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Old 06-15-2010, 01:00 PM   #11 (permalink)
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Default Re: older cat gradually loosing weight

I just got back from the vet half an hour ago. I typed up the results (see below). The diagnosis was hyperthyroid. The prescription is 2.5 mg of Methimazole twice a day. Yes, I did discuss the idea that T4 is cummulative and the possibility of starting at 1.25 mg twice a day. He indicated that there is a threshold does (my words not his) at which Methimazole is effective. He suggested a vet visit in one month. Anyway here are the results sorry about the quality I guess I can't paste a table from MS word, and I will be going to the store to get some wet cat food.


SUPERCHEM
Test Results Ref. Range Units
Total Protein 6.1 5.2-8.8 g/dL
Albumin 3.6 2.5-3.9
Globulin 2.5 2.3-5.3
A/G Ratio 1.4 0.35-1.5 IU/L
AST (SGOT) 127 (HIGH) 10-100
ALT (SGPT) 534 (HIGH) 10-100
Alkaline Phosphatase 88 6-102
GGT 1 1-10
Total Bilirubin 0.1 0.1-0.4 mg/dL
BUN 34 14-36
Creatinine 0.7 0.6-2.4
BUN/Creatinine Ratio 49 (HIGH) 4-33
Phosphorus 4.9 2.4-8.2 mg/dL
Glucose 97 64-170
Calcium 9.8 8.2-10.8
Magnesium 1.8 1.5-2.5 mEq/L
Sodium 159 (HIGH) 145-158
Potassium 4.2 3.4-5.6
Na/K Ratio 38 32-41
Chloride 123 104-128 mEq/L
Cholesterol 150 75-220 mg/dL
Triglyceride 30 25-160 mg/dL
Amylase 1567 (HIGH) 100-200 g/dL
Lipase 25 0-205 IU/L
CPK 1274 (HIGH) 56-529 IU/L

CBC
WBC 9.1 3.5-16.0 10^3/L
RBC 8.3 5.92-9.93 10^6/L
HGB 12.0 9.3-15.9 g/dL
HCT 40 29-48 %
MCV 48 37-61 fL
MCH 14.6 11-21 pg
MCHC 30 30-38 g/dL





RBC MORPHOLOGY NORMAL
Differential Absolute %
Neutrophils 3731 41 2500-8500 /L
Lymphocytes 5005 55 1200-8000 /L
Monocytes 182 2 0-600
Eosinophils 182 2 0-1000
Basophils 0 0 0-150
Platelet Estimate Adequate
Platelet Count 177 (LOW) 200-500 10^3/L
Platelet clumps are present. Platelet clumping is a common in-vitro phenomenon and prevents accurate automated or manual platelet counting. The platelet estimate is the best minimum indicator of the adequacy of platelet numbers. Any reported platelet count indicates only the minimum platelet number.

T4
T4 16.1 (HIGH) 0.8-4.0 g/dL

ADD-ON URINALYSIS
Color Yellow
Appearance Cloudy
Specific Gravity 1.027 1.015-1.060
pH 6.0 5.5-7.0
Protein Trace (HIGH) Negative
Glucose-Strip Negative Negative
Ketones Negative Negative
Bilirubin Negative Negative
Occult Blood Negative Negative
WBC/HPF 0-1 0-3 HPF
RBC/HPF 2-3 0-3 HPF
Casts/LPF None Seen Hyaline 0-3 LPF
Crystals/HPF None Seen HPF
Bacteria None Seen None Seen HPF
Transitional Epithelia/HPF 0-1 0-1 HPF
Ft Droplets 11-20 HPF


URINE MICROALBUMIN (FELINE)
Microalbuminuria 1.0 <2.5 mg/dL
The MA test is normal.
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Old 06-15-2010, 01:46 PM   #12 (permalink)
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Default Re: older cat gradually loosing weight

OK, not unexpectedly, your cat is hyperthyroid. The rest of the bloodwork and urinalysis look good EXCEPT for her liver enzymes. It looks like she's battling a liver problem at the moment, in addition to hyperT. Go to:

http://www.broadwayvh.com/site/view/832 ... 92sm55i901

and download the following descriptions:

ALT high - severe
AST high

Your vet is incorrect about there being a threshold for methimazole effectiveness. Methimazole can be effective at extremely low doses for some cats. It's such an individual reaction that each cat must be dosed carefully and individually to find the minimum dosage that controls the hyperT without doing other damage in the body, particularly to the liver. Since methimazole can be liver toxic, and since your girl's liver already appears to be in trouble, I strongly advise you to reconsider the dose your vet has prescribed. You have every right to insist that your cat's dose be reduced and to bring her in for TT4 testing every 3 weeks until you find the appropriate dose. If, for some reason, you decide to chance the higher dosage your vet has prescribed, please, PLEASE do not put retesting off for a month. In fact, if dosing at that higher level, you should retest in 2-3 weeks, esp. with her liver compromise. When you retest, make sure to also retest her liver enzymes (ALT and AST).

