# Resthyro for Hyperthyroid



## spockally (Mar 7, 2011)

Hi to you all! I hope everyone and every kitty are doing good! I just registered a few days ago and am very happy to find this forum. All kitties are so cute! I am so glad that there are many cat lovers here. I am living on the street that all neighbors own cat except for one family, so it is nice to know many people love cats here!

The reason I am posting here today is that I have a question about hyperthyrooid. My baby, Spock, is 12 years old and has no symptom of hyperthyroid as far as I know and I observe. I took him to the vet for annual check-up which I was neglectant about 10 years because he is indoor cat living with his best friend cat, Ally, all his life. And I admit that I was wrong and feel stupid for not taking them for annual this long. I took them for annual becuase I want to rescue one stray cat who started coming to our yard. Then, the vet said Spock has heart mumur and elevated thyoid. The blood test showed that whatever value to determine hyperthyroid is 7.4 although the normal range is between 0.8 and 4.0. The vet told him to be on daily medication or radioactive iodine shot. According to my research about the medicine, it has some side effects, even like liver damage. I know it is necessary to treat this disease to avoid complication but I am thinking about bringing him to another vet to be checked again and maybe tested again for second opinion. I found also this natural herbal product "Resthyro" to treat this disease. I was wondring if anyone used it and if it helped to lower the level of the value on the test. If anyone can share your experience or thoughts about hyperthyroid, I really appreciate! I have been crying everyday about him and feel scared of losing him. Thank you so much for reading such a long post. Thank you!!!!


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## laurief (Jun 22, 2008)

spockally said:


> I just registered a few days ago and am very happy to find this forum.


Welcome to the Cat Forum. We're glad you're here and are always glad to help answer questions where we can.



> Spock, is 12 years old and has no symptom of hyperthyroid as far as I know and I observe.


I'm sorry to hear of Spock's diagnosis, but it's actually a very good thing that he has been diagnosed, because untreated hyperT can be deadly. Fortunately, hyperT can be successfully managed or even cured in most cats, depending on the treatment you choose. The most common symptoms of hyperT are ravenous appetite coupled with weight loss. These cats may also be more vocal and hyperactive than usual, and may drink water excessively. As you already know, cats with uncontrolled hyperT may also develop heart murmurs, but these can sometimes resolve once the hyperT is brought under control. Occasionally, a cat can have hyperT without any of these symptoms, or with entirely different symptoms.



> The blood test showed that whatever value to determine hyperthyroid is 7.4 although the normal range is between 0.8 and 4.0.


This does indicate that he is hyperT, but it doesn't necessarily tell you anything about the severity of the disease or how long he may have had it. Let me offer you a little hyperT primer so that you'll understand more about it and your treatment options.

HyperT is a complicated disease because it puts the entire body into a state of hyperactivity. This includes the heart and kidneys (more about this later). It seems that many vets are not well versed in hyperT, its testing, or its treatment options. I am pleased to see that your vet has already recommended either daily medication or radioactive iodine treatment (I-131), as those are the preferred treatment options. 

I-131 is the treatment of choice for hyperT cats with healthy kidneys because it is CURATIVE in almost all cats who undergo the procedure. It involves a single, subcutaneous injection followed by a period of quarantine at the administering hospital while the radioactive material dissipates to a safe level. This is a very costly treatment up front, though the cost is comparable to or less than the medication alternative over the long run, and again, it is the only CURE for hyperT.

HyperT can also be managed, but not cured, with medication – either methimazole or carbimazole. As you’ve already discovered, medication is not risk-free. Some cats experience unpleasant side effects that can range from mild to life-threatening, though many cats remain on medication for many years with no problems at all.

Although I have no direct experience with or knowledge of Resthyro, I doubt it is effective at either treating or managing hyperT. I recommend referring that question to the hyperT mailing list (linked below). I have gained most of my information and knowledge about hyperT from the mailing list, its members, their posts and message archives, and the research papers and other educational files stored in the "files" section of the list's Yahoo website. I strongly recommend you join that list. Even if you prefer not to post, you can learn a great deal by doing searches for specific information in their message archives and by reading the uploaded files. You may also, of course, ask whatever questions you may have of the list members by posting to the list. I'm sure there are members of the list who have researched and/or used Resthyro who can answer your questions about it. You can read about and join the list through this link:

feline-hyperT : A support list for people whose cats have been diagnosed as hyperthyroid (hypothyroid also welcome).

Let me back up a bit now and elaborate on hyperT and the meds used to control it. The Total T4 test does not test the actual function of the thyroid gland. It merely measures the amount of T4 thyroid hormone circulating through the bloodstream at the time of the test. It cannot tell the vet whether the T4 hormone level is the result of excess hormone accumulating in the bloodstream over time as a result of mild hyperactivity of the thyroid gland or whether it accumulated quickly as a result of more severe hyperactivity of the thyroid gland.

Some vets, however, seem to think that a very high T4 indicates the severity of the disease (which it does not - it ONLY indicates a very high level of circulating thyroid hormone in the blood)), and therefore prescribe too high a starting dose of methimazole. Methimazole itself does nothing to eliminate excess circulating hormone. Methimazole only helps to limit the amount of new hormone released by the thyroid. So all of that excess circulating hormone is either used by or eliminated from the body naturally and gradually after Methimazole therapy is started.

Here's the problem. If the starting dose of Methimazole is too high and shuts down the thyroid production too far, you won't know it until after the excess circulating hormone has been naturally utilized or released from the body, and that can take 1-3 weeks after starting the too-high dose. After that 1-3 week time frame is when a "crash" may happen ... if it's going to happen. If a crash happens, your cat will become hypOthyroid and may become extremely ill - nauseous, inappetant, weak. Usually this condition can be reversed by lowering the Methimazole dose, but occasionally the cat simply cannot recover and will fail. 

A while ago, someone posted on this forum about their newly diagnosed hyperT cat. I warned him about the high starting dose of methimazole that his vet had put his cat on, and I begged him to start at a lower dose and work up to a higher dose, if necessary, to prevent his cat from "crashing". Unfortunately, he chose to ignore my warning and go with his vet's recommended dose. A few weeks later, his cat crashed so badly that he had him euthanized. It was a tragic and, in my belief, totally preventable loss of life. I don't want to see that happen to another cat.

