Wednesday, November 5, 2014
Jack and I131
So I have been blogging about Jack and his issues but I thought I should make a full post about what went on so there would be a good reference point if ever I feel the need to share my story with someone.
Jack, born in 2002, has had a nearly lifelong dance with urinary issues. He blocked for the first time when he was three or four years old. We had a hard time with it, and he reblocked pretty quickly. At the time Eli had already blocked and was on 'prescription' urinary food and we had successfully transitioned him to canned food without issues. Em was still alive and she was diabetic, so she was on diabetic food. Trying to feed my household of cats three different types of food was not easy. I read a lot and learned more about feline nutrition and realized the best food for my urinary boys was the best food for my diabetic cat and it was also the ideal diet for any cat, which led me down the road to feeding raw.
For years Jack did very well on this diet unless he got into things he shouldn't. I would bring home dry food for the foster kittens and he would find it and chew through bags. I brought home wheat based cat litter and he did the same, and again with the corn based litter. I was able to control his urinary issues knowing what happened to him and giving him acidifying supplements and limiting the amount of plants he ate.
A couple of years ago I bought some treats that were made in China. The print on the bag was so small and barely legible and the buzz words on the front of the package were so akin to what I was looking for that I didn't bother to search for those three words. Shortly after he ate them he started having problems and started urinating around the house. I could not figure out why, no one could. I blame the treats, and to this day I still do. Might it have been a major coincidence, sure. Might it be the treats, why not. They will never take responsibility for it though. Heck to this day they still don't know why jerky treats made in China are killing pets, but anyway..
Jack's tolerance for plant based ingredients went to about 5% to less than 1% of his diet. Whenever he got too much, he would start peeing, and on a few instances would block. It got so very expensive for us. Vets recommended the Perineal Urethrostomy (PU) surgery for him which would remove his penis so he would have a much harder time becoming blocked. I didn't much like this idea because how would I know when he was uncomfortable?
I was without a vet at this time since my last vet gave my cat medication without my permission and did not care that I was upset. I had taken Jack to several different vets to examine him when he would start urinating. I was running out of vets in the area that I could go see because each one invariably would do something that gave me some serious concerns about allowing them to continue to treat my cats. I ended up taking him to one of the newer clinics in the area owned by a vet that used to work with a woman I used to work with. I am not completely satisfied there, but at least they accept what I want and what I don't want. The vet that saw him there the first time suggested running a full blood panel on him since nothing showed up upon initial exam and she found he was hyperthyroid.
Later I joined a hyperthyroid board and apparently inappropriate elimination can be a sign of hyperthyroid. He had none of the other symptoms: eating too much, drinking a lot, weight loss.
The vet gave me the option of medication. They put Jack on 2.5mg of methimazole twice a day, and we retested his blood three weeks later. His thyroid level was on the very bottom rung of normal which scared me because we were supposed to test him at four weeks. The vet was pleased with where he was and suggested I keep up that dose. I went to support boards online and learned that he should be in the middle of normal and the track he was on would lead him to be hypothyroid. I immediately cut his dose in half - a fairly standard dosing for a cat - and we retested him in four weeks and his thyroid level was right in the middle of where it was supposed to be.
We were very lucky that he did not have kidney issues being hidden by his high thyroid levels. If we had, we would have dealt with that too.
There are four ways to treat hyperthyroidism in cats. The first is medication. The medication suppresses the thyroid production, but does nothing to treat the actual condition that is causing the problem. Leaving the tumors will allow them to continue to grow and risk them turning malignant. There are also some significant side effects that some cats have to deal with.
The newest way is to remove all iodine from the cat's diet by feeding them the new thyroid diet. This can help cats that can't be medicated, and people who can not afford additional treatments, but the food is very low quality and provides very poor nutrition for cats. If you are looking at long term solutions, this is not one of them. My biggest problem with this food is there no animal based proteins in the dry food. For an obligate carnivore this should not be an option. There is a nice write up on why the iodine deficient food is not a good choice here, so I will just leave it at that.
They used to perform surgery to remove the nodules on the thyroid, but this is very invasive, and the success rate isn't what it is with I131. Also the cost is often comparable to I131.
The 'gold standard' of hyperthyroid treatment is now I131. Since the thyroid is the only known organ in the body to use iodine, they believe that making it radioactive will kill the highly producing tumor nodule, leaving the less active normal thyroid gland alone. They inject it into the muscle and let it do its thing. The only down side of this treatment is sometimes they give too much and it does kill off some normal thyroid gland and the cat becomes hypo. Faced with having to pill Jack for the rest of his life, hopefully six to eight years, I was willing to risk that. Jack is easy to pill, but no matter what I do and how I go about it, it was obvious that he would prefer I not do that. There were times that I missed his pill and he started showing signs of being uncomfortable, so I was faced with his urinary issues becoming more of an issue, and when I added up the cost of the pills (not to mention the regular blood work) it would have only taken a few years before the cost of I131 would have been less.
I then had three options for treatment centers. There is a place with in my own state, but it is owned by the same clinic that sent Jack home covered in blood when he blocked while I was in Kansas. There is the popular nationwide chain that is located in Massachusetts, and there is Angell in Boston MA. They are one of the few places that are willing to take on a cat with multiple health issues. Because Jack has a recent history of urinary problems, I decided to go with Angell. One thing that I really liked about their program is that they do a thyroid scan prior to dosing to be sure of the size, shape and location of the tumor. Some places dose on weight and some dose on the thyroid level in the blood. I feared that both were more likely to lead to hypo, so this added to my choice of Angell. The cost was several hundred dollars more than my local place, and the two hour road trip to get there was not an easy decision to make, but when I weighed the benefits it was really the only option I could live with.
Jack blocked the last time I went on a trip, so we had plans to have him go in hospital while I was at BarkWorld. Due to their schedule, he had to go in on Monday and they generally release on Saturday. They scan on Monday after drop off and give the treatment on Wednesday. We had made arrangements to pick him up on Sunday when I arrived home so I could pick up my boy, but they only did pick ups until four, so we had plans to pick him up first and then me, but he was hiding while at the vet - very unlike my outgoing boy - so my husband went and picked him up on Saturday.
We had plans to isolate him, but he did not want that at all, and when he got free the other cats were not bothered by his presence other than to sniff him wondering where he was, so we just let him have free run. He is spending more time with me and my husband than is recommended, but he is needy and confused when we push him away, so I am putting up with the radiation. I don't engage in many activities that would put me in contact with a lot of radiation, and I asked for pat downs at the airport instead of the x ray machine, so I'm hoping I'll be okay. Jack generally wants 10-20 minutes of lovin in the morning and the evening, and I am putting an end to it a bit earlier than he would like.
Fortunately the side effects from the treatment will only show up in the blood work, so there really isn't anything to watch for now and my only job is to make him happy. He is himself in every way, aside from his being slightly more needy since the trip. I was told he would be radiation free and all restrictions should end on the 15th and at that point I'll let him lick my nose (and eyelids) all he wants. Sometime after that I will take him in for a follow up blood test to see how he is doing. So far we haven't had any known instances of inappropriate elimination, so I think things are going well.
I ended up coming down with my annual cold a few weeks early so I've been in bed for the past two days and all of my cats have been VERY happy about that. I currently have all seven of them in the bed with me.