Thứ Ba, 31 tháng 12, 2013

The Colonel after his radioiodine treatment

The Colonel was one of our favorite hyperthyroid patients at the Animal Endocrine Clinic. We first met him over two years ago, when he was referred to us for severe and uncontrolled hyperthyroidism.
His thyroid tumor was huge and resistant to treatment, necessitating a large dose of radioiodine to cure him. 

The Colonel ended up staying with us for a long time after treatment since the owner has small children in the house, but none of us minded; we all loved having this wonderful cat at our practice! He had a super personality and enjoyed each day with a zest for life.  

He later when on to develop hypothyroidism, which we successfully managed with daily thyroid hormone replacement therapy. Unfortunately, he later went on to develop cancer of he urinary bladder, which lead to urinary obstruction and worsening of his kidney failure.

The Colonel's owner wrote this tribute in memory of him. This cat poem puts into words, so beautifully, what we all feel when we lose one of our best friends.  I wanted to share it with all of you so you can get a sense of how special this cat really was to all of us. 

However, I must warn you — you will likely cry as you read this touching epitaph, as we do everytime we reread it. 

We all loved this cat.  He truly will be missed.

Dr. Mark Peterson and Staff at the Animal Endocrine Clinic


Watching the gerbils during his long boarding period at the hospital


GONE 
by Beverly Cole 

I don't have to close the bedroom doors, no longer worried your nails will wreak havoc on the rugs.

I am cleaning up the last kernel of your Lord forsaken litter, a battle that I waged for years, that I have finally won. A pyrrhic victory.

I am picking off fur from my sweater without my usual grumbling. The fur will appear less and less now, the couch clean, no tufts of orange and white randomly floating through the air.

There's no more food to order for you. No more subcutaneous fluids to stave off kidney failure. No more thyroid medication. No heartburn relief pills.

We fought for you as hard as you fought for yourself. No, you fought even harder. You loved your life with a passion experienced by few, as simple and serene as it was.

I am taking your fleece blanket out of the dryer. Your urine stains now replaced by my salty tears.

You were just a cat. A 4-year-old flunky mouser who wound up at a shelter. At your best—16 pounds of pomp and circumstance and brilliance and at your worst — a shrunken shell of what was, desperately clinging to life despite the pain.

I haven't told the kids yet, just saying you're at the doctor when they asked me where you are. The little one calls to you in her small voice, then says "maybe he's in his room and you forgot," she says. No, dearest, I haven't forgotten where he is. When I close my eyes, I see you on the cold steel table, now lifeless, yet still filled with your impenetrable dignity although your eyes are now sunken and still.

I am packing up your brush, the same brush we bought when we started together, 13 years ago. When I groomed you the first time, you meowed and yawned at the same time, rolling onto your back, bored and happy, then gently nipped my hand to remind me who was in charge, a devilish glint in your eyes. When I brushed you this last time, you barely moved your head, so I stopped, not wanting to cause you more pain.

Your fur wasn't always urine soaked. Your smell wasn't always unbearable. That was only recently, after the cancer in your bladder had obstructed your ability to urinate, after the kidney failure had taken over. Before that you were impeccable. Meticulously grooming until your fur shone.

I still hear your cry—strong and plaintive, demanding, not the crusty, faltering mew you have been able to muster recently.

It is hard to be in this house without you. My stomach feels void when I realize that the small crackle I hear is not your footsteps coming upstairs to say goodnight to the kids. I stop myself when I enter the house, almost hearing my voice greet you hello, as I have for the last 13 years. You're not here to answer or come over. You'll never be here again.

I see a ghost of you on the couch waiting for me to sit down at night. I am trying to decide what's more devastating—reliving your death every moment I re-realize you're not here, or knowing that I will get used to your absence.

You were just a cat. You were mine. And I miss you so. My dear, dear friend.

You were my best friend, many times my sole ally, and you trusted me with your life. I hope it was a good one.

The Colonel (1997-2013)

Thứ Ba, 24 tháng 12, 2013

I am very concerned about my 14-year old male DSH cat. He was diagnosed in the spring with hyperthyroidism and has been treated with oral methimazole (Tapazole). 

 After the first 6 months of treatment, I brought him back to my vet because I was concerned about how skinny he was (very little weight gain on the medication). The vet tested him and increased the Tapazole dosage. He said not to be concerned unless he continued to lose weight.

Now, 2 months later, my cat's weight has held steady on the increased dose of methimazole, but he still remained so skinny that I brought him back for another recheck— even though he wasn't losing weight. It turned out he has developed anemia, so severe that he needed a blood transfusion. He had a bone marrow biopsy, which was consistent with a regenerative anemia. Now my vet wants to just wait and redo his CBC to see how he is in another week.

