Erica & Carter
Member Since 2016
Hi everyone,
Long time no talk, sorry about that. Our move across the country took a lot of my attention, but we are finally settled in beautiful Seattle, WA and I'm very happy to be closer to home in Vancouver, BC.
So, this might be long, but I'm a mess and would love some advise...
Carter has been in remission for nearly 11 months now, which is great, but now some other health problems have come up.
Back up to about 8 months ago, where Carter started experiencing some acute vomiting usually no more than an hour after meals, and it was first chalked up to transitioning him to raw. Then next assumed to be food intolerance and possibly a scarf/bar deal, so I changed him to novel protein canned food and got a slow feeder, which I don't think made a difference either way. I decided to go with EZ Complete and cook his food, which, if my memory serves me correctly, he did really well on (maybe one case of vomiting over 3 months?) but I was struggling financially due to this move, and decided to put him back on high quality canned: tried Weruva, but he would have some more vomiting issues with that, then I tried Bravo canned (no carra., no gums) and he has been doing pretty well on it comparatively, until this month the acute vomiting has become more frequent.
Now before we moved from AL to WA, IBD was considered a possibility, but I wanted to establish care up here first before attempting to explore that option - which I did, as I now work for a specialty veterinary hospital. So I had signed all my animals up for pet insurance a few weeks ago, but since they were all slightly overdue for their annuals, they needed to come in anyway to establish care and a baseline of health for any pre-existing conditions. I knew I wanted to bring Carter in any way, and I know he has pre-exiting conditions, and had possibly more issues brewing, so I knew going into the appointment there would be more things that could surface that he won't be covered for. I'm likely going to switch his insurance to accident/emergency only, as he has too many pre-existing conditions for it to be worth it. But anyways, that wasn't my main concern, as I noticed other symptoms occurring over the past few weeks that had me alarmed. He has hairloss on his ears, weight loss, loss of fur quality, ravenous hunger and of course, the acute vomiting continues. I had been wanting him to be seen regarding the IBD, but now of course I'm thinking he has to be hyperthyroid. We ran a full senior panel on him and I got the results last week.
ALT was 671, up from 234 in 2016, and 42 in 2014.
T4 was 3.8, up from 1 in 2016, and 1.8 in 2014.
We ran of TSH and a free T4(which I know now is kind of useless/old way of determining hyperT) and go those results yesterday.
TSH is less than o.03
Free T4 was 30
TSH is indicating hyperthyroidism, while the free T4 is not - which is more than likely, a false negative as the Feline Hyperthyroid Center has basically said that we should be looking at the TSH, not the free T4 for determination - and that looking at the free T4 is more of an old school approach.
Given that he is in the high grey area of hyperT, and symptomatic, I believe we are going to be starting the Methimazole - low dose.
Now, regarding his high ALT, it was recommended that we do an abdominal ultrasound, which we did, on Monday. Results were inconclusive, but did show the liver being coarse with some abnormalities, but no obvious masses, and NO evidence of IBD. Intestines were completely normal, and I was speaking to the ultrasonographer who kindly did this ultrasound for me for free being I'm an employee, and he didn't see any evidence to support IBD, not even slightly or he would have suggested a biopsy. I know a biopsy is the only way to determine for sure, but his thoughts are the same as mine - the acute vomiting is due to the hyperT. He's never had issues with diarrhea either, to warrant more evidence towards IBD.
For the liver, we are going to support it with Denamarin and first treat with antibiotics to rule out a bacterial infection. Re-test in 4-6 weeks, and if no improvement or it worsens, opt for a biopsy of the liver. I'm not sure if we are going to start treating with a low dose of Methimazole along with the antibiotic and Denamarin, as the treatments could conflict with each other and prevent us from seeing if the liver is being treated properly, or if they want to treat the liver first and wait 1-2 months before starting Methimazole. The high ALT could also be related to the hyperT, so it's possible by treating the hyperT, the liver values will improve.
To top it all off, he has reoccuring conjunctivitis in both eyes that we are treating with an antibiotic gel, but we don't know if it is flared up by seasonal allergies or not, causing him to scratch his eyes, and reinfect himself with bacteria, etc. So that was another question - does he need to see a dermatologist? He's used similar gel for his eyes before, which works temporarily to heal, but then comes back... so I guess we will see once this dose is done.
Regarding the i131 treatment, I'm not sure how soon I'd be able to afford that - I know he isn't in "abnormal" numbers yet but just thinking ahead. I'm fortunate that by working at a veterinary practice I have got most of this treatment discounted, some things even free, but for things like the i131 or a dermatologist, I'd have to seek treatment at another practice, where I wouldn't be lucky enough to get a discount and be able to pay my remaining bill over time where as I can at my job thanks to my lovely practice manager.
