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Re: [FH] IM Update-Would Like Some InPut (Long)

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  • KAPTIVA@WEBTV.NET
    Hi Candace..... Having read your post, I am sighing too. I am responding to the whole group post rather than the private one, because my opinion may be a bit
    Message 1 of 11 , Jul 1, 2006
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      Hi Candace.....

      Having read your post, I am sighing too.

      I am responding to the "whole group" post
      rather than the private one, because my
      opinion may be a bit radical and checks
      and balances from the goup are welcome.

      At this point, I would seriously talk to my
      Vet about weaning Skylar off both meds
      for around 10 days and having a "clean"
      T-4 taken to get an answer on whether
      or not he has Hyperthyroidism.

      If he does, than you can decide to
      go the med route or the radio iodine
      route to treat it.

      If it is not Hypethyroidism but indeed
      a Heart Condition, then you can focus
      on treating this condition.

      The Doctor "loop" appears to be going
      nowhere on getting this answer....now,
      the IM is raising a new series of "maybes"
      without giving you an answer to your
      first question.

      Your description of Skylar's inappetance
      appears to be from nausea....the pepcid
      should work with acid stomach.....we've
      given it to our CRF Guys when needed
      and it has helped. It was helping
      Skylar too.

      We used Carafate for our Maggie when
      she was in end stage renal failure and
      had ulcers.....this is a coating for either
      throat, mouth or stomach ulcers...it is
      difficult to take as I'm sure you have
      noticed....Maggie hated it and as soon
      as her ulcers cleared, we stopped using
      it...it really made her not want to eat.

      I don't know why he would recommend
      this to you when he refused to believe
      that Skylar had a nausea issue to begin
      with.

      Your step on moving to the transdermal
      version of the hyper t med is a good one,
      as this should help with some of the
      nausea issues.

      This is what I would do as a first step.
      Then I would work at weaning off both
      meds and taking a "clean" blood sample
      for Hyper T.

      Hope it's helpful.

      Tell Skylar that I would have hissed and
      bitten a few people at that Clinic myself
      and give him a hug from his buddy,
      Holiday.

      Fran
    • moonpye
      Hi Fran, You have been such a wonderful help. Yes, after his next echo, late July the cardiologist is going to have to figure out what meds to wean him off of.
      Message 2 of 11 , Jul 1, 2006
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        Hi Fran,

        You have been such a wonderful help.


        Yes, after his next echo, late July the cardiologist is going to have to
        figure out what meds to wean him off of. I cant even imagine that what
        nightmares that visit will entail, and what in the world the cardiologist is
        going to think, now that the IM specilaist has decided that Skylar
        cannot have Hyperthroidism. Maybe the echo will reveal something as to
        whether he has just Heart Disease alone.



        Then what about his original symptoms of Hyperthyroidism: weight loss,
        excessive water drinking, restlessness, some howling, aggressiveness,
        ravenous appetite for foods like butter.

        *After being on the Methimazole and Atenolol, every one of those symptoms
        have disappeared.*
        **
        **

        *Can Atenolol have the same effect as Methimazole on these Hyperthyroid
        symptoms?*
        **

        If it does, and he is being treated for both HCM and HyperT, he could be
        weaned off the Methimazole.


        But if the Atenolol does not control them, then the Methimazole is
        controlling his HyperT symptoms and that would mean he has Hyperthyroidism.
        Right?


        *So if he is HyperT and it is being controlled by Methimazole. I think his
        heart echo would show some improvement if his heart disease is in relation
        to the Hyperthyroidism. Is this correct?*
        **

        The whole problem is that the blood test T4's are coming back too low to be
        hyperthyroidism.
        The cardiologist said it was rare but it is also very possible for him to
        have Hyperthyroidism, especially after doing the echo. The IM specialist
        disagrees.



        We told him we were giving Skylar Pepcid AC and he asked why. We said
        because he was acting nauseous and we think it's from his
        medications. We told him he was feeling better on the Pepcid. He said it
        couldn't possibly be working and the only thing that would work for nausea
        before a meal was Carafate, as it coats the stomach. He didn't even believe
        that Skylar was feeling better since being on the Pepcid AC. That why we
        got it, because he said its the only thing that would work, if he's
        nauseous, so he would give to us if we wanted to try it.


        The main problem his is continuing weight loss, Maybe with the transdermal
        Methimazole, the Carafate, the Pepcid AC he will want to start eating a
        larger quanity of food.





        Skylar says thank you Fran, and is giving Holiday a hug back!


