Pallina, hyperthyroid cat. Seeking advice

[Lilith]

Let's face it, Antonio, some people just have Godot as their middle name ... infuriating though, grrrr!

Perhaps your local vet could tell you how long that fluid lasts in the fridge?

All the very best, and from Mousey too

[Antonio]

HL would cause the increased liver values, but it's not common at all. Her increased kidney values would explain the decrease in kidney size, it is unfortunately common when hyper-t is treated.

I called my vet before noon. He wanted to know how the visit with the IM vet had gone. So I told him the IM vet was sick and my appointment was cancelled and asked him to comment on the reports.
He said that it's strange that a HL is being presumed, because Pallina misses all symptoms of this and she hasn't shown any behaviour that could have led to HL. She's not overweight (she was in early 2016, then the HT came in play and she lost much weight), she has always been eating, sometimes a little less, but she never fasted longer than the times she needed to before a visit. No other level in the blood report says she is at the early stage of a HL. So he said that he doesn't trust that report too much, as we say over here "he handles that report with the pliers", that means he takes that report with a pinch of salt.
About the increased creatinine level, he said that in his opinion 2.0 and 2.2 are the same thing, because the measurement of the creatinine is never very accurate and ten different measurements will give out ten different values.

Let's face it, Antonio, some people just have Godot as their middle name ... infuriating though, grrrr!
Perhaps your local vet could tell you how long that fluid lasts in the fridge?
All the very best, and from Mousey too

I asked my vet how long that sample could last in the fridge, he answered that 4-5 days would still be fine,
I am considering whether to re-book another appointment at the same vet early next week, or to book an appointment somewhere else, but don't know where.
The name of this sick vet was given to me by the lab vet, and I knew that name before because he's very well known around for his deep knowledge of all cats' disease.

[Antonio]

I ended up re-booking at the same vet. New appointment on next Tuesday, 4 pm.
It would have been much handier for me a morning appointment, though. I never liked appointments in the afternoon, I'm less ready to any kind of question and Pallina could be tired, she usually sleeps in the afternoon

I asked the doctor who took my call whether the fluid sample I'm storing in my fridge will still be good on next Tuesday. He said that probably it won't and if they think it's not good for a test they will draw some fresh fluid from Pallina's chest.
I have already stated that I won't allow any new needle in her chest, because she gets very stressed by this and if they want to run that test, they will have to use what they already have.

I do hope they won't play more tricks on me

[Patricia]

Hi Antonio,

I hope all went well at the vets today and they were able to use the previous sample to do the test. He sounds like a good vet so I hope you get a satisfactory conclusion this time.

[Antonio]

Hi Patricia, hi all,

I went to this new vet yesterday, I was there 4 pm sharp!
This vet is a well-known (probably countrywide) specialist in cats, he writes articles on the web and has a wide experience in infective diseases. I knew him by name, I had read some of his articles in the past years.

Well, the new vet wanted to know everything about Pallina, I showed him all the reports of the last 6 months, a thick pile of paper. He read them all, then he re-read them. Yesterday I also got the reports for her total bilirubine, 0.77 mg/dl [0.0-0.3].
Both my vet and the new vet said it isn't the case to take action at the moment.
Then he visited Pallina and made three x-rays. He found that Pallina has some arthritis and feels some pain at her hind legs. As a matter of fact I had the same idea, since she was limping a bit in the last few weeks.

This vet told me that it is normal for a cat to have some fluid in their chest, and that draining it all is wrong. The average amount is 10-30 ml, and it is functional to the breathing process and lungs and heart health. He said that a cat can easily survive without problems with up to 120-130 ml of fluid in their chest and still not showing breathing issues.
He confirmed that Pallina's problem is no infection-related and absolutely no lymphoma-related.

From the x-rays he saw that Pallina's cranial lung lobes are atelectatic, that means that these parts of her lungs are not filled with air anymore, they're like compact tissues, fibrotic. These lobes are reduced in size as well, and have some empty space around them. This causes them to "swing" in her chest and this gives inflammation which, in turn, leads to fluids build-up.
The condition is not reversible and hopefully it should not progress, though this is not sure.
So far Pallina is compensating and not suffering for air reduction, just because she is elder and not very active, but should she be more active or be under stress, then she could be panting.

