We’re Going To NYC (And The Cat Made Us Do It)!
Now that Polly’s rehab is finally in a place we feel comfortable, it’s about time I give everyone a full update on the cat. As you might recall Taggart got diagnosed with hyperthyroidism back in early May, and at the time we were facing two difficult options -> Put her on the horrible meds which control the thyroid levels, but do not cure the progressive disease. Or give her an expensive radioactive I-131 treatment which requires a hospital stay and 15-days of special post-treatment handling, but does cure the disease.
This has been another long and somewhat complicated story, but I think we’re finally getting to an answer here, and it’s going to require yet another trip to another place that was never originally on our radar to visit. In a year that’s been pretty much entirely dictated by our paws, it’s probably no surprise that our next stop is entirely the cats fault (and we’re actually pretty excited about where this is going to take us) but wow…it’s been a helluva process to get here!
Once again, for non paw-readers you’re welcome to completely ignore this post (I’ll be getting back to more regular RV stuff next), but for those as paw crazy as us who might be curious, feel free to read on. Also, we’re looking for some tips for the next stage of our travels (see bottom of this post) so if you have any those we’d love to hear them too. Here’s the full feline tale:
We Started Taggart On The Meds In May
When Taggart was originally diagnosed we chose to put her on the thyroid meds (Felimazole -> a coated version of Methimazole) as a first step. Not only was this going to give us time to figure out what to do, but it would tell us how her kidneys were doing and whether she was going to be a good candidate for the curative radioactive I-131 treatment.
You see Hyperthyroidism kicks the body into a “hyper” state where everything goes into overdrive, including the kidneys and this can often mask underlying kidney disease (a common problem in older cats). The only way to know for sure is to use the meds to bring T4 levels back down to normal and see how the kidneys react. Some I-131 clinics even require you to do this before they’ll accept your cat as a patient for radioactive treatment.
But It’s Taken Us Months To Get The Meds Right
Thyroid medication is serious stuff (over-dosing can literally kill) so the recommended protocol is to start low and go slow.
For cats the starting dose should be no more than 1.25 mg, twice a day, for least a month, then you re-test to see where the thyroid levels are. If they’re too low you up the dose slightly and try again in another month. If they’re good you should still plan to test at the 2 month point to check that the levels are stable. If you get two consistent readings (over two months) you’re good to go and you don’t have to test again for at least 6 months. Easy Peasy right?
Of course some cats turn out to be more tricky to stabilize than others, and given that our paw babies never take the easy route it’s no surprise our girl was in that very category. In Taggart’s case it’s taken us almost 5 months to get it right!
Part Of The Problem Was Lab Discrepancies
The first test we did on Taggart after 3 weeks on the meds showed her thyroid levels were in the right range. However this was an in-house test done at Banfield Pet Hospital in Portland OR, and this turned out to be a problem later on. You see in-house testing is cheap, but can also be notoriously inaccurate. There’s a ton of variation in how the equipment is maintained and how well it is calibrated (or not). So, unless you use the same equipment at the same lab for every test you can get widely varying results. It’s fine for getting an “estimate”, but not really appropriate for detailed testing.
We found this out the hard way when we re-tested Taggart end of June while we were still at Long Beach, WA. There’s no Banfield here so we took her to a local vet and I decided to use an external lab that specializes in thyroid testing. The lab had been recommended on several of the Feline Thyroid forums I was following, and is well known for their reasonable prices and accurate results. The local vet took the blood draw and I mailed the vials to Hemopet/Hemolife in CA for analysis. Two days later I got the full results by e-mail.
Sadly, the results showed that her thyroid levels were still way too high. Clearly the first test from Banfield had not been accurate enough…ugh! So, we were back to square one. We upped the thyroid meds from 1.25 mg 2x per day to 2.5 mg 2x per day, waited 4 weeks and got ready to test again.
It Took 2 More Changes (& Supplements) To Get Her Stable
It took two more dosage changes to get her levels in-line (at 2.5 mg 2x/day her levels actually went too low, so we had to reduce again to get them just right), but we finally got her stabilized. We had to work around some nausea issues which we resolved with a daily dose of Slippery Elm, and we also had to work around some immune issues which we resolved when I added 4LifeTransfer Factor (great supplement for older cats!) to her food. It took some experimentation, but we got there in the end!