        Candace with Cinnamon and Skylar





        On 7/1/06, KAPTIVA ATWEBTV <KAPTIVA@... > wrote:
        >
        > Hi Candace.....
        >
        > Having read your post, I am sighing too.
        >
        > I am responding to the "whole group" post
        > rather than the private one, because my
        > opinion may be a bit radical and checks
        > and balances from the goup are welcome.
        >
        > At this point, I would seriously talk to my
        > Vet about weaning Skylar off both meds
        > for around 10 days and having a "clean"
        > T-4 taken to get an answer on whether
        > or not he has Hyperthyroidism.
        >
        > If he does, than you can decide to
        > go the med route or the radio iodine
        > route to treat it.
        >
        > If it is not Hypethyroidism but indeed
        > a Heart Condition, then you can focus
        > on treating this condition.
        >
        > The Doctor "loop" appears to be going
        > nowhere on getting this answer....now,
        > the IM is raising a new series of "maybes"
        > without giving you an answer to your
        > first question.
        >
        > Your description of Skylar's inappetance
        > appears to be from nausea....the pepcid
        > should work with acid stomach.....we've
        > given it to our CRF Guys when needed
        > and it has helped. It was helping
        > Skylar too.
        >
        > We used Carafate for our Maggie when
        > she was in end stage renal failure and
        > had ulcers.....this is a coating for either
        > throat, mouth or stomach ulcers...it is
        > difficult to take as I'm sure you have
        > noticed....Maggie hated it and as soon
        > as her ulcers cleared, we stopped using
        > it...it really made her not want to eat.
        >
        > I don't know why he would recommend
        > this to you when he refused to believe
        > that Skylar had a nausea issue to begin
        > with.
        >
        > Your step on moving to the transdermal
        > version of the hyper t med is a good one,
        > as this should help with some of the
        > nausea issues.
        >
        > This is what I would do as a first step.
        > Then I would work at weaning off both
        > meds and taking a "clean" blood sample
        > for Hyper T.
        >
        > Hope it's helpful.
        >
        > Tell Skylar that I would have hissed and
        > bitten a few people at that Clinic myself
        > and give him a hug from his buddy,
        > Holiday.
        >
        > Fran
        >
        >


        [Non-text portions of this message have been removed]
      • KAPTIVA@WEBTV.NET
        Hi Candace.... Did Skylar ever have a high Free T4? Prior to any medication? Or did your Vet just start the Methamazole based on the Clinical Symptoms? Both
        Message 3 of 11 , Jul 1, 2006
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          Hi Candace....

          Did Skylar ever have a high Free T4?
          Prior to any medication?

          Or did your Vet just start the Methamazole based on the Clinical
          Symptoms?

          Both the thyroid and the heart regulate
          the body.

          The Methamazole is designed to slow
          down the thyroid and this results in slowing down the body...including
          the heart and other organs.

          The Atenolol is designed to slow down
          the heart and this results in slowing down
          the body as well...including to some
          extent the thyroid and other organs.

          So, you would definitely see a difference
          in the hyper t symptoms (racing heart, etc.) with the Atenolol alone.

          However, I don't think that it would effect the Blood Level of Free T
          4...if in fact is was elevated prior to starting the Atenolol.

          I also think that the appetite problem is
          probably more severe with the Methamazole than it would be with the
          atenolol.

          Lots more members in the group have
          experience with atenolol than I do, am
          sure that you will hear from them.

          In the meantime, take a deep breath,
          and keep Skylar eating.

          There is a very good assist feed group
          headed up by Linda, you might want
          to investigate it at some point in the
          future.

          Fran

          PS... I am Hypothyroid and one of my
          symptoms was a very, very slow heart
          rate and very very low blood pressure.

          My meds are designed to speed up my
          Thyroid. If I take too much, my heart
          rate is off the charts and my blood pressure through the roof.

          Thyroid and heart rates are very intertwined...as would be meds for
          each.
        • moonpye
          Hi Fran, On 3/11/2006 this are his very first T4 results: Yes, he did have a High Free T4ED before starting any medication. It was 79 High(10-50)reference
          Message 4 of 11 , Jul 1, 2006
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            Hi Fran,


            On 3/11/2006 this are his very first T4 results:

            Yes, he did have a High Free T4ED before starting any medication. It was 79
            High(10-50)reference range.


            The Reg T4 1.5 Low(0.8-4.0) reference range.