What has caused this condition, though, is unknown and it seems it cannot be determined for sure. Usually it happens after a pneumonia, which Pallina never had. Or it happens following a mechanic trauma, which she didn't have either. The weirdest thing is that even if she had a trauma this couldn't have involved both lungs the same way.
So the origin of the problem might remain a mistery.

The fluid sample that my vets drew from her chest on last Thursday during the scan was still fine for the test of electrophoresis of the proteins. So he's going to test it.

The new vet also assessed that Pallina is dehydrated due to the diuretic she's taking and he said that he's going to change the med to another one. Which diuretic will be determined by the urinalysis he is going to do on a sample of urine he took from Pallina's bladder during the visit.
He said that the diuretic I'm giving her (benazepril hydrochloride + spironolactone) works fine only when the proteins in the fluid to be expelled are below 3 g/dl, Pallina has 4.4 g/dl. This makes the fluid thicker and not drainable. The diuretic, so, calls water from the blood and tissues, leading to a dehydration of the patient.

He also said that Pallina hepatic lipidosis isn't worrying at the moment, she's eating, so no problem.
I told him that she used to eat 2 cans a day, but now she struggles to eat 2 cans even with her dose of cypro. He said she's fine like this. Although her weight dropped from 5.6 kg to 3.2 kg (12.3 lbs to 7 lbs) in a few months, this is her normal weight, because Pallina is small sized, she was overweight when she was fine.

He said that he has never seen a similar case before, and at the moment he doesn't know how to help me and Pallina. He will also give her a cortisone med, but he still has to figure it out which one. He held all the reports I took him and wanted all the scanned images taken during the Belgium hospitalization.
He shoud call me later today or on Thursday morning.

Meanwhile he said to keep pilling Pallina as usual and he gave me a sample bottle of supplement pills for her liver. It's a supplement very similar to the Denamarin, but it's produced over here, because Denosyl and Denamarin are no longer imported to Italy.
He said that her liver levels are higher than the range, but not worrying.
No other supplement or vitamins should be required at the moment.

He was astonished that I had so many weird and rare cases in my home... I have talked with him about Lola and her troubles.
Lola had two rare or extremely rare issues. Pallina has been hyperthyroid in the apathetic form (which is uncommon) and now this.
He said I have defeated all medical stats!

The visit lasted an hour and 40 minutes, I paid 140 euro for the visit, the tests and the 3 x-rays.

Last night I gave Pallina 1/8 pill of Cyproheptadine (0.5 mg) and she ate a lot, but this morning she didn't want to eat, though she was following me around the house waiting for her dish of food. As soon as I gave her her bowl she turned away. I wonder if I have to increase the dose to 1/4 pill, or to give her 1/8 pill twice daily.
She's always feeling cold. She wasn't like this last year.

[booktigger]

Wow, sounds a very thorough vet, do hope that he can find a new medication combination that works for her, good that he isn't overly concerned though.

[Lilith]

That's amazing thoroughness - and value!

It's good that there's no immediate cause for concern - and as for sometimes missing a meal, all mine do that from time to time; I just leave the food down and they go back to graze on it later on.

Fusses to her and all the best as always

[Patricia]

Hi Antonio,
Thank you for all your news.
Yes I agree that is very good value. I remember paying about 110 euro just for a blood test and a ten minute appointment. This vet seems very thorough. Maybe Pallina's weight loss could be due to the diuretic also. So the other vet shouldn't have been syphoning the fluid from Pallina's chest, if I've understood right. Maybe her appetite is reduced since having the radio-active iodine treatment as she isn't HT anymore.
Does she seem quite happy in herself? Is she playing and showing interest in things around her?
The vet seemed quite impressed with Pallina and Lola making medical history!

