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Author Topic: New Hyperthyroid diagnosis  (Read 3055 times)
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rbauer
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« Reply #30 on: April 19, 2019, 04:07:37 PM »

I might be getting a little ahead of things but if in a few weeks the T4 is still high, and there is a delay getting a dental or into an I131 program, is it reasonable to start Mabel on just 1.25 daily methimazole ?   Also is it a real bitter medicine?  How is the compounded liquid suspension?
« Last Edit: April 19, 2019, 06:07:52 PM by rbauer » Logged
Mandycat
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« Reply #31 on: April 19, 2019, 06:58:37 PM »

You are probably getting a little ahead of yourself, but if it seems necessary to start the methimazole, a dose of 1.25 mg would be okay.  Methimazole really needs to be given in doses twice a day, so, if you mean 1.25 mg per day, that would be .625 mg twice a day.  We can discuss that more later, though.  If the T4 is still as low as it is now, I wouldn't consider starting the methimazole unless you observe more hyper-t symptoms, the vet palpates an enlarged thyroid nodule, or we see lab results that are clues to confirming hyper-t.  It is far more harmful to treat than not to treat if you are not confident of the diagnosis. 

If you do start the medication, the methimazole pills are a little bitter, but very small.  The pill is actually a 5 mg tablet that is split into 4 pieces that are 1.25 mg each, so not a very large pill to give.  They can be given wrapped in a product called Pill Pockets, which are like a treat.  Or you can wrap it in a piece of cheese or other soft treat.  You can have it compounded in a transdermal gel form that is applied to the upper, inner hairless part of the ear and absorbed from there. It can be compounded in a liquid form that is flavored (chicken or tuna usually).  It can also be compounded into a treat form.  So, there are many options.  The least expensive option is the pill.  The other options cost a bit more.  For the pills, you can use either the human generic methimazole, which is a 5 mg tablet that you can get from any pharmacy, or you can use the veterinary brand of methimazole called Felimazole.  The Felimazole is usually obtained from the vet or a veterinary pharmacy on-line and is more expensive.  It is a 2.5 mg tablet.  Either tablet must be split with a pill splitter to get the correct dose when that is smaller than the dose the pill comes in.

The Pepcid (famotidine) is safe to give nightly.
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rbauer
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« Reply #32 on: April 21, 2019, 12:14:53 PM »

Hi Mandycat, the medicine and the dosing doesn’t sound too bad now that you explained all the options, and it would probably just be temporary until she gets into the I131 program.  I have run into some new challenges with Mabel this weekend with food however.  I’ve been having difficulty getting her to eat her full rations the past couple days if it’s served in her bowl.  She leaves a lot of food behind and walks away. Today I put fortiflora on the food and that helped a little.  Feeding her directly out of my hand helps even more.  There’s something about eating out of the bowl that she’s not comfortable with at the moment but if I keep refilling my hand with bite size portions she eats out of my hand just fine.  The bowl is ceramic and raised off the floor by four or 5 inches so it really is the ideal set up, but for whatever reason she is avoiding it.  I’m very much aware of her recent weight loss, and the tendency to lose even more, so I might need to keep hand feeding her for now to get the full daily amount of food into her.  She was not like this before starting Pepcid but that might just be a coincidence. 
« Last Edit: April 21, 2019, 12:39:58 PM by rbauer » Logged
GKit
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« Reply #33 on: April 21, 2019, 02:04:06 PM »

rbauer, is Mabel still on buprenex?

The blood in her last urinalysis coupled with this eating relapse makes me twitchy that she should get checked for a UTI,  assuming all this is not tooth-pain related. There was no bacteria mentioned in the UA results, so it is possible the blood might be a result of the presence of crystals, and her kidney numbers are good, so that makes it a bit unclear what is actually going on. It is possible, in my experience, to see no bacteria in urinalysis (under the microscope) yet test positive when they culture the urine.

