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I-131 radioactive iodine aftermath

Posted: Tue Jul 09, 2019 9:06 pm
by Mollycat
I know there are already a few threads on hyperthyroidism and radioiodine treatment but 1 I don't want to tag this onto any one of those and 2 this is about post treatment recovery.

So Molly had her treatment in March and at first seemed to be a very different cat on return, much more chilled, more cuddly, and generally less feral. Her cravings have gone - dairy, fish, mashed potato, all high iodine so maybe the tumour was making her eat them. But she seems to change all the time, which makes some sense if her hormones are still fluctuating and her body is getting used to being euthyroid again and adjusting to mild renal failure as well. All this I can handle.

She did not present as a typical hyperthyroid, there was no weight loss at all, her T4 was definitely high but not very high, normal changes in liver enzymes, but also high bilirubin that made the vet suspect an ongoing liver issue - but the hospital found nothing in her pre or post checks to support this idea. Her hyperthyroidism was actually found in a routine blood screen when I took her in with acute digestive issues including but not limited to yellow diarrhoea. Yellow for bilirubin, seemed reasonable to me.

But now we are 14 weeks post treatment and she started having loose (not liquid but very soft) stools that are partially yellow again. Just yesterday we got the first solid one but still with one yellow section. It's taken me a long time to be sure it was her because other cat Boo also has digestive issues which have only just been brought under control with steroids ... we don't know what he has. Also she has not produced a fully formed furball since she was diagnosed last November, just a few half-formed ones.

My question is, is it normal post I-131 to continue getting occasional diarrhoea, or should I worry? I'm awaiting a delivery of Pro-kolin, I've tried giving her a capsule of Nutraflora which just seems to have caused very bad smelling wind. She already has hills i/d dry and has been on Felix for 4 months without issue until recently.

How long has it taken other cats to settle fully post treatment? I have read it can take up to 6 months to a year and we are only 3 months in. Was there a change in hairball production?

Is it possible she has caught whatever Boo has, which has never been identified in stool sample or blood testing? Vet suggests could be just IBD or possible lymphoma but either way steroids would be the preferred treatment at his age and given his general health.

Any thoughts here would be helpful, I am totally baffled not so much by one cat but by the two of them having such similar problems and yet apparently nothing contagious. And Molly has not yet had her 6-8 weeks post treatment check as we just don't have £250 after her treatment and me losing my job. Obviously we will go to the vets as soon as we can, most likely borrowing again.

Re: I-131 radioactive iodine aftermath

Posted: Wed Jul 10, 2019 11:51 am
by booktigger
No experience I'm afraid, but yellow would suggest liver to me. Might be worth speaking to the vets and seeing if they can do some kind of reduced price follow up, I assume the £250 includes tests as well as a consultation?

Re: I-131 radioactive iodine aftermath

Posted: Wed Jul 10, 2019 12:11 pm
by Kay
loose yellow poo could be pancreatic or liver issues - have you tried limiting her fat intake? older cats can struggle with fat without there being any disease as such present

Tiffany has problems digesting fat but I have seen an improvement feeding Gourmet Perle as it is lower fat than most - unfortunately all the better quality higher protein foods are relatively high in fat, but as they say any food is better than none

how is Molly if you only feed Felix? because FAGAIL is also low in fat - to make up for the poor protein in supermarket foods you could add in some tinned chicken and tuna, which are both high in animal protein and very low in fat

Re: I-131 radioactive iodine aftermath

Posted: Wed Jul 10, 2019 1:25 pm
by Mollycat
To be honest I don't have a problem with the price, only finding it if that makes sense. The training and facilities that go into a modern vet practice I know it's a lot of money but a good one is worth every penny, plus all the work they do that they don't get paid for like wildlife, strays and charities. If it was emergency I would ask for a payment plan rather than a discount. They are really good to us ... well we have spent nearly 7000 in 18 months between 3 animals!!

The crisis that sent us to the vets in the first place was yellow diarrhoea and vomiting then she stopped eating, which is so not Molly.
Her tests were, Molly vs normal:
T4 70 (55)
ALT liver enzyme 106 (84) fits with hyperthyroid
Bilirubin 15 (10) does not fit with hyperthyroid

On retest 2 weeks later bilirubin was normal at 3.8 (0-10), total T4 was 62 (up to 55) and free T4 was 65 (up to 40) and there was no more yellow though her stools were still a bit grey and stodgy.

I did some research and elevated bilirubin can be due to hyperthyroidism but it is possible she has an underlying liver issue. Vet wanted HT resolved before doing any more investigations. The thing with Molly is she is so nervous and traumatised that she is to be handled as a feral - luckily a timid one rather than an aggressive one - but not pillable and only 1 in 3 attempts to get her to the vets is successful. She never settled at all in hospital and they had to give her appetite stimulants and she lost 300g while in there, she really is an extremely difficult cat. And way too intelligent, you can't trick her the same way twice or bribe her and she only saw me put a pill in a pill pocket for the other cat once and now she won't touch the stuff even without a pill and even though she has never had a bad experience with it and she loved it before that. So number of vet visits have to be minimised and as much as possible done whenever we are there - that's why I hope not to have to take her before I have the money for the full blood tests.

On discharge post treatment all her liver readings were perfectly normal. She had minor damage to one eye and a slight thickening of heart muscle, and as was quite likely mild renal failure, all to be expected. But all liver readings including bilirubin and T4 and TSH perfectly normal. This suggests to me that her liver issue is linked to her hyperthyroidism and that's why I'm wondering about how long it takes for the body to settle back into being normal again after treatment and whether this could be just one of those fluctuations. The soft poo with some yellow now is nothing like the evil yellow liquid we got when she was first diagnosed, and she is eating and interacting normally, just a little quiet, and obviously I am watching like a hawk for any signs of trouble.

Sorry this is so detailed and long winded and thank you for bearing with me, now I'm on to diet.

Molly has always been greedy and fat since I had her at 6 years old, but her weight was getting really out of hand and any attempt to cut down just made her aggressive and more insecure. So I put her on Hills diet food but i made a big mistake. She was on Metabolic dry and r/d wet. Not only should these two never be mixed because they work in different ways, also the r/d is not for long term use. But this is what she had for 18 months and was down to a healthy weight and was having real meat and Webbox treats. Of course now I blame myself for her health troubles because I gave her a very bad mix of foods. Stabilising her pre-treatment she was on y/d which she loved and put on about 2-300g in 3 months.

Since treatment I first worried about her weight but she put on a little but not too much, she has 2 pouches of AGAIL senior and sometimes has some i/d dry and sometimes leaves it. Would the fat content affect bilirubin though? I/d is 24% fat so not too high if the recommended balance is around 40-50% protein and 30% fat and she has very little of it, AGAIL is 12% fat and that is her staple.

If the bilirubin is not linked to hyperthyroidism, then the most obvious in her first attack would have been a very early hepatic lipidosis due to not eating for a couple of days, but that would not explain it now. She had scans so any cancer or bile duct blockage would have been spotted. Another prime cause is a red blood cell parasite and she would not have had normal readings in between then and now. if she had FIP we'd know about it by now! The strange thing is that all her liver readings were normal in March and all were normal in November except ALT due to hyperthyroidism and this freak bilirubin. Unless she has some kind of chronic gall bladder infection or inflammation and it just happened to be ok when she was in for treatment.

Sorry for rambling, believe it or not your comments have set me thinking differently and constructively!