Jackie Update

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dgk - 11 May 2004 17:51 GMT

Ok, No parasites. T3 is normal but T4 is elevated (6.9 and normal is
4.0). So it is a bit inconclusive. The Vet says that Tapazole (sp?)
can cause cats to stop eating somewhat (because of upset stomach)
which is not something she can take right now, and he would prefer
that we just wait a few weeks until the mouth ulcers are gone. She is
on antibiotics to deal with those and he feels that the ulcers could
be the primary cause of her weight loss. Apparently if she can't chew
the food properly it won't be assimilated (or laminated as it were).

It doesn't seem likely to me but I suppose it's possible. The real
problem is that we can't get more blood out of her and putting her
under is too risky. It could be diabetes or kidneys or anything else
and we just can't do anything more right now. He says to wait a few
weeks until she is more comfortable and hopefully gains some weight. I
did note that she is not drinking much water.

She had some diarrhea yesterday, nothing major, just a bit loose here
and there. I noticed it after she sat on my pants. The most likely
cause is eating too much combined with the antibiotic. The advice to
just sit tight for a bit is probably good. I think she might be
gaining a bit of weight and it's only been three days. Boy does she
eat.

Oh, the boys were out in the backyard yesterday so I let her roam
around upstairs (where her room is). She checked out all the rooms and
then wanted to go downstairs but I wouldn't let her do that yet.

They all got to look at each other while I sat between them. Lots of
stares and a few muttered cat curses but nothing overly unhappy. Looks
like it might work out.

I have a call into the petstore and will find out more of her history.
I await the return call. I need to know how long she has been this
thin.

I suppose I could take a trip to the Specialty Vet but I think I will
just sit tight for a week or so and see how it goes. I really don't
want to put her through too much right now. Well, there is all that I
know at this time. I can't wait to get home and feed her some more.

Dave

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Laura R. - 12 May 2004 03:47 GMT

circa Tue, 11 May 2004 12:51:23 -0400, in rec.pets.cats.health+behav,
dgk (sonicechoes-spamless@hot-nospamp-mail.com) said,

> Ok, No parasites.

Good news.

> T3 is normal but T4 is elevated (6.9 and normal is
> 4.0). So it is a bit inconclusive.

Has the vet recommended a T3 suppression test? AIUI, in cats with
elevated T4, giving the cat T3 (orally) will cause the T4 to decrease
in a cat that isn't hyperthyroid, but not in cats that are
hyperthyroid.

> The Vet says that Tapazole (sp?)
> can cause cats to stop eating somewhat (because of upset stomach)
> which is not something she can take right now, and he would prefer
> that we just wait a few weeks until the mouth ulcers are gone.

Is Pepcid an option for her? I know that my vets prescribed it for my
CRF cat for his tummy acid and it has helped immensely. Also, did the
vet mention any high-calorie foods or supplements? (e.g., Hill's A/D
or Nutrical)

Also, Tapazole is apparently pretty nasty tasting, which can cause
inappetance, and adjusting the dose can sometimes help, too.

> She is
> on antibiotics to deal with those and he feels that the ulcers could
> be the primary cause of her weight loss. Apparently if she can't chew
> the food properly it won't be assimilated (or laminated as it were).

Well, we certainly don't want her improperly laminating! You end up
with a verrry shiny house! ;-)

> It doesn't seem likely to me but I suppose it's possible. The real
> problem is that we can't get more blood out of her and putting her
> under is too risky.

Yeah, cats just don't have that much blood volume. With Alex's blood
draws when he was having chemo, we had to make sure that they weren't
too close together. Poor little things.

> It could be diabetes or kidneys or anything else
> and we just can't do anything more right now. He says to wait a few
> weeks until she is more comfortable and hopefully gains some weight. I
> did note that she is not drinking much water.

Well, if it is diabetes or CRF, since the vet has examined her and
come up with at least an initial course of treatment, at least both
diseases tend to be chronic rather than acute. How much is "much"
water? Do you feed her wet food?

