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Author Topic: New Hyperthyroid diagnosis  (Read 3050 times)
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rbauer
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« Reply #45 on: April 24, 2019, 03:35:38 PM »

Is anyone using a slanted bowl like the small version of this one so that pate style food doesn’t get packed into the walls and/or pushed over the edges of a regular Durapet bowl?

https://www.amazon.com/Ourpets-Company-2400012856-Tilt-Stainless/dp/B010Q45WE8/ref=pd_sim_199_1/138-8437997-6689910?_encoding=UTF8&pd_rd_i=B010Q45WE8&pd_rd_r=044c79ab-66e7-11e9-b80c-09dbc8d3b34b&pd_rd_w=4WIUT&pd_rd_wg=71hN2&pf_rd_p=90485860-83e9-4fd9-b838-b28a9b7fda30&pf_rd_r=ZV98CWN3DFXCY1A9DPD2&psc=1&refRID=ZV98CWN3DFXCY1A9DPD2

Right now if I serve the prescription pate food in a 10 oz paper Dixie bowl, and hold it at an angle while she eats, that works perfectly and she can lick the food in a natural upwards direction and really clean the dish.  Nothing gets stuck anywhere and gravity keeps it in the low section.  Wondering if this tilt bowl might work as well ?

This is another option maybe

https://www.amazon.com/dp/B07G23DV4F/ref=sspa_dk_detail_4?psc=1&pd_rd_i=B07G23DV4F&pd_rd_w=56POA&pf_rd_p=46cdcfa7-b302-4268-b799-8f7d8cb5008b&pd_rd_wg=QlXw4&pf_rd_r=T15VY59AX9NQF9HHP62F&pd_rd_r=dbb9865d-66ea-11e9-b12e-253105b62179



« Last Edit: April 24, 2019, 03:45:53 PM by rbauer » Logged
NedF
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« Reply #46 on: April 24, 2019, 04:01:12 PM »

I use the first one but only for dry. It does keep the food in the center of the bowl but the bottom is flat and not slanted. The slanty part is just the rim. Petsmart carries these for about 5 bucks.
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"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 #47 on: April 27, 2019, 06:34:03 AM »

It seems that Mabel is still “learning” how to eat the prescription pate style food.   Smiley.   Before her illness she ate dry food and sometimes a chunky/gravy or sliced wet food, so watching her try to eat pate style food is kind of like watching one if us lean forward and eat a plate of mashed potatoes without utensils.  She’s getting better at it though. After reading way too many online reviews of various dishes and bowls I finally just got her this.  Hoping that it will help with the wasted food caked around the current dish, or spilled over the edges onto the floor, and maybe it will keep her chin cleaner.  

https://www.amazon.com/dp/B06ZZX6QLL/ref=dp_prsubs_2

Another thing I found helpful through trial and error is to not serve more than 1/4 of a 5.8 oz can at a time.  That seems to limit waste and she eats more of it.
« Last Edit: April 27, 2019, 06:44:20 AM by rbauer » Logged
rbauer
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« Reply #48 on: April 28, 2019, 08:55:40 AM »

Very pleased to report that Mabel cleaned the new Cat Guru dish.  Smiley  I did not have to scrape all of the wet food back into a pile and put it down in front of her again to get her to finish like I was having to do with the old dish.   It seems to work as advertised and reviewers say.  I watched her eat and as she licked the pate up the rippled incline it would form into a small clump that would roll back towards her mouth and she could chomp it.  Whereas with the old dish the pate style food would just keep getting pushed around the plate. 

I also found a new healthy snack for in between meals to help with her weight.  Trader Joe’s Just Chicken white meat chicken.  It’s just white chicken meat that’s cubed for salads.  Fully cooked and no chemicals, preservatives or seasonings of any kind.  It’s bland as can be and she loves it.  Don’t confuse it with another chicken product they have that is sliced- that one is seasoned with pepper and other things and not appropriate for cats.
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alek0
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« Reply #49 on: April 28, 2019, 06:05:13 PM »

When it comes to healthy snacks, my cats love steamed chicken. It works better than having it cooked or baked, since the meat remains juicy and tender.

Very simple to do actually. All you need is a cooking pot or pan which has a tight fitting lid. The you need some kind of a metal rack, I use one for cooling cakes. You put the rack in, boil some water in the kettle and fill it in to the level below the rack. Put the plate with some chicken on the rack, cover the pan with the lid and put it on high heat to keep water boiling so that there is plenty of steam. It would be done in about 10-15 mins or so, just uncover and cut through one piece to check, if it changed colour all the way through it i done. Mine go nuts over chicken drumsticks done that way, even those who normally refuse anything chicken.

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rbauer
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« Reply #50 on: April 29, 2019, 03:48:39 PM »

Never thought of steaming the chicken for Mabel. It would definitely be moister and tenderer.  What a great idea.  I have a pot with the rack for steaming fish and vegetables that I can use.  Her doctor just gave me the okay to supplement with chicken instead of trying to force more Royal Canin into her - as long as her stools stay good.  