Because we aren't sure if the methimazole caused the anemia, he isn't putting him back on it right now. He recommended trying Hill's y/d. I tried it (just one can), but my cat isn't keen on it (won't eat it), and he is skinnier than ever now so I don't have the luxury of giving it a chance — I don't want to risk him starving to death!

Now that he's been off the methimazole for about a month. I am really worried about him because he's lost even more weight.

My questions include the following:
  1. Can a cat with anemia or recovering from anemia still be a candidate for radioiodine treatment?
  2. Can a severely underweight cat be treated for radioiodine treatment? He's only 5 pounds now!
  3. If my cat has been off of the methimazole for a month, how much time do we have to get him treated again for his hyperthyroidism? Do we need to restart the methimazole before we do the radioiodine treatment? I'm worried he'll die before I can get it properly addressed. 
  4. If I do go for the radioiodine treatment, will he have to wait for a period of time to be treated, since he's eaten a bit of y/d?
Thank you so much!

My Response:

Sorry to hear that your cat isn't doing well. Although rare, antithyroid drugs, including methimazole, can produce hematologic abnormalities, including hemolytic anemia in cats (1-5).  If the drug is responsible for the anemia in your cat, it should never be restarted because that would be life-threatening.

Even if we forget about the anemia for a moment, it is certainly clear that methimazole has not been an effective treatment in your cat. Feeding a low-iodine diet (y/d) might help if he would eat it (many cats won't) but that too is less likely to be successful in cats with severe, chronic, or advanced hyperthyroidism.

Treatment with radioiodine would probably the best treatment, but we would need to be certain that the anemia is resolving before moving forward with this treatment. Anemia is a sign, not a diagnosis in itself. If the methimazole isn't causing it, we need to figure out what is responsible, since that is a sign of serious disease. The good news is that if it is regenerative, that suggests that the bone marrow will be able to respond once the insulting factor (e.g., methimazole) has been removed. Nonregenerative, aplastic anemia is a rare but very serious complication of methimazole treatment in man (5,6), which has only been reported in 1 cat (7); let's hope that this is not the case in your cat.

If the anemia resolves and doesn't recur now that your cat is off the methimazole, I would strongly consider the radioiodine treatment. To do that treatment, we do NOT need to pretreat a cat with methimazole; in fact, we like to have owners stop the drug 1-2 weeks prior to I-131 treatment. Feeding a small amount of y/d will not interfere with the treatment. And finally, severely underweight cats with hyperthyroidism certainly can be treated with radioiodine. Since it's likely that your cat's thyroid tumor may be larger than the average hyperthyroid cat, a larger dose of radioiodine might be needed.

References:
  1. Peterson ME, Hurvitz AI, Leib MS, et al. Propylthiouracil-associated hemolytic anemia, thrombocytopenia, and antinuclear antibodies in cats with hyperthyroidism. J Am Vet Med Assoc 1984;184:806-808. 
  2. Peterson ME, Kintzer PP, Hurvitz AI. Methimazole treatment of 262 cats with hyperthyroidism. J Vet Intern Med 1988;2:150-157. 
  3. Baral R, Peterson ME. Thyroid gland disorders In: Little SE, ed. The Cat: Clinical Medicine and Management. Philadelphia: Elsevier Saunders, 2012;571-592.
  4. Peterson ME. Hyperthyroid diseases In: Ettinger SJ, Feldman EC, eds. Textbook of Veterinary Internal Medicine: Diseases of the Dog and Cat. Fourth ed. Philadelphia: WB Saunders Co, 1995;1466-1487.
  5. Yamamoto A, Katayama Y, Tomiyama K, et al. Methimazole-induced aplastic anemia caused by hypocellular bone marrow with plasmacytosis. Thyroid 2004;14:231-235. 
  6. Edell SL, Bartuska DG. Aplastic anemia secondary to methimazole-case report and review of hematologic side effects. J Am Med Womens Assoc 1975;30:412-413. 
  7. Weiss DJ. Aplastic anemia in cats - clinicopathological features and associated disease conditions 1996-2004. J Feline Med Surg 2006;8:203-206. 
  8. Peterson ME, Broome MR. Radioiodine for feline hyperthyroidism In: Bonagura JD, Twedt DC, eds. Kirk's Current Veterinary Therapy, Volume XV. Philadelphia: Saunders Elsevier, 2014 (in press).

Thứ Hai, 23 tháng 12, 2013

Hi Mia!

By now, the world is well aware that a major benefit of an international pen-pal blog is presents! You introduced me to TimTams (a delicacy that I am beyond obsessed with), and just today I got Aussie Toast Stamps and an "ugly" Christmas sweater that is not ugly at all!!

But in all seriousness. I love packages. I love mail of any kind. I get very excited when I hear the crazy mailman in the hallway (although lately he has been putting our mail in other people’s mailboxes so I have to wait until our kind neighbors pass it along). Anyway, I love all mail. Mail is like a present.