            On 7/1/06, KAPTIVA ATWEBTV <KAPTIVA@...> wrote:
            >
            > Hi Candace....
            >
            > Did Skylar ever have a high Free T4?
            > Prior to any medication?
            >
            > Or did your Vet just start the Methamazole based on the Clinical
            > Symptoms?
            >
            > Both the thyroid and the heart regulate
            > the body.
            >
            > The Methamazole is designed to slow
            > down the thyroid and this results in slowing down the body...including
            > the heart and other organs.
            >
            > The Atenolol is designed to slow down
            > the heart and this results in slowing down
            > the body as well...including to some
            > extent the thyroid and other organs.
            >
            > So, you would definitely see a difference
            > in the hyper t symptoms (racing heart, etc.) with the Atenolol alone.
            >
            > However, I don't think that it would effect the Blood Level of Free T
            > 4...if in fact is was elevated prior to starting the Atenolol.
            >
            > I also think that the appetite problem is
            > probably more severe with the Methamazole than it would be with the
            > atenolol.
            >
            > Lots more members in the group have
            > experience with atenolol than I do, am
            > sure that you will hear from them.
            >
            > In the meantime, take a deep breath,
            > and keep Skylar eating.
            >
            > There is a very good assist feed group
            > headed up by Linda, you might want
            > to investigate it at some point in the
            > future.
            >
            > Fran
            >
            > PS... I am Hypothyroid and one of my
            > symptoms was a very, very slow heart
            > rate and very very low blood pressure.
            >
            > My meds are designed to speed up my
            > Thyroid. If I take too much, my heart
            > rate is off the charts and my blood pressure through the roof.
            >
            > Thyroid and heart rates are very intertwined...as would be meds for
            > each.
            >
            >


            [Non-text portions of this message have been removed]
          • Leah Ferron
            Candance, I know I said I was taking a break but I have to weigh in here. Alec would want me to. You had two tests tell you that Skylar had HyperT, right? Both
            Message 5 of 11 , Jul 1, 2006
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              Candance,

              I know I said I was taking a break but I have to weigh in here. Alec would want me to. You had two tests tell you that Skylar had HyperT, right? Both were before any thyroid meds, right? HyperT can cause heart problems, and heart problems mask hyperT. I did some reading on this when Alec was first diagnosed with RCM. I was hoping for hyperT but alas it was not. My cardiologist (that i wasn't too fond of and never saw again) did give me good advice about the hyperT. She suggested the T3 test which is conclusive. HyperT in kitties can be very tricky to diagnosis and even T4 tests can come back negative at times when there is HyperT. Ask about the T3 test from your cardiologist, regular vet or IM. Insist if you have to. I am not impressed with this IM, at all. Question everything the vets do and do a lot of online research! Questioning a vet is not a bad thing and they can explain better what you find out on the internet because it can be confusing, If Skylar has hyperT,
              there is a chance that the heart condition may resolve so this diagnosis is the most important to make! Fight for your kitty, you are Skylar's voice.

              Leah and her cats and angel Alec




              ---------------------------------
              Do you Yahoo!?
              Next-gen email? Have it all with the all-new Yahoo! Mail Beta.

              [Non-text portions of this message have been removed]
            • moonpye
              Hi Leah, I m glad you wrote. It was only his first test that had the High FreeT4ED, because he started medication after that test. We did ask the IM about the
              Message 6 of 11 , Jul 1, 2006
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                Hi Leah,


                I'm glad you wrote.


                It was only his first test that had the High FreeT4ED, because he started
                medication after that test.



                We did ask the IM about the T3 suppression test, after he told us they
                didn't do the thyroid scan there anymore.

                .
                He said it was not done anymore. It was not reliable so
                they stopped using it. It's not accurate enough so he poohed it.


                Candace with Cinnamon and Skylar







                On 7/1/06, Leah Ferron <leahandhercats@...> wrote:
                >
                > Candance,
                >
                > I know I said I was taking a break but I have to weigh in here. Alec would
                > want me to. You had two tests tell you that Skylar had HyperT, right? Both
                > were before any thyroid meds, right? HyperT can cause heart problems, and
                > heart problems mask hyperT. I did some reading on this when Alec was first
                > diagnosed with RCM. I was hoping for hyperT but alas it was not. My
                > cardiologist (that i wasn't too fond of and never saw again) did give me
                > good advice about the hyperT. She suggested the T3 test which is conclusive.
                > HyperT in kitties can be very tricky to diagnosis and even T4 tests can come
                > back negative at times when there is HyperT. Ask about the T3 test from your
                > cardiologist, regular vet or IM. Insist if you have to. I am not impressed
                > with this IM, at all. Question everything the vets do and do a lot of online
                > research! Questioning a vet is not a bad thing and they can explain better
                > what you find out on the internet because it can be confusing, If Skylar has
                > hyperT, there is a chance that the heart condition may resolve so this
                > diagnosis is the most important to make! Fight for your kitty, you are
                > Skylar's voice.
                >
                > Leah and her cats and angel Alec
                >
                >
                > ------------------------------
                > Do you Yahoo!?
                > Next-gen email? Have it all with the all-new Yahoo! Mail Beta.<http://us.rd.yahoo.com/evt=40788/*http://advision.webevents.yahoo.com/handraisers>
                >
                >


                [Non-text portions of this message have been removed]
              • moonpye
                Hi Leah, again We will ask the cardiologist at his next echo in 3 1/2 weeks about the T3 test, after she does the echo. Depending on what she can determine
                Message 7 of 11 , Jul 1, 2006
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                  Hi Leah, again


                  We will ask the cardiologist at his next echo in 3 1/2 weeks about the T3
                  test, after she does the echo. Depending on what she can determine from the
                  echo about his heart, she might want to do it.