[Antonio]

Hi all,
On late Thursday the new vet sent me an email and told me to start giving Pallina a new med, prednisolone pills, 5 mg, one pill daily. This should reduce the inflammation in her lung and reduce the fluid build up. I'm sure this would also help her with her IBD or stmach issues.
He also switched the diuretic from Spironolactone to Fortekor.
He adviced me to test Pallina in 10 days time with a new chest scan to evaluate the effectiveness of the new therapy.
He concluded that the origin of the fibrosis and inflammation in Pallina chest won't be assessed, it will remain a mistery. Hopefully the fibrosis will not spread to the rest of her lungs.
Friday was a religious holiday over here, so all shops and pharmacies were closed, I bought the new meds on Saturday and started the new therapy on the same day.

Meanwhile, on the HT cats Yahoo Group, a couple of members questioned the reliability of the lab who ran the thyroid tests in the last months, and urged me to ask my vets to take a blood sample and send it to an accredited IDEXX lab. They say that the low thyroid levels are to be ascribed to a HYPO-thyroidism because after three months her thyroid should have gone back to normal function. In their opinion, Pallina could be one of those few cases that respond to I-131 with HYPO-thyroidism. This could be the reason for her poor appetite.
The strangest things happen in my house!

On Saturday she was rather sick and ate very little food, but she was active and lively. Yesterday she was feeling better and ate her usual two cans, but she also drank twice as much water!!! As for the rest, she's as usual, she follows me around, loves on me, looks for cuddles, watches the world out of the window. On Saturday she also asked me to be allowed outside for a few minutes.
It's a weird situation.

[booktigger]

I do hope the steroids work for her, just make sure you do regular bloods to make sure they aren't affecting her organs. Wouldn't surprise me if Pallina is a rare case who develop hypo-thyroidism!!

[Lilith]

Hi Antonio, I'm sorry to hear all this - seems like complication after complication, but I think the main thing is if she's placid and happy and eating enough - by which I mean, in an elderly cat, not always sticking to a routine. Sometimes Mouse sleeps in - other times she's waiting for her breakfast at 5am.

Been looking back at Pallina's T4 result - was it 'officially' 19 but would have been lower due to the machine? Mouse's results came back today and her T4 is 19.9, so I asked, was this a good level and was told it was perfect. However, all labs seem to give back different results; the one my vet used initially was dramatically different to the one from the lab the Wetherby Centre uses. So, although I'm not terribly clever about stuff like this, I feel that it does rather beg the question, does it depend on the lab as to what the T4 level really is?

If the worst comes to the worst (and I hope it doesn't) will the Ghent clinic have Pallina back for a second course of treatment if she is hypo?

Paws crossed and crossed again and Shahi python is PLAITING himself that this won't be the case!

Lots of purrs from Mousey and fusses to Pallina x

[Antonio]

I do hope the steroids work for her, just make sure you do regular bloods to make sure they aren't affecting her organs. Wouldn't surprise me if Pallina is a rare case who develop hypo-thyroidism!!

Hi Booktigger, I will have a new blood test done on Dec 21. I called my vet a couple of hours ago to tell him the outcome of the specialistic visit of last Tuesday. I asked them to have a new blood test, complete with thyroid, but tested at a different lab.
Since so many rare conditions have landed in my house, I wouldn't surprise either

Been looking back at Pallina's T4 result - was it 'officially' 19 but would have been lower due to the machine? Mouse's results came back today and her T4 is 19.9, so I asked, was this a good level and was told it was perfect. However, all labs seem to give back different results; the one my vet used initially was dramatically different to the one from the lab the Wetherby Centre uses. So, although I'm not terribly clever about stuff like this, I feel that it does rather beg the question, does it depend on the lab as to what the T4 level really is?

As a technician often involved in certified measurements, I can say that the quality of a reading is strictly related to the machine that is performing the measurement, let alone the person who is using the machine and the procedure used to do the job.
This is the reason why the HT Yahoo Group adviced me to have the test repeated at an IDEXX lab, that is certified with a high standard.
I called IDEXX in Italy this morning. They didn't want to talk with me, because I'm not a doctor, but I have been told that the sample will be sent to Germany!
My vet agrees with sending the next blood sample to IDEXX in Milan, Italy. I will ask them for an SDMA test as well.
My vets used to do an in-house thyroid test, then this summer they decided to use an external lab, We had the same levels from both labs. This doesn't mean, though, that they are both precise and reliable.

