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

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  • 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 1 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 2 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 3 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 4 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
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            > Yahoo! Groups Links
            >
            >
            >
            >
            >
            >
            >
            >
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