Hyperthyroid/Mild Kidney Issues

ObeseChess

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Well, folks, I guess it's one of those things that happens to cats as they get older.

Sassy, who I pulled off the street a few years back, is 14 on the low end - testimony from neighbors suggests that she could be closer to 17 or 18, but the vet's guess based on dental health is 14. At her check-up this past weekend, we noted that she had lost about half a pound and did her usual blood work. She's been on very low dose felimazole (2.5mg) for a few years for hyperthyroidism. Her thyroid values have continued to increase - right now I think she's at 6.2mcg, whereas optimum is between 1 and 4.7 (this time last year she was at 4.8). She also has very early stage, very mild kidney disease, which he says is likely related to the hyperthyroidism. Right now we are upping her dosage of felimazole to 3.75mg a day - the vet says that right now it's a balancing act, as lowering thyroid levels too much too quickly can make the kidney damage worse due to the change in blood flow - and going back for more blood work next month.

He does not believe we need to modify her diet as she is already getting high quality senior cat food (Tiki Cat "Silver," grain free, low phosphorus, high omega-3s) and drinking plenty of water.

She is otherwise very healthy - her teeth are clean and sharp, her vision, hearing, and cognition are all perfect, her coat is soft and smooth, she eats normally and drinks plenty of water, blood pressure is great, all other blood work looks "perfect" per the vet, and she remains playful, active, and curious - she has recently learned how to open cabinets and drawers, and she's almost got the hang of light switches.

The vet says she's probably still got a few years left as long as we get everything sorted with the thyroid, but I am, of course, aware that this is the beginning of the end for Sassy. She's my first cat, so I had just kind of planned on her living forever and I'm not thrilled about confronting reality.

Does anyone have any other insight, tips, etc on keeping her happy, healthy, and comfortable for as long as we can? Supplements, general advice, etc?

Thanks!
 

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Hi -
This concerns me that your vet is stating there's no need to change the diet.
she had lost about half a pound
If this were my cat, and I had much of the same issues with my angel Poppycat, I would be looking at adding calories so as to try and halt the weight loss, because it won't stop otherwise.

Weruva has low phos as well as extremely low phosphorus foods, --the last one being Weruva WX, which doesn't require a vet prescription. This is wonderful for kidney kitties.
Wx Phos Focused
You will see a statement on the cans that the WX food isn't nutritionally complete. Weruva was required by the AAFCO to make that statement because the phos level is lower than their requirements, or the food would never have made it to the sheves. All other nutrients in the WX varieties meet AAFCO requirements.

However, regarding iodine levels in cat food, for your informational purposes there is Hills Y/D which is specifically made for cats with Hyper-T, in that the iodine levels are very minimal. I'm just mentioning this (I realize you're using the med for her) because although Weruva maintains iodine levels as low as the AAFCO will allow, Tiki Cat doesn't list iodine in their nutritional breakdown and my experience in researching other brands was that some companies can have high levels of iodine. You may want to contact Tiki Cat and ask.

Also, make sure your vet keeps a very close eye on her liver numbers as you go along.
 
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ObeseChess

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Hi -
This concerns me that your vet is stating there's no need to change the diet.

If this were my cat, and I had much of the same issues with my angel Poppycat, I would be looking at adding calories so as to try and halt the weight loss, because it won't stop otherwise.

Weruva has low phos as well as extremely low phosphorus foods, --the last one being Weruva WX, which doesn't require a vet prescription.
Wx Phos Focused
You will see a statement on the cans that the WX food isn't nutritionally complete. Weruva was required by the AAFCO to make that statement because the phos level is lower than their requirements, or the food would never have made it to the sheves. All other nutrients in the WX varieties meet AAFCO requirements.
Oh, sorry, I was unclear - what I meant is that he does not think that her food is causing issues (as lower quality and/or dry foods can lead to kidney issues) and that it is fine to keep feeding her the Tiki Cat, but you are correct that he does want to see if we can get more calories in her to get her to put some weight back on (Tiki Cat makes a high calorie food additive expressly for this purpose), and I am going to be weighing her weekly and reporting to him until the follow-up appointment next month. I hope that makes more sense and clears up your concerns. I will certainly talk to him about the Weruva low phosphorus foods too, and I appreciate the recommendation.

EDIT: and yes, full blood panels are being done every six months, including liver values. We may do these quarterly going forward as we monitor the CKD and thyroid more closely.
 
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Hi. Feeby (19+ yo) was diagnosed 3 years ago with hyperthyroidism and has since been diagnosed with CKD. Your vet has said the same thing as mine re: the balancing act. Not letting the thyroid level go too low to keep the kidney disease less progressive. So, I was told to try to keep her T-4 between 2.0 and 3.0. And, that can harder said than done. Feeby is currently at 1.9 so we are not making any changes to her thyroid meds.

