Pippin's experiences with hyperthyroidism

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fjm
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Pippin's experiences with hyperthyroidism

Post by fjm » Sat Jan 27, 2018 1:17 pm

I know there have been several threads on hyperthyroidism, but everyone's experience is slightly different and I thought it might be helpful to document Pippin's progress here.

Part 1

Pippin is a 14.5 year old neutered ginger dsh. He has suffered from moderately severe arthritis for the last few years, and has a small daily dose of Loxicom for it. Because of the Loxicom he has 6 monthly vet check ups - in summer 2017 the vet flagged up that he had lost weight, and was showing signs of possible hypertension. In late November 2017 the weight loss was even more obvious, and the vet suspected hyperthyroidism, recommending a blood test which confirmed the diagnosis. In early December Pip started on 1mg/5ml of Thyronorm drops a day - a check up and blood test three weeks into treatment showed a steadier, more normal heart ryhthm, thyroid results back into the normal range, and kidney and liver functions within normal ranges. I find the drops very easy to give - he gets half the dose in the morning and half in the evening, gently squirted directly into his mouth (I avoid giving them on food in case one of the other animals eats it).

Apart from weight loss Pippin had shown none of the typical signs of hyperthyroidism, perhaps because it was caught comparatively early. He remained placid and rather lazy, and was neither noisy nor hyperactive. His appetite was good, but not excessive, and his coat was in good condition for a cat of his age. He began to gain weight as soon as he started treatment, going from 4.77 to over 5 kilos in three weeks.

I discussed the treatment options with my vet (disclaimer - I am not a vet. This is my understanding of the options from discussion and research):
1 Do nothing, in which case his metabolism would eventually run faster than his ability to absorb calories and nutrients and prove fatal.
2 Treat long term with Thyronorm. Medication treats the symptoms, but not the underlying problem. The thyroid tissue continues to grow, releasing more and more thyroid hormones, and potentially requiring increased doses of medication, which may in turn have increased side effects.
3 Diet. A specially formulated diet is available that in essence starves the thyroid gland of the iodine it needs to make the hormones. It only works if no other food or treats are ever available to the cat, so that wasn't going to work round here!
4 Surgery. My vet has performed many successful removals of the thyroid glands, but any general anaesthetic carries a risk. The cure rate for surgery is good, but not as good as radio-iodine therapy.
5 Radio-iodine treatment. Radio-iodine is now considered the gold standard treatment, with a very high cure rate and a non-invasive procedure. The downsides are the cost, the time the cat spends hospitalised until the levels of radioactivity drop to a safe level, and the even longer time the cat and all urine, faeces, etc, etc have to be contained and managed once home (I am not on mains drainage).

Pippin is not insured, but I have a savings account for vet fees so I am fortunate not to have to make my decision based upon restricted finances. Once my vet knew that I was considering radio-iodine treatment, and that I understood the costs involved and the need to keep Pippin in isolation for several weeks, he was very confident that it is the best option for Pippin, and referred him to the Hyperactive Cat Centre in Wetherby. Meanwhile Pippin continues on the same dose of Thyronorm, and is slowly filling out again.

To be continued.

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Re: Pippin's experiences with hyperthyroidism

Post by Lilith » Sat Jan 27, 2018 4:28 pm

Yes indeed I agree, symptoms and experiences can be so varied with this distressing disease that all the information that can be gathered, the better!

When my Mousey began to look thin and scruffy, I assumed it was old age catching up with her - until I read Antonio's thread about Pallina and began to suspect HT. As you know, Mouse didn't do well on meds as she was disturbed by pilling (and in truth it was thought that since her T4 level was so high, she might not respond well to Felimazole) but has made a good recovery since radio-iodine treatment. Thank goodness I discovered this forum in time! I'm glad Pippin's maintaining health and condition so well with the Thyronorm though, and Mousey and I wish him well with the referral to the Weatherby Centre, will be following this thread with interest, and good luck Pippin :)

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Re: Pippin's experiences with hyperthyroidism

Post by fjm » Sun Jan 28, 2018 11:28 am

I thought just the same, Lilith - "He is old - old cats get thin." I was watching for signs of kidney problems, but not for hyperthyroidism.