Vets generally recommend a starting dose of 5-10 mg of Methimazole daily (generally split into two daily doses). This is the dosing recommendation they read in their standard veterinary pharmaceutical text. Unfortunately, many people, including myself, have found that even the lower end of this dosing recommendation is too high for our cats and has thrown them into hypothyroidism. Luckily, I was able to bring my cat back to euthyroid (normal thyroid levels) by lowering the dose. Others weren't so lucky with their cats.

On the hyperT mailing list, and in some veterinary research literature, you will find a much safer recommendation to start methimazole at a dose of 1.25 mg twice daily (1.25 mg once daily if the cat has known kidney disease), with retesting in 3 weeks. If euthyroid has not yet been achieved, a small dose increase of 1.25 mg daily is added and the cat is retested in another 3 weeks. This 3 week schedule of retest-med adjustment continues until euthyroid is reached.

This "start low and go slow" approach to dosing offers several critical advantages. First, it allows the body to slowly adjust to the decreased thyroid hormone. Second, it helps avoid severe crashes and hypothyroidism from occurring. Third, it protects the kidneys from the potentially devastating effects of a crash. There is NO disadvantage to starting on a low dose of Methimazole and working your way up, as necessary. It is the safest approach for your cat and one I hope you will discuss with your vet if your vet prescribes the standard starting dose of 5-10 mg daily.

Most cats can take methimazole with no or few side effects if dosed with the “start low and go slow” approach, though some may have a more difficult time with the med. Vomiting, inappetance, and facial itching are the most common side effects that some cats may experience. If these side effects occur, there are strategies such as always administering the med with a meal, using a transdermal form of methimazole or switching to carbimazole, which tends to have fewer digestive side effects.

Kidneys are a primary concern when starting thyroid med therapy because hyperT can mask renal failure. HyperT makes the kidneys work in overdrive, and blood tests cannot differentiate between healthy kidneys performing normally and sick kidneys being forced to work harder by the effects of uncontrolled hyperT. Both healthy kidneys and hyperactive ailing kidneys may have blood values within the normal range, so you can't know whether or not your cat's kidneys are truly healthy until AFTER you have normalized your cat's thyroid hormone levels. If, at that point, his bloodwork still shows healthy kidneys, then you can rest assured that they really are healthy.

This is where things get really complicated. IF your cat's kidneys are ailing, hyperT can actually help them function better to some degree. But that means you will have to balance the management of both conditions (hyperT and chronic renal failure) so that the hyperT can continue to support the kidneys without damaging other body systems.

Let's assume for the sake of this illustration that your cat DOES have masked CRF in addition to hyperT. Think of it as a teeter totter. You have CRF on one side and hyperT on the other. Since you didn't mention anything about your cat's kidney values being elevated, I'll assume that they're currently in "normal" range in his bloodwork. Since T4 is elevated, that puts the hyperT side of the teeter totter high in the air while the masked CRF side is solidly on the ground - certainly not the level balance we're striving for. Now let's put I-131 on the same side as the hyperT. This sends the hyperT side of the teeter falling to the ground as it CURES the hyperT; but without the support of the hyperT-induced hyperactivity, the previously masked CRF is now unmasked and goes sky high - still no balance here, just traded one set of illness symptoms for another. So how do we find that balance we're looking for between the two illnesses? Thyroid med, that's how. Forget the I-131 and use the med instead. The med now goes on the side with the hyperT, and by carefully adjusting the dose, we can balance that teeter so that CRF and hyperT both hopefully hold steady at a level that maintains the best possible degree of health for the cat.

If you decide to consider I-131 treatment for your cat, it is VERY important that you do a thyroid med trial first to get your cat's thyroid hormone level stabilized in normal range BEFORE you make a decision about I-131 treatment. That is the ONLY way you would be able to tell whether your cat's kidneys are healthy to determine if your cat would be a good candidate for I-131.

Try not to let yourself be too overwhelmed by this diagnosis. HyperT is a disease that can be cured or successfully managed in the vast majority of cats. You’re already taking a great first step in educating yourself about it. The more you know, the better a position you’ll be in to partner effectively with your vet and advocate for the best possible care for your cat. If I were in your place (and I have been … twice), I would start my cat on a low dose of methimazole or carbimazole immediately to start bringing his thyroid levels down gradually, then retest in 3 weeks and go from there.

Hang in there. This is one dragon you can slay.

Laurie


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## spockally (Mar 7, 2011)

Laurie:

I do not know how I can say "THANK YOU" for explaining to me all the things you wrote. I tried to find more information I could as much as possible, I was still having hard time and getting the same kind of findings. I was not aware of what the value means on the test and apparently misunderstood that Spock's condition is twice as bad as the normal condition. I have not had a chance to look at the link that you attached but I will definitely look into it and learn some more to understand better. The suggestion you gave me is going to be very helpful; starting the med dosage with the smallest or much smaller than the vet prescription. I want to help him to be under control of this disease but I do not want to cause any other problems, neither. I feel very fortunate that you read my posting and answered to it. I truly thank you for your help and time regarding this post. I hope you and your kitties are doing well. Again, thank you soooo much!!!!


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## laurief (Jun 22, 2008)

> spockally said:
> 
> 
> > Laurie:
> ...


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## spockally (Mar 7, 2011)

Thank you again, Laurie. My cats, fortunately, had any serious sickness until now so I was panicky as you can tell but all the information and research you assured me to calm down and gave me some comfort. I do really appreciate that you shared all the knowledge and experience with me. I am sure you spent days and night trying to figure out what to do for your babies. I thank you for your kindness and thoughtfullness. 

I am sorry but I have two more question. The thing I am really concerned about medicine (Methimazole) is the side effect. As you pointed out, if I start from very low dosage, I can minimize the side effect as well. Have you ever noticed any side effect on Tommy? I read vomiting, depression, even liver damage! as side effect. By treating Hyper-T, it is not great if Spock develop liver damage, I thought....
Another question is how you are giving Tommy medicine. My vet said that it comes in tablets or liquid (she did not give me the dosage). I have never given med to our cats (well, maybe long time ago, I gave liquid dewormer and I do remember they did not like it), so I wonder how people give med. I read some other threads about giving med to cats and examined some techniques that I should learn. I was wondering how you are administrating it to Tommy. I am thinking about putting the med in wet food, which Spock was not given for years..... I do appreciat eif you can share your experience again but I understand everyone is busy, so don't worry if you cannot 

Thank you again and I hope Tommy's conditon will maintain stayble. We want our babies stay healthy and happy!


