I-131

[loulilah]

Dear all,

My cat was recently diagnosed with hyperthyroidism during routine bloodwork in preparation for a dental procedure.

We quickly decided the radioiodine treatment was the only/best decision for us. However, we are having a very difficult time knowing how to choose a doctor or clinic that performs the procedure.

We are based in New York City (Brooklyn), the costs vary widely, with the most well-known doctor (Peterson) quoting a cost of $3250, while a clinic 2h30 hours away in Pennsylvania costs $1150, one-third the price! There are several other options on Long Island and elsewhere nearby that cost somewhere in the middle.

Cost is a big concern for us, but of course we want our little guy to get someone good, competent, caring, and - most importantly - who has a good track record.

Does anyone have any recommendations in the New York area? And/or any reassurance about this procedure being so straightforward that it doesn't really matter who performs it. Please help! I'm really at a loss here...

Thanks in advance!

 

[babiesmom5]

My cat had the I-131 treatment years ago we were totally pleased. You really need to get a vet with a lot of knowledge and experience in this procedure as its irreversible once done.

I would be glad to discuss my experience further and recommend someone in PA just outside Philadelphia if you care to PM me. How old is your cat?

 

[BestBabyC]

Dear all,

My cat was recently diagnosed with hyperthyroidism during routine bloodwork in preparation for a dental procedure.

We quickly decided the radioiodine treatment was the only/best decision for us. However, we are having a very difficult time knowing how to choose a doctor or clinic that performs the procedure.

We are based in New York City (Brooklyn), the costs vary widely, with the most well-known doctor (Peterson) quoting a cost of $3250, while a clinic 2h30 hours away in Pennsylvania costs $1150, one-third the price! There are several other options on Long Island and elsewhere nearby that cost somewhere in the middle.

Cost is a big concern for us, but of course we want our little guy to get someone good, competent, caring, and - most importantly - who has a good track record.

Does anyone have any recommendations in the New York area? And/or any reassurance about this procedure being so straightforward that it doesn't really matter who performs it. Please help! I'm really at a loss here...

Thanks in advance!

I can tell you exactly where , Red Bank Valley Animal Hospital in Tinton Falls, NJ. I'm in manhattan . I consulted with Peterson's office . I also consulted with profs at vet schools and even called a famous vet that posts YouTube vids who works in Orange County, CA. My girl cat was barely hyper t so I had time . What is your cat's free T4?
Now this part is critical , ALL places dose too high and your cat will become hypothyroid within the first 6 months , definitely at a year . Ask Dr P's office and as many experts across the country . Then they will need pills daily for life , will be fat and depressed . The dose is critical . Vets either got upset when I asked them to adjust lower or started saying I was getting bad info . Dr P does dose very low . I didn't take her there for other reasons , I was not in agreement with the study protocols because it involved dose adjustments and that was unacceptable . But i won't go into the rest because I don't want to bad mouth him as he does do better work than most.
Do not take your cat to Cornell u either , they sedate and the students do it! They have short rotations so for most , it's their first try and they consult with the dr via Skype .

There are very important things you must do:
1) medication trial and run labs again. This is to see if her kidneys are sound . Hyper t conceals kidney damage . This step is critical , many cats pass away from this . Medication trial. I did mine for 3 weeks then off 10 days , then treated her
2) abdominal and cardiac ultrasound
3) chest X-ray

The scintography is not necessary at all and there are drawbacks .

After tx, you need to check her labs 30 days post , 3 months, 6, 9 and 12. The kidneys and to see if she went eurothyriod or hypothyroid

Believe me , I spent 4 months collecting endless data , the doses are high because the company that sells it, gives them a chart . The $1100 places are the worst , they're mills and the stats are , 80% become hypo. They'll tell you no but they're certainly lying .they don't want to have to repeat it for free so they dose high , plus they don't care .

All the places gave me a dose quote that was 2 to 2.5 times what she ended up getting . She is 1.5 years out, cured and has been checks 7 times via labs and exams .