Part 2

Pippin was referred to the HCC just after Christmas, and I got a phone call from them almost immediately to chat about Pip and make sure I knew what the treatment involved. It took rather longer to sort out an admission date - I needed to fit having him at home following the treatment around family commitments, so in a later discussion with the HCC vet I decided on the 27th February, as giving plenty of time to sort everything out. By then, with luck, the cross Pennine roads will be less likely to be blocked by snow, too!

I was talked through the isolation process, we discussed Pippin's diet (they are obviously not very used to cats who are cooked for!), and checked a couple of other things I was not sure about (like storing used cat litter…). A few days later I received all the admissions documentation, including the IDEXX shipper for blood and urine testing. Once I was registered as a client I also received a password to view the very helpful videos the HCC has made on managing cats at home following the treatment - right down to how to take off rubber gloves without contaminating them!

Pippin will stop medication about two weeks before admission, halving the Thyronorm for a few days first. He will have a full vet examination and blood and urine taken for testing a week or so before admission. He will need to be starved on the morning he is admitted, as they prefer to give a sedative before giving the radio-iodine (more than understandable, given how some cats behave!). Once he has received the treatment he will be in very close isolation (large crate) for 5-10 days until his radiation levels drop to a safer level for those in contact with him. At this point he could come home, or can stay longer at the centre, in a larger, cattery style pen. The cost of the treatment includes up to 14 days boarding, and longer periods are possible if necessary - as I have no children or pregnant women in the house and no possibility of becoming pregnant myself I plan on bringing him home after 14 days, if I can last that long!

He will need to be strictly confined for the first two weeks after coming out of close isolation, and kept away from people and from toileting outside for two more weeks after that - which means around three weeks in the spare bedroom if he spends two weeks at the Centre. I am not on mains sewage so will also need to keep all used litter safely stored in the garage until 6 weeks after his treatment date, several metres from any well-frequented areas.

I am budgeting around £2,500 for the treatment, including blood tests, follow up, etc. For comparison the Thyronorm is less than £25 a month, but to that must be added regular vet checks and blood tests, which would bring it up to at least £500 a year. Pippin is very easy to dose, but even he is getting a bit fed up with me poking a syringe into his mouth so often, even if it is accompanied by chicken and sausage.

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Re: Pippin's experiences with hyperthyroidism

Post by Lilith » Sun Jan 28, 2018 8:26 pm

Glad you're all fixed up :) I take it you have to travel along the dreaded M62 - all paws and tails crossed for good weather!

I too wondered how the diet aspect would work, but I can imagine the Centre will cope. The videos sound like a new thing; I didn't see them, and they sound like a very good idea - I went into CONTORTIONS with my rubber gloves :lol:

Yes, it does seem like a huge outlay at the time, but if a cat's on meds all its life that can work out just as expensive.

All the best to the lad, and you too :)

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Re: Pippin's experiences with hyperthyroidism

Post by Antonio » Mon Jan 29, 2018 1:58 pm

@fjm, it seems your cat Pippin might be one of the uncommon cases of apathetic hyperthyroidism.
The thyroid produces more hormones than it should, but no symptoms show.
My cat Pallina wasn't eating more, was placid and quiet, her coat was fine, she was only losing weight due to the fact that she was actually eating less than what she had to.
Ask your vet if this is a case.
I think that nothing changes for the treatment, but the clinic where you are going to might be interested.

I had my cat treated in August. In ten days time we'll have the last blood test after treatment, and so far it seems it has worked fine.

Because here in Italy we have no facilities for the radio-iodine therapy, I had to travel to Belgium, and the cost of the scintigraphy, the preliminary tests (Pallina also had an x-ray and two chest scans done), the I-131 shot and hospitalization was of 950 euro.
It might sound like a bit expensive, but it is the same amount I would have spent in 14 months of meds and monthly blood works. Now I'm entering the 6th month after treatment, I am halfway into the expenses that I have saved.
She stayed at the clinic for 5 days and I was asked to follow some safety rules once back home for 4 weeks, rules that I partially disregarded.