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## laurief (Jun 22, 2008)

spockally said:


> Thank you again, Laurie. My cats, fortunately, had any serious sickness until now so I was panicky as you can tell but all the information and research you assured me to calm down and gave me some comfort.


I'm glad I could offer some comfort and help you calm down a bit. I do know what it's like to panic about an ailing animal companion, because I occasionally still panic if something critical happens to mine, esp. if it's something with which I have no experience. I do really appreciate that you shared all the knowledge and experience with me. 



> I am sure you spent days and night trying to figure out what to do for your babies.


Indeed I did, but I've also made a regrettable number of mistakes over the decades, many of which my animals suffered for. I try never to make the same mistake twice, though, and rely on the animals to teach me much of what I need to know in order to take proper care of them.



> I am sorry but I have two more question.


Never apologize for asking questions. How else are you going to learn?



> The thing I am really concerned about medicine (Methimazole) is the side effect.


Methimazole is a very strong drug with potentially strong side effects, though as I said before, most cats can take it for extended periods with few or no negative side effects at all. This is one reason why I-131 is the treatment of choice for hyperT. It cures the disease and eliminates the need for long-term methimazole use. If I lived anywhere near a clinic that offers I-131, and if I could have borrowed enough money for the procedure, that's what I would have chosen for Tommy. But such is not the case, so I maintain Tommy on carbimazole.

If I-131 isn't an option for you logistically or financially, or if Spock turns out to have renal insufficiency and is not a good candidate for I-131, then methimazole or carbimazole are your only choices. You really can't let hyperT go untreated, because unmanaged hyperT is far more deadly than the meds are likely to be.

When Tommy was first diagnosed, I started her on low dose methimazole, but she had mild nausea on it, so I switched her to carbimazole. Carbimazole converts into methimazole in the cat's body AFTER it leaves the stomach, so it tends to not cause stomach upset the way methimazole sometimes does. Tommy has never had any noticeable side effects on carbimazole. My first (deceased) hyperT cat, Billy, also had mild nausea on methimazole but did well with no med-related nausea once I switched him to carbimazole.



> Another question is how you are giving Tommy medicine. My vet said that it comes in tablets or liquid


These meds can also be compounded into flavored soft chews and transdermal gels. I use liver flavored chews that I order from BCP Pharmacy in Houston, TX. Tommy LOVES her liver chews and snarfs them down as treats. When Billy was taking methimazole before I switched him to carbimazole, I gave him his pills in Pill Pockets. He happily ate them that way.

Transdermal gel is useful for cats who experience digestive upset with these drugs. The gel is applied to the inner ear flap where the med is absorbed through the skin, so it completely bypasses the digestive tract.



> Thank you again and I hope Tommy's conditon will maintain stayble. We want our babies stay healthy and happy!


You're welcome again, and thank you for the well wishes. I wish you and Spock the same.

Please don't hesitate to post again if you have any more questions.

Laurie


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## spockally (Mar 7, 2011)

Laurie, 
Thank you so much again for all the information that you gave me! I feel like a personal vet for Spock on my side  

Methimazole's side effect still worries me because Spock sometimes throws up. So, I wonder if I should ask my vet to change prescription to Carbimazole if it has less side effect. In either medicine, I really want to start with the lowest dosage as you advised me. My husband is really anti-medicine (or doctor?) person. He originally even said that we cannot afford the cost of medicine. I said ???? it is only about $20 per month and he explained that it won't be the only cost that he concerns. Once Spock is on medication, he has to be checked many times and other problems will show up, etc. Do you need to take Tommy every month for blood work? Well, within my budget, I want to treat him! I cannot leave it like this. My husband worries if the vest cost is going to drain our savings which I do not think and I think we can handle as long as we set the budget. There is a facility nearby, about 45 minutes away from where I live, doing I-131. In order to do that, as you mentioned, Spock has to be a good candidate. Also, I was told that he has to be on medication at first to regulate his system. In either way (if I decided to do I-131 or not), he needs medication. I hate to put him on daily medication but I need to so that he does not have other complications.... 
Speaking of I-131, so far I have not found any information about the side effect. All the things I found so far says "safe" and I am not sure if it is true. So, I need to do more research about it. "radioactive" scares me, especially about the fact that we cannot even touch until he is free from radiation after the shot. It sounds dangerous to me.... The cost is concern as well. My vet said that it is about $1000. If it totally cures, has no side effect, and is safe, I do not mind paying it for Spock. 
Thank you so much again for giving me the link to order the medicine. I checked the website and it sounds like very good idea. I should ask my vet to send prescription to this company! It is just amazing how much you know!
I am sorry again about babbling whatever what is on my mind. Thank you again for your help and reading this. I wish I can be help for any when of if needed in near future! Have a great day!


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## laurief (Jun 22, 2008)

spockally said:


> I feel like a personal vet for Spock on my side


I'm not a vet. I'm just an animal lover with five decades of animal caretaking under my belt. The more I learn about their maladies, the more I realize I still have to learn. My 4-leggeds are constantly educating me.



> Methimazole's side effect still worries me because Spock sometimes throws up.


Vomiting can be a symptom of uncontrolled hyperT, so it's possible that once he's regulated properly on the med, he won't throw up as much. Then again, all cats vomit from time to time, so you shouldn't worry too much about it unless it's happening frequently.



> So, I wonder if I should ask my vet to change prescription to Carbimazole if it has less side effect.


Carbimazole is more expensive than methimazole because it's only available from compounding pharmacies in this country (as far as I know). So you might want to start with a low dose of methimazole administered in Pill Pockets and see if Spock can take it without digestive upset. That's certainly your least expensive option. If it does make him nauseous or cause any other unpleasant side effects, you can always switch to carbimazole. That's what I did with both Billy and Tommy.



> In either medicine, I really want to start with the lowest dosage as you advised me.


That's a wise decision and the safest option for Spock, even though the retests will add to your expense.



> Do you need to take Tommy every month for blood work?


No. In the beginning, I took her for a retest every 3 weeks so that I could adjust her med dose until she achieved euthyroid (normal thyroid levels). After she achieved euthyroid, she only required retesting once every 6 months to make sure she remained euthyroid.

Billy was a different matter. After he achieved euthyroid, I had to have his blood retested every 3 months because he was also in renal failure and had hyperparathyroidism. Because of his multiple illnesses, I had to keep a closer and more frequent eye on his blood values.