Taggart been stable for a while now and she shows it. Her “hyper” symptoms are completely gone, she’s gained back some weight and she looks really good. The best news of all? As her T4 levels have come down her kidney levels have stayed fairly stable. For those who like the nitty gritty, her creatine and BUN levels rose somewhat, but stayed well within norms (I used Hemopet to test these too, by the way). This is great news and means that she is healthy enough for the radioactive iodine treatment.
There Are Many I-131 Clinics, But Only A Few Top-Notch Ones
During this whole process I’d been furiously researching I-131 clinics across the country. In my typical OCD fashion I’d been reading research papers learning everything I possibly could about the treatment. On a basic level it’s a pretty straight-forward process. You just inject some radioactive iodine into the thyroid. That kills off all the tumor cells. Then, as long as the disease hasn’t progressed too far there’s still some “healthy” thyroid left which kicks into action and brings everything back to normal.
The problem is that there’s very little consensus in the vet industry about how much radioactive iodine to use. Many clinics just use a “standard” 4 mci (millicuries) dose and don’t dose the injection individually to the cat. This may be too much for many kitties which can lead to hypothyroidism (thyroid levels go too low and can’t recover) and even cancer-related issues later on. This is a well-known problem in humans that undergo radioactive therapy, but is less-researched in cats. However the short time I’d spent on the thyroid cat forums showed it was clearly a big problem in cats too.
The “gold standard” method to minimize this is to do a thyroid scan (thyroid scintigraphy) before the treatment and dose individually to the cat based on the size and development of the tumor. It doesn’t guarantee success, but it vastly improves outcomes.
With this knowledge in hand I started compiling lists of clinics and calling around. I think I called around 50 or so clinics and the list narrowed fast. It turns out there are only a handful of clinics that actually do thyroid scintigraphy in the US, and an even narrower list that dose individually to the cat. In fact, if you want to work with the best, leading-edge research vets in the field there are only TWO places to go -> AVMI in Los Angeles, CA or Hypurrcat in New York, NY.
Dr. Broome (the head vet at AVMI) and Dr. Peterson (the head vet at Hypurrcat) are the top researchers in the world of feline hyperthyroidism. Pretty much every paper out there has one of their names on it and their clinics are literally most advanced I-131 clinics in the world. If you want the best, those are your spots.
New York It Is!
I sent all Taggaart’s blood results to Hypurrcat last week and she got accepted into the clinic for treatment Oct 3rd. Its going to be another hit to the pocket-book and she’ll have to stay for 3 days before we can take her home, but I know without a shadow of a doubt that she’ll be in the best hands possible.
Once she’s home we’re going to have to package and store her radioactive pee for a while (that should be fun), plus she’ll need to do 1, 3 and 6 month blood tests to see how her thyroid is recovering. On the risk side there is still a chance she goes hypo, and there’s a small (very small) chance the treatment won’t work (in a small % of cats you have to do it twice), but we’ve stacked the odds as much as we possibly can in our favor. That’s really all we can do.
So, What’s The New Travel Plan?
We’ll be heading out of Ann Arbor this weekend to take a quick trip to the West Coast of the MI “mitt” (we can’t leave without seeing Sleeping Bear Dunes and Traverse City). Then we’ll be high-tailing it over to New York to get ready for Taggart’s treatment.
While Taggart is at the clinic we plan to spend some days exploring the big city. Then we’ll embark on a new-to-us route down the Eastern Coast of the US to hit our winter bookings in Florida. This means (sadly) we’ll miss Kentucky and the Bourbon Trail, but we’re going to see tons of new stuff along the Eastern Coast, and maybe even catch some of the fall leaves turning too. We’re pretty excited.
If you have any tips on “must do” stuff along our new route PLEASE do comment below. Dog-friendly tips, as always, are most welcome, as are special out-of-the-way spots that you know we’ll love! This route is all new to us, so we’re all open ears, both furry and not.
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