What are your cat's kidney values - creatinine, BUN, and phosphorus, in particular?

Are you familiar with Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Everything You Need to Know to Help Your Cat (felinecrf.org)? A very comprehensive web site about all things CKD. I have learned a lot from this site and reference it often. So, don't let the size of it intimidate you from reading through it. You can always start here - Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - What You Need to Know First (felinecrf.org).

The big issues tend to be poor appetite and sometimes nausea. Feeby is given mirtazapine (Mirataz transdermal gel for the inner ear) for the former, and intermittent ondansetron for any nausea. There will come a time when your cat will benefit from sub-Q fluids which can be given at home (not hard at all). As far as food, you can try seeing if your cat will eat lower phosphorus foods, but if she will not phosphorus binders can be added to regular cat food to offset the phosphorus effects. Feeby does not like any of the CKD prescription foods nor most of the lower phosphorus foods, so she gets Phos-Bind added to the foods she will eat. These are the most common issues, but each cat is different, so other things may crop up for your cat, and most are covered in Tanya's web site.

I also give Feeby baby food meat (Gerber Stage 2 or Beechnut) to supplement her calories. All but the chicken flavor, due to calcium content, can be made nutritionally complete by adding EZ Complete. A 2.5 ounce jar is anywhere from 70-90 calories depending on the flavor/brand.
 
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ObeseChess

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I will pull the kidney values when I can, I think I have them in an email somewhere. I will read the CKD guide, I missed that! Thank you!

Sassy's appetite is just fine and she is already eating what I thought were low phosphorus foods, but Tanya's guide above suggests that the Tiki Cat Silver is actually fairly high in phosphorus, comparatively, so I will see if I can switch her to something lower. I appreciate that, and thanks to Furballsmom Furballsmom for pointing it out - I'll see if I can get the Weruva stuff after discussing with the vet. She is mercifully not a picky eater and has historically liked Weruva's offerings in the past.

Sassy also loves human food and will be thrilled at the prospect of having to eat, say, baby food meat or more chicken or fish.

Thanks again to both of you!
 

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https://www.idexx.com/files/feline-hyperthyroidism-diagnostic-update-en.pdf

The hyperthyroidism can mask pre-existing kidney disease because it increases the blood flow to the kidneys. The way my vet explained it is that we want to keep a balance of the thyroid levels on the high side of normal to keep blood flow to the kidneys but not so high as to cause hypertension and the other problems that result from hyperthyroidism. The above article explains quite a bit fairly quickly about hyperthyroidism.
 
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ObeseChess

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https://www.idexx.com/files/feline-hyperthyroidism-diagnostic-update-en.pdf

The hyperthyroidism can mask pre-existing kidney disease because it increases the blood flow to the kidneys. The way my vet explained it is that we want to keep a balance of the thyroid levels on the high side of normal to keep blood flow to the kidneys but not so high as to cause hypertension and the other problems that result from hyperthyroidism. The above article explains quite a bit fairly quickly about hyperthyroidism.
Hi there! Yes, that's basically my understanding as well, that the kidneys basically "adapt" to having the excess of blood and that it's possible to overcorrect this and cause further damage. She's been mildly hyperthyroid for quite a while but her kidneys have always been healthy up until this most recent check-up, so I think we caught whatever is happening very early. The vet notes that she has a strong, healthy heart with good blood pressure and is very hydrated and that both of these are mitigating factors.

So, it's my hope that as long as she keeps taking her meds, especially at the increased dose, help her live a long and comfortable life of digging through my cupboards yet.

Thanks for the link!
 
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ObeseChess

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Alright, well, we are managing. We've switched her to a low phosphorus diet pretty seamlessly - she quite enjoys the Weruva WX Phos Focused and the Young Again Senior Carnivore pet food noted on Tanya's site above.

The problems now are twofold.

One, getting her enough calories - I think that will largely subside when the calorie-dense Young Again pet food comes in (she inhaled the samples, but the big bag of food itself is not going to arrive until Friday evening). I'm also supplementing with the Tiki Cat "senior comfort" calorie supplement, so hopefuly we can beef her up a bit. If needed, I'll try the baby food + EzComplete method that FeebysOwner FeebysOwner has discussed elsewhere. But she's gotten very picky over the past few months. We've ruled out nausea and dental issues as she has a big appetite, it appears to just be behavioral, just a constant guessing game of "I don't want this food, I want that food." Frustrating but not insurmountable.