Hopefully Mandycat can comment further.
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rbauer
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« Reply #34 on: April 21, 2019, 03:02:09 PM »

Hi Gkit, Mabel is no longer on buprenex.  Do you think she may be in pain?  From past experience with many dentals over many years, I became aware of a pattern that she can only take buprenex for 2-3 days before developing diarrhea from it even when she is well.  Never understood why. it’s not supposed to cause diarrhea.  So she was on it but quickly got off it.  Maybe if I put her back on this eating problem will temporarily improve, but will need to be mindful of her stool quality.  She should be getting a new urinalysis by cytocentesis at the recheck visit. She had crystals last time.
« Last Edit: April 21, 2019, 03:15:43 PM by rbauer » Logged
GKit
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« Reply #35 on: April 21, 2019, 06:06:01 PM »

I was thinking Mabel’s food setback was painful tooth related, but since it sounds like she has been off the buprenex for some time, and she has been eating well/normally in the meantime, making this less likely. Also, with as many dentals as she’s had, you probably know better than me how a painful tooth presents itself. :-)

Gypsy, my IBD/IBS kitty, has some odd reactions to meds as well. I would not rule out the Pepcid being an issue. It may not be the drug itself, but one of the inactive ingredients in the tablet.  Sometimes switching to another brand can help, but a more definitive test would be to take it out and see if she goes back to eating from her bowl, and then you can decide what to do from there. It is possible to get famotidine compounded as well, if inactive ingredients in the tablet turn out to be the problem.

A urine culture is a step further (and more $$) than a urinalysis, where they culture the urine for about 5-7 days to see if anything grows. They will usually also do a sensitivity test to see what antibiotics would be most effective. Since no bacteria were reported?  in her most recent urinalysis, this is probably why they didn’t add a culture, but if Mabel is still losing weight (hope not!) and vomity when she has her recheck, it might be something to ask the vet about.
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rbauer
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« Reply #36 on: April 22, 2019, 03:00:22 AM »

Hi Gkit, thanks for your message.  I gave Mabel some buprenex before bed last night and she is very playful this morning.  Got me awake an hour early even.  Going to try breakfast as soon as the food softens in water.  The compounded Pepcid was ordered Saturday and should arrive tomorrow.  It’s a soft chew chicken flavor available from vets first choice.  They partner with my vet’s practice and offer a compounded, liquid, melt, or chew of just about any cat medication from what I can tell.  I also emailed the doctor and asked if we could please get a sedated oral exam and any extractions now rather than wait several more weeks until after Mabel’s recheck.  I don’t see any reason to wait. You mentioned that Gypsy IBD/IBS.  Have you found a good combination of foods and medications that keeps everything mostly okay? 
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rbauer
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« Reply #37 on: April 22, 2019, 10:23:44 AM »

Breakfast did not go too well.  Mabel appears to have developed an aversion to water soaked dry food now. I think she bit into a few that were too hard in the past and she knows they hurt.   I converted the meal into a slurry instead.  Around lunch time I was able to get about 1/3 of a can of RC gastrointestinal high energy canned food into her by hand feeding her mouth sized portions.  I will keep doing this as long as necessary to make sure she gets about 200 kcals/day.  She also got her first dose of cobalaquin today in a pill pocket.   Her Buprenex is .05 mg given every 12 hours. Strength is .5 mg/ml.  This is only half the normal prescribed dose but it seems to help and might not trigger the diarrhea if the dose is kept low.  We’ll see what happens. 
« Last Edit: April 22, 2019, 10:39:39 AM by rbauer » Logged
rbauer
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« Reply #38 on: April 22, 2019, 02:47:16 PM »