                  Thanks Candace with Cinnamon and Skylar



                  On 7/1/06, moonpye <moonpye@...> wrote:
                  >
                  > Hi Leah,
                  >
                  >
                  > I'm glad you wrote.
                  >
                  >
                  > It was only his first test that had the High FreeT4ED, because he started
                  > medication after that test.
                  >
                  >
                  >
                  > We did ask the IM about the T3 suppression test, after he told us they
                  > didn't do the thyroid scan there anymore.
                  >
                  > .
                  > He said it was not done anymore. It was not reliable so
                  > they stopped using it. It's not accurate enough so he poohed it.
                  >
                  >
                  > Candace with Cinnamon and Skylar
                  >
                  >
                  >
                  >
                  >
                  >
                  >
                  > On 7/1/06, Leah Ferron <leahandhercats@...> wrote:
                  > >
                  > > Candance,
                  > >
                  > > I know I said I was taking a break but I have to weigh in here. Alec
                  > > would want me to. You had two tests tell you that Skylar had HyperT, right?
                  > > Both were before any thyroid meds, right? HyperT can cause heart problems,
                  > > and heart problems mask hyperT. I did some reading on this when Alec was
                  > > first diagnosed with RCM. I was hoping for hyperT but alas it was not. My
                  > > cardiologist (that i wasn't too fond of and never saw again) did give me
                  > > good advice about the hyperT. She suggested the T3 test which is conclusive.
                  > > HyperT in kitties can be very tricky to diagnosis and even T4 tests can come
                  > > back negative at times when there is HyperT. Ask about the T3 test from your
                  > > cardiologist, regular vet or IM. Insist if you have to. I am not impressed
                  > > with this IM, at all. Question everything the vets do and do a lot of online
                  > > research! Questioning a vet is not a bad thing and they can explain better
                  > > what you find out on the internet because it can be confusing, If Skylar has
                  > > hyperT, there is a chance that the heart condition may resolve so this
                  > > diagnosis is the most important to make! Fight for your kitty, you are
                  > > Skylar's voice.
                  > >
                  > > Leah and her cats and angel Alec
                  > >
                  > >
                  > > ------------------------------
                  > > Do you Yahoo!?
                  > > Next-gen email? Have it all with the all-new Yahoo! Mail Beta.
                  > > <http://us.rd.yahoo.com/evt=40788/*http://advision.webevents.yahoo.com/handraisers>
                  > >
                  > >
                  >


                  [Non-text portions of this message have been removed]
                • Sue at MAGDRL
                  Candace, I was trying to word a response but Leah said it all. Stand up for Skylar and push back with this IM. He sounds like he knows a lot, but doesn t
                  Message 8 of 11 , Jul 1, 2006
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                    Candace,

                    I was trying to word a response but Leah said it all. Stand up for Skylar
                    and push back with this IM. He sounds like he knows a lot, but doesn't
                    understand how it all fits into the big picture. You will have to guide him
                    to get the best for Skylar. Don't back down!


                    Sue



                    ----- Original Message -----
                    From: "moonpye" <moonpye@...>
                    To: <feline-heart@yahoogroups.com>
                    Sent: Friday, June 30, 2006 7:51 PM
                    Subject: [FH] IM Update-Would Like Some InPut (Long)


