This is long and ridiculous. If you have not yet had the "pleasure" of reading one of my ramblings, I'd probably advise you to move past this one as well, it's probably not pretty Just word vomit at it's finest.
I am fairly new to this site and have a had couple of threads related to one of my kitties, Biscuit (9yo tabby). She's had a few absence seizures a year the last couple of years and things really ramped up starting mid September, when she had head tremors lasting 5 minutes in the middle of the night. The next day we took her to the vet and found her ALTs to be 4x what they should be at 488. Fast forward 5 weeks and she has had two separate stays at the e-vet (one overnight/2 day stay, an ER visit (not admitted) and another 2 night/3 day stay a couple weeks later). At the first hospitalization, by the time we got her there (an hour drive from primary vet), she had low oxygenation and was not breathing well, and she went from stable to scary very quickly.
They did full bloodwork up, chest x-rays, abdominal x-rays, abdominal ultrasound, echo, EKG, and everything came back normal except for the enzymes. No explanation whatsoever for what was causing the elevated liver enzymes or her seizures.
At the next ER visit after another seizure (not admitted) they did another EKG to appease me and that was normal.
At the 2nd hospitalization, it happened to coincide the same week she had a neuro consult at the same facility, they did more bloodwork, urinalysis, brain MRI, CSF tap. Based on all of her symptoms the neurologist prepared us for the likelihood of her having a meningioma. It's unncommon for cats her age to get epilepsy, and especially since she's not having grand mal seizures, it's even more strange. Her symptoms indicate pressure on specific parts of the brain. However, ALL of that came back clean. No tumors, no infections, no autoimmune, nothing. She was diagnosed with Atypical Idiopathic Epilepsy and started on Keppra three times a day.
(unrelated to the diagnosis, but bloodwork showed that her ALTs had gone back down to normal in the 2 week period since the last tests).
This past weekend (2 weeks later) she had a dental cleaning that had already been scheduled. We had planned to cancel it but since her liver enzymes were normal, the vets felt confident that the anesthesia should be fine. They ran new bloodwork (included in her annual exam) and I asked them to run a thyroid test. Every single vet (at least 5) I've seen in the last several weeks have laughed and told me I am crazy because there is NO WAY she is hyperthyroid because cats "that look like her cannot have hyperthyroid". She is overweight and her coat is nice. But she eats constantly, drinks more water now, and she's lost 2.5 lbs since May. I asked my vet to run it anyway because I've already spent an ungodly amount of money, another $40 to rule another thing out is not going to break me.
Lo and behold, her T4 is 6.9. Also her ALTs are back up to 280. They prescribed Methimazole 2.5mg twice a day. However, I've already done a ton of reading on HT and the vet I saw (her usual office but diff vet than my normal one) gave me almost zero information on HT. So I immediately emailed all of the info to the neurologist, to at least ask if the Keppra could cause the elevated T4 or to make sure there would be no interaction with the two drugs. By the time I finished speaking with his nurse last Monday night, I had an expedited appt scheduled for 11/13 to see an endocrine specialist at that facility for I-131 treatment. We will meet with him that day, he will examine her and do another ultrasound and another echo and if all checks out, she can actually get the treatment that day, so we have not started the Methimazole.
I've been spending basically all my spare time reading up on HT and anything else I can find and I am rollercoastering between feeling like it's too fast to jump to I-131 because she's not showing symptoms to feeling like the appointment can't come soon enough because her teeny tiny kitty heart is going to burst at any moment.
Also I am cycling through anger because I've read that another indicator of early stage HT can be mild elevation of ALTs with no apparent causation. Well, why would no one question that, especially after I took the time to question it? Also, I read that liver enzymes don't fluctuate quickly, but then how could hers go from 488 on 9/21, to 130 on 10/8 to 280 on 10/27. I'm not a vet but that seems like a pretty big change to me. And her creatinine is 0.6. I've gone through every single bloodwork she's ever had and it has always been 1.4-1.8 until this year when it was 0.9, 0.7, 0.6 and again now 0.6. How is that not a flag of some kind? Apparently low creatinine can be an indicator of muscle wasting, despite the fact that everyone has deemed her as having no muscle wasting (but has gotten mighty boney for someone who is fat). These two things can very well be completely unrelated, but if they are possibly not, then why dismiss me so easily?
