Don - "Fuzzy"; Phil's littermate

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Don's "Links" page on hyperthyroidism, CRF, and hypertension

Excel spreadsheet of Don's values.

Movie: Don relaxing in the backyard (March 6, 2004)

Don is a very affectionate, well-behaving, super-sweet "Big Boy." He is currently the oldest in the gang of nine. I know he misses his littermate, Phil. When Phil and Don were allowed to go out to the backyard under close supervision, Phil usually sat under a big butterfly bush at the corner. When Don goes out to the backyard, he runs to the bush meowing as if he's calling his brother. Your mom misses Phil, too, Don.

Healthwise, Don is doing great except for his hyperactive thyroid glands and early stage of kidney insufficiency. He also has hypertension - high blood pressure which is controlled well.

July 11, 2004 - It has been a while (more than 6 months!) since Don's last update. He is doing quite well. First, his current medications:

• Methimazole (for hyperthyroidism): 2.5mg AM, 1.25 mg PM
• Norvasc (for hypertension): 1.25mg AM and PM
• Calcitriol (for PTH; preventative): 15 ng AM
• Potassium gluconate (for low potassium): with each meal
• Dried alminum hydroxide powder (for high phosphorus): with each meal

He weighs 13lb plus, has good appetite, doesn't vomit, likes to drink water from a medicine dropper, and loves laying on the grass in the backyard. His last blood test was in the end of May.

T4 = 2.90
BUN = 37
Creatinine = 2.8
Phosphorus = 3.8
Potassium = 4.1

Looks pretty good! By the way, he's not on fluid therapy yet, and he's not eating renal food. (He can't tolerate commercial canned food. He'll have watery diarrhea right away.)

His new hobby is being vacuumed off his shedding fur!

December 27, 2003 - Don had a blood test yesterday to check his thyroid and kidney functions. Our biggest surprise was that he is now hypOthyroid with T4 at 0.4!

Because Don had a similar episode of decreased T4 with 1.25 mg methimazole BID (the lowest was 2.03, though, not as low as this time), Dr. recommends alternating [1.25 mg twice a day] and [2.5 mg AM and 1.25 mg PM] and reevaluate his T4 again in two weeks. She doesn't want to create a sudden, big change but gradually decrease the methimazole dosage and see how he does. We might go down to 1.25 BID after two weeks depending on his thyroid value.

His creatinine is obviously up to 4.0 (0.8-2.3) from 3.0 two months ago. BUN 61 (15-34), potassium 3.6 (3.9-5.3; will increase potassium gluconate a little bit), phosphorus 4.1 (3.0-7.0), HCT 35.1 (29-45; slowly decreasing from 46 1.5 years ago). His sodium is a bit higher than the normal range at 160 (147-156). I'm hoping his urine CS will come back soon.

He doesn't exhibit any overt symptoms other than drinking more and peeing more than other cats. He has very good appetite and is now over 13 lb (was 12 lb 4 oz a couple of months ago). He has no vomiting, nausea, lethargy and he is not on sub-q. So far, other than his unexpected low T4, he is doing quite well on methimazole, Norvasc, and potassium gluconate

***** Old updates (chronological order) *****

August 26, 2002 - Don was diagnosed with hyperthyroidism in the middle of August. He will be 13 years old in September, 2002. It's not unusual for a cat of Don's age to have overactive (hyper) thyroid. He had a dental work back in March 2002 and his T4 level at that time was mid- to high-normal. When he started drinking and urinating a lot more than usual (polydipsia and polyuria), I decided to take him to the vet to recheck his values. His T4 was 4.69, which is higher than normal. Don was started on 1/2 tablet (2.5 mg) of Tapazole (generic name is methimazole) a day. (I give him 1/4 of a pill twice a day, 12 hours apart.) So far, his body seems to be handling the medicine very well. He doesn't have any apparent side effects. Because his kidney values are getting up at the same time, the doctor is closely watching Don's T4 and kidney values (BUN, creatinine, phosphorus, potassium, sodium, HCT/PCV, urine specific gravity, etc.).

Don is now mom's big boy after his brother, Phil, passed away on September 11, 2001 and Holly on October 2, 2002. He is a gentle-mannered, well-behaving, easy-to-medicate, model cat in the household (except when he is really hungry, he'll turn into a toilet paper monster).