                    > Hi everyone.
                    >
                    > Sorry I took so long to write. We didn't get back till late yesterday
                    > afternoon, after having not such a wonderful day at the IM specialist.
                    >
                    > The IM specialist does not think Skylar has Hyperthyroidism because of his
                    > too low T4 numbers and first original High FreeT4ED. He heard a grade 1
                    > murmur which he believes is from heart disease. He and his assistant
                    could
                    > not feel an enlarged thyroid, (though his other 2 drs. could) The only
                    > definite test is the thyroid scan which they do not do there anymore, the
                    > next closest one is 4 hrs. away.
                    >
                    > He had all the symptoms for Hyperthyroidism when we first brought him in:
                    > weight loss,
                    > excessive drinking, ravenous appetite at times, some day & night howling,
                    > and some aggressiveness. No nausea, vomitting or lip smacking, or GI
                    > issues.
                    >
                    > So the IM spec. is only going by his numbers from the T4's. He is
                    > disagreeing with cardiologists diagnosis and echo report of probable Hyper
                    T
                    > with his first heart murmur which was a grade 4 being contributed to and
                    by
                    > HyperT. (Sigh)
                    >
                    >
                    > He thinks he could have something with his pancreas, GI, cancer, or his
                    > teeth that is causing him to lose weight. He said his teeth were bad and
                    > full of tartar (his other 2 drs. said he had tartar, but nothing of
                    concern
                    > right now). He said he needed to have a dental cleaning because there
                    could
                    > be something under the tartar like a hole or a crack that's causing him
                    not
                    > to eat properly, (but he sniffs his food and makes an icky face and walks
                    > away like he's nauseous, not like like his teeth hurt). I understand that
                    > he could have possible dental issues but, why can't he be hyperthyroid
                    also,
                    > if he has all the symptoms.
                    >
                    > Aren't they supposed to treat the cat not the numbers?
                    >
                    > While he's under anesthesia for a 1/2 hour for the dental cleaning he
                    > wants him to have a scope. $1,100 for both, not including the next heart
                    > echo he has to have for $500.
                    >
                    > *Is it safe for cats to go under anesthesia for a 1/2 hour who have heart
                    > disease?*
                    > **
                    > **
                    > The IM spec. does not think that the medications could be making him
                    > nauseous. Even though he lip smacks, makes peanut butter mouth, smells
                    his
                    > food and walks away, gets a drink of water, then comes back to eat. He
                    > sometimes makes an icky face at his food like eewww,I don't like this at
                    > all. Sometimes his tongue flails when he eats or drinks water.
                    >
                    > **If this only started this after a month or so on the meds, wouldn't
                    nausea
                    > and inappetance be contributing to his continuing weight loss?
                    >
                    > *Does this sound like strictly nausea alone?*
                    > **
                    > *Or nausea and dental issues?*
                    > **
                    > *Or just dental issues alone?*
                    > **
                    > **He did not have any nausea or mouth problems prior to starting the
                    > Atenolol 3/31/06 and the Methimazole 4/4/06.
                    >
                    > He seems to be eating better on the Pepcid AC, but the IM specialist said
                    > that there is no possibe way for Pepcid AC to alleviate nausea, if taken
                    > before a meal, whatsoever. It can deplete the body of immune fighting
                    acids
                    > or something like that.
                    >
                    > He wouldn't okay the SEB, without documentation from a noted source that
                    it
                    > is safe and non toxic.
                    >
                    > He gave us Carafate and said this was the only thing that would work to
                    > control nausea, even though Skylar "cannot possibly be nauseous on his
                    > piddly doses of medication".
                    > (Sighs again).
                    >
                    > He has already had 2 doses of Carafate before his last 2 meals and he is
                    > eating less then when on the Pepcid. Does anyone know about Carafate? Is
                    > it supposed to work right away?
                    > Should I just add back the Pepcid AC 1/4AM & 1/4PM or just 1/4 or none at
                    > all? How would I dose the Carafate and the Pepcid to give him both?
                    >
                    > He wants to see his daily caloric intake for 4 days. He wants to see if he
                    > is eating a normal amount of food and still losing weight, or not eating
                    > enough food due to nausea or his teeth or both or something else. He
                    wants
                    > me to get a gram scale and weigh every piece of Skylar's food that he
                    > eats for 4 days and chart it. (Easier said then done) . (Sighing again).
                    >
                    > So my sister and I have decided to try the most affordable and stress free
                    > option we have to for Skylar right now. We are going to start Transdermal
                    > Methimazole (less GI effects than the pills) and will see if he starts
                    > eating better on that and the Carafate. As for the Atenolol, the IM
                    > specialist will have to speak to the cardiologist and see if she wants to
                    > substitute it for another medication. The cardiologist will have to
                    decide
                    > about both his medicines, I guess after his next echo which will at 4
                    months
                    > now late July, instead of 6 months. She would have to confirm that he
                    does
                    > not have Hyperthyroidism. But what if she does that and takes him off
                    > Methimazole and all his HyperT symptoms comeback and he starts losing more
                    > weight?
                    >
                    > For some reason, no one wants to believe that he can
                    > possibly be nauseous and have inappetance from Methimazole and Atenolol.
                    > Side effects of both these drugs say this, don't they? Even if he has
                    > something else like dental problems, why can't he still nauseous and have
                    > Hyperthyroidism with or without Heart disease? (Sighing Again)
                    >
                    > Forgive me, but am I not seeing something clearly or am I missing
                    something
                    > all together.
                    >
                    > I will start measuring his caloric intake and see what that reveals.(Sorry
                    > to keep sighing)
                    >
                    > So, now were more confused about everything ,as if that were possible,and
                    > this visit just made it worse.
                    >
                    > Poor Skylar hated it there and had a really bad time. He was a 4 week old
                    > feral kitten when we found him. He's not good with strangers and very
                    > sensitive to his surroundings and pain. The asst. dr. was feeling his
                    throat
                    > and pressing his esophagus and he started hissing, she said she must of
                    hurt
                    > him, then she went to take his temperature and he freaked out hissing and
                    > trying to bite everyone.. The IM specialist became afraid to touch him.
                    He
                    > can't handle all this and it's just so upsetting.
                    >
                    > Thank you for listening.
                    >
                    > I would appreciate your knowledege.
                    >
                    > Candace with Cinnamon and Skylar
                    >
                    >
                    > .
                  • savionna@aol.com
                    Hi Candace, ... I m confused about what you mean by too low T 4 numbers. According to your posts, the cat s *original* thyroid readings on 3/11/06...before
                    Message 9 of 11 , Jul 2, 2006
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                      Hi Candace,