> She had some diarrhea yesterday, nothing major, just a bit loose here
> and there. I noticed it after she sat on my pants. The most likely
> cause is eating too much combined with the antibiotic. The advice to
> just sit tight for a bit is probably good. I think she might be
> gaining a bit of weight and it's only been three days. Boy does she
> eat.

Well, that's definitely better than the alternative! :-)

> Oh, the boys were out in the backyard yesterday so I let her roam
> around upstairs (where her room is). She checked out all the rooms and
[quoted text clipped - 3 lines]
> stares and a few muttered cat curses but nothing overly unhappy. Looks
> like it might work out.

See? You knew you wanted her. :-D

> I have a call into the petstore and will find out more of her history.
> I await the return call. I need to know how long she has been this
> thin.

From the reading I've done, if her T4 is that high even though her T3
isn't, that's usually pretty indicative of hyperthyroidism. I can
probably dig up some references to make sure, but IIRC, T3 tends to
fluctuate more than T4 and therefore be less reliable an indicator.

> I suppose I could take a trip to the Specialty Vet but I think I will
> just sit tight for a week or so and see how it goes. I really don't
> want to put her through too much right now.

Sounds like a plan.

> Well, there is all that I
> know at this time. I can't wait to get home and feed her some more.

Good luck, and bless you for taking in an older cat.

Laura

Signature

I am Dyslexia of Borg,
Your a.s will be laminated.

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dgk - 12 May 2004 16:11 GMT

>Has the vet recommended a T3 suppression test? AIUI, in cats with
>elevated T4, giving the cat T3 (orally) will cause the T4 to decrease
>in a cat that isn't hyperthyroid, but not in cats that are
>hyperthyroid.

No, but we couldn't do anything right now anyway. No way to get more
blood.

>Is Pepcid an option for her? I know that my vets prescribed it for my
>CRF cat for his tummy acid and it has helped immensely. Also, did the
>vet mention any high-calorie foods or supplements? (e.g., Hill's A/D
>or Nutrical)

I'm not sure there is a problem here. She was a bit moist yesterday
but there were also some normal stools. I'll give it another day.

>Well, if it is diabetes or CRF, since the vet has examined her and
>come up with at least an initial course of treatment, at least both
>diseases tend to be chronic rather than acute. How much is "much"
>water? Do you feed her wet food?

I leave her dry food (science diet this time) during the day because I
want her eating something, but she really likes the wet stuff. Her
first feeding (morning and night) gets the antibiotic mixed in. Then,
for the evenings, I give her more food spaced an hour apart or so. I
think her teeth are bad for the hard stuff. Certainly one fang is
missing. She may be missing most of her teeth. I can't really tell
yet.

When she took a stroll into the bathroom (where the normal cat feeding
station is) she did take a big drink at the pet fountain. She barely
touches the water in her bowl, which is in the Cat Introduction Room.
She is confined there almost all the time. I'm not sure when she is
going to join the boys on a regular basis.

There was a major screaming session yesterday between the three of
them. She was in the room with the door open and came waltzing out.
The boys took a bit of offense and hissed at her. She hissed back.
Nipsy seems to be getting along with her a bit but Espy is freaked
out. Still, nothing unexpected and, for the first major interaction, I
think it went pretty well.

>From the reading I've done, if her T4 is that high even though her T3
>isn't, that's usually pretty indicative of hyperthyroidism. I can
>probably dig up some references to make sure, but IIRC, T3 tends to
>fluctuate more than T4 and therefore be less reliable an indicator.

I'll look into it some more. I would consider radiation rather than
foul pills. Surgery is out. But since she would have to be boarded for
a week or so for radiation, it will have to wait. It's still premature
since I want more tests done before I do anything.

One oddity is that she walks a bit funny, like her backend sways
somewhat. Maybe girl cats just walk differently than boy cats? I can't
really figure out just what it is that seems a little off. Perhaps
some arthritis or maybe an old injury. I can't even decide which leg
it is, or even if there is anything wrong at all.

