevated blood pressure that goes along with hyperthyroidism masks early kidney disease (so, monitor the renal values). And a small percentage of cats have an immune system reaction to the drug that can cause a drop (in some cases severe) in the red and/or white blood cell counts (so we watch the CBC). If all is going well, the thyroid and liver values should drop when the hyperthyroid problem is treated (and monitoring the T4 or Free T4 by equilibrium dialysis lets us know if we need to adjust the methimazole dosage).

Why medication for a month or so before radioactive iodine? Well, since radioactive iodine concentrates in the thyroid gland, it destroys the active (read: abnormal) thyroid tissue (and most cats recover normal thyroid function after treatment, unlike people - the abnormally high throid levels in cats are usually caused by a tumor). Anyway, drop the thyroid levels quickly, and you may see kidney problems showing up - with medication, you can adjust the drug dose to a somewhat happy medium; if you give I-131, it's permanent.

The average cost of radioactive treatment at the referral center I most commonly use is around $1200, including the diagnostics they do there and hospitalization. Average stay is about 7 days (they do get checked several times a day, but they don't get a lot of hands on care until the radiation levels go down). BTW, my understanding is that people getting the same treatment get it as an outpatient and are sent home - go figure!. The cost of the methimazole tablets here is around $30 to $35 for a month (I just checked and it's not on the infamous "$4 list" from WalMart).

I've had cats that I've had on methimazole for years that do great with it; last fall I had two cats in a week that had BAD drug reactions to it (one became very anemic, the other had uncontrollable vomiting on it - and he'd been on it for 5 years, but had a recent increase in his dosage).

Common signs of hyperthyroidism: weight loss, increased appetite (although about 20% have a drop in appetite), vomiting and/or diarrhea, elevated heart rate, increase in size of thyroid gland, elevated liver enzymes, heart murmurs, elevated blood pressure.

Sources for more information: www.veterinaryparter.com (specifically http://www.veterinarypartner.com/Content.plx?P=A&A=1197&S=2&SourceID=42) and www.radiocat.com (looks like they have a treatment center in Pittsburgh; IMHO, their website is a bit biased towards radioactive iodine treatment *grin*)

Drop me a note if you need any other info :-)

[cellio]

Thanks for all the information! Wow, I figured the treatment would be more expensive -- based on no real data, now that I think about it. (When Erik needed surgery a bit more than a year ago for a blocked bile duct, I ended up being out about $4K by the end. I was expecting something comparable.) There's something very appealing about doing something once and being done, if and only if it doesn't introduce bigger problems.

It sounds like drugs are the first step in any case. If treating the hyperthyroidism doesn't aggrivate his liver problems or cause/unmask kidney problems, it sounds like I should ask her about the radiation treatment.