> There is a facility nearby, about 45 minutes away from where I live, doing I-131.


You're lucky to have one so close.



> I was told that he has to be on medication at first to regulate his system. In either way (if I decided to do I-131 or not), he needs medication.


That's correct. As I explained to you earlier, you have to get his thyroid regulated on medication first so that you can accurately evaluate his kidney function. He will only be a good candidate for I-131 if his kidneys are healthy. If his kidneys are ailing, it would be best to maintain him on medication so that you can keep the hyperT and renal disease in better balance.



> Speaking of I-131, so far I have not found any information about the side effect.


In most cats, I-131 is very safe, has no negative side effects, and is curative. However, in a _very_ small percentage of cats, hyperT will return after I-131, requiring another treatment with I-131 or treatment with meds. More than 95% of cats are cured with a single I-131 treatment.

The way I-131 works is that it targets and destroys only diseased thyroid tissue, leaving any healthy thyroid tissue undamaged so that it can function properly after the procedure. Occasionally, so much of the thyroid tissue is diseased that there isn't enough healthy thyroid left after I-131 to function adequately. If that happens, the cat becomes hypothyroid and requires thyroid supplementation for the rest of his life. This isn't a big concern, however, since thyroid supplementation doesn't cause side effects at proper dosage, and it's an inexpensive med.



> Thank you so much again for giving me the link to order the medicine. I checked the website and it sounds like very good idea. I should ask my vet to send prescription to this company!


Again, carbimazole is more expensive than methimazole, so you might want to give methimazole a try first to see how Spock handles it. If you do decide to use carbimazole, you can reduce cost by ordering a 6 mo supply to save on more frequent overnight shipping (unless you're likely to do I-131 after a couple of months). Also, you can ask your vet to order it at a strength of 10 mg/chew. The chews are pretty large, and they're easy to cut into smaller doses with an inexpensive pill cutter. I cut the chews into halves, quarters and eighths for Tommy.



> I wish I can be help for any when of if needed in near future!


That's what it's all about - passing on the knowledge we gain to other folks who can benefit from it. I'm sure you'll learn a lot from Spock that you can share with others in the future.

Laurie


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## spockally (Mar 7, 2011)

Laurie:
Thank you again. I finally get Methimazole today. It is liquid and the bottle says "5mg/ml" and the instruction says "give 0.25 ml every 12 hours." Since 0.25 ml is quarter of 1 ml, I need to give quarter of 5 mg, which is 1.25mg each time. I get to talk to the vet and asked if it is okay to start with only once a day to see how his system handles and he was happy to agree with it. I will start with this 1.25 mg per day from tonight. I hope Spock can handle this and the level will go down. 

I did not know that carbimazole is more expensive. Thank you for telling me that. It is good to know there is alternative med if he cannot tolerate Methimazole. I will let you know how he handles Methimzole if you do not mind  After I hear lots about this Hyper-T and treatment from you who actually have Tommy to take care of for his Hyper-T instead of articles over the internet, I feel much more comfortable giving med to Spock and more knowledgeble about Hyper-T. I just joined the Yahoo! website as well to gain more knowledge. Thank you again and have a good weekend!


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## laurief (Jun 22, 2008)

spockally said:


> I finally get Methimazole today.


I am VERY pleased that your vet takes a conservative and safe approach to dosing. I know that methimazole makes you nervous, but it would probably be fine to start him on 1.25 mg twice daily. My only concern with once daily dosing is that a dose only lasts 12 hrs, so Spock will essentially be getting no medical treatment for the other 12 hrs of the day. If you don't want to start with 1.25 mg twice daily, it would be better to split the once daily 1.25 mg into two, 63 mg doses daily, instead (or as close to it as you can get).



> I did not know that carbimazole is more expensive.


I'm guessing that liquid methimazole is more expensive than methimazole pills, too, though it's probably still cheaper than carbimazole.



> I will let you know how he handles Methimzole if you do not mind


Mind??? I'll come find you if you don't keep me updated! ;-)



> Thank you again and have a good weekend!


You're welcome again. Oh, I think I forgot to tell you that even if Spock does experience mild side effects from methimazole, those side effects usually go away within the first three months of treatment. But starting with a low dose often avoids bad side effects altogether.

I hope you and Spock both have a great experience with methimazole and that his path to euthyroid is smooth and free of side effects. 

Laurie


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## spockally (Mar 7, 2011)

Laurie:

I apologize for not writing this long. I am originally from Japan (maybe you shoukl be able to tell from my awkward English!) and have been busy contacting my family and friends in Japan making sure everyone is safe under the earthquake circumstance. Thank God, everyone that I know of is safe but I am just concerned about many, many people who lost their lives and suferred from this disaster. 

To keep you updated, Spock has been on Methimazole about a week and he is doing good so far. Only once (or maybe twice, not sure which cat did it... I have three cats now!) he threw up and that was it. he does not like taking the med which is liquid form. I just kind of squirt in his mouth.... Since he is doing good so far, I am thinking about making it to twice a day as instructed by the vet and see how he is going to handle. I will let you know again! 

Thank you again for reading it and hope you and your babies are doing good! Have a great day!


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## laurief (Jun 22, 2008)

spockally;740077I apologize for not writing this long.[/QUOTE said:


> No apology necessary.
> 
> 
> 
> ...


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## spockally (Mar 7, 2011)

Hi, Laurie. It has been long again since I logged in... I hope you and your baby is doing good! 