I can tell you the internist , Dr Green at red bank is the best ever. Very intelligent , honest and an outstanding dr. My cat stayed 4 days. Twice a day I received status calls, 1 from the tech and one from Dr Green. You will not get that from ANY office in New York State, I checked with all of them. Also, red bank is 24 hrs with a house full of specialists . It was around $2200 but I'm not positive . But that came with the X-ray , ultrasounds , exams , boarding and treatment . The hospital is better than anythybb you'll find in New York plus they care about their reputation and animals .

I know Dr Green is away until 9/5 because I tried to take my boy in for another reason . Ask your regular vet to start your cat on a medication trial now and check his labs again , Dr Green will not treat your cat unless she knows her kidneys can survive it. All other places will tell you no problem .

Hope that helps . Let us know how it turns out no matter where you end up taking kitty and best of luck

 

[BestBabyC]

One more thing , my girl cat went low on her T4 at first which is common but imagine if she had that double dose , she was certain to go hypo which was the confirmation about dosing . Her vet told me to expect it and I told him I was confident she would not because of what RB hospital did. But she never went hypo just low end of normal . Then her labs returned Perfect and remained so .

Please check your cat's kidney function on a medication trial before you treat her with i-131, there is no going back . If her kidneys are not functioning properly , which only a medication trial will reveal. you should consider foregoing I-131 and pill her daily , she can live a robust life that way .

 

[loulilah]

How important is doing the pill medication first? We tried pills the first few days after diagnosis, but it was horrible for both me and the cat! Since I-131 requires being off treatment for 7-14 days prior, our vet (as well as several clinics) recommended stopping the pills immediately and going straight for the I-131, since he'd only had a few days' worth.

 

[BestBabyC]

How important is doing the pill medication first? We tried pills the first few days after diagnosis, but it was horrible for both me and the cat! Since I-131 requires being off treatment for 7-14 days prior, our vet (as well as several clinics) recommended stopping the pills immediately and going straight for the I-131, since he'd only had a few days' worth.

Right , but you're confusing two issues here . You were not doing a medication. Trial, you were going to treat with medication long term to address her hyper t. If you tell a vet I don't want to go the medication route , I rather so I-131, of Course they would say then stop the drug , wait 10 days and go for it.

That has absolutely nothing to do with a medication trial for checking kidney function with the full intent of doing I-131 if kidneys are healthy . I'm not talking about a medication trial for you to see how life is like giving pills, I am saying to check kidney function while eurothyroid to see if she can withstand I-131 I didn't do a medication trial to see how bothersome giving my cat medication would be , the trial I'm referring to is done Solely to test kidney function while eurothyroid. So your vet is not saying what you wrote at all. She is simply saying you have two choices , you can pill her daily or go with I-131.
Your vet has made no mention of a medication trial to check kidney function to see if she is a candidate for I-131 from what you've said so far . If your vet doesn't know this is critical then not sure what kind of vet she is. Or maybe she mentioned it to you .

If you want to gamble your cat may die after I-131 then I guess it's not important to do one. For me , there is no way I would ever take my cat for I-131 without knowing she had the best chance of surviving it .

Two things can happen and do so very frequently
1) cats treated with i-131 reveal kidney issues and pass quickly or more slowly but you will need to manage her with a lot of medication , saline , etc
2) the majority become hypothyroid in the first year and stay that way . You have to give a pill a day and the cats quality of life is forever affected

It's about your cat and saving her life and giving her the best one , not getting it over with . If she is on a medication trial for 3 weeks, she is buffered from worsening . Yes you hsve to do more labs . The whole thing is costly and I get that , but I decided on I-131 and so did you and we live in this god foresaken city so the bills are tremendous . California does the whole thing for $800, best vets.

