Rex: Wednesday update (hyperT, liver, pancreas, heart probs)

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Carolynn FletcherGA & RobbieGA

Carolynn FletcherGA & RobbieGA

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Talked with Rex's vet... we're going to do fluids, more pain meds, an appy stim if he needs it, antibiotics (if his temp is up when I take it in a few minutes) and a beta blocker to try and get his heart rate down (was over 260 upon discharge Monday night). We'll redo the labs next week if I can get him in. If the liver values go down, that will be a mixed reaction: good that they're coming down, bad because it would point more strongly to a reaction to the Tapazole. Need to also read up on colangiohepatitis in cats as a possibility... but it could also still be some sort of liver cancer. The levels can be elevated by the hyperT being crazy, but not by this much. I'm thinking of the ultrasound, but need to do conservative care first-- get him feeling better and then see if I can afford it. I know there was more, but I was in my car so couldn't take notes.

(for more history: viewtopic.php?f=28&t=24569)

Continued thanks for the prayers and support...
 
((((((((((((((((((((((((((((CAROLYNN and REX)))))))))))))))))))))))))))))

I am so sorry there are so many things complicating diagnosis and help. Crossing all paws that his liver can bounce back with supplements and that its not ongoing.
 
OK good, you have a plan.
I like plans because it gives you a direction, and any action helps towards the goal.

I had thought that fluids and heart issues don't mix well - I could be totally wrong, but do you need to take caution and give lesser amounts with heart issues?

If the liver values improve by next week, it's not positive that it's the Tapazole is it? Could it be something else? At least better numbers is a good thing, yes?

What a/b are you giving?

I wish I had some knowledge to give some suggestions or ask some decent questions, but I have been very lucky with mine and nobody's been really sick.

How's he acting now? Does he seem to be improving in any ways at all? How long do you suppose it will be before you see some changes, did the vet say anything about times?

I hope Rex starts to feel a bit better with your actions and plan.
 
Forgot to mention that we're also giving him Denosyl for his liver.

Gayle, the heart problem is that it's racing because his hyperT is out of control, but we need to keep him hydrated so he doesn't feel crappy from that, leading to more issues. He'll get 75mL a day and we'll go from there-- trying to be a bit conservative, but also get the fluids in him that he needs. Really the only sure way to know if it's the Tapazole is to restart it again (we had to stop it because of all these other issues) and see if it makes him sick, which really isn't a nice option.

Last night he did come down and cuddle with Kelly (my youngest DD) for a bit while we watched a movie and came for breakfast this morning and ate a little bit :smile: . So there is some improvement. He's got a long way to go, but it's nice to see him not quite as miserable.

Now, we need to keep fingers, legs, eyes and paws crossed that Honey does well on the Tapazole.... :roll:
 
Carolyn,

Hugs to you and Rex. I just wanted to mention that I had a cat that reacted very badly to tapazole. (AST was 16000+). Her liver enzymes were back to normal within 4 weeks of stopping the tapazole. Since she was borderline hyper-T, we just decided to monitor her and her T4 has not changed in 4 years. But, my vet told me there are other drug therapies that work. Here is one reference - scroll down to "is there an alternative",
http://www.marvistavet.com/html/body_thyroid_treatment__oral_medica.html
 
Carolynn,
What about splitting up the fluids throughout the day?
I mention this suggestion as Oliver's Xrays showed enlarged heart and vet says he has a heart murmur, but all his issues are not major so we are on a watch n see mode.

Anyways, when I gave him fluids, we gave 100ml/day but split them into 2 times, morn and eve, so maybe that could be good for Rex.

It's good to hear he came down for a bit yesterday and that he's seeming better.
I hope today brings more improvement.
 
Hi Carolynn,

Tilly had strongly elevated ALT (GPT) and GLDH one month after starting a low dose of carbimazole for hyperT. Since her liver values had been normal for years prior, we concluded hepatotoxicity due to carbimazole. And after stopping the drug, ALT and GLDH returned to the normal ranges.

Carbimazole is an analogue of methimazole (Tapazole); carbimazole gets converted to methimazole in the body and is therefore very similar in action.

If you read the literature for both drugs in cats, hepatotoxicity is relatively rare. However, when I took Tilly in for radio-iodine treatment in August, the vets at the center in Gent said that in their experience such a reaction was not that rare in cats.

I haven't followed previous posts about Rex, but am assuming there is a reason you are not opting for radio-iodine or a thyroidectomy.
 
Boy I dont know all these words and terms mean (hope I never have to) I'm just sending prayers for hope and health for Rex, and prayers for strength and guidance for you Carolyn.
j.
 
Thank you again... everyone.

Kirsten, thanks for the input. His vet and I did touch on carbimazole and both are a bit leery of that, too, because it is broken down into the methamizole and we could be in the same boat. I'm not sure just what we'll do. Trying to get the denosyl in him has been a complete failure... was able to get the antenolol in him because it's a quarter of a tablet and I hid it in gravy Fancy Feast.

He is eating much better.... just like a kitty with uncontrolled hyperT-- which he is. :-Q I see him eating and acting better and smile... then remember that there is still something very wrong and my options are limited. I don't believe the thyroidectomy is very successful... the I131 is... but I can't afford either one anyway. I'm a single mom to 2 growing girls and a family of 8 cats (4 of which need meds daily) and I just can't do it. :cry:

Rex goes back on Wednesday for a recheck of all his labs (CBC/chem, T4) so maybe we'll be able to better figure out what we can do. Sure, starting the Tap again would be ideal... but I have to admit that it scares the hell out of me.

(((hugs))) and thanks to all of you...
 
OK he's eating better and acting better; just those two things are reasons to celebrate, yes?
It is best to take the good that is given, and keep thinking positive.
Nothing will be accomplished by thinking negative or wishing we could do more or feel sad that everything has not become better.

Let's take the good bits and enjoy them. Then later when testing again, let's hope for more good results.

Pats and scratches for Rex; tell him good boy for eating better, and pass along our good wishes for his continued improvement.
 
Hi Carolynn,

I initially had a thyroidectomy performed on Tilly in January. There aren't many centers that do radio-iodine treatment in Germany (2 in total) and the quarantine period afterwards are lengthy. The latter reason was why I initially chose thyroidectomy. (N.B. in Gent/Belgium, where we went in August, the quarantine is a lot shorter, but unfortunately I didn't know this in January).

The reason the surgery was unsuccessful was because the surgeon (oncology specialist) was unconvinced that Tilly really had hyperT and only took out a portion of the left lobe. He should have taken out everything. When we had the scintigram done prior to the radio-iodine treatment in August, it was the right lobe that lighted up. And her symptoms after surgery only initially got slightly better, but then quickly got worse again. Her T4 never got better, but continued to rise.

Although I live in Germany I consult with an internal med specialist in Canada. She does thyroidectomies all the time for her clients' cats, because if I remember correctly, geographically it is a long way to the nearest radio-iodine treatment center. Also, some of her clients couldn't afford it, even if they were able to drive there. And I think the quarantine is pretty long too (?).

Anyway, what I am trying to say is that I wouldn't discount a thyroidectomy. This type of surgery can be extremely successful in curing hyperT. But you need to find someone who is experienced in doing this type of surgery. There is a small chance that a cat may have ectopic thyroid tissue (the vets in Gent said ~10% of cats they see have this), which would prevent surgery from being completely successful also.

I also found hyperT extremely frustrating to deal with. I wish Rex the very best.
 
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