Hyperthyroid early CKD cat (Mumu's new thread)

FeebysOwner

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Hi. I know I previously read on the H-T forum (I know you are on that site too) that you clean the ear not in use. When dosing one ear, you clean the other one so it is ready for the next dosing. Whichever ear is being dosed does not get cleaned until the opposite ear is being dosed.

I don't know about the base it is in - hopefully someone here or on the H-T forum can offer advice from that perspective.
 

Antonio65

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Hi, do you think that this eargel is irritating Mumu's skin? You say that she tries to run away when it's time to apply the gel. Do you think it burns or stings?
I remember that my cat Pallina didn't bother much about the gel, and didn't try to run away from it or that she had any irritations on her ears. She was much more bothered by the handling and rubbing, she didn't like to be handled much, but apart from that she was fine with the gel, much better than with the pills.
Is it possible that the base for that gel has an ingredient that Mumu is sensible to? Would it be possible to ask the compound pharmacy to use a different base?

As for cleaning the ears, I never did that. And at first I didn't even wear disposable gloves. Then I was told to, and so I just cut the fingers from these gloves and covered my finger with one of them. One glove was 5 applications worth.
 

John Perram

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Potential Side Effects
If Mumu's ears are particularly sensitive, they may become irritated from the transdermal gel, which is why it's important not to apply the medicine to the same ear over and over. The witch hazel will also gently clean away any excess medication that hasn't been absorbed. Otherwise, the potential side effects are the same as for the oral medicine: lethargy, vomiting and loss of appetite. Facial itching is rare, but more serious. If Tabby experiences any of these side effects, contact your vet so you can adjust the dosage.
 
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WMM201

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Hi. I know I previously read on the H-T forum (I know you are on that site too) that you clean the ear not in use. When dosing one ear, you clean the other one so it is ready for the next dosing. Whichever ear is being dosed does not get cleaned until the opposite ear is being dosed.

I don't know about the base it is in - hopefully someone here or on the H-T forum can offer advice from that perspective.
Hi FeebysOwner FeebysOwner , yes, the other group also advised to clean Mumu's ears. I did that when I gave her mirataz, because I was told to, so I should have just been doing that with the methimazole, despite what the pharmacist said. I hope it takes care of it. The other group said that Lipoderm is already the best base for the ear gel, so I just have to be diligent with cleaning Mumu's little ears. 😺
 
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WMM201

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Potential Side Effects
If Mumu's ears are particularly sensitive, they may become irritated from the transdermal gel, which is why it's important not to apply the medicine to the same ear over and over. The witch hazel will also gently clean away any excess medication that hasn't been absorbed. Otherwise, the potential side effects are the same as for the oral medicine: lethargy, vomiting and loss of appetite. Facial itching is rare, but more serious. If Tabby experiences any of these side effects, contact your vet so you can adjust the dosage.
Hi John Perram John Perram , Mumu is definitely getting alternate ears with the gel. I will look for some alcohol free witch hazel, thanks for the suggestion!
 
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WMM201

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Hi, do you think that this eargel is irritating Mumu's skin? You say that she tries to run away when it's time to apply the gel. Do you think it burns or stings?
I remember that my cat Pallina didn't bother much about the gel, and didn't try to run away from it or that she had any irritations on her ears. She was much more bothered by the handling and rubbing, she didn't like to be handled much, but apart from that she was fine with the gel, much better than with the pills.
Is it possible that the base for that gel has an ingredient that Mumu is sensible to? Would it be possible to ask the compound pharmacy to use a different base?

As for cleaning the ears, I never did that. And at first I didn't even wear disposable gloves. Then I was told to, and so I just cut the fingers from these gloves and covered my finger with one of them. One glove was 5 applications worth.
Hi Antonio65 Antonio65 I wonder if Mumu might be reacting a little to the latex finger covers I have been using. I switched to using just my finger, but I have some non latex gloves that I will try instead now. I think Mumu runs because she knows I coming with medication, but she can't tell what kind I have, so she just runs! She doesnt seem bothered when I apply it. According to the H-T group, the Lipoderm base her medicine is in is already the least irritating kind, so I am now switching the other variables and doing some ear cleaning. It is a little odd that only one ear is red, but who knows?
 

neely

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I wonder if Mumu might be reacting a little to the latex finger covers I have been using. I switched to using just my finger, but I have some non latex gloves that I will try instead now. I think Mumu runs because she knows I coming with medication, but she can't tell what kind I have, so she just runs!
The compound pharmacy where I get Carleton's Methimazole provides finger cots to apply the gel. I never thought to ask if they are latex or not but fortunately they don't irritate his ears. The pharmacist did tell me to clean his ears daily so I've been doing it on a regular basis. I have my own strategy when giving Carleton his med to try and catch him off guard before he can run. Cats are so smart and they observe everything you do. He doesn't seem to mind too much and it's so much better than trying to pill him.