So basically Carter is being riddled with a few different illnesses and I guess I'm feeling overwhelmed. Diabetes, hyperT, conjunctivitis, possible allergies, etc. On the bright side his kidneys looked great and he still is crystal free in his urine!
Now, before the hyperT diagnoses, I had been wanting to try him on the SEB/George's/Probiotic slurry 20 minutes before a meal, to see if that would help with the vomiting/regurgitation, but now I'm thinking if it's due to the hyperT, reducing acid build up won't help or prevent it from happening right? I used to give SEB with food and didn't notice a difference, and with so much going on I don't want to put effort into a supplement that won't really work for his specific case. I know the 2 hour rule with SEB due to absorption issues, but now I'm paranoid about giving it to him at all, I just want to make sure he is getting his medication properly and I don't want to alter the results in any way. Also I'm not yet sure of his medication schedule, but I don't think giving him the slurry will be feasible anyways as I'd have to wake up at 4am, and I wouldn't be home to give it for dinner. I work 12 hour shifts so the timing is just hard. He eats 3 meals a day (would benefit from 4, as sometimes the regurgitation I feel is due to the meal being too large) but even with an autofeeder, I can't make it happen because he will be eating cooked, and my others will be eating raw. Also, I know it's pointless to be giving probiotics with antibiotics as they cancel each other out so to speak, but I SHOULD be giving S. Boulardii to help prevent any diarrhea from the antibiotics, correct? And the continue with the probiotics after the antibiotics are finished?
How much S. Boulardii should I be giving? For the probiotics, I was giving 1/8 tsp twice daily of the Wholistic brand for cats, maybe I should go back to human grade though, the Renew brand. I think I did 1/2 capsule twice a day.
Should I look out for anything specifically that could cause his BG to rise regarding medication for any of these issues?
My plan is to switch him back to the EZ Complete with cooked, and regarding meds/supplements... I'll have to see what our plan is on Friday. I know roughly what we are going to be giving, but timing and scheduling is up in the air.
I feel like my head is spinning. I just want to do the best I can for him. We have actively been trying to keep his weight down, as he was obese and over 20+ when we adopted him two and a half years ago, but now he is 10 pounds and too thin I feel for his size. I don't want him to lose anymore weight, and want to get the vomiting under control. If anyone has any input, advise, thoughts, experiences they would like to share, I'd appreciate it.
Long time no talk, sorry about that. Our move across the country took a lot of my attention, but we are finally settled in beautiful Seattle, WA and I'm very happy to be closer to home in Vancouver, BC.
So, this might be long, but I'm a mess and would love some advise...
Carter has been in remission for nearly 11 months now, which is great, but now some other health problems have come up.
Back up to about 8 months ago, where Carter started experiencing some acute vomiting usually no more than an hour after meals, and it was first chalked up to transitioning him to raw. Then next assumed to be food intolerance and possibly a scarf/bar deal, so I changed him to novel protein canned food and got a slow feeder, which I don't think made a difference either way. I decided to go with EZ Complete and cook his food, which, if my memory serves me correctly, he did really well on (maybe one case of vomiting over 3 months?) but I was struggling financially due to this move, and decided to put him back on high quality canned: tried Weruva, but he would have some more vomiting issues with that, then I tried Bravo canned (no carra., no gums) and he has been doing pretty well on it comparatively, until this month the acute vomiting has become more frequent.
Now before we moved from AL to WA, IBD was considered a possibility, but I wanted to establish care up here first before attempting to explore that option - which I did, as I now work for a specialty veterinary hospital. So I had signed all my animals up for pet insurance a few weeks ago, but since they were all slightly overdue for their annuals, they needed to come in anyway to establish care and a baseline of health for any pre-existing conditions. I knew I wanted to bring Carter in any way, and I know he has pre-exiting conditions, and had possibly more issues brewing, so I knew going into the appointment there would be more things that could surface that he won't be covered for. I'm likely going to switch his insurance to accident/emergency only, as he has too many pre-existing conditions for it to be worth it. But anyways, that wasn't my main concern, as I noticed other symptoms occurring over the past few weeks that had me alarmed. He has hairloss on his ears, weight loss, loss of fur quality, ravenous hunger and of course, the acute vomiting continues. I had been wanting him to be seen regarding the IBD, but now of course I'm thinking he has to be hyperthyroid. We ran a full senior panel on him and I got the results last week.
ALT was 671, up from 234 in 2016, and 42 in 2014.
T4 was 3.8, up from 1 in 2016, and 1.8 in 2014.
We ran of TSH and a free T4(which I know now is kind of useless/old way of determining hyperT) and go those results yesterday.
TSH is less than o.03
Free T4 was 30
TSH is indicating hyperthyroidism, while the free T4 is not - which is more than likely, a false negative as the Feline Hyperthyroid Center has basically said that we should be looking at the TSH, not the free T4 for determination - and that looking at the free T4 is more of an old school approach.