Last year, the members of the hyperT mailing list created a database of our dosing experiences. The database has been submitted to Plumbs (the standard veterinary pharmaceutical text used by vets) to help reevaluate methimazole dosing guidelines in the next edition. If you join the hyperT mailing list (link below), you will be able to access the database where you will see that the majority of our cats are being maintained at euthyroid (normal thyroid levels) at lower daily doses than the 5 mg that your vet has prescribed, proving that methimazole is very effective at low doses.

http://pets.groups.yahoo.com/group/feline-hyperT/

As I have stated many times in many threads to many hyperT caretakers, there are nothing but advantages for the cat by following the "start low and go slow" dosing protocol for methimazole. It is undeniably safer and could potentially make the difference for your particular cat between recovery of her liver and complete liver failure.

Laurie
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Old 06-16-2010, 05:45 PM   #13 (permalink)
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Default Re: older cat gradually loosing weight

Hi your cat may have chronic renal failure (kidneys) especially considering her age. My Razzle was diagnosed with hyperthyroidism about a year ago. I tried the medication but it made him throw up. I went with the radioactive iodine treatment. Expensive $1200.00 but it cured him. While getting the treatment the vet said his urine was cloudy so I had my regular vet check it and he has chronic renal failure (CRF) stage 1. It's now stage 3. Your cats BUN/Creatinine ratio is very high. That's why it might be CRF plus the cloudy urine. Two great sites to go to are felinecrf.com and felinecrf.org. You can check lab results on those sites. Didn't your vet check or mention to you about testing for CRF or liver disease? I think he should especially considering the cat's age, cloudy urine, and lab results. Make sure you check your cat's weight, eating and water intake, urine and stool, energy level, and anything else routinely. Make a chart to keep tract of all the results.

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Old 07-14-2010, 07:44 PM   #14 (permalink)
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So I ended up following my vets advice and giving 2.5 mg twice a day and wait four weeks before retesting. I realized your "start low and go slow" approach made sense but he convinced me. Here are her new results:

SUPERCHEM
Test Results Ref. Range Units
Total Protein 6.7 5.2-8.8 g/dL
Albumin 3.5 2.5-3.9 "
Globulin 3.2 2.3-5.3 "
A/G Ratio 1.1 0.35-1.5 IU/L
AST (SGOT) 48 10-100 "
ALT (SGPT) 55 10-100 "
Alkaline Phosphatase 13 6-102 "
GGT 2 1-10 "
Total Bilirubin 0.1 0.1-0.4 mg/dL
BUN 51 (HIGH) 14-36 "
Creatinine 2.1 0.6-2.4 "
BUN/Creatinine Ratio 24 4-33
Phosphorus 4.7 2.4-8.2 mg/dL
Glucose 86 64-170 "
Calcium 9.7 8.2-10.8 "
Magnesium 2.2 1.5-2.5 mEq/L
Sodium 151 145-158 "
Potassium 4.3 3.4-5.6 "
Na/K Ratio 35 32-41
Chloride 117 104-128 mEq/L
Cholesterol 163 75-220 mg/dL
Triglyceride 70 25-160 mg/dL
Amylase 2155 (HIGH) 100-200 g/dL
Verified by repeat analysis.
Lipase 25 0-205 IU/L
CPK 375 56-529 IU/L

CBC
WBC 6.1 3.5-16.0 10^3/L
RBC 6.9 5.92-9.93 10^6/L
HGB 10.6 9.3-15.9 g/dL
HCT 32 29-48 %
MCV 47 37-61 fL
MCH 15.4 11-21 pg
MCHC 33 30-38 g/dL


RBC MORPHOLOGY NORMAL
Differential Absolute %
Neutrophils 3599 59 2500-8500 /L
Lymphocytes 2318 38 1200-8000 /L
Monocytes 61 1 0-600 "
Eosinophils 122 2 0-1000 "
Basophils 0 0 0-150 "
Platelet Estimate Adequate
Platelet Count 307 200-500 10^3/L

T4
T4 0.3 (LOW) 0.8-4.0 g/dL
Verified by repeat analysis.