The pet shop wasn't a huge help in any of this. They really don't know
her history. Oh well.

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Phil P. - 12 May 2004 14:31 GMT

> Ok, No parasites. T3 is normal but T4 is elevated (6.9 and normal is
> 4.0). So it is a bit inconclusive.

You might want to speak to your vet about a free T4 by equilibrium dialysis
(fT4ED) assay. The fT4ED is the most accurate way to measure a cat's thyroid
function. Its especially more sensitive in assessing thyroid function in
sick cats that might have concurrent or secondary illnesses that could alter
tT4 results.

Don't let the word "dialysis" scare you! A simple, routine blood sample is
all that's needed. The sample is dialysed *after* its taken from the cat.
The test requires only about a 1 1/2 ml sample of blood and costs about $20.

The T3 suppression test is only good for diagnosing borderline cases when
the tT4 consistently falls inside the normal range.

The Vet says that Tapazole (sp?)

> can cause cats to stop eating somewhat (because of upset stomach)
> which is not something she can take right now,

We were having a few problems with some our hyperthyroid cats experiencing
adverse effects from Tapazole. In many of the cases, I found the problem to
be the dose, not the drug.

I solved most of the problems by stopping the treatment for a few days and
then restarting the treatment at a lower dose and then I gradually increased
the dose until the cat could handle the therapeutic dose without any adverse
effects. Some cats just need a little time to gradually adapt to the
medication.

In serious cases where therapy could not be stopped without significant
risks, I switched the cats to either carbimazole or iopanoic acid
(Telepaque). Both of these drugs produce significantly fewer and milder
side
effects than Tapazole - carbimazole is probably the better of the two.
Unfortunately, neither drug is available commercially, however, both drugs
are available through compounding pharmacies and therefore, cost a bit more
than Tapazole.

Antithyroid drugs have the advantage over radioiodine tx of being
"adjustable" whereas I-131 is irreversible. Hyperthyroidism is a dynamic
disease and antithyroid drugs give you the flexibility to adjust the therapy
as the disease changes. This ability is particulary important for cats with
underlying kidney disease. In older cats with both diseases, sometimes you
must strike a very delicate balance between an "acceptable" level of
hyperthyroidism and an "acceptable" level of azotemia. You can accomplish
this only with antithyroid drugs.

and he would prefer

> that we just wait a few weeks until the mouth ulcers are gone. She is
> on antibiotics to deal with those and he feels that the ulcers could
> be the primary cause of her weight loss. Apparently if she can't chew
> the food properly it won't be assimilated (or laminated as it were).
>
> It doesn't seem likely to me but I suppose it's possible.

Possible but not probable. If your vet suspects nutrient malassimilation, a
simple gross examination of the feces for undi?gested food might help him
determine if malabsorp?tion or maldigestion is happening. In the vast
majority of cats with hyperthyroidism weight loss is usually the result of
increased energy expenditure.

The real

> problem is that we can't get more blood out of her and putting her
> under is too risky. It could be diabetes or kidneys or anything else
> and we just can't do anything more right now. He says to wait a few
> weeks until she is more comfortable and hopefully gains some weight.

Speak to your vet about restarting her Tap at half or 1/4 of her therapeutic
dose and gradually increase the dose as she adapts to the medication. If
that doesn't work, try carbimazole. Many cats that can't handle Tap take
carbimazole without any adverse effects.

I

> did note that she is not drinking much water.

If she's eating canned food, she's meeting nearly all her water needs
directly from her diet.

> She had some diarrhea yesterday, nothing major, just a bit loose here
> and there. I noticed it after she sat on my pants. The most likely
> cause is eating too much combined with the antibiotic.

Could also be caused by rapid gastric emptying and shortened small and large
bowel transit times. Drop a stool sample off at your vet.