Now she looks fine, but we're investigating into an issue that the vets in Belgium found out during the preliminary tests.

Best of luck to Pippin!

EDIT : you can find my thread on Pallina's HT experience in the list of threads

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Re: Pippin's experiences with hyperthyroidism

Post by lilynmitz » Thu Feb 01, 2018 6:46 pm

My old girl Lily had HyperT for years. I think she was about 12 or 13 when diagnosed, and the vet decided to operate to remove both glands, which he found were hugely enlarged, and she was fine for a few years after. But then the contrary little puss grew new glands somewhere in her chest cavity, which is fairly rare but can happen. These are inoperable, and I knew she wouldn't cope with the radio-iodine treatment, (nor was it on offer at this surgery so she would have been sent absolutely miles away for this) so we controlled it with pills thereafter. They were so small I used to hide them in webbox treats (soft meaty sticks), so she never knew she was getting pilled, she just knew she got a lot of treats! :lol: Despite numerous other medical conditions (renal failure, bladder stones, high blood pressure and arthritis), my creaky old lass made it to 17 before her heart finally gave out.

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Re: Pippin's experiences with hyperthyroidism

Post by fjm » Thu Feb 22, 2018 8:26 am

Pip had his pre-admission check up with my vet yesterday. He needed to be off the Thyronorm for at least a week before the blood test - the difference within a very short time was very obvious. He has lost weight, is uncomfortable, and I think hurt his arthritic shoulder jumping and has been hobbling for the last few days. That's not directly a result of the hypothyroidism, but I had noticed a small but definite improvement in muscle tone and ease of movement after he had been on medication for a month or two, which dropped off very quickly when he came off it. I have been giving him a full, rather than half, dose of loxicom, and it seems to be improving slowly. I am also offering him meals several times a day, and watching to be sure he eats them (the other animals are only to keen to help, given half a chance!).

Results are all as expected so far. Bloods have gone off to IDEXX, and his blood pressure was well within range for a cat who was at the vets, had just had a blood test, and was generally feeling somewhat disgruntled. The only failure was the urine test - I corralled him into the cat carrier as early as I could, but he still had an empty bladder and the vet didn't even attempt to aspirate.

He goes in next Tuesday. The spare room is well on the way to being sorted out ready for him, and while he is in purdah I will reorganise cat flaps to make life easier for him - at the moment there is jumping involved, and that is obviously not something he can cope with any more. I am really hoping that the radio-iodine will be effective as quickly as the Thyronorm was - it is very hard to see him uncomfortable, to know there is a bottle of stuff in the kitchen that would make him feel much better, and to know I mustn't give it to him!

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Re: Pippin's experiences with hyperthyroidism

Post by Antonio » Thu Feb 22, 2018 8:53 am

@fjm,
The effects from the radio-iodine treatment will not be visible right away, it could take weeks or months to be effective.
In several cases the treated cats get HYPO thyroid for a period of time, then they tend to get better.
My cat Pallina was treated with radio-iodine in last August, but the first two blood tests (30 days and 90 days post treatment) came back as HYPO thyroid. The request from the I-131 facility was to have another test done after 180 days, but I decided to have another test done in between, 150 days. Well, after 5 months she was getting EU-thyroid, that is her thyroid was starting working fine at last. The last test, done two weeks ago, confirmed that we're free from this problem now!

Ask the vets who will do the treatment to Pippin what you have to expect in the first weeks/months after the treatment, and what you can do in the meanwhile if certain symptoms do not die off.

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Re: Pippin's experiences with hyperthyroidism

Post by fjm » Thu Feb 22, 2018 1:13 pm

Thanks Antonio - the hope is that stopping the medication well before treatment should help reduce the risk of him becoming hypothyroid, but I know it can take a while for the thyroid to balance out. My own vet reckoned he should respond nearly as quickly to the absence of excess production as he did to the Thyronorm, but that may be rather optimistic - I am hoping to see significant improvement 4-6 weeks from the treatment date. If I can rearrange the house to make it easier for him to get around he can then have a lovely Spring and Summer pootling around the garden and courtyards and lazing in the sun, building up his strength!