And, what is the likelihood that she really DOES have heart issues and all of the tests missed it, even the echo? (She also had ProBNP done in May to test for HCM and that came back normal/negative). And even if she really was "clean" in September, how quickly could she develop heart failure if she's hyperthyroid? And what are the chances of it being reversible, especially since hopefully we've caught it early enough since she's not showing severe symptoms (ie not very underweight, coat still full/silky, no murmur, I don't even know what else).
I can see her heartbeat at times in her throat, so I assume it's her jugular. I feel like that's not normal, like when she's laying down. My mom's used to do that before she had an ablation done, so I assume if it's not normal for people the same might be true for cats. But wouldn't that be expected if she's HT?
Is there any downside to going straight to I-131 this quickly? To me it seems logical to put a stop to the HT as quickly as possible to stop any damage to her other organs as quickly as possible, but am I not taking something into account?
I doubt anyone is still reading this mess of a post. I wouldn't be. But I just need someone to talk me off my proverbial ledge. I feel like I have no one to talk to. All of the vets can only say so much, and if she does have heart issues I can't keep bringing her in at every tiny thing I read because it's just going to keep stressing her out more. People in my life already think I'm obsessed. My family is understanding but think I'm causing myself more harm than good by reading things. But if I'm not reading then I'm not educated and I have no clue what to ask. I know that Dr. Internet can only tell us so much, but at least I can familiarize myself with concepts and terms and ask semi-educated and relevant questions. And so far it's paid off because my instincts have gotten us this far. For instance, being stubborn on the HT thing.
But I just don't want to fail her now.
I don't really know what I'm looking for in terms of responses. Just had to vent I guess? If anyone has experienced similar, did you catch it early? do you wish you could have treated sooner, or later? did your baby get heart disease way faster than you expected? (ie, had a clean bill of health for sure and then suddenly didn't?) Was it reversible?
Also, what kind of behavior changes did your cats have? I know the big things like being more active, etc. But for instance, when she's laying down but alert (like head up) with her legs out in front of her, she's like constantly re-adjusting her front paws, almost like restless leg syndrome. It's not dramatic jerky movements, they are small & delicate movements but I can't really describe it. And I can't find anything online that matches. Not sure if it's related or just her being finicky as she ages? Now I feel like everything might be a symptom.
And her voice has changed. It seems much more delicate and a little higher than normal, and she's less vocal most days. I miss my annoyingly loud, whiny, demanding, relentlessly yelling cat.
I am fairly new to this site and have a had couple of threads related to one of my kitties, Biscuit (9yo tabby). She's had a few absence seizures a year the last couple of years and things really ramped up starting mid September, when she had head tremors lasting 5 minutes in the middle of the night. The next day we took her to the vet and found her ALTs to be 4x what they should be at 488. Fast forward 5 weeks and she has had two separate stays at the e-vet (one overnight/2 day stay, an ER visit (not admitted) and another 2 night/3 day stay a couple weeks later). At the first hospitalization, by the time we got her there (an hour drive from primary vet), she had low oxygenation and was not breathing well, and she went from stable to scary very quickly.
They did full bloodwork up, chest x-rays, abdominal x-rays, abdominal ultrasound, echo, EKG, and everything came back normal except for the enzymes. No explanation whatsoever for what was causing the elevated liver enzymes or her seizures.
At the next ER visit after another seizure (not admitted) they did another EKG to appease me and that was normal.
At the 2nd hospitalization, it happened to coincide the same week she had a neuro consult at the same facility, they did more bloodwork, urinalysis, brain MRI, CSF tap. Based on all of her symptoms the neurologist prepared us for the likelihood of her having a meningioma. It's unncommon for cats her age to get epilepsy, and especially since she's not having grand mal seizures, it's even more strange. Her symptoms indicate pressure on specific parts of the brain. However, ALL of that came back clean. No tumors, no infections, no autoimmune, nothing. She was diagnosed with Atypical Idiopathic Epilepsy and started on Keppra three times a day.
(unrelated to the diagnosis, but bloodwork showed that her ALTs had gone back down to normal in the 2 week period since the last tests).
This past weekend (2 weeks later) she had a dental cleaning that had already been scheduled. We had planned to cancel it but since her liver enzymes were normal, the vets felt confident that the anesthesia should be fine. They ran new bloodwork (included in her annual exam) and I asked them to run a thyroid test. Every single vet (at least 5) I've seen in the last several weeks have laughed and told me I am crazy because there is NO WAY she is hyperthyroid because cats "that look like her cannot have hyperthyroid". She is overweight and her coat is nice. But she eats constantly, drinks more water now, and she's lost 2.5 lbs since May. I asked my vet to run it anyway because I've already spent an ungodly amount of money, another $40 to rule another thing out is not going to break me.