They are also suggesting changing her Pepcid to Prilosec but I don’t think we’ve really given the Pepcid long enough to fully work.  It’s only been about 8 days on Pepcid and vomiting has definitely improved.  No vomit since Thursday.

The other thing they suggested is maybe changing her prednisolone 2.5 mg  Monday, Wednesday, Friday which is just used for itching currently, to a higher dose that is more useful for IBD.  She used to be on higher doses before her itching was under control.  I was thinking to just let her stools be the guide and leave things alone unless she has symptoms again but I don’t know.  Do a lot of people put IBD kitties on higher pred and is it generally a good thing even if kitty is asymptomatic at the moment on diet change and cobalequin only?

Wednesday is dental day 1.  The university will examine her and decide if they will do a procedure on dental day 2.  I hope that they don’t bulk at a slightly elevated T4 and tell me she can’t do anesthesia unless I get it lower.  I will be really disappointed if they say that. I don’t want her living on buprenex every day just to eat.  We need to get those bad teeth out.  Her heart rate and blood pressure are normal.  Labs posted here were pretty good too.  So I hope they still do the dental even if T4 is a little off.

« Last Edit: April 29, 2019, 03:55:43 PM by rbauer » Logged
Mandycat
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« Reply #51 on: April 29, 2019, 07:04:00 PM »

I would not use Prilosec for Mabel.  It is a medication that is in a class of drugs called Proton Pump Inhibitors.  It is used for acid reflux in humans.  However, that whole class of drugs have recently been found to have very serious adverse effects in humans.  It is virtually almost impossible to get off of the drug once one is on it for any length of time due to the acid rebound that happens when it is discontinued.  A study done on cats showed that this hyperacidity does occur in cats as well when it is discontinued.  It also has other adverse side effects.  I would give the Pepcid more time rather than start this medication.  Here is the link to one article about its use in cats.  Scroll down to the side effects.  I don't think Mabel needs vomiting, diarrhea, etc. caused by this medication.   The side effects from long-time use are even worse.  For instance, it causes B12 deficiency and kidney issues in humans, which I would think could also be true for cats.    

            https://www.vetinfo.com/omeprazole-for-cats.html

Here is another article about using Prilosec for cats.  This one says it is used ONLY for stomach ulcers in cats.  Unless your vet is sure Mabel has a stomach ulcer (doubtful), I would stick with the Pepcid, which, IMO, is safer for cats.

             https://www.petconsider.com/can-i-give-my-cat-prilosec-safely/
« Last Edit: April 29, 2019, 07:19:18 PM by Mandycat » Logged
NedF
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« Reply #52 on: April 30, 2019, 04:28:28 AM »

I also would not give Prilosec. My own experience with it was as Mandycat said - very difficult to get off it and it caused digestive problems while I was on it. I also get kidney stones now (not sure if Prilosec is the cause but it seems too coincidental).
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"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 #53 on: April 30, 2019, 06:48:42 AM »

Thank you Mandycat and NedF.  I will be sure not to give Mabel Prilosec.  I think that we have a combination of feeding routines and pepcid that is working pretty good now.  I’m not too keen on the idea of increasing her steroid either unless the benefits would outweigh the risks.  The diet and supplements might be enough right now.
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rbauer
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« Reply #54 on: May 01, 2019, 10:44:35 AM »

Mabel was seen by both dental and internal medicine today.  She has two or three painful resorptive lesions that were visible during her physical exam.  She is staying overnight and will have her dental procedure done first thing in the morning.  They are also going to do the cytocentesis and culture.  She will have a dental recheck in two weeks and will see internal medicine again during the same visit.  At that time they will take up managing her hyper t and get her into i131 if the diagnosis is confirmed.  The only outstanding condition still to address is the mild IBD and whether I should change her prednisolone from 2.5 mg m w f to every day dosing.  I’m told by her local vet that this will help with a lot of things including appetite and weight gain.  Is it safe though?  I was always under the impression that pred was something to avoid unless you really can’t.  
« Last Edit: May 01, 2019, 12:50:53 PM by rbauer » Logged
Fizzy1
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« Reply #55 on: May 01, 2019, 12:06:30 PM »

Please be sure to post after Mabel’s dental, we’ll be thinking of her tomorrow!  I don’t know what to tell you about the pred.  Can you wait until she is seen by the internal med doc in two weeks?  They might offer a different opinion.
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I once asked a four year old what the secret of life was.  "Feed the kitties," she said, "Feed the kitties."--Ellis Felker
Mandycat
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« Reply #56 on: May 01, 2019, 08:43:57 PM »

I will be keeping Mabel in my thoughts and prayers tomorrow with wishes of a uncomplicated dental procedure. I'm glad it is being done by the veterinary dentist.  Resorptive lesions are best handled by the experts.  