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Re: Pippin's experiences with hyperthyroidism

Post by Lilith » Thu Feb 22, 2018 3:39 pm

Best of luck for the big day :)

The isolation will soon pass and then he can get his life back :D

Lots of love and fusses to the lad x

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Re: Pippin's experiences with hyperthyroidism

Post by fjm » Mon Feb 26, 2018 8:57 am

Sod's Law at work - I booked Pip's admission date ages ago, allowed plenty of time to get there by the A65/A59 route I know well, arranged to visit friends in Beverley overnight and to call in on another friend in York on the way back, and now there is a major severe weather warning for snow across most of the route for precisely the time I will be travelling! I think I will make a motorway dash of it instead - I'd planned on taking the dogs with me, but may need to rethink that if I am likely to get stuck on the M62 for hours. Oh joy...!

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Re: Pippin's experiences with hyperthyroidism

Post by Lilith » Mon Feb 26, 2018 9:56 am

Oh hell nooooo! :o :(

This week of all weeks ... yes, the forecast's very forbidding.

All the very best of luck, all paws and tails crossed here for you and Pippin and Co!

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Re: Pippin's experiences with hyperthyroidism

Post by Antonio » Mon Feb 26, 2018 2:47 pm

Hopefully the weather conditions will be better than they forecast.

Over here the weathermen frightened us with stories of severe snow storms, like never seen in a decade, with winds up to 100 km/h and a wild drop of the temperature as from yesterday.
Well, it turned out that we had just 1 inch of snow, no wind at all and the temperature is just -2°C, totally manageable.
Today is bright and cold, but nothing really serious.

All the best to you and Pippin!

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Re: Pippin's experiences with hyperthyroidism

Post by fjm » Mon Feb 26, 2018 3:07 pm

I think it may well be similar here, Antonio. Watching the changing - and improving - forecast I'm hoping I can go the route I know best, avoiding motorways. Always best to avoid the M61/M62 if you can!

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Re: Pippin's experiences with hyperthyroidism

Post by Antonio » Mon Feb 26, 2018 10:28 pm

Fjm, unfortunately I'm not familiar with your motorways, I am Italian and live in northwest Italy, but I agree that you should go the route you know best. It's always the best idea!
Please, keep us posted ;)

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Re: Pippin's experiences with hyperthyroidism

Post by fjm » Tue Feb 27, 2018 4:48 pm

Probably best to treasure your ignorance, Antonio! If you have ever driven on the Peripherique in Paris it gives a flavour of life on the average UK motorway these days...

I took Pippin in this morning - the roads were clear but there was a lot of spray and snow flurries, so I was glad to get there safely. The vet was a little concerned about Pip's blood pressure (perhaps just as well no one was measuring mine), and recommended putting him onto medication as a precaution. Apart from that all was well, and I very reluctantly said goodbye and left him there, with 28 pots of frozen home cooked food, a large pot of extra special treats, half a dozen small blankets smelling of home, and a final hug. I have just had a phone call to say that he has had the injection, and is coming round well from the sedation - sitting in front of his cell asking for attention. I know he will be fine, but I miss him already. He spends most of the day sprawled asleep on a chair or sofa, but it is such a companionable sort of sprawl...

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Re: Pippin's experiences with hyperthyroidism

Post by Lilith » Tue Feb 27, 2018 5:42 pm

Ohh I've been thinking about you!

So glad you've got the lad delivered safely, yes, Antonio, the M62 is notorious especially on the Pennine stretch but so glad you negotiated it Fjm, and he really will be in the best of hands and already on the road to recovery :D

In Wakefield we've had amber warnings but very little snow but a friend in Bradford couldn't see her car this morning. Stay safe, and hopefully by the time Pippin needs to go home the weather will be much better.

Mousey sends purrs to Pippin and Pallina and all the best from me x

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Re: Pippin's experiences with hyperthyroidism

Post by fjm » Tue Feb 27, 2018 6:08 pm

I avoided the motorways and went over the pass at Blubberhouses - a bit mucky in places, but everyone else seemed to opt to go round by the valley, so not much traffic and the roads were clear. Fabulous coming back - pristine snowy hills, blue skies, bright sunshine, and all the better from being viewed from a toasty warm car!

