Maggie is Hyperthyroid and the Vet is a Moron-updated 1/19

[doodlebug]

This has all been happening over the last 2+ weeks...between the holidays, my store and dealing with the situation I haven't really had a chance to write about it here. Things have calmed down a bit and I wanted to share because it's another example of just how diligent we need to be when it comes to getting our babies good medical treatment.

Some background...I've been going to a practice with 4 vets, but in the last 5 years I always ask for one specific vet as I don't really like the others. There is one I actually hate, he took care of Callie's IBD for a while and I've always felt that if I knew enough to question more and had switched vets sooner that she may have lived a lot longer. So...the vet I liked left the practice a few months ago and I hadn't figured out yet where I wanted to go.

I wake up on the Monday before Xmas to Maggie vomiting like crazy...a small hairball and a little food in one pile and then 3 pretty big pools of liquid. She's on the floor hunched over, heart racing so fast I can see it pounding, panting and drooling. I confined her to a bathroom and after monitoring her for an hour or so and seeing her get a little better...she stopped panting and drooling, but was hiding behind the toilet, hunched over and staring at the wall I decided it was vet time. Since I hadn't picked a new vet, I called the old one knowing they'd get me in right away and while I'm not fond of them, they'd get her past the crisis.

They got me in within an hour and of course I get the jerk that I hate. He examines her and says he thinks it's her thyroid...which wasn't a surprise as I had noticed a few things that made me think something was brewing and had planned to pick a new vet in Jan and get her checked out. Gave her fluids, a shot for nausea and drew blood. Couldn't get urine because her bladder was empty.

I go home and start researching. I remembered laurief posting here about hyper-t and making sure to start the dose of methimazole off low. I dug up her posts and links and started reading. The next morning the vet calls...hyper-t is confirmed (her T4 was off the chart) and her glucose level is high, so a urine test is needed. He says he'll call in the methimizole prescription and I start asking him about dosing. He said the manufacturer of the med recommends 5-10mg twice a day. I mentioned that I had been doing some reading and that it is recommended that the dose be much lower (1.125 mg twice a day, definitely not higher than 2.5 mg twice a day) to avoid side effects and the possibility of pushing the cat into hypothyroid. His response was "there's lots of stuff out on the internet and most of it is wrong"...we went back and forth and finally I decided not to argue any further. The med was going to be a transdermal gel, so I figured I just cut it back myself and go find a new vet.

So I go pick up the prescription...after this conversation about keeping the dose low, the jerk doesn't even keep it on the low side of the manufacturer's recommendation...he ups it to 7.5 mg twice a day...6 times the dose that is recommended by all the authorities on the subject. The guy is completely out of touch and dangerous.

Since Maggie was showing absolutely no signs of diabetes, I decided to hold off on the glucose test until I had her settled on the meds and got through the holidays. I get a lot of info on the vets from my customers...whenever someone comes in saying "my vet recommended this food" or "my vet sent me to you" I always ask who their vet is. So I chose one that I've had multiple customers say good things about and I met her at an event in October and it seemed like we were really on the same pag.

Took Maggie in yesterday for the urine test. The new vet was horrified at the methimazole dose the other vet prescribed. The look on her face when I told her was priceless. Maggie's urine test came back good...the glucose was perfect and her urine is concentrating well, so she doesn't believe that there is underlying kidney disease. Maggie will have another T4 test today and a full blood test in 2 weeks. If all is well, I'm going to consider doing radioactive iodine treatment, which will cure the hyper-t.

So don't be afraid to question. I hate to think what could have happened if I had blindly followed this vet's prescription.

[laurief]

Oh, Doodlebug! I am so, SO glad that the information I shared very likely saved Maggie's life. The vet who tried to poison her ought to be reported to your state's veterinary board. Someone that vindictive and dangerous shouldn't be allowed to practice. I'm so glad you found a new vet with a functional brain!

Coincidentally, another of my cats was diagnosed hyperT during the holidays, as well. So, I, too, am once again in the midst of regulating med to achieve euthyroid. Mew is due for his first retest, which I will schedule for Monday.

I envy your access to I-131. My nearest I-131 clinic is 200+ miles away and requires a hospitalized isolation of 2+ weeks after treatment. Not only do I not have transportation down to the clinic, but I would never put Mew through 2+ weeks of isolated hospitalization. So Mew, like Tommy and like Billy (RIP), will be maintained on med (carbimazole) indefinitely. If I lived closer to an I-131 clinic that had an iso period of 3-5 days, I'd opt for I-131, instead.

In case you'd like to try to educate the idiot vet who tried to poison Maggie, you can join the hyperT mailing list and then print out the studies and the dosing database available in the list's files section at Yahoo. Or, you could just tell the vet to read the information and references available in the current edition of Plumb's Veterinary Drug Handbook (which every veterinary practice I know of uses as their drug reference).

Here's hoping that Maggie and Mew achieve euthyroid successfully and without complication ... and that Maggie will prove to be an excellent candidate for I-131.