                      In a message dated 6/30/06 8:02:34 PM, moonpye@... writes:


                      > The IM specialist does not think Skylar has Hyperthyroidism because of his
                      > too low T4 numbers and first original High FreeT4ED.
                      >
                      I'm confused about what you mean by "too low" T 4 numbers.

                      According to your posts, the cat's *original* thyroid readings on
                      3/11/06...before methimazole...was 1.5 micro-g/dL (0.8-4.0) for Total T4 and 79 pmol/L
                      (10-50) for Free T4. By 6/26/06, on 3.75mg methimazole, his Total T4 dropped to
                      0.4, which indicates overdose.

                      As I'd mentioned previously, cats can present with a *normal* Total T4 and an
                      *elevated* Free T4 for reasons that are currently unclear. Some vets consider
                      this situation to be hyperT and treat with medication. Other vets do not. It
                      is a judgment call that needs to be based on the *total picture* of the
                      individual cat, incl the clinical signs. (It might be helpful to think of the
                      thyroid as a "speed" regulator in the body. Sometimes the thyroid speeds up when
                      other organs are slowing down or there is an overall imbalance.)

                      Here is the passage again from the article "Basal Free Thyroid Hormone
                      Determinations":

                      "The finding of a high free T4 by dialysis concentration
                      (despite a normal total T4) in a cat with a history and physical exam
                      findings
                      (e.g., a palpable thyroid nodule) consistent with hyperthyroidism, would
                      support
                      the diagnosis. Occasionally, however, cats with nonthyroidal illness have
                      high free T4 by dialysis concentrations for reasons that are unclear.
                      Therefore, to avoid a misdiagnoses of hyperthyroidism, free T4 should always
                      be
                      evaluated in conjunction with a the total T4 concentration. In general, an
                      high
                      free T4 by dialysis value and low total T4 concentration (< 20 nmol/L or 2
                      µg/dl)
                      is indicative of nonthyroidal illness while a mid- to high-normal T4
                      concentration in conjunction with an high free T4 value (measured by
                      dialysis)
                      is suggestive of hyperthyroidism."

                      > He had all the symptoms for Hyperthyroidism when we first brought him in:
                      > weight loss, excessive drinking, ravenous appetite at times, some day &
                      > night howling,
                      > and some aggressiveness.  No nausea, vomitting or lip smacking, or GI
                      > issues.
                      >
                      And his blood glucose was normal, right?

                      > He thinks he could have something with his pancreas, GI, cancer, or his
                      > teeth that is causing him to lose weight.
                      >
                      It could. Does the cat have any clinical signs or diagnostic findings
                      currently to support digestive disorders or cancer? A cat with pancreatitis,
                      gastritis, or inflammatory bowel would have a history of vomiting, diarrhea, guarding,
                      etc.

                      What was Skylar eating usually (brand, flavor, canned or dry) before the
                      Hill's a/d?

                      > He said his teeth were bad and
                      > full of tartar (his other 2 drs. said he had tartar, but nothing of concern
                      > right now).  He said he needed to have a dental cleaning because there could
                      > be something under the tartar like a hole or a crack that's causing him not
                      > to eat properly
                      >
                      And that could be a contributing factor...along with other contributing
                      factors.

                      > I understand that
                      > he could have possible dental issues but, why can't he be hyperthyroid also,
                      > if he has all the symptoms.
                      >
                      See above.

                      > Aren't they supposed to treat the cat not the numbers?
                      >
                      Yes, they are. But your vets aren't (apparently).

                      > While he's under anesthesia  for a 1/2 hour for the dental cleaning he
                      > wants him to have a scope. $1,100 for both, not including the next heart
                      > echo he has to have  for $500.
                      >
                      A scope for what reason?

                      > *Is it safe for cats to go under anesthesia for a 1/2 hour who have heart
                      > disease?*
                      >
                      This is just my opinion, but I wouldn't put a cat under anesthesia without
                      very valid reason.

                      > The IM spec. does not think that the medications could be making him
                      > nauseous. 
                      >
                      He doesn't? Has he ever read the package inserts or the PDR for atenolol and
                      methimazole (in humans)?