The vet said I should cut her dose in half and retest in another four weeks.

Also she now weighs 5 lbs 4 oz. That is up from 4lbs 1 oz a month ago.
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Old 07-15-2010, 04:01 PM   #15 (permalink)
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Originally Posted by just_jason View Post
I realized your "start low and go slow" approach made sense but he convinced me.The vet said I should cut her dose in half and retest in another four weeks.

Also she now weighs 5 lbs 4 oz. That is up from 4lbs 1 oz a month ago.
Well, your vet's high starting dose did make your cat go hypothyroid, as I expected it would, and your cat's kidney values did rise, which is also a common occurrence. On the upside, the high starting dose didn't cause her kidneys to crash, which is very fortunate (and lucky), and it has addressed the hyperT so that she is able to put on weight again, which is great.

At least your vet has enough sense to cut back the dosage significantly, though he's still recommending too long a gap before the next retest, IMO.

Has your girl had any adverse side effects to methimazole (nausea, vomiting, diarrhea, lack of appetite, lethargy, facial itching)?

Laurie
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Old 07-15-2010, 07:21 PM   #16 (permalink)
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Originally Posted by laurief View Post
Well, your vet's high starting dose did make your cat go hypothyroid, as I expected it would, and your cat's kidney values did rise, which is also a common occurrence.
So you think her overdose is responsible for the high amylase and BUN?

The vet said he thought the elevated BUN might be due to her still being a little dehydrated. Would an overdose on methimazole cause her to be dehydrated?


Quote:
Originally Posted by laurief View Post
Has your girl had any adverse side effects to methimazole (nausea, vomiting, diarrhea, lack of appetite, lethargy, facial itching)?
I think she felt a bit itchy for the first day or two. She was lethargic before taking methimazole and she still is but I've seen improvement. She still needs to regain muscle mass but she has made a few jumps she was to weak to make before. It also became harder to make her pur and she became more aloof. The purring seems to have improved already with the lower does but she is still less social. Her appetite had been decreasing, I guess the low T4 could account for that though. By decreasing I mean that she ate almost none of her dry food, she also ate less of her treats but she didn't show much of a loss of interest in her wet food. Currently, I give 1.5 oz of wet food twice a day. Since she has been effectively eating all wet food as a result, I should probably just offer her more right? My gut feeling is that she would eat one and a half cans a day, maybe two.
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Old 07-15-2010, 07:46 PM   #17 (permalink)
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I would give her as much wet as she wants.

We give the girls each 3/4 of a 3 ounce can twice a day. Normally we leave a bit of dry out during the day (Evo), but my daughter's cat is visiting and a food pig. I want Zoey to gain a bit, so she get a little extra wet.

During the summer and winter, we add a bit of water to their food for extra hydration.
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Old 07-15-2010, 08:32 PM   #18 (permalink)
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So you think her overdose is responsible for the high amylase and BUN?
Amylase is not reliable in cats, so the elevation of that enzyme has no significance. BUN is a different matter. It is one of the kidney values, along with creatinine. Creatinine is kidney-specific, but BUN can elevate for non-kidney reasons. The fact that both your cat's BUN and creat have risen, however, does imply some degree of renal insufficiency, even though her creat is still in the high normal range.

The methimazole is probably not responsible for the elevation in her kidney values. It's more likely that it just unmasked pre-existing renal insufficiency. Uncontrolled hyperT causes all of the body systems to work in overdirve, including the kidneys. If the kidneys are diseased, as is likely the case with your girl, hyperT's influence will make them work harder, and they may appear normal in bloodwork as a result. That's what may have been happening at the time of your girl's first blood test. Her uncontrolled hyperT at that time was making her diseased kidneys work harder, masking their true condition in her bloodwork. Now that the hyperT has been turned to hypoT and her metabolism has slowed waaaay down, the true condition of her kidneys has become apparent in bloodwork through the elevations in her kidney values.