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Re: Pippin's experiences with hyperthyroidism

Post by alanc » Tue Feb 27, 2018 7:09 pm

Glad you got Pippin to Wakefield and got back safely. The snow seems very patchy - we have only had a thin smattering so far and that came down when the Met Office forecast said there was only a 10% chance of snow - earlier when they gave a 60% chance we didn't have any.

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Re: Pippin's experiences with hyperthyroidism

Post by Lilith » Wed Feb 28, 2018 11:51 am

fjm wrote:I avoided the motorways and went over the pass at Blubberhouses - a bit mucky in places, but everyone else seemed to opt to go round by the valley, so not much traffic and the roads were clear. Fabulous coming back - pristine snowy hills, blue skies, bright sunshine, and all the better from being viewed from a toasty warm car!
That sounds gorgeous - ugly name but beautiful countryside. I have a very old book that says the name's derived either from Anglo-Saxon 'bluburhus' - 'house of the blueberry' (bilberry?) or an old pub called Blue Boar House ... bit of tmi for the day.

So glad you got him there yesterday; it's very snowy in Wakefield today and we're sheltered in the centre, and wickedly cold, so in more exposed parts I dread to think what it's like ; even a few miles away lorries are stranded and the Yorkshire Sculpture Park's had to close. Hope everyone's staying safe.

You'll be getting a phone call today to tell you how he is - they do look after them well, all the best :)

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Re: Pippin's experiences with hyperthyroidism

Post by fjm » Wed Feb 28, 2018 12:56 pm

One phone call already - yesterday afternoon, to say he had the radio-iodine injection, was recovering well from the sedation, and was sitting at the front of his pen wanting to talk to people but not yet relaxed enough to eat. I can't imagine him not eating for long, and am hoping he made up for lost time once things were quiet and dark at night. Pip likes routine, and I am sure he will relax once he knows what to expect when.

eta: And a second update by email - he is eating, using the tray nicely, bright and cheerful, being friendly and asking for attention, and generally settling in well. So excellent news!

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Re: Pippin's experiences with hyperthyroidism

Post by Antonio » Thu Mar 01, 2018 7:56 am

Sounds like Pippin has a great attitude towards what is new and other people, that is good indeed! :D

I know it for sure that my cat does not eat much (or at all) when she's away from home.
When my cat Pallina stayed at the clinic in Belgium, I provided them 24 cans of food. She stayed there from Monday at noon to Friday at 9 am. What I know is that she couldn't eat on the first day due to some tests she had to do. I think she ate something at night. And she couldn't eat on Tuesday because she had to receive the I-131 shot, so I reckon she was able to eat from Tuesday afternoon.
When she was released on Friday morning, I got the remainder of the food I gave them, and only 11 cans were in the pack... 13 cans gone... That was weird, 13 cans in 3 days... I can only imagine how much food they wasted!
Last edited by Antonio on Thu Mar 01, 2018 10:28 am, edited 1 time in total.

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Re: Pippin's experiences with hyperthyroidism

Post by fjm » Thu Mar 01, 2018 9:29 am

Yes, he is a very laid back cat in general, but he has spent a bit too much time at vets recently and doesn't much like them as a result. Once he associates a human with food and stroking they are very welcome, though, and as eating and sleeping are his two favourite activities a place that provides a warm and comfortable bed and near constant meals is his idea of heaven!

13 tins in 3 days! I hope they were small ones! I took 28 rather large frozen meals, as I am planning leaving Pip for two weeks - I think once he has settled there it will be easier for him to get used to confinement in a new place than to come home after a few days and not be able to roam at will in his usual way. After that with luck the spare room will feel comfortably familiar but not too restrictive. The meals were large because he was so hungry after coming off the Thyronorm that normal sized portions were not enough - I reckoned I would rather have some thrown away than him be hungry. He can stand to gain more weight, so that wasn't a concern. And it made me feel better cooking a carefully balanced mix of rabbit, chicken, beef and vegetable stock, and garnishing each pot with chunks of chicken and a little chopped liver - he would probably be just as happy with Felix, but I like cooking lovely meals for my family and friends!