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November 11, 2002 - Don has been on 1.25 mg Tapazole once a day instead of twice a day for the past week or so. That means, he's only getting 1/4 tablet in 24 hours. The reason for the decreased dosage is due to his elevating kidney values. BUN* is at the high-end of the normal and creatinine** is over the normal range. This means his kidney functions are declining. He's 13 and I still consider him as not too old, but if we convert cats' age to human age, he's over 68 years old according to PetPlace article. Hmmm. I guess he's getting old. He's a senior citizen!

* BUN = Blood urea nitrogen; urea levels in the blood. Urea is a waste product, which comes from the cells' utilization of protein.

** Creatinine = A waste product in the blood resulting from muscle activity. If cats' kidneys are healthy, they will filter out this waste. If their blood contains too much creatinine, and the urine contains protein, then their kidneys may not be working well.

December 22, 2002 - His T4 shot up to 5.06 on 1.25 mg once daily dosage. BUN and creatinine were on the high side, but within the normal range. The vet and I decided to go back to 1.25 mg twice daily.

Here are his numbers (numbers in parentheses are reference range of Antech Diagnostics Lab):

T4 = 5.06 (0.8-4.0)
BUN = 36 (14-36)
Creatinine = 2.0 (0.6-2.4)

Don also had constant diarrhea for about two months. He started not liking our homemade raw diet around last August, but he started to eat it again. As soon as we switched back to the raw diet, his stool improved and he's been having perfect poops!

At this checkup, we also did a biopsy of a lump on his right shoulder. I noticed the lump last summer and have been monitoring its growth. Back in summer when I first mentioned it to our vet, she felt it and said she thought it was some fat deposit or benign cell growth. The pathology report came back as basal cell tumor, which usually is benign. (Whew!) It is growing very, very slowly and not causing any problem, but we will take it out when Don is going to get his dental next time.

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January 12, 2003 - Recheck of Don's thyroid and kidney values. T4 is down almost right in the middle of the reference range, which is very good. However, his kidney values are up, but not too high to start on sub-q fluids or medications.

T4 = 2.90 (0.8-4.0)
BUN = 62 (14-36)
Creatinine = 3.0 (0.6-2.4)
Phosphorus = 4.3 (2.4-8.2)
HCT = 45 (29-48)

His BUN looks high but creatinine is the value that is more important to monitor (raw diet with limited carbohydrates usually causes higher BUN value). He is still in an early stage of renal insufficiency (I like the term "renal insufficiency" than "renal failure"). We'll monitor his kidney values closely. I might ask our vet if we can alternate the dosage of Tapazole 2.5 mg daily and 1.25 mg daily to see if that helps keep the kidney values down without affecting his thyroid value so much.

Symptom-wise, he is acting normal, eating well, grooming well, playing, running, cuddly, no diarrhea or vomiting. He is his usual wonderful self.

February 24, 2003 - Don had his dental work and a mass removal on Saturday, February 21. His lower right tooth had to be pulled. The surgeon who worked on Don told me that the tooth was crumbly and ready to be pulled anyway. The root was also affected so Don had a kitty version of "root canal." The mass that was removed was on his right shoulder. The pathological analysis confirmed it was *benign* basal cell tumor. The "tumor" was growing slowly since last August and was about the size of a nickel when it was removed. ("Tumor" isn't always malignant; i.e., cancerous. There are benign tumors like basal cell tumor.) Don had to stay overnight because the doctor wanted to monitor his post-surgical progress. His incision was about 2 inches. I was given a couple of "T-shirts" to put on Don to prevent him from licking the incision site; it's not really a T-shirt, but more like a tube with two holes cut out by scissors. It is very loosely woven material and Don gets the fiber stuck on his tongue when he licks. I decided to use a baby onesie instead. Here are some photos of Don wearing his yellow onesie.

May 26, 2003 - Don's newest bloodwork is in.

T4 = 3.69 (0.8-4.0) - normal
BUN = 68 (14-36) - high
Creatinine = 3.7 (0.6-2.4) - high
Phosphorus = 5.9 (2.4-8.2) - within normal range but getting high for a CRF cat
HCT = 39 (29-48)

BUN is high but that is to be expected due to his meat-based diet. Creatinine is holding steady for now, which is more important. Phosphorus is slowly rising. T4 is good.