Just had a call with Mabel’s doctor.  They can do a dental on Wednesday but cautioned me that she just went through a lot and there are some low risks for a complication.  The other choice would be to wait another week or two and keep treating her as I have been and maybe adding Mirtazapine transdermal to build her strength and weight back up.  For now I elected to do the dental but have about 24 hours to change my mind.  This is a tough decision.  Not sure whether to get the teeth done immediately now or manage her medically for another week. 
« Last Edit: April 22, 2019, 03:59:24 PM by rbauer » Logged
GKit
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« Reply #39 on: April 22, 2019, 07:36:10 PM »

I hope Mabel ate dinner for you. After a lot of trial and error I ended up feeding Gypsy homemade raw food. I am pretty sure she is allergic to corn and peas and fish, so this was the best way for me to control all the ingredients in her food. We tried metronidazole, but it was not as effective for us as changing the food and getting rid of all the allergens. We could not do prednisolone because of her frequent urinary tract infections.

Not sure what to tell you about scheduling the dental versus medical management. You had mentioned a while back the vet had detailed her reasons for wanting to wait—are you still comfortable those reasons make sense in light of the latest round of tests and events?  If not, I would consider seeking a second opinion, since another vet seeing all the reports and data would be best able to weigh the risks/reward of a dental versus her new reluctance to eat from her bowl. Maybe I am not understanding the situation correctly? but I’m not comfortable that it seems the vet left this decision to you without more guidance, since Mabel is not eating well.
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rbauer
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« Reply #40 on: April 23, 2019, 06:34:06 AM »

It’s great you found a combination works and that’s all natural.  That’s the best.  

I thought about things overnight and am considering waiting and having the university hospital do the dental instead.  They could see her next week.  The benefits to going to the university are that they have seen her many times over the years, she’s an older cat and they are a 24 hour facility that may be better equipped to deal with a complication than the neighborhood vet hospital, and dental is all that the dental department does.  

The only downside is needing to keep medicating her with buprenex for another week, but so far she is tolerating it and seems comfortable.  She’s laying in all her favorite spots, grooming, and playing, whereas before she was hiding under things all day. Last night and this morning she ate wet food from a stainless steel dish by herself.
« Last Edit: April 23, 2019, 06:43:14 AM by rbauer » Logged
GKit
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« Reply #41 on: April 23, 2019, 03:39:53 PM »

Yay for eating! -whispers so as not to jinx it
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Mandycat
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« Reply #42 on: April 23, 2019, 05:08:37 PM »

I agree with the decision to have the dental done by a veterinary dentist at the university.  Having 24 hour coverage is a definite plus after surgery.  Will be keeping Mabel in my prayers.
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NedF
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« Reply #43 on: April 23, 2019, 09:55:20 PM »

I've been following this thread but haven't posted since I don't know much about hyperthyroid. I just wanted to say I'm glad Mabel is feeling better today.
« Last Edit: April 24, 2019, 09:55:23 AM by NedF » Logged

"It seems that some creatures have the capacity to fill spaces you never knew were empty."  - Jean-Luc Picard
rbauer
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« Reply #44 on: April 24, 2019, 08:55:44 AM »

A big thank you to everyone for all your continued help, support, and encouragement.  Purrs and kisses from Mabel too Smiley. I spoke to Mabel’s doctor yesterday and cancelled the dental at their office. The plan is to take Mabel to the university veterinary hospital dental department next week.  When I called the nurse there even remembered Mabel and was very glad that we were coming in.  I don’t know why we ever stopped going there every year- sometimes twice a year for her periodontal disease and FORLs.  It’s so important to stay on top of their dental care even if you think your kitty is doing fine. Lesson learned the hard way here.

Mabel’s current daily regimen is:

Royal Canin gastrointestinal high energy food
Fortiflora
Cobalequin Oral b12
Prednisolone 2.5 mg M-W-F long term ongoing for itching
Buprenex .05 ml every 12 hours
Pepcid 1/4 tablet at bedtime

Upcoming appointments are for dental, repeating all blood work, repeating urinalysis with sensitivity and culture.  

« Last Edit: April 24, 2019, 09:32:50 AM by rbauer » Logged
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