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

[cahwyguy.livejournal.com]

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.

However, this will make him easier to find in the dark.

[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 :-)

[indigodove.livejournal.com]

Poor Erik! I hope you can find a workable solution that makes him healthier. Good luck.

[schulman.livejournal.com]

I've done the radioactive cat thing. (I do not actually spend all my time and money on expensive veterinary treatments for my cats, but it does feel that way sometimes.)

It worked perfectly for my cat Cricket; she soon regained weight and became slightly less neurotic until she died a year and half later of unrelated causes. She was otherwise healthy at the time, though, so she didn't have Erik's liver concerns.

My vet referred me to Radiocat (http://www.radiocat.com/), a traveling practice that does monthly (I think) treatment cycles at Northview Animal Hospital, just off McKnight Road. The techs were very nice, and were obviously used to reassuring owners who were surrendering their precious snookums. They kept Cricket for five days, then returned her with a bag of Sweatscoop litter and strict instructions to wear latex gloves while I scooped, flush the radioactive cat poop and clumps down the toilet, and for God's sake not to throw any of it in the trash because it would set off radioactivity alarms at the waste facility and they'd come after me and there would be Terrible Consequences. (Seriously, Google "radioactive cat poop" and you'll find a news story where this happened.)

Anyway. I had two weeks of radioactive litter box detail, trying to keep her off my pillow, and washing my hands after touching her; and then she was back to what passed for normal. I didn't even have to separate her from the other cat. All in all, fairly painless compared to having to pill her every day.

By the way: You can also get Tapazole in the form of a cream that you rub into the cat's ears. Don't you wish you could get people medicines that way?

[rectangularcat]

Claudia has been getting treatment for her overactive thyroid for close to a year now - her weight is stabilized and she has vomitting/diarhhea very infrequently. It really happened over the course of months but of course a substantial weight loss for a cat is like a pound and it takes at least 2 for me to notice!

I too had a choice between the 3 options, I opted for the Tapazole medication with blood test monitoring every 3 months. I didn't want to take a then 12 year old cat through surgery and the radioactive option would have meant a lot of travel for me as it is not being done locally. If the meds had not worked, I would have gone for a different treatment - that would have been a fun trip with my radioactive cat in a plane!

We've had to adjust her med dosage a couple of times but it seems that her thyroid function is regaining with time. She gets the Tapazole in the form of a cream and she looooooooooves getting her ears rubbed to get it. Kitty Spa! It costs me about 20$ canadian for 2 months. She has regained about 0.5 of a pound. I am not too concerned about her regaining weight as she was pretty big to start with - she is finally normal now and is eating normal food for the first time in years (as opposed to weight loss cat food).

Claudia has had liver problems in the past (HEPATIC LIPIDOSIS) - she is fine though now.

[cellio]

Yeah, but Embla is the one I need that for. :-)

[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.

[cellio]

Thanks. So do I. Sounds like the radiation isn't as bad as I'd feared.

[cellio]

Thanks for the information! My vet said she thought there was now a place in the North Hills where this could be done -- sounds like Radiocat. I'm glad to hear that you had a good experience with them.

Google "radioactive cat poop" and you'll find a news story where this happened.

The overlords at work who monitor web traffic might just be wondering about that. :-)

By the way: You can also get Tapazole in the form of a cream that you rub into the cat's ears. Don't you wish you could get people medicines that way?

Ooh, that's definitely worth trying!

[cellio]

I'm glad that's working so well for Claudia. (I must admit that when I started to read your comment I thought "wait, the large cat has a weight-reducing condition?". :-) )

that would have been a fun trip with my radioactive cat in a plane!

Oh, I can just imagine what TSA would do with that...

Erik has cholangial hepatitis and maybe also pancreatitis. (He did when he had surgery; I don't know how you tell if you can't look inside.) He gets periodic courses of antibiotics to keep that in check.

[sue-n-julia.livejournal.com]

How long he needs to be sequestered is affected by two things: 1. how quickly he clears (i.e. urinates and defecates) the iodine out of his system; 2. how picky the hospital is. When he comes home, he'll still be a little radioactive.

We went that route with Vandal because he wasn't tolerating the meds well at all -- he had scratched his ears and neck RAW!!!!!! Apparently a side effect of the meds is itching!

Vandal is still going strong 20 months later.