Given that he is in the high grey area of hyperT, and symptomatic, I believe we are going to be starting the Methimazole - low dose.
Now, regarding his high ALT, it was recommended that we do an abdominal ultrasound, which we did, on Monday. Results were inconclusive, but did show the liver being coarse with some abnormalities, but no obvious masses, and NO evidence of IBD. Intestines were completely normal, and I was speaking to the ultrasonographer who kindly did this ultrasound for me for free being I'm an employee, and he didn't see any evidence to support IBD, not even slightly or he would have suggested a biopsy. I know a biopsy is the only way to determine for sure, but his thoughts are the same as mine - the acute vomiting is due to the hyperT. He's never had issues with diarrhea either, to warrant more evidence towards IBD.
For the liver, we are going to support it with Denamarin and first treat with antibiotics to rule out a bacterial infection. Re-test in 4-6 weeks, and if no improvement or it worsens, opt for a biopsy of the liver. I'm not sure if we are going to start treating with a low dose of Methimazole along with the antibiotic and Denamarin, as the treatments could conflict with each other and prevent us from seeing if the liver is being treated properly, or if they want to treat the liver first and wait 1-2 months before starting Methimazole. The high ALT could also be related to the hyperT, so it's possible by treating the hyperT, the liver values will improve.
To top it all off, he has reoccuring conjunctivitis in both eyes that we are treating with an antibiotic gel, but we don't know if it is flared up by seasonal allergies or not, causing him to scratch his eyes, and reinfect himself with bacteria, etc. So that was another question - does he need to see a dermatologist? He's used similar gel for his eyes before, which works temporarily to heal, but then comes back... so I guess we will see once this dose is done.
Regarding the i131 treatment, I'm not sure how soon I'd be able to afford that - I know he isn't in "abnormal" numbers yet but just thinking ahead. I'm fortunate that by working at a veterinary practice I have got most of this treatment discounted, some things even free, but for things like the i131 or a dermatologist, I'd have to seek treatment at another practice, where I wouldn't be lucky enough to get a discount and be able to pay my remaining bill over time where as I can at my job thanks to my lovely practice manager.
So basically Carter is being riddled with a few different illnesses and I guess I'm feeling overwhelmed. Diabetes, hyperT, conjunctivitis, possible allergies, etc. On the bright side his kidneys looked great and he still is crystal free in his urine!
Now, before the hyperT diagnoses, I had been wanting to try him on the SEB/George's/Probiotic slurry 20 minutes before a meal, to see if that would help with the vomiting/regurgitation, but now I'm thinking if it's due to the hyperT, reducing acid build up won't help or prevent it from happening right? I used to give SEB with food and didn't notice a difference, and with so much going on I don't want to put effort into a supplement that won't really work for his specific case. I know the 2 hour rule with SEB due to absorption issues, but now I'm paranoid about giving it to him at all, I just want to make sure he is getting his medication properly and I don't want to alter the results in any way. Also I'm not yet sure of his medication schedule, but I don't think giving him the slurry will be feasible anyways as I'd have to wake up at 4am, and I wouldn't be home to give it for dinner. I work 12 hour shifts so the timing is just hard. He eats 3 meals a day (would benefit from 4, as sometimes the regurgitation I feel is due to the meal being too large) but even with an autofeeder, I can't make it happen because he will be eating cooked, and my others will be eating raw. Also, I know it's pointless to be giving probiotics with antibiotics as they cancel each other out so to speak, but I SHOULD be giving S. Boulardii to help prevent any diarrhea from the antibiotics, correct? And the continue with the probiotics after the antibiotics are finished?
How much S. Boulardii should I be giving? For the probiotics, I was giving 1/8 tsp twice daily of the Wholistic brand for cats, maybe I should go back to human grade though, the Renew brand. I think I did 1/2 capsule twice a day.
Should I look out for anything specifically that could cause his BG to rise regarding medication for any of these issues?
My plan is to switch him back to the EZ Complete with cooked, and regarding meds/supplements... I'll have to see what our plan is on Friday. I know roughly what we are going to be giving, but timing and scheduling is up in the air.
I feel like my head is spinning. I just want to do the best I can for him. We have actively been trying to keep his weight down, as he was obese and over 20+ when we adopted him two and a half years ago, but now he is 10 pounds and too thin I feel for his size. I don't want him to lose anymore weight, and want to get the vomiting under control. If anyone has any input, advise, thoughts, experiences they would like to share, I'd appreciate it.
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My mind went the same place as Tricia's so I am glad to hear that his bowels look good. I assume no lymph node involvement either? I just heard a scary stat from a vet on how many lymphoma cats don't have thickened bowels. But the hyperT sounds like it may be it. You may want to join a thyroid group. I joined 
