Palliative care for Rex... Honey not well (hyperT)

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Carolynn FletcherGA & RobbieGA

Carolynn FletcherGA & RobbieGA

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I'll start with Honey... she's an approximately 10 year old, one and a half-eared stray that wandered into my life 3 weeks after losing Fletcher. She was emaciated, but purred as soon as she was touched. At the vet's, a large lump was found on her thyroid, but the T4 level was in mid normal range. The free T4 was slightly elevated, so we started her on Tapazole. She has been unable to gain weight (except for the inital 1/2 pound) and is only 5 lbs 1 oz. For the last few days, she has been vomiting 4-6 times a day and appears to not be as happy/comfortable as she was, so we're going to stop the Tapazole and see if that is the cause of the vomiting. Her inability to gain weight is concerning-- to me and my vets. If it's not the Tapazole making her sick, we'll run another set of labs then look into xrays and and ultrasound to see if there's a more sinister reason for her to remain so emaciated.

Now Rex... as you may know, he is also hyperT (T4 levels at 23 on last test). He, too, was on Tapazole but had a toxic reaction to it and his liver began to fail, he lost 30% of his weight in less than a month, and I came very, very close to having to decide whether or not to send him to The Bridge. We stopped the Tapazole and started pain meds, fluids, Atenolol (for his heart--- rate was over 270, now down to about 180) and Denosyl for his liver (bilirubin was 8.7, now 0.8, should be less than 0.4). Because of the liver toxicity, his vets and I have decided not to restart the methimazole. Due to that, his hyperT will remain "uncontrolled." He is not a candidate for a thyroidectomy or I131 because we can't put him on the Tapazole (or even Carbimozole) to reign in the hyperT to make him stable enough for surgery or sedation. So he will receive his heart meds and we'll monitor his blood pressure and try to keep him as happy as I can for as long as he can stay with me.

I know there will be many who disagree with this plan, but I have to do what I think is best for Rex. I can't risk sending him into liver failure again. Right now he is back to being a happy, snuggly boy and I'll do my best to keep him that way...
 
Oh (((Carolynn))) I'm so very sorry that you're having such a difficult and worrisome time with your kitties. Whatever happens going forward Honey and Rex are very blessed kitties to be loved by you.


Sometimes all you can do is palliative care and there is NOTHING wrong with that whether some disagree or not. I know how much you love your kitties - we all know - but there isn't always anything much that can be done. Sometimes treating helps and sometimes it doesn't. Personally I think that your decision is just that - your decision! You won't let them suffer and you will love them and care for them better than anyone else could.

Please give them both love and hugs from me and keep some of that for yourself as well, okay?
 
Agreed. You are amazing and your kitties very lucky to have you and your Vet in their corner. Sending prayers for you and your babies.
jeanne
 
(((((((((((((((((((((((((CAROLYNN)))))))))))))))))))))

I am so sorry both Honey and Rex are not doing well. Wrapping you in many cyber hugs and sending "rally and fight" vibes to Honey and Rex.
 
you just take care of your kitties the best you can and do not worry what others think. you are doing a fantastic job and hugs to you. prayers that all goes well
 
You already know that I support you in your decisions because you don't make any of them lightly. You have always looked out for the best options for the quality of life for your furry kids.

Give them both lots of snuggles from me (along with the rest of the kids, including the non-furry ones), okay??? kthnxbai!
 
Oh Carolynn,
Sometimes palliative care is THE best decision. Rex knows you love him and you have done everything for him. I only know with some little ones and with my mom - one system works against the other as far as the treatments go. You can only do your best and then you give them ALL your love. Which you always do. Rex is in such a loving home and we are all behind you 100%.
Wishing you and I could be so near one another to help each other more thru these rough times!

Sending you and your girls and of course Rex and Honey and all your others - a most GIGANTOMUNGO hug! :YMHUG:
 
Not sure why anyone would disagree with a plan that seems the best of a bunch of bad options. I'm sorry that all of you are going through this.