Although I mentioned that I was thining about giving the medicine to Spock twice a day (0.25ml=1.25mg each time) as prescribed by the vet, I started thinking maybe he should stay with only once a day and be checked for the blood work with the condition.... There are two reasons for this. First, I am still skeptical about the side effect of this med. If the lowest dosage he is taking now works good on him, it does not make sense to increase the dosage. As you suggested, I agree with "low and slow" and I thought I should see how his level is before I increase the dosage. The second reason is that I started wondering if there was any mix-up in bloodwork. I know that the vet mentioned that Spock might have heart mumur and this could be due to hyperthyroid. So, the result of Spock's bloodwork might be true. Other than heart murmur suspect, however, he does not show any symptoms. When I took him in for that check-up, I also brought another cat, Ally. Her bloodwork came back fine but she is losing weight. The vet said that it is due to her gingevitis which she will have teeth cleaning on Thursday hoping that she will gain back her weight after that. When I brought her in for antibiotic shot for the teeth cleaning, I noticed that she lost some more weight within a few weeks. This could be due to the fact that I sometimes need to hide the food for Spock and Ally in order to separate from Tora whom I adopted recently because of his diarrhea condition, but her excessive weight loss made me wonder if Ally is the one who actually has hyper-T, not Spock... This might happen IF the staff at the vet office mixed up their blood sample. I do not want to take Ally to be tested again but I know that Spock has to be tested anyway to check his Hyper-T level, so in case Spock is not the one who really has hyper-T, I thought he should stay with minimum dosage. I was really stupid enogh to bring both of them at the same time and I learned that I will never do it again in order to prevent possible mix-up. I know I am going crazy but I thought it is better to be precautious.... Again, it got long and I am sorry. Just wanted to let you know how things are now with my babies.... I just wish there is no such a thing like hyper-T!!! Have a good day


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## spockally (Mar 7, 2011)

I took Ally in for her teeth cleaning because she has gigevitits. The vet called me later and said that he noticed that Ally lost weight. He suspects that she might be the one with hyper-T instead of Spock!!!!! I said that it was exactly the same thing I was thinking. Maybe their bloodwork were mixed up in the office or at the lab...He is going to run the bloodwork for Ally again and I will get the result tomorrow. IF, IF, Spock did not have hyper-T and I was giving Methimazole only once a day, do you think it caused any problem on his health? AH...... I just hope not. I am so worried and worried. And, if Ally is the one, I just hope she will be okay with her teeth cleaning and possible teeth extraction (if needed) under hyper-T condition....


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## spockally (Mar 7, 2011)

Hi, Laurie! How have you been? I feel it has been long since I talked with you. How is Tommy doing? I hope you can find this thread again 

I took Spock to the vet for the first bloodwork after he started Methimazole and got the result back. Now the value was 5.2, so it went down from 7.3. Since it is still out of normal range, the vet told me to give twice a day of 0.25 ml...

Before the blood was drawn, I told the vet that I have been giving Spock 0.25 ml (1.25mg equivalent) only once a day (aroud 9:30pm) due to the concern of the side effect. He was not sure if the result will be reliable one because it has been almost 12 hours since he had the last dosage (I took Spock to the vet for the test at 9am next morning). Well, in spite of these facts (I gave once a day although it was recommended to give twice a day AND over 12 hours since the last dosage), his value went down and not too bad ( I was told that normal shoud be under 4.0), I thought. So, I was wondering if it is okay to give him half of the current dosage, which will be 0.125 ml (0.625 mg), twice a day instead of 0.25ml twice a day. I was told no because total amount per day will still be the same as the current dosage..... I guess I do need to increase the medication, which I prefer not to. I feel so bad about Spock and just hope he does not hate me for giving him this med 

Today's result about Spock's bloodwork was dissapointing for me because I was hoping that his value will be in nomral range which he does not have to increase the medication. It did not turn out like that, plus another cat, Ally, had this vomiting bouts which scared me a lot. Then, another one, Tora's loose stoll is not improving.... I am just overwhelmed too much and depressed. I just pray all my kitties will be healthy someday again  I pray for you and Tommy doing well as well


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## laurief (Jun 22, 2008)

spockally said:


> Hi, Laurie! How have you been? I feel it has been long since I talked with you. How is Tommy doing?


Tommy and I and all the other kids are doing well. It's sweet of you to ask.



> Before the blood was drawn, I told the vet that I have been giving Spock 0.25 ml (1.25mg equivalent) only once a day (aroud 9:30pm) due to the concern of the side effect. He was not sure if the result will be reliable one because it has been almost 12 hours since he had the last dosage


Your vet is correct about that, and I'm sorry I didn't think to tell you about that myself. For accurate results, blood should be drawn between 4-8 hrs after the last methimazole dose. Ideally, it should also be drawn after a 12 hr food fast so that lipemia (fat in the blood sample) won't skew the results. For the sake of consistency in testing, you should try to have all retests done at as close to the same interval after dosing as possible. I believe I also told you that when methimazole is only administered once a day (which is NOT the recommended dosing), it should be given first thing in the morning, NOT later in the day or at night.

I always take Tommy in for testing as close as possible to 4 hrs after her morning dose of carbimazole (I dose twice daily). That way I can take advantage of her regular overnight fast and only have to extend it by a few more hours in the morning before her test.

Unfortunately, if you want an accurate retest for Spock, you really should take him in for another test within that 4-8 hr post-dose interval. I certainly wouldn't put too much stock into results from blood drawn 12 hrs post-dose.



> So, I was wondering if it is okay to give him half of the current dosage, which will be 0.125 ml (0.625 mg), twice a day instead of 0.25ml twice a day.


Until you get an accurate test within the 4-8 hr post-dose window (which I recommend doing ASAP), twice daily dosing at .625 mg is fine. That's the only way you'll know how his hyperT is really responding to that dose and whether he needs a dose increase. I recommended twice daily dosing before, and that hasn't changed. Methimazole reaches peak effectiveness during that 4-8 hr post-dose window, and dosing only once daily leaves a lot of hours in each day inadequately managed.



> I was told no because total amount per day will still be the same as the current dosage


That's true, but it does make a difference in terms of how the med is absorbed and metabolized in Spock's system over a 24 hr period.



> I guess I do need to increase the medication, which I prefer not to.


Again, you won't know that until you get a retest run within the 4-8 hr post-dose period. I would expect, though, that you will need to increase his dose, and you shouldn't hesitate to do so if it is necessary. 1.25 mg daily is a very, very small dose that has advantages when starting the med, but it's unrealistic to expect that low a dose to achieve euthyroid in most cats. Even Billy, who was only mildly thyrotoxic at diagnosis, could not achieve euthyroid on that low a dose.

Here's something else you need to keep in mind. If Spock's kidneys are healthy, the optimal target for his T4 is in the bottom half of the reference range (the closer to the bottom of the reference range, the better). The only time you'll want to maintain his T4 in the upper half of the reference range is if he has some degree of renal insufficiency.



