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When do you say enough?

Discussion in 'Cat Health and Nutrition' started by McBenson, Apr 11, 2011.


  1. McBenson

    McBenson PetForums Member

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    My cat started losing weight very quickly about 18 months ago so I took him to the vets and it was picked up straight away that he has thyroid problems. He started on medication and has to have 3 monthly blood tests till his thyroid levels are normal. It was stable for a bout 6 months then went a bit haywire again so more frequent blood test. The problem is that he has started to have panic attacks at the vets when he's having the tests. They have to cage him till he calms down but he really doesn't like it at all - I don't blame him, I went through a couple of years with something similar myself but at least I understood what was happening to me.
    My poor wee man is 14 yrs old and just wants a quiet life to retire into. Is there a point where I say stop now, he's had enough? Or do I just keep at it? As much as I love him and would be devasted to lose him I want him to be happy and do what is in his best interests. The vets that I'm with cater for mostly weathly people so money issues in their eyes never come into their decisions and they seem to be more interested in treating the owner than the animal.
    I have a friend in a similar situation with a cat of the same age and condition whose vet has advised against treatment and tests and just let her live out her days in peace. My friend is registered with a charity vet so money is an issue there and they deal with people who mostly have no insurance and no spare cash.
    I just want to do what's right by my cat - I don't want him to suffer or be in any distress.
     
  2. missye87

    missye87 PetForums VIP

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    Hiya,

    I know exactly how you are feeling!
    Would you be able to speak to your vet about simply keeping your kitty on the meds and having less blood tests?
    When I was told that Sooty might have hyperthyroidism, they said it would nee to be under control for the rest of his life, so after initial diagnosis he would be permanently on the meds regardless, and there wouldn't be much point bringing him in for further tests unless he gets worse. In fairly sure that stressing him out too much isn't going to make things any better!
    Turned out he had Chronic Renal Insufficiency (early stages of chronic renal failure) and he is on meds permanently for the rest of his life. The vet said maybe 6-monthly tests and to just bring him in if he has any changes in behaviour, or in sleeping, eating/drinking and toilet patterns.
    I give a verbal update every month as I pick up his meds anyway, and the vet can either just continue or if he thinks something is up he asks me to bring him in.

    Sooty seems happy with that, as he hates going to the vets too. Although he is getting better now, he howls the place down until we get in and then he just plonks himself down on the table and sulks :D
     
  3. hobbs2004

    hobbs2004 PetForums VIP

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    Your friend was told to stop treatment and just let it take its course? :(
    Please don't even consider going down that route just yet.

    Just like for us humans, there are three treatment options of feline HT.

    1) medication
    2) surgery
    3) radioactive iodine

    If your cat is no longer responding to one, then perhaps he could be tried on another brand of medication? (Ianthi will be along soon no doubt and I am sure she will be able to help a lot more if you have his latest T4 results ect handy or could even post them).

    Alternatively, 14 years is really not a great age for a cat, and if you are lucky you might have him for another 6 years if it is all nicely controlled. So, perhaps surgery (with a prior blood test to check suitability) would be another option. They don't always work but they are certainly worth a try.

    Radioactive iodine is perhaps the least invasive of the options after medication but it would mean that your cat would need to be isolated for a while at the surgery who does that, which can be distressing. Even when he comes home, you will need to keep your distance from him for another wee while as he will still be radiating.

    I would read up on all of these approaches and definitely talk to Ianthi when she comes on.

    Best of luck! :)
     
  4. buffie

    buffie Mentored by Meeko

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    Excellent advice as always from hobbs.
     
  5. MoggyBaby

    MoggyBaby PetForums VIP

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    When my old Sluggie was dianosed with this, when he was 13, the vet suggested medication to control it but, as Sluggie was ALWAYS a little sod for taking tablets, I knew that going down that route was never going to be an option. So the vet did an op and we were lucky in that it was only one side of the thyroid that was causing the problem so the vet took that bit out and left the other half in. Sluggie proceeded to have a further 4 happy, tablet free, years before the remaining bit of thyroid went doolally and couldn't be stabilised.

    I'm not saying that your cat would be a case exactly like Sluggers was but we owe it to our furbabies to explore every avenue available.

    Good luck & please keep us informed of progress.
     
  6. Ianthi

    Ianthi PetForums VIP

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    Just to add to the very good advice above-Firstly, left untreated the cat will die basically so it's not an option really. Is it just the blood testing or is he OK with vet examinations?