The second, bigger issue we are having now is that she will not take her meds and it is driving me insane. She reliably took chicken pill pockets twice a day every day for the past four years. She now, as of maybe six weeks ago, will not touch them. Nor salmon flavor. Nor tuna flavor. Nor catnip flavor. None of them. She will not even look at them. If I hide her pills - two tiny little pills - in grilled chicken, grilled salmon, canned tuna, cheddar cheese, butter, yogurt, you name it, she will eat around them or vomit the pills back up. We tried the syringe of flavored medication and she would immediately vomit it back up. So now I've got a transdermal for the felimazole in the mail and have tried to get her adjusted to me touching her ears in preparation - just a gentle swipe in the tip of the ear, like I'd need to for a transdermal medication, and then she gets a churu treat and and an extra brushing session. This worked for three days, and now the gentle swipe of the ear is immediately met with biting, scratching, and hissing. Assuming I can adjust her back to letting me touch her ears, this is fine for the felimazole, but she also takes a tiny, tiny, tiny dose - 0.625mg - of amlodipine, and I don't know how I'm going to start sneaking that past her again.

It's like she's decided she's had enough of being alive and is going to make it as miserable as possible for everyone involved. I mean, I know that's not the case given how cuddly, playful, and curious she is, but, again, this is driving me insane. Both issues - the constant guessing game with the food and the refusal to take pill pockets - happened at the same time out of nowhere a few weeks ago, and multiple vets have determined that there's nothing physically wrong, it's just behavioral.
 
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So now I've got a transdermal for the felimazole in the mail and have tried to get her adjusted to me touching her ears in preparation - just a gentle swipe in the tip of the ear, like I'd need to for a transdermal medication, and then she gets a churu treat and an extra brushing session....she also takes a tiny, tiny, tiny dose - 0.625mg - of amlodipine, and I don't know how I'm going to start sneaking that past her again.
That is so odd, well kind of anyway. Feeby will take crushed felimazole in a bite of food or a lickable treat. Ditto with the amlodipine. Neither appears to have enough taste to dissuade her from eating them this way. Other meds are a whole different story!!!.

I have used pill pockets and pill masker - both of which Feeby got tired of over time (not nearly as long as you used them). I did manage to use these for a while longer by coating them in Forti Flora. So, you could try that too. But try giving her those meds crushed up into a bite of food or one of the many lickable treats they have. I use Churu, but also Vitakraft, Temptations, Catit, Fussie Cat, and Squeeze Ups - just so, like her foods, she never gets the same thing all the time.

I don't think it is behavioral at all, although I sometimes want to scream when Feeby gets picky about her meds and her food - which is a lot!!!! .
 
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ObeseChess

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That is so odd, well kind of anyway. Feeby will take crushed felimazole in a bite of food or a lickable treat. Ditto with the amlodipine. Neither appears to have enough taste to dissuade her from eating them this way. Other meds are a whole different story!!!.

I have used pill pockets and pill masker - both of which Feeby got tired of over time (not nearly as long as you used them). I did manage to use these for a while longer by coating them in Forti Flora. So, you could try that too. But try giving her those meds crushed up into a bite of food or one of the many lickable treats they have. I use Churu, but also Vitakraft, Temptations, Catit, Fussie Cat, and Squeeze Ups - just so, like her foods, she never gets the same thing all the time.

I don't think it is behavioral at all, although I sometimes want to scream when Feeby gets picky about her meds and her food - which is a lot!!!! .
Yeah, Sassy seems to be able to smell/taste the medicine no matter what I put it in, and then she will avoid that thing for weeks. Even pill pockets without anything in them, she’s very skeptical of. I imagine her keen senses are how she survived outdoors near a wildlife refuge before we rescued her - no other cats in that neighborhood did - but it sure is a pain in the butt for me.

Re the pickiness with food, she may also be feeling bad, our hope is that getting her back to normal with the transdermal felimazole will eliminate the pickiness issues and if not we can troubleshoot further.
 
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ObeseChess

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Well, fingers crossed - I reached out to the folks who make EzComplete for some samples. In the process, the nice lady I spoke to, Laurie, suggested it may be nausea, which is often undiagnosed in cats. She recommended I try slippery elm bark syrup, which she gave me a recipe for. I ran out and bought some slippery elm bark tablets and gave Sassy a 1:1 mix of the syrup plus some tuna juice and 20 minutes later she ate an (empty) pill pocket out of my hand for the first time in weeks.
 
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ObeseChess

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No luck with pill pockets with pills in them, but she does seem to be in better spirits. I’ll get up early tomorrow and give her some more. Minimal drama with the transdermal ear goop this evening, though I’m thinking only about half of it got through the fluff while she was shaking her head around. Her taking pills again would be ideal!
 