I hope cleaning Mumu's ear(s) regularly will help it from getting irritated and red. :crossfingers: Best of luck, please keep us posted.🤗
 

Antonio65

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Hi Antonio65 Antonio65 I wonder if Mumu might be reacting a little to the latex finger covers I have been using. I switched to using just my finger, but I have some non latex gloves that I will try instead now. I think Mumu runs because she knows I coming with medication, but she can't tell what kind I have, so she just runs! She doesnt seem bothered when I apply it. According to the H-T group, the Lipoderm base her medicine is in is already the least irritating kind, so I am now switching the other variables and doing some ear cleaning. It is a little odd that only one ear is red, but who knows?
I am sure I would use non latex gloves, but I don't think this is the problem behind Mumu's issue.
I applied the gel to my cat's ears with just my fingers too, until someone told me that this way I would have absorbed half of the dose I was giving my cat. Though it would have probably done nothing to me, it would surely reduced the amount of methimazole my cat was taking.
Best of luck, and please let us know how it goes.
 

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I would ask you vet if there is some sort of gentle soothing cleanser that you just gently rub on... When I gave a terminal kitty the mirataz to stimulate appetite, I would put the ointment in one ear and gently clean the other at the same time. I don't know if the methimazole has something in it that irritates, but you should definitely ask.
 
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WMM201

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Hi Everyone! Been a little MIA with Mumu, but so far, so good. I've taken to cleaning her ears with a warm cloth everyday, and her ears now look fine and happy with the ear gel. I still use gloves most of the time. Her appetite has also been good, and she is back to her ideal weight of 8.2 lbs. She is due for a blood recheck on May 17, which is early since her last blood recheck was mid April. However, I wanted to check on her phosphorus levels, because looking over her records, I noticed that her phosphorus had been around 6 as of a few months ago. For a CKD kitty, I read that this is too high. I called my vet to ask if we should try a phosphorus binder with Mumu's food, but she wanted more recent bloodwork before making that call, which is why we've moved her hyperthyroid blood recheck up. This time, we're getting the senior panel to have as much information as possible. I also called the Exclusively Cats hospital where the vet usually refers her cat patients for I-131 treatment. The woman I spoke with was a tech, I think, and she didn't seem to think that Mumu's early CKD would be a problem at all for the I-131. I asked if they do thyroid scans/scintigraphy to calculate the iodine dose, and she said she hadn't ever heard of a thyroid scan. That gave me pause! However, it is an option to set up a second opinion consultation with the vet there, and I plan to do so after the May 17 blood recheck results come in. Right now, I still feel best about the Ohio State University vet school clinic, even though it's a 3 hr drive away, because their information does include scintigraphy as a "if needed" option. Based on what Antonio65 Antonio65 and others have advised, I'd rather go through a little more trouble and get the most tailored treatment and have no regrets. I still haven't made an appointment yet for Mumu, but I hope for later this summer! M MamaKat9 how is Smoke doing? I read about poor little Sierra, and am sending hugs!
 

Antonio65

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The woman I spoke with was a tech, I think, and she didn't seem to think that Mumu's early CKD would be a problem at all for the I-131. I asked if they do thyroid scans/scintigraphy to calculate the iodine dose, and she said she hadn't ever heard of a thyroid scan. That gave me pause!
I would avoid a facility where they perform such a therapy but haven't heard of that scan before.
Looks for something better.
 

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I wish you all the best with Mumu. I would not damn a vet for the ignorance of the tech. Is it possible that they do some sort of determinative scan etc., but maybe not call it that? I am still cautiously optimistic about Smoke's progress. He gets his 3 month blood work this Friday... its not exactly 3 months, but I am having the vet come to do blood work on Sierra, who is on multiple medications for cancer (in her sinuses) palliative/comfort treatment, so I figured I should do both and save myself the expense of a second house visit in 2 weeks time.