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Re: Pippin's experiences with hyperthyroidism

Post by Antonio » Thu Mar 01, 2018 10:39 am

They were 80 grams cans.
Pallina would usually eat 2 cans a day, but sometimes even just one.
She was an apathetic hyper-T cat. This means that even though she was clearly hyper-T (fT4 and T4 way over range), her symptoms were the opposite of a classic hyper-T cat, no increased appetite, no hyperactivity, no edgy attitude. She was much more relaxed and slow, with a lessen appetite. She was losing weight not because of her hyper methabolism, but because she wasn't eating anymore.
That said, it's very unlikely she was eating all that food while she was at the clinic.
So I presume that they would open a can in the morning, she wouldn't eat it, then they opened up another can around early afternoon and another one in the evening. And all of them went in the trash...
Pallina lost 500 grams of body weight between Monday at noon and Friday morning! So clearly she didn't eat much... :(

Now she's eating 1 and a half can a day (120 grams), which is less than she should, but at least she's eating. She also suffers from IBD, so I guess that this disease plays a big role in her disturbed appetite.

Best of luck to Pippin!
Please, keep us posted as soon as you have news from Wakefield :D

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Re: Pippin's experiences with hyperthyroidism

Post by Kay » Thu Mar 01, 2018 10:55 am

Pippin sounds a lot like my bridge boy Trigger - he was in purdah for 16 days, and put on 500gms - the staff commented that he seemed to be content to just sit in his cage and silently observe his surroundings, without making any fuss or demanding attention

he came home without any signs of trauma from his experiences, though his total delight at finding himself back home was lovely to see

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Re: Pippin's experiences with hyperthyroidism

Post by Lilith » Thu Mar 01, 2018 12:57 pm

Pippin is a lucky lad with his supply of home cooking :)

It must feel so strange without him.

I don't know what it is about the Wetherby Centre but my Mouse has always been an ultra-timid cat, but even she was confident with the staff and ate well when she was there, as her photo at the centre and her weight gain showed.

When she was admitted they took her blood pressure and she purred. Now we all know that cats can purr under pressure - but the bp went DOWN :o :D

All the best, and you'll have him back before you know it :)

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Re: Pippin's experiences with hyperthyroidism

Post by fjm » Fri Mar 02, 2018 7:19 pm

Daily messages saying Pip is settled, cheerful, eating well and using his tray “nicely”, which I assume means no digestive problems. Only another day or two, with luck, before he moves into the more spacious cattery style accommodation. I shall have to get on with sorting out the spare room for him as soon as I get home from my weekend away - he will be home before I am ready at this rate!

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Re: Pippin's experiences with hyperthyroidism

Post by fjm » Mon Mar 05, 2018 3:40 pm

Pip has now moved to a bigger space, so all is going as expected. Time really is flying - two weeks seemed oodles of time to get everything ready, and here we are with only a week to go. Lidl had nice big covered litter trays for £7.99 when I was in last week, so I have treated us to one of those, and I have a posh IATA approved carrier waiting to be put togther (the old squishy comfortable canvas one is not suitable for transporting a radio-active cat). The Centre provides a suitable litter, so I don't need to worry about that, but there are still a few things to shop for, like Marigold gloves...

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Re: Pippin's experiences with hyperthyroidism

Post by Lilith » Mon Mar 05, 2018 4:36 pm

Bless him! He'll be able to watch birds and squirrels in the grounds - hopefully the squirrels will be emerging from hibernation; they wake up on milder days. Those split level pens are great.

Time does go faster than you expect. Soon you'll have him home and into a routine - and then that time will pass quickly too :D

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Re: Pippin's experiences with hyperthyroidism

Post by Antonio » Mon Mar 05, 2018 5:19 pm

I used disposable gloves, and only for a limited time, because I got tired of those things on and off my hands several times a day :D

As soon as the weather gets friendlier I wiil get rid of the content of the spare bin at the backyard. I think that radioactivity of the used litter must be null now.

Pippin will be home before you know it ;)

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