All this talk of gifts actually relates to our favorite topic (dog science!) because there seems to be a subtle shift in the thinking about pets as gifts. For as long as I can remember, I’ve had the idea that it’s not a good idea to give a pet as a gift. A quick look around the Internet reifies this belief:

PAWS: “Giving a pet as a gift is usually an ill-advised decision that can end tragically.”

Dogs Trust: “A dog is for life, not just for Christmas.”

Dr. Andy Roark, VetStreet: "Friends Don’t Surprise Friends With Commitments. Pets = Commitments."


Dr. Karen Becker: "5 Reasons Not to Give a Pet as a Christmas Gift This Year."

(Source)
But there's a new conversation brewing, and a few studies point in a different direction. A recent survey by the ASPCA found “no significant relationship between receiving a dog or cat as a gift, whether a surprise or not, and the receivers’ self-perceived love or attachment toward the pet.” Additionally, “receiving a dog or cat as a gift does not negatively impact that pet, either by altering the human-pet bond, or by shortening the time the pet is kept in the home.”

Maybe there is more to the story than, Don’t Give A Pet As A Gift! And if that’s the case, we should consider how pets could be gifted in ways that benefits both people and animals. 


I also wrote about this topic on Scientific American. If you're going to gift a pet, I highlighted two suggestions by Wisconsin Humane Society Executive Director, Anne Reed: 1) Carefully think about what the gift recipient wants and not what you want, and 2) Think about giving an adoption kit with all the necessary animal accouterments, and then take a trip to the animal shelter together. 

I'm excited that this topic is on the table for discussion. At the same time, we should keep in mind that this study comes from a small survey of 222 people scattered across the USA who received a dog or cat as a gift in the last 10 years. I would love more details into what makes for successful or unsuccessful pets as gifts. 


Speaking of presents, I'm off to eat some Tim Tams! Happy Holidays and Happy Belated Birthday to you!!

Julie

Reference 

Weiss et al. 2013. Should Dogs and Cats Be Given as Gifts? Animals 3, 995-1001. Open Access

More Reading On Pets As Gifts 
Julie Hecht: Should Pets Be Given As Gifts? Scientific American 
Jessica Pierce. Giving Pets as Gifts: Should You or Shouldn't You. Psychology Today
ASPCA Blog: Pets As Gifts—Wrap ‘Em Up!
ASPCA Blog: Give a Gift of a Dog or Cat This Holiday Season!
Andy Roark: Video: Think Twice Before Giving Pets as Gifts. VetStreet
 

Thứ Ba, 17 tháng 12, 2013


Is feeding the low-iodine diet (Hill's y/d) an appropriate or reasonable choice for a hyperthyroid cat that is allowed outside and hunts? 

Will the diet work to control the hyperthyroid state if the cat eats small prey?

My Response

No, Hill's y/d would not work to lower the high serum T4 and T3 in a cat in this situation.

All species (cattle, pigs, chickens, birds, mice and other rodents) all contain iodine in their muscle tissue (1,2). Iodine may be ingested in the diet as a supplement, but it's also present in soil, which ends up in the plants ruminants and other animals may eat (3,4). Remember that iodine is an essential nutrient and is needed by all animals (including humans!).

This cat, by eating birds and rodents (not eating an iodine deficient diet, of course), would ingest too much iodine for the y/d to be effective. To lower T4 secretion, the diet has to be very, very low in iodine.

References:
  1. Hemken RW. Factors that influence the iodine content of milk and meat: a review. Journal of Animal Science 1979;48:981-985.  
  2. Downer JV, Hemken RW, Fox JD, et al. Effect of dietary iodine on tissue iodine content in the bovine. Journal of Animal Science 1981;52:413-417. 
  3. Whitehead DC. Studies on iodine in British soils. Journal of Soil Science 1973;24:260-270.  
  4. Fuge R, Johnson CC. The geochemistry of iodine — a review. Environmental Geochemistry and Health 1986;8:31-54.

Chủ Nhật, 15 tháng 12, 2013

Hi Julie,
Photo by Mel Travis | What About Charlie?


goodness me, what happened? I was at the amazing Working Dog Conference 2013, then launching the Global Poo Power! Challenge, I blinked and suddenly it's mid-December already? Huh?! Gosh!

Sorry for being absent for a few weeks, I've been focussed on getting as much content from the #workdogs13 event up on the Working Dog Alliance website as possible, so that everyone can access the fantastic content that was shared by a wide range of speakers. From the conference proceedings, to PDF of presentation slides, audio and even You-Tube clips combining them all, you can now share in everything from Dr Nicola Rooney's keynote presentations, to fresh new research on working dogs; unique stories about dogs used in conservation programs and rescue groups working to provide positive endpoint outcomes; practitioners views on breeding and rearing working dogs and insightful facts and figures about areas like greyhound racing and thoughts on why there is such high 'wastage'. 