The vet that I used for Smoke's I131 treatment did not call the scan anything in particular, but did tell me that they tailored the dose to his needs since his numbers were not excessive. It was his symptoms that drove the need for the treatment. Some cats do not show any symptoms (and only 30% of hyperthyroid cats noticeably lose hair at all) at the levels that Smoke was at, but he was bald on 3/4 of his back and was always agitated and food aggressive. I tried for a year starting before the initial lock down for the pandemic, to figure out what was going on with multiple bloodwork, diagnostics etc. It wasn't until my daughter, who has a thyroid condition herself, noted that his symptoms were like some of hers, that I thought to ask for the extra thyroid bloodwork which came back with the elevated levels... the levels had been increasing over the normal blood panels done, but were not yet at the alert maker without the free T test. The regular vet and the specialist who did the I131 treatment both thought the numbers were not high enough yet to initiate treatment... I said... will it get better on its own? can you help his skin/fur issues and behavior problems?...As both answered NO that the numbers would just get higher if I waited... I said, then just take care of it NOW before the other organs are compromised...additionally the methimazole made him SICK and lethargic, this was worse than the agitation. His hair has since grown back, but is patchy due to damage done to the follicles during the period he was bald, and he is more himself. You sometimes have to do research (I pay for access to Tufts, Cornell and Michigan U. cat specific research and newsletters for layman and veterinarians - NOT WIKKIs) and go through multiple vets to get what your babies need, I wouldn't delay too long. If Mumu is a candidate for the treatment I still lean towards doing it. The methimazole does not CURE or SLOW down the cause of the thyroid condition, the I131 does. The methimazole can/does also have deleterious effects on the other organs. If Mumu is already a CKD cat, it will only get worse.
 
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WMM201

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I've got another update on Mumu's hyperthyrodism (and CKD). We got a senior profile and urinalysis for her this Monday, one month out from her last bloodwork, because I wanted to get her phosphorus number for her CKD. Her T4 in the latest test results is 3.1, and her creatinine is the same at 1.8, BUN almost the same at 34 (vs 36 in April). The SDMA number went down from 19 to 16. Her phosphorus is is high for a CKD cat at 6.4, so we're starting her on a phosphorus binder. I'm using Phos-Bind, and giving it according to the package directions. I also noticed that her creatine kinase number is very high, 1200 (64-440 is the reference range), but the vet didn't mention it when we went over the bloodwork over the phone. Her neutrophils are also on the low side, 2.613 (the reference range is 2.62-15.17), and went down from 3 in April. Again, her vet didn't mention it when we went over the results initially. I don't really know what these readings indicate, but I wrote to ask about the creatine kinase, because it's so much higher than the reference range. If anyone has had experience with this creatine kinase reading, I'd love to know your thoughts!

The vet thinks that her HT treatment hasn't unmasked any very severe kidney disease, which is great to hear. She seems to be a good candidate for the I-131 treatment, so I've called and talked to two treatment centers. The Exclusively Cats clinic said that dosage would be adjusted based on her diagnostic T4 levels, and when I asked about a minimum dosage, they didn't provide one, but the tech did say that a CKD case sometimes has the dosage adjusted to be lower. A re-do in case the treatment doesn't take would be the same cost as an initial treatment. The Ohio State Veterinary Medical Center said that their low dose is 2 microcuries, and that it's likely that it's what they would give to Mumu. Because Mumu is responding well to medication, they wouldn't do a thyroid scan or scintigraphy for her. If there is a need for a re-do, it's a reduced cost. Both places said that they wouldn't do any supplementation right after treatment in case of hypothyroidism, but would monitor the bloodwork and symptoms after treatment to see if supplementation would be needed.

Right now, I'm pretty certain that I will get the I-131 treatment for Mumu this summer, but I'm still undecided about where to take her. Ohio State is marginally less expensive, and a longer drive away, but it does have a larger staff and be up on the latest research as a veterinary school? The two places are scheduling for the same time in the summer, too. So it's kind of a tough call for me! I'd appreciate any advice!
 

neely

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I'd love to offer advice but I'm not at that point yet. I'm waiting until we bring Carleton in for his next bloodwork and urine check before I make a decision. When I decide to go ahead with the I-131 treatment I've already talked to our vet and we both agreed on the same hospital which is a university affiliated veterinary specialty center. There are two places where we could have it done but I'm much more inclined to go with this one and since our vet agreed that's one less decision I will have to ponder.

I'm sure you will get more helpful advice and suggestions from the members with further H-T experience My thoughts and best wishes to Mumu and you. 🤗
 
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WMM201

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I'd love to offer advice but I'm not at that point yet. I'm waiting until we bring Carleton in for his next bloodwork and urine check before I make a decision. When I decide to go ahead with the I-131 treatment I've already talked to our vet and we both agreed on the same hospital which is a university affiliated veterinary specialty center. There are two places where we could have it done but I'm much more inclined to go with this one and since our vet agreed that's one less decision I will have to ponder.

I'm sure you will get more helpful advice and suggestions from the members with further H-T experience My thoughts and best wishes to Mumu and you. 🤗
You know, neely neely , I found the university affiliated center's tech to be both more knowledgeable and also more, I don't know how to put it, not really trying to book Mumu on the schedule for the I-131 treatment. Which actually made me feel better, that he was very good about answering my questions but wasn't trying to sell me the services. The tech at the other clinic was very kind also and answered as many questions as she could, and wasn't pressuring me either, but she didn't quite have the same depth of answers for me. I am still mulling it over, but I do also feel better about OSU right now. But, above all, sending my best to Carleton for his coming recheck and to you!
 
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