Pallina's T4 level was <12.9 (not 19) on the last two reports, this means that it could have been lower and the machine just couldn't read it.
At IDEXX this morning they didn't want to tell if their machines are enabled to lower levels... I don't understand these misteries and secrets!
Hopefully my vet will have this info from them.

If the worst comes to the worst (and I hope it doesn't) will the Ghent clinic have Pallina back for a second course of treatment if she is hypo?

I don't think that it is available a treatment for HYPO as it is for HYPER.
As far as I know HYPO cats are treated with meds only.

Thanks for your support, it means a lot!

[Lilith]

Aaagh sorry Antonio - not the sharpest nail in the box today!

Good luck to her and do hope she doesn't need any more treatment; hope her levels settle down - fusses to her

[Antonio]

Aaagh sorry Antonio - not the sharpest nail in the box today!

Good luck to her and do hope she doesn't need any more treatment; hope her levels settle down - fusses to her

No need to apologize, Lilith!
I can't wait being back home, I want to see how she's been doing today!

Fusses to Mousey too
How is she? Is she doing fine?

[booktigger]

I would have thought two machines giving the same result was reliable, when Lucy's calcium levels went up the first thing they do is a retest to make sure human error isn't to blame.

[Antonio]

I would have thought two machines giving the same result was reliable, when Lucy's calcium levels went up the first thing they do is a retest to make sure human error isn't to blame.

Unless both machines are calibrated and certified, there is no guarantee at all that what has been read is true. This is the hard truth in the world of certifications and reliable reports, which I have to face nearly everyday in my job.
Of course, in a easier world, we can consider two identical results as reliable.
My above consideration is valid when you have use the reports in an official presentation, where anybody could question them.

[Antonio]

Yesterday I called the Ghent University to ask why they didn't reply my emails. They checked, the emails were in, they had read them, but not replied.
The assistant left a message to the vet, she said I should receive a reply soon.
As soon as I told her who I was, she said "Oh, yes, Pallina, I remember!". How is it possible she remembered my cat's name after 4 months?
Anyway, I haven't heard from them as yet...

[Antonio]

No answer yet from Ghent...
However yesterday we have re-scheduled the next tests for Pallina.
On Thursday 21st December we'll have an ultrasound scan to see if the new meds are effective for her chest fluids.
The thyroid test at the IDEXX labs (to cross check the reliability of the currently used lab) has been postponed to at least January 2, because the vet said that with all the holidays in the middle, the blood sample would have been stored somewhere for too a long time.
This sounds good and reasonable, but it means that I will have to stress Pallina twice in a few days

[booktigger]

Good luck with the scan, shame they can't do the bloods at the same time.

[Patricia]

Hi Antonio,

Just back last night from an eight day visit to London so I'm just catching up now with all your news. I hope you had some positive news from the scan today. It's a pity you weren't able to speak directly with a doctor in Belgium, they don't seem very efficient in their feedback - probably short staffed.
Wishing you all a Happy Christmas - including Mouse and Pallina!

[Lilith]

And a very happy Christmouse from Mouse and Lil (and Emily and Molly) too x

[Antonio]

Hi Patricia, hi Lilith.
Thanks for calling
Patricia, I hope you had a nice time in London.

The scan this morning revealed a good amount of fluid in Pallina's chest. The vet drained 140 ml, more than twice the amount at the end of November. Her lungs are the same as the last time, her heart is fine. A sample of this fluid has been tested, again, and the results are consistent with the other tests.
Pallina had a bad response from the draining. As it happened before, she came back home with a rough breathing. I recorded the sound of that rough breathing and sent it to the vets who told that it's the first time they hear that sound and cannot help me .

The cortisone didn't work. I send an email to the IM vet who visited her two weeks ago. He wanted the today's reports in order to prepare a new therapy plan.
I think he will come up with "an idiopathic disease".