> I feel so bad about Spock and just hope he does not hate me for giving him this med


Why on earth would Spock hate you for giving him medicine that makes him feel better? Spock's not an idiot, you know. He's aware that his body is feeling better. You really have to adopt a more reasonable and positive attitude toward his treatment. Consider this another hammer-upside-the-head moment. ;-)



> Ally, had this vomiting bouts which scared me a lot. Then, another one, Tora's loose stoll is not improving


I know how worrying it can be when our kitty kids don't feel well, but some of this is pretty normal for cats. Many cats vomit from time to time ... mine certainly do. They have a hair-trigger where vomiting is concerned. I don't get worried about it unless it occurs daily and/or happens frequently after meals and/or contains blood. Ally's bloodwork came back fine, right? So she's probably just having run of the mill kitty vomiting. It happens.

Loose stool can be cause by a variety of things ranging from internal parasites to digestive upset to serious illness. What have you done to address this issue with Tora?



> I am just overwhelmed too much and depressed


. 

You need some perspective here. Spock is improving, Ally is just doing what cats do, and Tora's loose stool is most likely a minor issue that will take some more time and different management or treatment to resolve. No "body" is perfect. At some time, we're all going to need to manage various physical issues in our own bodies and the bodies of those we care for. That's just life. You may as well get used to it. 



> I just pray all my kitties will be healthy


Things are already better for both Spock and Ally than they were a month ago. You're just too worried to have noticed the improvements. Stop indulging the negative and start acknowledging the positive. Positive energy is a very healing force.

Laurie


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## spockally (Mar 7, 2011)

Laurie:
Good morning to you and Tommy! It is good to hear from you again  I am glad that you and Tommy (do you have other cats? or is he the only baby for you?) are doing well!

Thank you again for explaining loooots of important things. I wished the vet or the nurse told me about the time frame for test to be taken. About fasting as well, no one mentioned that to me. So, I really appreciate that you taught me about it! 

After I read what you wrote, I really regret that I did not give Spock twice a day, instead of once a day. When I started ginving this med to him, it was very hard and I needed my husband to hold him. He does not have time in the morning so I was giving Spock this med at night. Now that it is getting easier for me to give this med by myself, I can do it in the morning and night. I do remember you suggested to do twice a day of 0.125ml (0.625mg), but this initial difficulty to administer the med to him was the reason for me to do it once a day at night. 

Although the vet that I spoke to yesterday said to give 0.25ml twice a day, I still want to try 0.125ml twice a day. As you said, although the total amount per day remains the same, I think changing it to twice a day might make a difference in terms of absorption and metabolize. So, I gave him 0.125ml this morning and will give another 0.125ml tonight and so on. I will bring him in again for re-check with this dosage and see how his value will be like. The vet said to bring him in 4-6 weeks later. 

I am sorry about letting it out about other issues like Ally's vomiting and Tora's loose stool on top of Spock's.... Over the weekend my 6-yr-old son got sick and I was maybe tired and worn out. Ally threw up again during the night (I think it was hers) but it had hairball in it, so I hope that was the reason! Yesterday there was nothing in it besides wet food and liquid and she just kept vomiting, so it scared me. As for Tora, I treated his roundworm with Profender, gave antibiotic to treat possible infection, try plain yogurt, try Probiotic and canned pumpkin and nothing was working. Recently I changed his diet to all grain free and more wet food less kibble. Also, I am suspecting I was overfeeding him, so I changed to scheduled diet. Finally this morning I saw a litte improvement in his litter box  I hope it gets better! 

You are absolutely right about negative and positive thinking! My husband always tells me I am just killing myself by worrying about too many things too much. I need to see more improvements on our kitties! I again thank you for reminding me and you are my mentor  Have a great day ahead!


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## laurief (Jun 22, 2008)

spockally said:


> do you have other cats?


Yes, indeedy! Quite a few, in fact. I am the only person who lives on a dead end road that is a prime animal dumping spot, so a lot of cats and one puppy have found their ways back to my farm over the last decade. If I ever find out who keeps dumping these poor animals on my road, there's going to be **** to pay. My road cuts through forest land, and it breaks my heart to think of how many felines and canines may have been killed by wild predators before they made it back to the relative safety of my farm. The ones who do manage to make it here in one piece, though, have a home for life with me.



> I wished the vet or the nurse told me about the time frame for test to be taken. About fasting as well, no one mentioned that to me.


If the vet neglected to explain these factors to you, (s)he was remiss not to do so.



> I really regret that I did not give Spock twice a day, instead of once a day.


Don't fret about it. It's easily fixable.



> Although the vet that I spoke to yesterday said to give 0.25ml twice a day, I still want to try 0.125ml twice a day. I will bring him in again for re-check with this dosage and see how his value will be like. The vet said to bring him in 4-6 weeks later.


Don't wait that long to retest. Spock's system will regulate to the new dosing schedule much more quickly than that, and the goal here is to bring him to euthyroid as quickly and safely as possible. The longer he is hyperT, the longer his body will continue to suffer the effects of hyperT. So take him back for a retest in 2 weeks and adjust his med dose then, if his T4 isn't yet in the reference range. 

When you finally do get him to euthyroid (T4 in the reference range), remember to have his kidney levels checked to verify his kidney function.



> Ally threw up again during the night (I think it was hers) but it had hairball in it, so I hope that was the reason!


That's very likely the cause of her vomiting, and it's certainly no big deal. It'd be a good idea to give her a dose of hairball remedy once or twice weekly to help her pass any more hair that may be irritating her digestive tract.



> As for Tora, I treated his roundworm with Profender, gave antibiotic to treat possible infection, try plain yogurt, try Probiotic and canned pumpkin and nothing was working. Recently I changed his diet to all grain free and more wet food less kibble. Also, I am suspecting I was overfeeding him, so I changed to scheduled diet. Finally this morning I saw a litte improvement in his litter box  I hope it gets better!


It sounds like you're on the right track to resolve his problem. Keep adding a small dose of probiotic for a while. That'll probably help. Avoid yogurt and any other dairy products, since many felines are lactose-intolerant. If the loose stool continues, ask your vet about treating him for coccidia and giardia.



> I need to see more improvements on our kitties!


More importantly, you need to rejoice in the improvements you've already been seeing in your kitties!



> Have a great day ahead!


You, too!