                      According to AstraZeneca...the *manufacturer* of Tenormin (which is Rx
                      atenolol), on their own prescribing information...*nausea* is the most frequent
                      adverse effect, at 4% of one population cited.

                      For methimazole, nausea and upset stomach are listed among the adverse
                      reactions, as is loss of taste and inappetance. HyperT itself can cause poor
                      appetite. Go to the hyperT group at http://groups.yahoo.com/group/feline-hyperT and
                      ask the caregivers using methimazole whether their cats have had nausea
                      problems from the meds.

                      > Even though he lip smacks, makes peanut butter mouth, smells his
                      > food and walks away, gets a drink of water, then comes back to eat.  He
                      > sometimes makes an icky face at his food like eewww,I don't like this at
                      > all.  Sometimes his tongue flails when he eats or drinks water.
                      >
                      Well, what does that tell you about your cat?

                      > **If this only started this after a month or so on the meds, wouldn't
                      > nausea
                      > and inappetance be contributing to his continuing weight loss?
                      >
                      Yes, it could.

                      > *Does this sound like strictly nausea alone?*
                      >
                      That's impossible to say...but it certainly sounds from your description of
                      the clinical signs that nausea is playing a role. And both the meds you're
                      using can be a contributing factor to nausea.

                      > **He did not have any nausea or mouth problems prior to starting the
                      > Atenolol 3/31/06 and the Methimazole 4/4/06.
                      >
                      Then it really sounds as if the lipsmacking, etc are a reaction to the meds,
                      no?

                      > He seems to be eating better on the Pepcid AC, but the IM specialist said
                      > that there is no possibe way for Pepcid AC to alleviate nausea, if taken
                      > before a meal, whatsoever. 
                      >
                      As I mentioned previously, famotidine is a medication prescribed for
                      hyperacidity in the stomach. It can help relieve nausea to the extent that the nausea
                      is caused by too much stomach acid.

                      > It can deplete the body of immune fighting acids
                      > or something like that.
                      >
                      Do you mean *amino acids*? How does Pepcid deplete amino acids?

                      > He wouldn't okay the SEB, without documentation from a noted source that it
                      > is safe and non toxic.
                      >
                      It's always a good idea to verify that any medication or remedy is safe. And
                      had the vet done so, he would have seen that atenolol was introduced in
                      1976...and caused heart failure in 19% and death in 3% of the tested (human)
                      population. Methimazole is known to cause liver toxicity in animals. Both drugs are
                      registered by the US FDA for us in humans only.

                      Slippery elm bark, conversely, has been used for *centuries*...and has been
                      listed in the US Pharmacopeia since 1862. From
                      www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/102610.shtml (which is the online version of the PDR
                      physicians use): "For much of the 20th century, Slippery Elm was a popular
                      over-the-counter remedy for sore throat and upset stomach. It was listed in The
                      United States Pharmacopeia until 1960, and was declared safe and effective by the
                      Food and Drug Administration. It disappeared from drugstore shelves only
                      after Dutch elm disease destroyed almost all the elms in the country."

                      > He gave us Carafate and said this was the only thing that would work to
                      > control nausea, even though Skylar "cannot  possibly be nauseous on his
                      > piddly doses of medication".
                      >
                      He's incorrect. Carafate, which is a human ulcer drug (not too different from
                      Pepcid), is *not* the "only thing" that controls nausea. It may be the only
                      thing that he knows...or the only thing that he wants to prescribe...but it is
                      far from the only remedy for nausea.

                      > Does anyone know about Carafate?  Is
                      > it supposed to work right away?
                      > Should I just add back the Pepcid AC 1/4AM & 1/4PM or just 1/4 or none at
                      > all?  How would I dose the Carafate and the Pepcid to give him both?
                      >
                      I (my opinion only) would get rid of both of them and use slippery elm bark.

                      > He wants to see his daily caloric intake for 4 days. He wants to see if he
                      > is eating a normal amount of food and still losing weight, or not eating
                      > enough food due to nausea or his teeth or both or something else.
                      >
                      And that's a good idea. It's always a good idea to keep track of how much the
                      cat is eating.

                      >   He wants
                      > me to get a gram scale and weigh every piece of Skylar's food that he
                      > eats for 4 days and chart it.  (Easier said then done) . (Sighing again).
                      >
                      But this is not necessary. You can figure out how much the cat is eating from
                      the can. If it's a 5.5 oz can...and you feed half...you're feeding about 2.25
                      oz. Etc. A/d contains 32 calories per oz. If he eats 2.5 oz, he gets about 70
                      calories. The average adult cat needs *about* 20-30 calories per lb of ideal
                      body weight per day. If Skylar is 10 lbs, he needs about 200-300 calories per
                      day.