And you should know it's not I-131 and it's over . You must get frequent labs after in case she goes into kidney failure or becomes hypo. You hsve to comit to the whole process . I did follow up labs at her regular vet who is a gem
And a great person , superb diagnostician . I can't say the same for 99.9% of vets in NYC . It's disgusting here

Let me give you a brief example , I spent $2800 yesterday at animal medical in manhattan and all my cat got was 1 shot that costs $3. They sent him home matted, terrified , th nurse was clearly on drugs and the oncologist was a savage , it's all about the money . They don't care even 5% about giving medical services in exchange for all that money . I was just at a shop, random guy heard me talking about my cat and said "don't ever take him to animal medical!" I said I kkow , experienced it yesterday . I never wanted to go there and delayed his treatment 2 weeks waiting to get in at red bank , I had no choice , he is dyinb . Now I don't know what they did to him. I received the wrong medication as well and has to eat some to be sure .

All I know is that you're taking a huge gamble taking advice from NYC vets . There are a few decent ones , but it's charlatan town . Be careful

 

[loulilah]

Thank you. I do understand the reasons for doing the medication are different - temporarily to unmask kidney issues or permanently as a replacement for I-131. But if the trial did reveal an underlying kidney problem, we'd still need to treat the thyroid first. As my cat is relatively young and in excellent health otherwise, there is no reason to think he wouldn't survive the treatment, especially as he was only recently diagnosed (his CBC was perfect 9 months ago, so he couldn't have had it longer than that.). Considering all this, our vet thought it unnecessary to do a trial, esp as there are very sensitive UA and bloodwork markers these days, and the delay in I-131 treatment and the stress to his system of going on and off meds might be more damaging. But yes, I'm concerned about dosage and having a hypo outcome.

 

[BestBabyC]

Thyroid function is not found in a CBC and labs 9 months ago are quite old to use for I-131. Hyper t masks kidney disease and elevates liver enzymes , hard on the heart , cats die if not treated so it's not a simple matter but it is very treatable so that's good.

If the trial did unmask kidney issues , you absolutely should NOT take your cat for I-131, you have 1 choice left at that point , treat her hyper t with medication and treat her kidney with medication and diet , depending where thirds are at with the kidney . So no, of kidney disease is unmasked , you would not still treat her hyper t first with I-131

Hope that helps

 

[BestBabyC]

Yes , your cat certainly could have and most likely did , have hyper t more than 9 months ago unless you have a TSH and T4 from 9 months ago that were perfectly normal , not on the high end of the range. A clean CBC tells you nothing about thyroid function. My cats labs , all, were normal . We ran a tsh free t4 t3 and not normal. Only if the cat has suffered organ damage from the hyper t, would the CBC show issues but not the kidney , it will make the kidney function appear excellent lab wise . And I imagine her ALT is elevated if she has a free T4 of 7.7, you may want to look at her recent labs , if you have something from the past month or so.

You don't know where your cat is at . There are no special and sensitive tests to overcome the way hyper t masks kidney disease .

I-131 is hard on the kidneys , they must be in good health and even then , cats can end up with kidney damage and they'll tell you this "didn't you know hyper t masks kidney issues, once we cured her hyper t, it surfaced, it's not the I-131". Only it is because you can work with her the way she is now with thyroid meds, indefinitely , not if her kidneys are shot from I-131. if she is borderline once on medication trial , I-131 is off the table .

Without a proper work up, neither Dr P nor RB will accept your cat for treatment . Only places like radiocat and the others you mentioned

 

[susanm9006]

I went through this with my Siamese Murphy about twelve years ago. We tried meds first but they made her really sick. I had two options for the radioactive treatment, our local University vet clinic or a specialty private practice vet. I went with the private practice. Before she could be treated she needed an evaluation echo cardiogram of her heart which is often affected by hyperthyroid, and couple months of blood pressure medication. After her blood pressure and heart were okay, she went to the clinic and stayed for two weeks. They were great, called me every day with updates, which were all good. Came home with a clean bill of health. I don't recall how many follow up visits but I know there were a few. Don't recall the cost either but I think it was around $3000

Murphy was about 13 at the time. She was completely healthy after treatment and lived to be 19, dying from lung digit cancer.