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 91 
 on: May 02, 2019, 03:25:25 PM 
Started by alek0 - Last post by Mandycat
Sending wishes for an good outcome for Mitzie's dental surgery. 

 92 
 on: May 02, 2019, 03:23:58 PM 
Started by rbauer - Last post by Mandycat
 I am glad Mabel is home and doing well.  I hope she has an uncomplicated recovery from that dental surgery.  Her mouth is going to be sore for a few days, but hopefully she will not have any more pain from bad teeth in the immediate future.  Sounds like the university hospital  has a very good and caring staff.

I am happy to hear that the university does have the ability to do the thyroid scintigraphy scan.  Yes, it will be helpful in determining the dose of I131, but, more importantly, it will confirm or rule out the actual diagnosis of hyper-t since they will be able to visualize the thyroid adenoma on the scan if she is hyper-t.  It is the most definitive way of to confirm the diagnosis of early hyper-t.  If confirmed, it will still be important to carefully calculate the dose of I131 so as not to overdose and cause hypo-t.  An appropriately low dose is very important in these early cases. 

 93 
 on: May 02, 2019, 02:39:45 PM 
Started by rbauer - Last post by rbauer
Mabel is home from the hospital now and is doing well.  

Her report says: “Mabel had resorptive lesions on her upper left carnassial tooth 208, upper left second incisor 202, and lower right canine 404.  Her upper left first incisor 201 had no visible crown but had a visible root remnant.  In addition her upper right molar 209 had mobility, calculus and gingivitis.  Tooth numbers 208, 209, 202, and the root of 201 were extracted.  Her lower right canine 404 had extensive bony resorption of the root which could not be extracted.  Instead the tooth’s crown was amputated, and the remaining tooth material was ground down.  The gingiva surrounding each tooth was sutured closed using absorbable suture material.”

This sounds like it was causing her a lot if pain, and it’s no wonder that she was dropping food and eating less. I had no idea of the extent of things, and feel really bad about it.   I’m so glad that we did the dental procedure today.

The staff at the university hospital were absolutely wonderful and cared for Mabel as if she were their own.  They called me with updates several times last evening and throughout the day today and really took excellent care of Mabel.

 94 
 on: May 02, 2019, 02:04:15 PM 
Started by catmom5 - Last post by catmom5
Thanks
She is not nearly as accepting of fluids as the others have been (CJ was a rock star), but I just ordered some terumo needles and that should help. She will be still for 100 ml now, which is progress.

Thanks, aleko, for the other information. Haven't had CKD in several years, so getting reoriented to these things. Getting pretty comfortable with cancers, though.  Undecided

 95 
 on: May 02, 2019, 01:59:49 PM 
Started by alek0 - Last post by catmom5
Thinking of you! Happy you have a specialist who can take care of the tooth issues.

 96 
 on: May 02, 2019, 01:57:19 PM 
Started by rbauer - Last post by catmom5
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.

 97 
 on: May 02, 2019, 04:11:58 AM 
Started by rbauer - Last post by rbauer
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.


 98 
 on: May 01, 2019, 08:51:29 PM 
Started by rbauer - Last post by alek0
Good luck with Mabel's dental, hope everything goes smoothly. Mitzie's dental is also tomorrow.

 99 
 on: May 01, 2019, 08:43:57 PM 
Started by rbauer - Last post by Mandycat
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.

 100 
 on: May 01, 2019, 12:06:30 PM 
Started by rbauer - Last post by Fizzy1
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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