                      > We are going to start Transdermal
                      > Methimazole (less GI effects than the pills) and will see if he starts
                      > eating better on that and the Carafate. 
                      >
                      If you have decided to use methimazole at all, then the transdermal form may
                      reduce adverse effects. Carbimazole is another thyroid drug that some
                      caregivers use when the cat can't tolerate methimazole. But I thought the internist
                      told you to stop the methimazole, didn't he? Or did I misunderstand?

                      > For some reason, no one wants to believe that he can
                      > possibly be nauseous and have inappetance from Methimazole and Atenolol.
                      > Side effects of both these drugs say this, don't they?
                      >
                      Yes, they do.

                      Candace, you are Skylar's caregiver and advocate, and Skylar is relying on
                      you to make informed decisions on his behalf. If none of the professionals
                      involved wants to believe you, then you have several choices: you can listen to
                      them instead of your own observations and information while Skylar continues to
                      suffer; you can insist that they listen to you until you get the care you want
                      for your cat; or you can find someone who will listen to you. You are the
                      vets' employer. The vets are offering a professional opinion, which you can agree
                      or disagree with. But the cat is ultimately your responsibility.

                      >    Even if he has
                      > something else like dental problems, why can't he still  nauseous and have
                      > Hyperthyroidism  with or without Heart disease?  (Sighing Again)
                      >
                      He can.

                      > Forgive me, but am I not seeing something clearly or am I missing something
                      > all together.
                      >
                      I don't know. But it seems clear to me that the practitioners involved with
                      Skylar are not being responsive to you nor providing the care you expect for
                      your cat. So you will need to decide what you want to do about that.

                      > Poor Skylar hated it there and had a really bad time.
                      >
                      I don't blame him. It sounds as if his needs were not being addressed.

                      > He
                      > can't handle all this and it's just so upsetting.
                      >
                      Of course it's upsetting. And your upset is telling you something.

                      If the type of care that you are getting for Skylar is upsetting to him and
                      you, then it might be time to consider another type of care. // Rosemary


                      [Non-text portions of this message have been removed]
                    • moonpye
                      Hi Sue, I agree with you and Leah, that s what we have been doing. That s what the specialists don t like, but that s what were doing. Thanks, Candace ...
                      Message 10 of 11 , Jul 2, 2006
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                        Hi Sue,

                        I agree with you and Leah, that's what we have been doing. That's what the
                        specialists don't like, but that's what were doing.



                        Thanks,

                        Candace






                        On 7/1/06, Sue at MAGDRL <susan@... > wrote:
                        >
                        > Candace,
                        >
                        > I was trying to word a response but Leah said it all. Stand up for Skylar
                        > and push back with this IM. He sounds like he knows a lot, but doesn't
                        > understand how it all fits into the big picture. You will have to guide
                        > him
                        > to get the best for Skylar. Don't back down!
                        >
                        >
                        > Sue
                        >
                        >
                        >
                        >


                        [Non-text portions of this message have been removed]
                      • Sue at MAGDRL
                        Candace, Too bad for the specialists and hooray for you! I have no sympathy or patience for people who harm animals in any way whether intentional or through
                        Message 11 of 11 , Jul 2, 2006
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                          Candace,

                          Too bad for the specialists and hooray for you!

                          I have no sympathy or patience for people who harm animals in any way
                          whether intentional or through ignorance.


                          Sue


                          ----- Original Message -----
                          From: "moonpye" <moonpye@...>
                          To: "feline-heart" <feline-heart@yahoogroups.com>
                          Sent: Sunday, July 02, 2006 8:51 PM
                          Subject: Re: [FH] IM Update-Would Like Some InPut (Long)


                          > Hi Sue,
                          >
                          > I agree with you and Leah, that's what we have been doing. That's what the
                          > specialists don't like, but that's what were doing.
                          >
                          >
                          >
                          > Thanks,
                          >
                          > Candace
                          >
                          >
                          >
                          >
                          >
                          >
                          > On 7/1/06, Sue at MAGDRL <susan@... > wrote:
                          > >
                          > > Candace,
                          > >
                          > > I was trying to word a response but Leah said it all. Stand up for
                          Skylar
                          > > and push back with this IM. He sounds like he knows a lot, but doesn't
                          > > understand how it all fits into the big picture. You will have to guide
                          > > him
                          > > to get the best for Skylar. Don't back down!
                          > >
                          > >
                          > > Sue
                          > >
                          > >
                          > >
                          > >
                          >
                          >
                          > [Non-text portions of this message have been removed]
                          >
                          >
                          >
                          >
                          > Your reply will go to the author of this message. If you feel your reply
                          will benefit the entire group, please change the "To:" line to
                          feline-heart@yahoogroups.com
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                          >
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                          >
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