I'm thinking to see another IM vet in the new year.

Yesterday, in the early morning, I sent another email to the clinic in Belgium, to two vets of the staff. They both read it, only one replied and has been writing to me several times yesterday and today to know as much as possible about Pallina's conditions. He wanted to have all the reports of these last 3 months. I hope he can give me an answer.

I will keep you posted.

Merry Christmas to you all

[booktigger]

I thought the other vet said not to drain the fluid from her lungs? Sorry that she has had a reaction to the procedure and that the steroids haven't worked. I hope they can find a solution rather than it being idiopathic, I know how frustrating that is!

[Lilith]

Sorry to hear - this is so frustrating!

Fusses to her and Mousey sends purrs, hope she's feeling better soon and good luck as always x

[Antonio]

Hi everybody and happy New Year!

A bit of update...

I am still waiting for a reply from Ghent doctors... The vet had told me that their IM professor was on holiday during the Christmas week and that she would be back after Jan 1st, so I am waiting. They should give me a word of advice on Pallina's last thyroid tests. I have also told them about Pallina's chest, I don't know if they are able to tell me something about it, but I guess not, because they haven't seen my cat in person.

On Dec 21st I had Pallina chest scanned and I sent all the reports to that vet who was very thorough at visiting Pallina about a month ago. He should have replied before Christmas, the therapy of prednisolone wasn't effective, and it was necessary to evaluate a new course of therapy. He didn't tell me anything, then it was Saturday, then Sunday, then Christmas and the 26th which is still holiday here... I waited two more days then I sent him another email to have a quick answer and a prescription for the new therapy. Nothing happened. Then Saturday and Sunday again, New Year's Day.
I hope to have news from him today, I know he's at his practice on afternoons only.

Pallina has been rather good, apart from a couple of bad days, around Christmas and the night of New Year's Eve.
Yesterday she was fine and this morning she had already eaten all her wet food can.

Right after Christmas I booked a visit with another IM doctor, a professor at the Vet University. The appointment is on Friday 12th January at 9:30 am.
I don't want to waste my time, I guess that the vet I'm waiting a reply from could tell me that he has no idea and that what Pallina has is idiopathic.
In my opinion nothing is idiopathic, either it has a name or it has a name.
With my Lola they were all telling me the same thing, and it took more than 2 months of daily visits to dozens of different vets to find out what she had, my poor sweet angel. They let her suffer pointlessly for over 2 months!

All the best to everybody!

[Lilith]

Hi glad she's much better at present, but as for the other stuff ... the long slog as usual eh?

Do wish you could find some resolution - all the very best as usual and purrs from Mousey to Pallina x

[Patricia]

Happy New Year to everybody!

Antonio, I hope you had a pleasant Christmas and New Year even though you were worrying over Pallina. It is not surprising with all the noise of the fireworks on New Years Eve she was put her off her food as most animals suffer at this time. It sounded like a war zone here.

She seems to be eating ok so try not to worry too much. I hope you receive some positive news soon.

[Mayday21]

Hi Antonio happy NY & hope Pallina’s feeling better. Paws crossed for your appt on thev12th. Lots of fusses to her & Lilith to Mousey as well. Vivian

[Antonio]

I tried to call the vet who visited Pallina a month ago, nobody answers. I called my vet and he told that the other vet is probably on holiday... So, this elusive vet visited Pallina, gave her a temporary therapy with prednisolone, asked me to have her checked after ten days so that he was able to assess the effectiveness of the therapy. I did as instructed, sent him all the reports and never heard from him again.
My vet has told me not to change the prescribed therapy until further instructions.
I have been giving Pallina a 5 mg prednisolone pill for 25 days now, which I am very uncomfortable with, and don't know what to do .
I think that this vet can go to hell. Thanks God I have an appointment in a week time with an IM professor. Fingers crossed he is able to understand something more.

[Lilith]

Good luck - hope this is a step in the right direction

Hi Mayday, thanks - purrs from Mousey and the gang to you and the Famous Four from Oz