Lo and behold, her T4 is 6.9. Also her ALTs are back up to 280. They prescribed Methimazole 2.5mg twice a day. However, I've already done a ton of reading on HT and the vet I saw (her usual office but diff vet than my normal one) gave me almost zero information on HT. So I immediately emailed all of the info to the neurologist, to at least ask if the Keppra could cause the elevated T4 or to make sure there would be no interaction with the two drugs. By the time I finished speaking with his nurse last Monday night, I had an expedited appt scheduled for 11/13 to see an endocrine specialist at that facility for I-131 treatment. We will meet with him that day, he will examine her and do another ultrasound and another echo and if all checks out, she can actually get the treatment that day, so we have not started the Methimazole.
I've been spending basically all my spare time reading up on HT and anything else I can find and I am rollercoastering between feeling like it's too fast to jump to I-131 because she's not showing symptoms to feeling like the appointment can't come soon enough because her teeny tiny kitty heart is going to burst at any moment.
Also I am cycling through anger because I've read that another indicator of early stage HT can be mild elevation of ALTs with no apparent causation. Well, why would no one question that, especially after I took the time to question it? Also, I read that liver enzymes don't fluctuate quickly, but then how could hers go from 488 on 9/21, to 130 on 10/8 to 280 on 10/27. I'm not a vet but that seems like a pretty big change to me. And her creatinine is 0.6. I've gone through every single bloodwork she's ever had and it has always been 1.4-1.8 until this year when it was 0.9, 0.7, 0.6 and again now 0.6. How is that not a flag of some kind? Apparently low creatinine can be an indicator of muscle wasting, despite the fact that everyone has deemed her as having no muscle wasting (but has gotten mighty boney for someone who is fat). These two things can very well be completely unrelated, but if they are possibly not, then why dismiss me so easily?
And, what is the likelihood that she really DOES have heart issues and all of the tests missed it, even the echo? (She also had ProBNP done in May to test for HCM and that came back normal/negative). And even if she really was "clean" in September, how quickly could she develop heart failure if she's hyperthyroid? And what are the chances of it being reversible, especially since hopefully we've caught it early enough since she's not showing severe symptoms (ie not very underweight, coat still full/silky, no murmur, I don't even know what else).
I can see her heartbeat at times in her throat, so I assume it's her jugular. I feel like that's not normal, like when she's laying down. My mom's used to do that before she had an ablation done, so I assume if it's not normal for people the same might be true for cats. But wouldn't that be expected if she's HT?
Is there any downside to going straight to I-131 this quickly? To me it seems logical to put a stop to the HT as quickly as possible to stop any damage to her other organs as quickly as possible, but am I not taking something into account?
I doubt anyone is still reading this mess of a post. I wouldn't be. But I just need someone to talk me off my proverbial ledge. I feel like I have no one to talk to. All of the vets can only say so much, and if she does have heart issues I can't keep bringing her in at every tiny thing I read because it's just going to keep stressing her out more. People in my life already think I'm obsessed. My family is understanding but think I'm causing myself more harm than good by reading things. But if I'm not reading then I'm not educated and I have no clue what to ask. I know that Dr. Internet can only tell us so much, but at least I can familiarize myself with concepts and terms and ask semi-educated and relevant questions. And so far it's paid off because my instincts have gotten us this far. For instance, being stubborn on the HT thing.
But I just don't want to fail her now.
I don't really know what I'm looking for in terms of responses. Just had to vent I guess? If anyone has experienced similar, did you catch it early? do you wish you could have treated sooner, or later? did your baby get heart disease way faster than you expected? (ie, had a clean bill of health for sure and then suddenly didn't?) Was it reversible?
Also, what kind of behavior changes did your cats have? I know the big things like being more active, etc. But for instance, when she's laying down but alert (like head up) with her legs out in front of her, she's like constantly re-adjusting her front paws, almost like restless leg syndrome. It's not dramatic jerky movements, they are small & delicate movements but I can't really describe it. And I can't find anything online that matches. Not sure if it's related or just her being finicky as she ages? Now I feel like everything might be a symptom.
And her voice has changed. It seems much more delicate and a little higher than normal, and she's less vocal most days. I miss my annoyingly loud, whiny, demanding, relentlessly yelling cat.