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I reached out to the folks who make EzComplete for some samples. In the process, the nice lady I spoke to, Laurie, suggested it may be nausea, which is often undiagnosed in cats. She recommended I try slippery elm bark syrup, which she gave me a recipe for. I ran out and bought some slippery elm bark tablets and gave Sassy a 1:1 mix of the syrup plus some tuna juice and 20 minutes later she ate an (empty) pill pocket out of my hand for the first time in weeks.
As I had previously mentioned, nausea can be a common issue for many things, CKD included. It is not so much that it is undiagnosed, but with some cats it is hard to tell if that is the actual issue with poor appetite.

What was this recipe? Just curious as I cannot get Feeby to take ondansetron for her possible nausea. Do you know what this concoction tastes like? You might want to test it yourself just so you know. If it doesn't taste particularly good, she may not take it consistently. If she can smell pills masked in pill pockets, as you think she can, she isn't going to eat something that smells/tastes poorly.
No luck with pill pockets with pills in them, but she does seem to be in better spirits. I’ll get up early tomorrow and give her some more. Minimal drama with the transdermal ear goop this evening, though I’m thinking only about half of it got through the fluff while she was shaking her head around. Her taking pills again would be ideal!
Does she have that much hair on the inside of her ear? That is one of the reason the transdermals are placed in the pinnae of the ear, because it is usually where the least amount of hair is. Also, you will need to clean her ears with a warm, dampened cotton ball or makeup pad every couple-three days to ensure the med doesn't build up in the ear, which can impact absorption and efficacy.

Oh, btw, don't touch the pills before putting them in pill pockets. Some members claim that causes the pill pocket to smell like the pills. Cut the pill pocket in half, use the half-pocket to pick up the pill and then cover it with the other half. Not saying it will work, because it really hasn't made much of a difference for Feeby, but it is worth trying.
 
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ObeseChess

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1. It's one cup of water to one teaspoon of slippery elm bark, boiled together and then simmered until it thickens. I've seen recipes that say a half cup of water and I think I'm going to try that next as the one I made is thinner than in the photos I saw on the website. It's supposed to have a very mild, sweet taste, but sometimes slippery elm bark can get a little iffy and take on a sour taste for any number of unknown reasons, so you are encouraged to taste it first to make sure that it is mild and sweet. It was indeed. I put some in my coffee this morning in solidarity. Sassy definitely noticed it wasn't just tuna juice and definitely had a "hmmmmmm... I'm not sure about this" moment this morning, but she ate it without much fuss again.

I could be projecting, but she seems to be in better spirits and the slippery elm certainly isn't hurting anything, so I'll keep using it.

2. The issue isn't so much that she has a lot of fur on the pinnae of her ear, the issue is that she wouldn't stop wiggling last night and some of the medicine got in the fluffier bits - she can really move those ears!. She was calmer about it today, but it's definitely going to take practice.

3. Yeah, that hasn't been the issue - she reliably took pill pockets for almost four years, and I never touched the pill and the pocket with the same hand - it's just that now she won't even touch them, any flavor, even if there's no pill in them, except for in very random circumstances when she feels like it. You had mentioned fortiflora and it's like, even if I toss them in fortiflora, she will just lick the fortiflora off and then spit the pill pocket back out.
 

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Pill pockets, crushing, hiding never worked for me on anything other than the dumbest of dogs.

Cats are too smart for that. The vet showed me how to give a cat a pill a long time ago and it has never failed, tilt the head back, pull the jaw down and flick the pill over the hump of the tounge, snap the jaw closed and rub the neck until the cal licks their lips.

If you spike their food they know it and act like you just offered them a rotten lemon.
 
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ObeseChess

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Yeah, on our next vet visit if she's not too drugged I might ask the vet for tips with that. I've seen people do it but I've never been able to figure out a way to do it comfortably. I am a competitive powerlifter and weigh just shy of 210, Sassy by contrast is just under 8lbs, so I worry about hurting her, even if I know it's very unlikely that I will do so via such a simple process as "giving her a pill."
 

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Cats are too smart for that. The vet showed me how to give a cat a pill a long time ago and it has never failed, tilt the head back, pull the jaw down and flick the pill over the hump of the tounge, snap the jaw closed and rub the neck until the cal licks their lips.
Sure, it might be the only thing to do with a cat that is on some TEMPORARY med, but it is not the way to go for a cat, most likely elderly, that will be on meds the rest of their lives and would need this done 3, 4, 5, or maybe even 6 times a day.
 

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Sure, it might be the only thing to do with a cat that is on some TEMPORARY med, but it is not the way to go for a cat, most likely elderly, that will be on meds the rest of their lives and would need this done 3, 4, 5, or maybe even 6 times a day.
I'm in that situation myself actualy Kabuto takes a pill twice a day for his thyroid he needs it for the rest of his life. Fortunatly he will sit on my lap and let me open his mouth and pop the pill in, then he goes right to his waterbowl to wash it down.

Like i said, cats are very smart animals.
 
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