Laurie


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## spockally (Mar 7, 2011)

Laurie:

I meant to reply to you much earlier, but I got busy with my son getting sick and staying at home and working.... always something prevent me from going to this forum  Anyhow, ohhhh, it is so nice of you to take home those poor kitties and puppies for good home at your farm. Because some people think I am crazy not thinking about the risk to take such as disease and/or having two cats already, I felt kind of silly adopting Tora who just started showing up from nowhere in our yard and staying outside in cold nights during February. I just wanted to help cute little innocent live.... and I am sure you feel the same way  They are just too precious to be left outside in danger (we live right next to woods so I totally understand!). 

After I read your messages again and again and again, I started thinking that what I was doing is wrong, or at least not right, for Spock. In the Hyper-T's forum in Yahoo! that you told me before, I posted a question asking if anyone is giving such a low dosage like I do (0.125ml twice a day) and what others think about what I am doing. All responders stated that I should follow the dosage recommended by the vet and the 0.25ml twice a day is the optimum minimum dosage to start with. As you said to me, most likely it is necessary to increase the dosage later anyway. So, if I do not do that now, I am just simply prolonging the process with more vet visits. I think you are absolutely correct about not being able to achieve euthyroid with such a low dosage and I started having concern about the complication from not being treated correctly. So, I started gving Spock 0.25ml twice a day from April 13 Wednesday. So far, he does not seem to have any side effect from more med. He is eating real well and not vomiting so far. I hope he stays this way and the next test will show good result 

I know I am going crazy again about this medication stuff, but I also wonder if it is possible for Spock to have hypothyroid by having 0.25ml twice a day. I heard that sometimes I-131 treatment causes hypothyroid, but is there any chance to cause hypothryoid by giving Methimazole? I know that the dosage that I am giving him is not overdose at all, but I was wondering if it is too much for Spock and cause something. Is there any signs to watch out? 

As for Tora, his poop got finally much better. It is not perfect but much much firmer after the diet change, so I brought his sample again to be checked to make sure he is safe to share litter box with Spock and Ally  As for Ally, she seems to get better after the episodes of vomiting. She likes to eat wet a lot now  Now I got to take care of my son who is suffering from sinus infection and asthma symptom.... Oh, well, I always have someone to take care of, but it is a good thing instead of me being taken care of by someone  

Hope you, Tommy and other precious ones will have good weekend! Give hugs and kisses to your babies


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## laurief (Jun 22, 2008)

spockally said:


> I meant to reply to you much earlier, but I got busy with my son getting sick and staying at home and working


I'm sorry to hear that your son has been ill, on top of your kitty worries. You really need a break, I know.



> I felt kind of silly adopting Tora who just started showing up from nowhere in our yard and staying outside in cold nights during February. I just wanted to help cute little innocent live.... and I am sure you feel the same way


You're right. I do feel the same way. When a new feline shows up on my farm, I always feel as though (s)he was somehow "sent" to me to take care of, and I can't turn them away. The last four who showed up were starving kittens. Before that, the strays and ferals were always young adults (all intact except for one severely starved, spayed female). Of course I have them all spayed and neutered as soon as possible. I just wish whoever keeps dumping these animals on my road would tie a thousand dollar bill around their necks to help pay their expenses.



> I think you are absolutely correct about not being able to achieve euthyroid with such a low dosage and I started having concern about the complication from not being treated correctly.


The goal is always to achieve and maintain euthyroid. You don't want Spock to be either hyper- or hypo-thyroid, because both conditions can cause other physical problems. I think 1.25 mg of methimazole twice daily is an appropriate step up for Spock now, but have a retest done in 2-3 weeks after starting the new dose. Don't wait any longer than that for the retest, because if the dose is either too low or too high, you want to be able to adjust it as soon as possible.



> I also wonder if it is possible for Spock to have hypothyroid by having 0.25ml twice a day.


Yes, it's possible but not likely. This is one of the reasons why you want to increase the dose in small increments and to retest no longer than 3 weeks from the start of the new dose. If you adjust the med dose by a small increment and he goes hypo-, he'll just go a little bit hypo-, and you can adjust the dose to bring him back up to euthyroid within 2-3 weeks with no harm done. The real problem with overdosing methimazole occurs when vets prescribe way too high a starting dose that sends the cat into severe hypo- within the first few weeks of treatment. Usually these cats will recover when the med is withheld for a few days then restarted at a much lower dose, but occasionally a cat is unable to recover from severe hypo- and may become extremely ill.

My Billy was started on a dose of 5 mg of methimazole a day (before I knew better), and he became very hypo- on that dose. Luckily, he recovered quickly after I reduced the dosage.



> I know that the dosage that I am giving him is not overdose at all, but I was wondering if it is too much for Spock and cause something. Is there any signs to watch out?


When Billy became temporarily hypo-, he was extremely lethargic, sleeping almost all of the time, and had very little appetite. Hypo- cats may also have gastric problems such as vomiting.

As for Tora, his poop got finally much better.... As for Ally, she seems to get better after the episodes of vomiting.... Now I got to take care of my son who is suffering from sinus infection and asthma symptom[/QUOTE]

I' glad to hear that the cats are improving, and I'm sure your son will, too, under your loving care.

Take care,

Laurie


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## MinkaMuffin (Apr 1, 2011)

You could always consider having the thyroid removed completely since like Laurie said, there are no side effects to thyroid supplements and if I-131 doesn't work, he'd have to be on meds for the rest of his life anyways.


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## laurief (Jun 22, 2008)

I, personally, would consider thyroid surgery an absolute LAST resort for a cat who has severe side effects to medication and who can't, for whatever reason, undergo I-131. Thyroid surgery is a delicate and risky procedure that can easily result in damage to the parathyroid glands, resulting in hyperparathyroidism, which causes a whole extra set of problems and symptoms. Also, removing the thyroid glands doesn't necessarily cure hyperT, since diseased thyroid tissue can exist outside of the glands themselves in the thoracic cavity. If that diseased tissue is present and the vet doesn't find and remove it all during surgery, the cat will continue to be hyperT even after the thyroid glands have been removed.

And, of course, any surgery and anesthetic event carries a certain amount of risk, esp. for the feline species.

Thyroid surgery is a last-ditch option, IMO. 

Laurie


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## MinkaMuffin (Apr 1, 2011)

Well, yea, you wouldn't do it on a whim, only if other things fail, and you'd have to make sure to get a vet who's experienced in removing them..