The advice to

> just sit tight for a bit is probably good. I think she might be
> gaining a bit of weight and it's only been three days. Boy does she
> eat.

Despite her increased food intake, she's probably still in a state of
chronic caloric and nutritional insufficiency. You're going to have to
slow her system down pretty soon.

I gotta run. I hope this helped a little.

Keep the faith.

Phil

> Oh, the boys were out in the backyard yesterday so I let her roam
> around upstairs (where her room is). She checked out all the rooms and
[quoted text clipped - 14 lines]
>
> Dave

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hamandcheese@betweentheknees.com - 12 May 2004 16:58 GMT

>The Vet says that Tapazole (sp?)
>> can cause cats to stop eating somewhat (because of upset stomach)
[quoted text clipped - 3 lines]
>adverse effects from Tapazole. In many of the cases, I found the problem to
>be the dose, not the drug.

When we were giving our cat tapazole before he finally received radio
iodine treatment, we got from our vet a chicken flavored soft treat
compounded with the proper dosage of tapazole. They are packaged in
individual blister packs.

The cat couldn't get enough and sure made it easy compared to
traditional pilling.

We got the double dosage ones and then sliced them with a knife into 2
servings. This was cheaper than buying single dose treats. They are
very easy to cut as they are a very soft treat and the blister pack is
re-sealable to keep the unused part fresh. We also received drugless
samples in different flavors to try first but he loved them all. There
is apparently no taste of the drug at all and it is evenly distributed
throughout the treat. I should have asked what other drugs are
available in this form.

You have to be careful that they stored safely as I'm sure he would
chew through the packaging and eat them all if he could.

-mhd

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dgk - 12 May 2004 20:27 GMT

>When we were giving our cat tapazole before he finally received radio
>iodine treatment, we got from our vet a chicken flavored soft treat
[quoted text clipped - 17 lines]
>
>-mhd

Thanks. That makes it easy.

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Phil P. - 15 May 2004 04:18 GMT

> >The Vet says that Tapazole (sp?)
> >> can cause cats to stop eating somewhat (because of upset stomach)
[quoted text clipped - 25 lines]
>
> -mhd

I've had pretty good luck with fish-flavored methimazole suspension with
difficult-to-pill cats. I haven't tried the chicken-flavored Tapazole
treats, but I'll certainly keep them in mind. Thanks.

Phil

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dgk - 12 May 2004 20:39 GMT

>> Ok, No parasites. T3 is normal but T4 is elevated (6.9 and normal is
>> 4.0). So it is a bit inconclusive.
[quoted text clipped - 11 lines]
>The T3 suppression test is only good for diagnosing borderline cases when
>the tT4 consistently falls inside the normal range.

...

Greatly appreciated and filed. Jackie hasn't been on any medication
yet. We aren't really even sure it is thyroid. I'm hoping so because
the other potential causes of her light weight are worse. I think I
give her a week or so, as the vet suggested, and then see where we
stand. I at least want the course of antibiotics to end so we see what
was infection and what is something else. The vet felt strongly that
clearing up the ulcers in the throat was the first thing to be done
and that the antibiotics would do that. We'll see.

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Johnny Comelately - 12 May 2004 21:38 GMT

> Ok, No parasites. T3 is normal but T4 is elevated (6.9 and normal is
> 4.0). So it is a bit inconclusive. The Vet says that Tapazole (sp?)
[quoted text clipped - 37 lines]
>
> Dave

I really hate to say this but,it sounds like Munchausen Syndrome by
Proxy , are you seeking attention by purposly making your cat sick? I
bet you are! C'mon Dave admit it....you like going to visit the vet
with your cat.

J.C.

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dgk - 13 May 2004 15:45 GMT

>> Ok, No parasites. T3 is normal but T4 is elevated (6.9 and normal is
>> 4.0). So it is a bit inconclusive. The Vet says that Tapazole (sp?)
[quoted text clipped - 44 lines]
>
>J.C.

I had to google that. Very funny.

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