    I would seriously consider having the thyroidectomy which basically puts an end to the medication at least for now anyway. However, do bear in mind the conditon will re-emerge about a year or so later because the unaffected lobe on the other side of the thyroid will also become overactive necessitating further treatment but at least this will give you some breathing space in the meantime! You can also opt for that to be operated on when the time comes!

    How often are the current tests? Do you know the current and previous T4s? If the difference is quite small then it's possible with a small increase in medication ( it's always advisable to adjust the medication gradually ) to get the level within range again very quickly without the need for excessive blood testing ( you will need some however ) based on the clinical response from the cat! I would discuss this with you vet firstly.
     
    #6 Ianthi, Apr 11, 2011
    Last edited: Apr 11, 2011
  7. McBenson

    McBenson PetForums Member

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    Hi, Thanks for all the replies.

    Kenny (my cat) was on 2.5mg felimazole every other day but last month this was increased to daily. He is having tests 3 monthly. He is fine with a vet examination and booster jabs but when they do the tests they take him to another room which is when he panics. I have not witnessed this for myself as "parents" aren't permitted in the back areas but the vets have had to come out and explain the delay for bringing Kenny back out recently. The last time I took him was to a new vet in the practice and I warned her that he is extremely nervous of the proceedure so be nice but she didn't belive me at first until she tried to put the needle in. I took 3 nurses and a vet to eventually get the blood.

    How much would it cost for a thyroidectomy?? The insurance I took out for him was to cover an illness for 12 months (at the time he was in perfect health and I didn't forsee something like this happening) so he isn't covered for this illness anymore. I'm not worried about the cost of the tests and medication but I really couldn't afford anything too expensive.
     
  8. Ianthi

    Ianthi PetForums VIP

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    So the next test is in two months?

    I think there's a very good chance if you were permitted to stay with him during the tests Kenny would be much calmer and I'm surprised the vets haven't suggested this. I know others who've found this so worth bearing in mind. I always stay. It's reassuring for the cat.

    Based on the medication level ( though it's important to stress there's often no direct correlation between this and T4 level, it varies accoring to the individual cat ) it sounds as if Kenny's T4 reading isn't all that out of range-though I don't know how much it has elevated since original diagnosis. Adjustments with a view to stabilising it can take a bit of time and dont forget that further down the line the same will happen again!

    Costs for the op vary according to where you live but I would expect to pay £400?. Considering it's a delicate operation it's important to get an experienced vet to carry it out. I'd approach your own vet first!
     
  9. McBenson

    McBenson PetForums Member

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    I don't think it is too far out of range but we can't seem to get the dosage right for him so we're back and forth quite frequently.

    £400 is ALOT less than I expected and the vets we go to are excellent in that respect. Kenny has been with them since 2002 and my dog was also registered there so we have a good relationship with them but they are notoriously expensive!

    I have recently acquired a new rescue dog who is registered with a vet she saw while in the rescue centre so I have chosen to keep her with them and they are alot cheaper than our regular vets. I was going to take Kenny to the new vets for his next test to see how they handle him and he's due his next test in a few weeks.
     
  10. Ianthi

    Ianthi PetForums VIP

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    Actually I've looked again at the dosing and owing to it's half life, Felimazole is best given twice daily ( 1.25 x 2 ) because it's only effective for 12 hours so maybe this is one reason for the difficulty in stabilising him. I would certainly call the vet now and suggest doing this first!

    Also, I would have thought that the every other day dosing would have resulted in a yo-yo effect based on the above!
     
  11. McBenson

    McBenson PetForums Member

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    They put him on it twice daily at first but his T2 level plummeted to around 12 so he was on once daily then every other day. It was stable for about 6-9 months but on the last visit his weight had dropped again and his level was 64 so they've put him back up to once daily. His renal function has always been fine though.
     
  12. Paddypaws

    Paddypaws PetForums VIP

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    Ianthi beat me to it.....but I will stress again that Felimazole needs to be given every 12 hours to achieve proper coverage. Dosing less frequently than this means that the cat will only be in normal range for a fraction of the time over a 24/48 hour period. For this reason many people split the tablets... into halves or even quarters to achieve the correct doseage...vets advise against this but it is safe to do ( use gloves when you handle the drug your self ) Really your vet is at fault for not handling this correctly.
    TBH, if the cat is otherwise in good health I would be looking seriously at surgery....long term it will work out cheaper than drugs and blood tests.
     
  13. Ianthi

    Ianthi PetForums VIP

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    I wonder how stable though!