(I have thryoid problems myself, so I know about the human equivalent of options anyways, I wasn't just throwing it out there on a whim >__<)


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## spockally (Mar 7, 2011)

> You're right. I do feel the same way. When a new feline shows up on my farm, I always feel as though (s)he was somehow "sent" to me to take care of, and I can't turn them away. The last four who showed up were starving kittens. Before that, the strays and ferals were always young adults (all intact except for one severely starved, spayed female). Of course I have them all spayed and neutered as soon as possible. I just wish whoever keeps dumping these animals on my road would tie a thousand dollar bill around their necks to help pay their expenses.


That is exactly how I feel when I started having Tora!!!!! I think God sent him to me and he was destined to be with us  He was a messanger from above warning to bring Ally and Spock to the vet asap to take good care of them and feed better food! It is very very very kind of you to take care of kitties and puppies like that. I can tell that you are such a nice person with very warm and kind heart  All babies are very fortunate in finding a way to your place. I just cannot believe somebody actually can dump kitties or puppies. Unfortunately, some people do not have heart.... 



> My Billy was started on a dose of 5 mg of methimazole a day (before I knew better), and he became very hypo- on that dose. Luckily, he recovered quickly after I reduced the dosage.


Thank you again for explaining about hypo-T. After I read what you said, I now know why it is so important to go "low and slow." In order to be in the just right range, the med seems to be adjusted little by little so cats do not be on extreme side of either hyper or hypo.... It sounds very hard but it can be achieved by checking early with new dosage as you said. I will watch out those signs that you mentioned. Is Billy doing ok now? I am glad that Billy became better after reducing the dosage. 

I thought my life around litter box was resolved finally now that Tora's production is much better. Today Ally stared having diarrhea....... I switched to Natural Balance limited ingredents wet food from yesterday (chicken/green pea for yesterday and duck/green pea for this morning) although she has been on Wellness. I hope she is okay and her poop will go back to normal after she goes back to Wellness. Phew... my Saturday so far is just spend on cleaning and cleaning. Hope you will have good weekend!!!!


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## spockally (Mar 7, 2011)

MinkaMuffin:
Thank you so much for reading my thread and giving me another option about surgery. I read about it but, as Laurie mentioned, it seems like lots of risks involved. Spock just started being on the medication and I am still considering whether or not he should be on the med forever or have the I-131 done later after his condition is stablized. I am keeping the surgery as the last resort, though. 
I am sorry to hear about your thyroid problem. I keep your good health in my prayers tonight  Have a great weekend!


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## laurief (Jun 22, 2008)

spockally said:


> Is Billy doing ok now?


I had to have Billy euthanized about a year ago. He was 20+ yrs old and had CRF, hyperT, hyperparathyroidism, and skin cancer for several years prior to his death. He was a very tough old man who did remarkably well with his various medical concerns up until the end. But they finally overwhelmed his body, and I had to help him move on.

I hope Ally's digestive upset has been resolved. Sometimes dietary changes don't agree with our feline friends.

Laurie


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## spockally (Mar 7, 2011)

Laurie:

I am very sorry to hear about Billy and I apologize for not being considerate to ask you such a thing. He went through many hardships in last seveal years.... just by thinking about how he and you were dealing with all sickness make me cry. It must have been really hard for both of you to go through. Thinking about the fact that he lived over twenty years, you must have taken care of super good as I always think of you. I am very sorry again for the loss and I pray for his peace tonight.


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## laurief (Jun 22, 2008)

There's no need for you to apologize. In spite of the challenges of managing Billy's medical issues over the last few years of his life, he was happy and comfortable and enjoyed being alive. I am not sad to remember him because we had many great years together. Billy was one of a kind, and I am honored to have had him as a companion for so many years. I miss him, of course, but I'm always happy for the reminders of my handsome Billy.

Laurie


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## spockally (Mar 7, 2011)

Laurie:
I am glad to hear that you cherish the sweet memories that you had with Billy. He IS very handsome kittie!!!! I am very sure that Billy will live forever in your heart and he is thinking of you every minute in heaven.


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## spockally (Mar 7, 2011)

Laurie:
I would like to update about spock's bloodwork result. His T-4 level was 3.2 this time (the vet said that normal range is between 1 and 4). So, he told me to keep giving the same dosage which is 0.25ml (1.25mg equivalent) twice a day. I need to bring him in 6 weeks later for re-check. Next time they will examine his kidney function because they have not checked it since the beginning of March. Do I need to keep bringing him in for bloodwork every month forever?

I was glad that his level went down and thus do not have to increase the medication. I just hope it will stay this way and someday he can have I-131. Of course I need to consult with my hubby's pocket......


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## spockally (Mar 7, 2011)

One more thing that I forgot to update....
The very first time Dr. P checked Spock in the beginning of March, he said that he heard heart murmur on Spock. This could be due to hyper-T and might be gone once Spock's T-4 level is controlled. Then, on Apirl 8, Dr. U, another vet in the same office, took Spock's blood sample for the test and checked his heart. Dr. U said that he does not heart murmur although Spock's heart rate was elevated but it could be from car ride and/or office visit. I was relieved to hear about what Dr. U said. Yesterday, I took him in for re-check of bloodwork of T-4 and saw Dr. P, the first vet that checked Spock. He again said that he heard heart murmur. I told Dr. P that Dr. U said Dr. U did not hear heart murmur. Dr. P suggested that another vet Dr. P or Dr. S or Dr. F can check if Spock really has heart murmur. Today Dr. P called me about the result and told me I can bring him in to be checked by another dr. but I said I want to try another vet to listen to Spock's heart six weeks later when I bring him in for next bloodwork. Spock does not like car ride and tends to get sick. I feel bad about Spock getting sick again by driving two days in a row  Dr. P said it is okay and see how his heart will be when his T-4 level is stabilized. If he does have heart murmur and it is not improved with hyper-T treatment, he needs to have ultrasound to check how his heart functions.... I just hope he does not have heart murmur. I need to do more research about it.


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## spockally (Mar 7, 2011)

Spock is losing appetite lately. He used to have good appetite for each meal (4 times a day). Somebody suggested to leave food all the time so he can eat any time he wants but I am sure other cats, especially Tora who is very big eater, will eat it as well. Tora has had loose stool problem and finally the problem is under control after the careful measurement of amount he eats. So, I do not feel like letting the food out all the time. I encourage Spock to eat and whenever there is an opportunity, I take him and leave him with food. I am concerned about his weight loss. How do I let him (only one cat out of several) eat more without affecting others? I appreciate your thought! Thank you!


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