The half-dog selfie movement took off at #workdogs13

The Poo Power! Global Challenge went off with a bang... 


(or is that a fart? LOVED your Scientific American Dog Spies pieces on why dog farts stink, Part 1: What are dog farts made of? here, Part 2: How to make dog farts less stinky here - captivating area of research and I do not envy the 'odour judge' who to had to decide if dog farts were scentless or unbearable, or somewhere in between!) and we enjoyed watching the photos get logged on the Global Poo Map



Science For Life 365

The student competition part of the Challenge is now over, but don't worry - it's not too late to download the free App and start to map the crap! It's super quick and easy to do and I know the Poo Power! team would really love to see some international 'contributions', so to speak. All details about how to participate as a citizen scientist can be found here.

SciEngage
As for me, well, I'm looking forward to closing out 2013 with the fun times in the sun with family, friends and reviewing results from the meta-analysis - as you do. 

What's on your list, Julie?

Mia

p.s. In case you were wondering, that gorgeous photo at the top of this post (it's my legs with my darling old dog Caleb, and my mother's dog, retired Guide Dog Haidee) - taken as part of a shoot done for this Dumbo Feather article 


© Mia Cobb | Do You Believe in Dog? 2013

Thứ Bảy, 14 tháng 12, 2013


My 4-year old Toy Poodle was diagnosed with atypical Addison's disease about 6 weeks ago. She weighs 11.8 lbs and is taking 1.25 mg of prednisolone per day. She is not receiving any mineralocorticoid supplementation (i.e., Florinef or Percortin-V) for now since her serum sodium and potassium levels are in the normal range. We will continue to monitor that because we know that that might change and mineralocorticoids will have to be added to her treatment.

For her glucocorticoid needs, we are using a 5-mg tablet of prednisolone that we cut into quarters to administer a 1.25-mg dose each day. This is extremely tricky, and there is probably never a day that she gets an exact dose because the tablets do not cut without some crumbling.

So I have two main questions:
  1. First, my dog has developed a ravenous appetite and finishes her meals very quickly. Normally, she has a picky appetite. I know that you generally recommend giving these dogs a much lower dosage, and that a lower dosage would be better for her overall health since she will be on this daily dosage for the rest of her life. Should her prednisolone dosage be lowered to help with the appetite issue? 
  2. Second, is there any other tablet or form of prednisolone that would be easier for us to administer to her so that she gets the proper amount each day? The 5-mg tablet just isn't working very well for us. 
Thank you for your help.

My Response:

The glucocorticoid replacement dose I use for prednisone or prednisolone in dogs with Addison's disease is 0.1-0.2 mg/kg/day. So at 11.8 pounds (5.4 kg), that calculates out to be only 0.5 mg/day, up to a maximum dose of 1.0 mg/day. So if you are giving your small dog 1.25 mg/day, that means you are giving too much of the drug. That would certainly be enough to induce iatrogenic Cushing's disease, as reflected by the increased appetite.

In dogs, prednisone is converted to prednisolone within the body. So basically, these two glucocorticoids can be used interchangeably.

I would try to lower the daily prednisone/prednisolone dose down to 0.5 mg each day. Administrating too much glucocorticoid will cause increased hunger (as you see in your dog).  Overdosage of prednisone, prednisolone or any other glucocorticoid can also lead to lethargy, weight gain, enlargement of the abdomen, muscle atrophy, and muscle weakness. Decreasing the dose of the prednisone or prednisolone should help prevent any of these problems.

Fig. 1: Prednisone is available as a 1-mg tablet
Fig 2: PrediapredOral prednisolone
liquid (1 mg/mL) 
Prednisone tablets are available as 1-mg and 2.5-mg sizes, which can be helpful in dosing small to medium-sized dogs (Figure 1).

In addition, both prednisone and prednisolone are available as a syrup/oral liquid or solution, available as a 1 mg/mL concentration (Figure 2).  Examples of liquid prednisolone products include Pediapred® (Celltech Pharm); Millipred® (Laser); Orapred® (Sciele); Veripred® 20 Hawthorn); and Flo-Pred® (Taro). For prednisone, Intensol® Concentrate (Roxane) oral solution is available.

All of these formulations are human-labeled products so your veterinarian may not be familiar with them. Your local pharmacy will know about them, however.

Either way, I'd get either the 1-mg tablets and give half a tablet a day. Or use a liquid formulation (1 mg/mL) and give 0.5 mg (1/2 mL per day).

References:
  1. Plumb, DC. Plumb's Veterinary Drug Handbook. Seventh Edition, Wiley-Blackwell. 2011.