S

Radio Cat

[dreamdancer85.livejournal.com]

I would HIGHLY recommend RadioCat. I ended up using them twice, once for Selina and once for Domino. The folks up in the North Hills give them as much love as they can while they are radioactive. Well worth the cost. It turns out Selina was allergic to the medication and nearly died. Feel free to contact me if you want more information. (ddancer85@earthlink.net)

Martha

Re: Radio Cat

[cellio]

Thanks! (And hi -- I didn't know you were on LJ.)

Re: Radio Cat

[dreamdancer85.livejournal.com]

Not really, my blog is at http://ddancer.blogspot.com/ for now.

[rectangularcat]

Well the large cat is more like a normal cat now. People who knew her back when, are astounded at the difference!

She used to be 7.9 kg (17 pounds), now she is 5.2 (11.5 pounds)! 6 pounds is a huge deal on a cat. I didn't notice she has lost weight when I brought her to the vet initially (after the loss of 3 pounds) - I was more worried about all her vomitting and lack of activity. The weight loss has been great for her - she had really bad problems moving around and hip issues. All good now!

My other cat used to be an 11 pound cat now she is 8.5 pounds. Sympathy? (She is fine, just more active as she is going outside now).

Poor Erik, so much to deal with on such a small boy.

[cellio]

Wow, that's quite a difference! I guess you've posted pictures of her in her larger phase, because I've never met her and that's the image I have. She's Baldur-class! :-) (At his last checkup Baldur had lost two pounds. I hadn't noticed.)

[ealdthryth.livejournal.com]

Good luck with selecting a treatment. I hope it goes well.

[cellio]

Glad to hear this worked well for Vandal! After everything folks here have said, I plan to ask my vet about the radiation treatment again. (We'll need to do drugs first in any case, which should tell us whether treating hyper-thyroidism causes other problems for him.)

[cellio]

Thanks; so do I. If we can fix the problem permanently, without doing other harm, I'm all for that.

[baron-steffan.livejournal.com]

Hmm. It's interesting that the cat is considered so radioactive after the radioiodine that he has to be sequestered. Radioiodine is used in humans, too, for diagnostic procedures and I believe for treatment as well; I don't know how "hot" one gets. (Why this all works is that the thyroid has a high affinity for iodine: thyroid hormone contains iodine).

As for medication, methimazole is a thyroid antagonist that is very commonly used in cats. I dispense quite a bit of it. Curiously, humans with thyroid problems are usually hypothyroid; cats are the opposite.

[cellio]

I'm guessing that the government would rather sequester the humans too, except they know that'd never fly. It seems odd to let the people out but not the cats; I would guess (and might well be wrong) that they'd need to put a lot more radiation into a human than into a cat.

(Why this all works is that the thyroid has a high affinity for iodine: thyroid hormone contains iodine).

Thanks. I had been wondering.

As for medication, methimazole is a thyroid antagonist that is very commonly used in cats.

I think that's the drug she mentioned. The brand is Tapazal (Tapazole?), but she also mentioned a generic form.

I should meet my cat's pharmacist someday; I have enough remote interactions with him. :-) (My vet knows an independent pharmacy that delivers; she calls prescriptions in and they have my credit-card number on file. I've seen the delivery person once; I don't even know where the pharmacy is. I've gotten excellent service from them so far.)

[jducoeur]

We went the Tapazole route when the problem came up for Comet. It was probably the right thing to do: he was too shaky for surgery to be a great option, and it proved pretty easy to deal with once he and I got used to medicating him regularly. I basically did that for the last year of his life, until the cancer got him...

[cellio]

Yeah, surgery is definitely out for Erik, so it comes down to drugs versus radiation. Since they won't do radiation without him having been on drugs first anyway, the next step seems clear. My vet tells me it's ok to crush the tablets and bury them in food, which lets me trade the difficulty of pill insertion for the monitoring (to make sure he, and only he, eats the laced food).

Huh?

[dreamdancer85.livejournal.com]

Unless they have changed things, Radio Cat definitely doesn't require you to try drugs first.

In fact, they have to be OFF the drug for a period of time before they can get treated.

Re: Huh?

[cellio]

Ah! Perhaps I misunderstood my vet -- or perhaps she misunderstood their policies, since she was speaking from memory and hadn't yet done the research.