    Just to add to PP's very good post ( always great to have an active practitioner on board! ) there's also the added problem, that owing to this unusual treatment regime which would undoubtedly result in wide daily (and day to day ) fluctuations in levels, the blood tests aren't an accurate measurement of his T4 levels! It all depends on what time of day they are taken! For instance, 64 doesn't sound that much out of range but of course we don't know how much higher or lower it potentially could have been at different times that same day! This his made things very complicated in terms of dose regulation! Poor little Kenny-I wonder how he 'felt' with all this going on!:confused:

    Depending on how he is at the moment I would certainly try splitting the tablet
    (2.5mg) in two and see the response. Hopefully it will hit the mark first time!
     
  14. Paddypaws

    Paddypaws PetForums VIP

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    Yet again Ianthi has pipped me to the post! I try to have bloods taken 4-6 hours after medication so that the drug has reached peak activity and the test is accurate.
     
  15. Doolally

    Doolally PetForums Senior

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    Ianthi and PaddyPaws have said it all really.

    I'd just like to add though, that hyperthyroid cats are often 'climbing the walls' and often a little difficult to take blood from/hold as they are so hyped, due to the increase in metabolism...So, it's likely that his stresseyness at the vets is due to his hyperthyroidism not being aqequately controlled, viscious cycle, but it'd be a shame to give up on him due to his condition making it difficult to keep on testing, but as he gets more stable it's a possibility he may be more tolerant of testing.
     
  16. Sacremist

    Sacremist Mum to 2 cats and a dog

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    Can I ask what the vet aims to achieve with these tests? Are they using them as a guide to the type or amount of medication to give?

    One of my cats was in kidney failure and initially we were testing her quite frequently. In the end, I said that I did not see the point. We knew her kidneys were failing so instead of testing her blood, we tried treatment and when we could see the treatment was not working because she was losing more and more weight and not eating, we PTS. We did this because the frequent testing was making her miserable.
     
  17. Sacremist

    Sacremist Mum to 2 cats and a dog

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    I have another cat who is in early stages of kidney failure and he does not like the blood tests. They said he reacted like he was possessed spinning his head from side to side. To get blood, they sedated him. He's been having tests for three years now, though, and he's become resigned to it and calmed down so he is no longer sedated. Plus his bloods have been good for the last two tests and we now only need to test him every six months. He still doesn't like it, but just accepts the situation.
     
  18. McBenson

    McBenson PetForums Member

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    well we went to the new vets today for blood tests and I must say they seem alot more knowledgable about thyroid problems. I wasn't allowed to go with Kenny for his tests and he did have a panic and the needle slipped leaving a rather large bruise.

    However - the vet confirmed what you all have been saying about giving felimazole twice daily and said it's normal that you either give it like that or not at all. He's left Kenny on the same dosage for now until the results come back but he's sure he will change that when he has more information. He doesn't advocate surgery unless in extreme cases as it has been recently found that cats produce thyroid elsewhere and it will not cure the problem so you perform surgery on an already ill cat just to continue meds.

    I am a bit angry about the previous vets advice (or lack of it) concerning Kenny's meds regime! This could have all been sorted by now and with much less disruption.:mad:

    Slight problem - Kenny has developed a cough and fluttering heart beat which may mean the start of heart problems but he wouldn't start invistigating as it is too disrupting.

    He has however advised me to start Kenny on a renal diet and I was wondering how to go about that.
     
  19. Ianthi

    Ianthi PetForums VIP

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    Glad to hear about new vets! What dose of Felimazole is Kenny on currently then? If you've been giving it twice daily before blood test then the next T4 should be more accurate and he should be easier to stabilise from now on. Do obtain result from vet and we can take it from there!

    The ectopic tissue migrating away from the thyroid has always been a risk issue really. However it doesn't apply to all cases and for a cat like Kenny ( though hopefully from now on he'll require less blood tests! ) it would be ideal. Perhaps this vet doesn't feel confident in carrying out the operation?

    Considering the 'heart problem' could well be related to the hyperT ( it's one of the risks when the metabolism is speeded up-this is one of the reasons it's vital to control the condition ) I would hope the symptoms would cease once T4 is within normal range. The stress of the vet visit may also be a contributory factor!

    I wonder why the vet is suggesting a renal diet? Blood test results? Again it's only when the T4 is with range that the true kidney condition ( untreated hyperT can mask pre-existing kidney problems ) is revealed and I would hold off until he's been stabilised. Renal diet are prescription diets and are available online.
     
  20. Paddypaws

    Paddypaws PetForums VIP

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    The other option of course is Radio active iodine. This costs around £1400 and involves the cat being kept in isolation for 2 weeks after the procedure, but it is curative ( although some cats can temporarily go Hypo-T )and will also target any migrated thyroid tissue.
     
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