I am going to be concerned about the hyper-t issue with that T4 being so borderline.  I hope that the vets there are very careful about their evaluation of that condition.  Do you know whether they have the ability to do the thyroid scintigraphy scan?  That would be the most definite way to confirm the hyper-t diagnosis.  There is another test called the T3 Suppression Test that can also be used for that purpose, but it isn't used very often these days and there can be some question of good compliance with the protocol used and that could make the results questionable.  I cannot stress enough how important it is to be absolutely sure that a cat is hyper-t before doing the I131 treatment.  If there is no hyper-t, the cat's thyroid will be totally destroyed by the radiation if the I131 is done.  When a cat is hyper-t, the normal tissue of the thyroid is in a state of dormancy and it is the abnormal cells of the adenoma that are producing the abnormal amounts of thyroid hormone.  Therefore, since the I131 radioisotope is taken up by only the abnormal cells, the normal cells are spared and will recover once the abnormal cells die off.  If the cat is not hyper-t, the normal cells of the thyroid will be able to take up the radiation because they are "awake" and they will all die.  This is will make the cat permanently hypo-t.  

If it is determined that Mabel is definitely hyper-t, the other concern would be that this facility carefully tailors the dose of I131 to the cat's specific needs.  A T4 of just 3.7 would require a very low dose of I131.  Otherwise, a dose too high would result in hypo-t as well, although it would not totally kill all of the thyroid cells.  It would just result in the thyroid not being able to function normally, so a thyroid hormone supplement would be needed to bring the T4 up to a normal range.  So, it is important that you discuss with them how they calculate the dose of I131.  Some facilities still use a one-size fits all dose protocol, which is crazy, but for some reason they have not kept up with the latest research on dosing of I131.  Hopefully a university based facility would not be doing that.  

I do not want to frighten you with this information.  I just want you to be aware.  We give this same guidance on the Yahoo Hyper-t Group so that the members there have the proper information to have a safe and effective treatment and know the right questions to ask when discussing the treatment with the facility.  Sometimes they find that they have to find another facility or risk a bad outcome.  You can ask the vets at the university if they are familiar with the research of Dr. Mark E. Peterson, a veterinary endocrinologist who is considered a foremost expert on feline hyper-t and has done research for many years. He was also the one who first recognized and described the disease.  He has recently researched protocols for dosing for I131 treatment, and confirmed the use of a low dose protocol was safest for all cats.  He is the one who wrote the article I gave you the link for about whether an elevated T4 and/or Free T4 are always diagnostic for hyper-t.  If Mabel's T4 is still not above the reference range when she is retested, you might want to discuss with the university vets the suggestions given in that article about waiting the retesting if the diagnosis is not clear.

I hope you know that I am not trying to take the place of the vet. I just want you to have a good foundation of information to make an informed decision about Mabel's treatment.  My concern is the borderline nature of the diagnosis.  If you had said he T4 was "7" or "10" or anything well above the reference range, there would be no question about the diagnosis.  But 3.7 is in what they call the "gray zone", so caution is warranted.  It may or may not indicate early hyper-t.  I will be looking forward to hearing about what the vets at the university have to say about the hyper-t diagnosis.
« Last Edit: May 01, 2019, 08:49:08 PM by Mandycat » Logged
alek0
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« Reply #57 on: May 01, 2019, 08:51:29 PM »

Good luck with Mabel's dental, hope everything goes smoothly. Mitzie's dental is also tomorrow.
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rbauer
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« Reply #58 on: May 02, 2019, 04:11:58 AM »

Thank you all for your continued thoughts, prayers, help and support with Mabel’s health issues.

Fizzy1, I will definitely consult with the university internal medicine department about the IBD issue also.  That’s a whole other problem but I think it will be manageable.  She seemed to improve a lot on just the diet change, fortiflora, and cobalequin so far.  So I’m hopeful.

Mandycat, thank you again for all of the good hyper t information. Yesterday during the dental exam I asked the medical team if they could possibly do a scintigraphy while she was there today. They said it would extend the anesthesia time too much with all the dental work they had to do, so it will have to be separate, but it definitely can be done and will provide very useful information for tailoring the dosage.  They are fast tracking and streamlining Mabel’s care in other ways however, for example, we got the internal medicine consult right on the spot yesterday, and another one will be scheduled to align with her dental recheck in two weeks.  They are also addressing whatever is going on with the bladder/urine.

Alek0, thank you. hope that Mitzie will be feeling a lot better soon after that tooth is taken out today.

« Last Edit: May 02, 2019, 04:18:01 AM by rbauer » Logged
catmom5
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« Reply #59 on: May 02, 2019, 01:57:19 PM »

Happy that you have good vets who are helping sweet Mabel. I always felt more comfortable having a university teaching hospital here for my girls and boys. Hoping for answers and a plan that will work for you.
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