Quote:
The vet said he thought the elevated BUN might be due to her still being a little dehydrated. Would an overdose on methimazole cause her to be dehydrated?
Her bloodwork doesn't give the impression of her still being dehydrated, so I don't believe that's a factor. As far as I know, methimazole overdose would only cause dehydration if it also caused vomiting and/or diarrhea in the cat.

Quote:
I think she felt a bit itchy for the first day or two. She was lethargic before taking methimazole and she still is but I've seen improvement. She still needs to regain muscle mass but she has made a few jumps she was to weak to make before. It also became harder to make her pur and she became more aloof.
It's difficult to tell which of her symptoms and behavior are or were attributable to the hyperT, hypoT, high methimazole dose, renal insufficiency, dehydration, and/or emaciation.

Quote:
Her appetite had been decreasing, I guess the low T4 could account for that though.
Yes, it certainly could, but so could any existing renal insufficiency and/or nausea caused by it or the methimazole. Still, the fact that she's gained more than a pound in a month is a very good indication that she's eating plenty right now, and that's great!

Quote:
Currently, I give 1.5 oz of wet food twice a day. Since she has been effectively eating all wet food as a result, I should probably just offer her more right? My gut feeling is that she would eat one and a half cans a day, maybe two.
I would eliminate all kibble from her diet (esp. with questionable kidney health) and feed her 5-6 oz of canned food a day split into 3-4 small meals.
It would also benefit her to mix some warm water into each meal to make it a thick gruel that she can lap up, if she'll eat it that way (most cats love canned food gruel). That would help keep her properly hydrated which will help support her kidneys.

You said in your first post that she had always been skinny at 8 lbs, so I'm guessing that her ideal weight would be somewhere between 8.5-9 lbs. With her hyperT controlled, you will hopefully be able to bring her up to that weight over the next few months.

BTW, your vet is now having you give her 1.25 mg of methimazole twice daily, right (I hope)? Not 2.5 mg once daily. She will maintain more even thyroid hormone levels if she is dosed twice daily.

Laurie
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Old 07-15-2010, 10:32 PM   #19 (permalink)
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Originally Posted by laurief View Post
Amylase is not reliable in cats, so the elevation of that enzyme has no significance. BUN is a different matter. It is one of the kidney values, along with creatinine. Creatinine is kidney-specific, but BUN can elevate for non-kidney reasons. The fact that both your cat's BUN and creat have risen, however, does imply some degree of renal insufficiency, even though her creat is still in the high normal range.
According to Feline CRF Information Center - Tests & Diagnostics
"Some vets feel that slightly elevated Amylase levels can sometimes be a pre-cursor to CRF before other symptoms occur."

Have you heard this? You mention renal insufficiency.

Quote:
Originally Posted by laurief View Post
Her bloodwork doesn't give the impression of her still being dehydrated, so I don't believe that's a factor. As far as I know, methimazole overdose would only cause dehydration if it also caused vomiting and/or diarrhea in the cat.
I think he got the impression from her physical. Either way renal insufficiency could cause dehydration as well right? She certainly drinks well but she doesn't urinate excessively in my opinion. I only change her litter box completely twice a week. I remember having to change it three time a week on occasion when she was younger.


Quote:
Originally Posted by laurief View Post
Yes, it certainly could, but so could any existing renal insufficiency and/or nausea caused by it or the methimazole. Still, the fact that she's gained more than a pound in a month is a very good indication that she's eating plenty right now, and that's great!
What testing beyond what has been done would also indicate renal insufficiency?

Quote:
Originally Posted by laurief View Post
BTW, your vet is now having you give her 1.25 mg of methimazole twice daily, right (I hope)? Not 2.5 mg once daily. She will maintain more even thyroid hormone levels if she is dosed twice daily.
Twice a day. I went out and bought a pill splitter and crusher. It worked, though not as easily as I hoped. Maybe I just need to get the knack of it or I'll buy another model.

Gratefully,
Jason

Last edited by just_jason; 07-15-2010 at 10:35 PM.
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Old 07-15-2010, 10:34 PM   #20 (permalink)
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I would give her as much wet as she wants.

We give the girls each 3/4 of a 3 ounce can twice a day. Normally we leave a bit of dry out during the day (Evo), but my daughter's cat is visiting and a food pig. I want Zoey to gain a bit, so she get a little extra wet.

During the summer and winter, we add a bit of water to their food for extra hydration.
How much do your cats way?
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