Laurie

[doodlebug]

I'm very glad you posted about it too! And that I remembered seeing it! I did join the Yahoo Hyper-T group.

She had her T4 test today and we're seeing progress. I have been dosing her at 1.875 mg twice a day. I couldn't do any less than that because of the strength of the prescription and didn't really want to toss it. Since that number fell between the 1.25 and 2.5 and it was transdermal gel I felt it was a reasonable starting place (as did the Hyper-T group). Her T4 was off the chart (>7) on the first test. It's now down in measurable range at 6. Since Maggie hasn't displayed any signs of side effects, the vet wants to double the dose to 3.75 twice a day, which is still only half of what the first vet prescribed. I'll bring her up to that dose over a few days. Then we'll re-check her levels in two weeks.

Yeah...I have a couple choices within an hours drive for the I131 and from what I understand they only require a 4 day stay. Definitely worth doing if she qualifies.

[laurief]

Originally Posted by doodlebug

Her T4 was off the chart (>7) on the first test.

My Tommy was 17.0 at diagnosis, but Mew was only 7.4 at diagnosis. It's not where they start out that counts. It's all about getting them back to normal.

Since Maggie hasn't displayed any signs of side effects, the vet wants to double the dose to 3.75 twice a day, which is still only half of what the first vet prescribed. I'll bring her up to that dose over a few days. Then we'll re-check her levels in two weeks.

That's a bigger dose increase than I'd be comfortable with. If Mew isn't euthyroid after his retest on Monday, I'll increase his dose by 1.25 mg/day and retest in three weeks.

Laurie

[doodlebug]

Yay! Maggie's T4 level is back in normal range. At half the dose that the other vet wanted to start her at! Her weight held steady at 8.5 lbs, which really isn't a bad weight for her, she's small cat. She could use maybe a half pound more.

We're going to try moving to the compounded treats...she's a cat that doesn't like to be handled and she's very smart so she's mastering evasion techniques. She's fast too. Grabbing her to do the transdermal gel has become a real challenge, I'm getting tired of having to think up ways to trick her...and I'm running out of ideas. So hopefully she'll like the treats and this will get a little easier.

Blood work to check her kidneys in 3 weeks, assuming all is well, then we'll start getting her scheduled for I-131 treatment.

[laurief]

That's great news! Unfortunately, Mew has had NO response to carbimazole so far. Looks like he may be one of those drug-resistant cats who requires a much higher dose than I'm comfortable with, but I'll keep increasing him slowly until his TT4 comes down where it should be.

About the chewable treats ... you may not have as much success with compounded methimazole as I have had with carbimazole. Carbimazole, btw, is a pro-drug of methimazole and converts into methimazole after it leaves the stomach. Carbimazole is mostly tasteless (has a very slight, sweet undertone), whereas methimazole is quite bitter. Because of methimazole's bitterness, I would assume it would be more detectable even in flavored, chewable treats. Just a little heads-up.

I hope that Maggie's creatinine comes back in normal range when tested so that she'll be a great candidate for I-131. I bet it won't take any time at all for her to pick up that 1/2 lb now that her metabolism isn't racing anymore.

Congratulations!

Laurie

[doodlebug]

Poor Mew...I hope he starts responding soon. Fortunately I saw changes in Maggie within a couple days.

The treats aren't a hit, but they're not a complete failure either. She really didn't want to get that gel on her ear yesterday morning and hid in places I couldn't reach until I gave up and went out to pick up the treats. She was interested until I actually put it in front of her. Then she nosed it and walked away. I broke off a piece and squished it on to a piece of freeze dried chicken and she ate it. A little refining and the process I used this morning looks doable on a regular basis...as part of the breakfast routine, I took the treat and cut it in 4 pieces (Maggie is a dainty little girl and likes things small), then rolled them in freeze dried chicken dust. She came over and ate 3 of them while I was dishing out the canned food. I popped the last piece on top of her food and she ate it right up. So that worked when she was hungry...we'll see what happens in a little while when she gets her night time dose...she already had her dinner...

[Susan]

I don't envy you...I'm not looking forward to the day when I need to medicate Muffs. I hope Maggie continues to eat the treats and that you get good news from the blood tests when the time comes.

[Auntie Crazy]

Doodlebug, I'm so sorry to hear about Maggie!! And so glad to see her improving. <<hugs>>

You guys probably have all the info sources you need, but just in case, here's a few articles from a well-renowned endocrinologist, Dr. Peterson, who frequently discusses HyperT on his blog:

Is It Feasible for Older Cats to Ingest the Optimal Amounts of Protein They Need Each Day?

Hyperthyroidism & Renal Disease: Is a "Tapazole Trial" Really Necessary?

Optimal Protein Requirements for Older Cats and Cats with Hyperthyroidism

Does Iodine Deficiency Cause Thyroid Disease in Cats?

Best of luck to all of you!!!!

AC

[October]

As you said, Lisa, this is a huge reminder that we need to be diligent and question stuff. And yay Laurie, who spread the info you needed and obviously did the trick.

Get better, Maggie!