Jen
 
All my best to you and your babies. I do know that when I start thinking about my wants and needs instead of those of the people and animals I love, I have had horrible experiences. At times like this I have HAD to ONLY focus on what was best for them. It seems that you already know this and I am sending you hugs too.
Libby and Callie
 
Hi Carolynn

I was debating whether or not to post ... His uncontrolled hyperthryroidism makes him less than an ideal candidate but does not preclude him from getting zapped (I131) or having surgery. You can call or have your vet call the local I131 place for more information. And a board-certified surgeon would do the thyroidectomy if your vet is uncomfortable with it (which is understandable since these surgeries are uncommon and you want to do the quickest cleanest surgery possible in a case like this). Of course these are both expensive, and whichever one you did you'd have to do asap before the hyperthryoidism gets even worse, so that may put these options off the table anyway. However I did want to put out there that there are options for cats who are intolerant of methimazole--again not ideal, but non-ideal patients have to undergo surgery and other procedures all the time. I don't envy your situation here, though, and don't feel any decision is the wrong one in this case.
 
Carolynn, I too hesitated to post as I don't want it to come across wrong. But I'll share our story just the same, trusting that you'll take it as is and not a judgement of what you should do.

Charlie developed hyperT and went on methimazole. We never really knew whether the culprit was the methimazole or complications from the hyperT, but his health started spiraling out of control ... severe IBD, CP, CRF, liver crises, hepatic lipidosis and feeding tubes, diabetes, etc. The IM vet at the university and I had lengthy conversations about where "the end of the string" was -- i.e., where it all started and what was causing what, what we could do differently to break the cycle -- but there was no way to know, the answers weren't clear.

Charlie was sick, wasting away, and miserable. His quality of life was not great and I was looking at euthanasia. However, in our discussions about I-131, the vet said that although he wasn't a great candidate for it, we could still do the technecium scan and GFR testing and, if he met minimum values, we could try the I-131. It was our "Hail Mary pass to the end zone" as I call it -- it was either going to kill him or save him.

Doing the I-131 was the best call I've ever made.

Although he had to be off all meds for 10 days prior and lost a significant amount of weight in that time, and although his GFR (glomelular filtration rate) as on the low end of the range at which they'll do the procedure, and although he looked like h3ll going into it, I truly believe it saved his life.

He came through the procedure remarkably well and lived several more years. Although he still had medical issues, the complex web got a bit simpler by taking hyperT off the table. He continued to suffer from IBD, but his coat returned to being soft and silky, his purr returned, and he started putting on weight. I had my loyal, loveable, desk-mate and bed-buddy back again ... until I ultimately lost him last December to inoperable liver cancer.

So to faintly echo what Jess said ... sometimes there are options, even if not ideal.

I respect your decision and support you wholeheartedly if palliative care is the way you go. I just wanted you to know that, for at least one other cat that appeared to have no options, there was a positive outcome.
 
((Carolynn)) I'm so sorry that your two kitties are having such a rough time - which in turn means such heartache and distress for you. From your care of your previous baby(ies) we all know that you ALWAYS have their best interests foremost and the love you have for them is well known. Whatever you choose will indeed be the best treatment for them. Sometimes we can only do so much and the rest is out of our hands.

Just sending along many, many hugs and hopes that both kitties can stay with you awhile longer, happily and with some measure of good quality of life. Your love for them is unquestionable.

I don't envy your choices - my heart goes out to you for the sadness that I know you're feeling.
Hugs,

Emmy & Dude (& Mittsi too)
 
((( Carolynn ))) I'm sorry that Rex and Honey are not at their best right now, but I believe they were sent to you and whatever path you choose will have their comfort and QOL at the heart of it. Years ago you may not have had, or may not have known about so many choices when caring for kitties with medical issues and is some sense I think that can make it harder to make decisions.

More (((Carolynn))).
 
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