Dr. O and I discussed about these numbers and we agreed to keep the 2.5 mg/day and 1.25 mg/day dosing of methimazole. She said she will start on phosphorus binders once Don's phosphorus value goes over 6, but I am thinking about starting on phosphorus binders now anyway. Dr. Kathy James on the big CRF list suggests phosphorus in the range of 4 for CRF cats. Also, because Don is on a mostly-meat homemade diet (due to his intolerance of commercial canned food and gluten), I think it is better to be proactive. I'm going to call pharmacies and find Alu-Cap (over-the-counter phosphorus binder many CRF cats take. For more details, check About Phosphorus Binders page by David Jacobson.).

Overall, he is doing well. He is still a "moist cat" and doesn't need hydration support such as subcutaneous (sub-Q) fluid therapy at this point.

July 10, 2003 - Don has not had his bloodwork done since the last update. I'm sort of antsy, though I'm sure Don isn't. Dr. O is moving to a new practice closer to our house. Good news for Don! The previous hospital wasn't that far (only about 15-minute car ride), but still Don didn't enjoy it. He either peed, pooped, or drooled (just like Phil) in the carrier on the way over there, or during the ride back home. I had to carry a roll of paper towel and a plastic bag in case of emergency. We have an appointment on the 22nd this month. It only has been two months since the last checkup, but I'm anxious to know where his values are. His only symptoms of renal insufficiency is drinking water a lot and peeing a little more than other cats. Other than that, he is quite normal.

Our new daily routine is a little outing to the backyard after I come home. Don and I go out to the backyard away from other cats and enjoy strolling in the garden together. He eats some blades of weed and I tend the plants. We then do a "meadow cat" routine: I run away from Don and call for him. He then runs to me with his tummy swinging. Really cute.

July 23, 2003 - Don had another bloodwork yesterday. Dr. O called and gave me the result briefly.

T4 is higher than the normal range and Dr. O doesn't like it that high. She recommends switching to 1.25 mg twice daily regimen to see if that will make his T4 come down to high-normal. She said they forgot to do phosphorus. Oh, well, it's OK for now. We are going to do another test in three weeks to check his T4.

I have a feeling that Don's loose stool is due to his high T4. We'll see whether that will change with increased methimazole administration.

Dr. O and I talked about sub-q again but we both feel Don doesn't need it at this point. His loose stool is not that bad and we don't think he is dehydrated. He is still asymptomatic in terms of CRF other than a little bit of PU/PD.

August 30, 2003 - Went in for a recheck after increasing the dosage of methimazole to 1.25 mg twice a day. Because it is Labor Day weekend, Dr. O won't get back the result of the bloodwork until Tuesday. She said she'll call me on Tuesday (and probably fax it to me). So, I have no number to report for now.

Don also got his blood pressure taken. It was over 210. He is hypertensive (high blood pressure). This is caused probably from either CRF or hyperthyroidism. Don started taking 0.625 mg of Norvasc once a day. Dr. O wants to recheck his blood pressure in a week, so we'll go back again on September 6.

Don was breathing rapidly on Thursday evening. I didn't count the breaths per minute but it was pretty fast and he was a little lethargic than usual. He didn't want to eat at all, either. Rapid breathing lasted through the night. I was almost ready to take him to an ER but he didn't seem to be in any distress, so I decided to just keep an eye on him. On Friday morning, he was back to his normal behavior. His breathing pattern was also almost normal. I mentioned this to Dr. O today. She took X-ray to rule out fluid buildup (which wasn't the case). Severe anemia can also cause rapid breathing, but Don's HCT (PCV) has been within normal range and it doesn't usually plunge so radically into lower teens (<15) to cause respiratory distress. Now that we know he is hypertensive, this episode of rapid breathing might have been due to the high blood pressure, she said. But at the same time, she said she noticed before that Don sometimes had a little bit of heart murmur. If Don shows the same symptoms again, Dr. O wants to consult with a cardiologist who also works at the same clinic to find out whether his episodes of rapid breathing are caused by high blood pressure or something else (such as heart disease).

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September 2, 2003 - Don's numbers are in. His T4 is all-time-high, 6.9. This is with 1.25 mg of methimazole twice a day. Dr. O wants me to switch to 2.5 mg in the morning and 1.25 mg in the evening and recheck. His BUN and creatinine are up slightly despite the higher T4 (usually higher the T4 is, the lower the kidney numbers are). So, his hyperthyroidism is slightly out of control with the current methimazole dosage, AND his kidney values are creeping up slowly. Not particularly what I wanted to hear.

T4 = 6.9 (0.7-5.2)
BUN = 64 (15-34)
Creatinine = 3.7 (0.8-2.3)
Phosphorus = 5.3 (3.0-7.0)
Potassium = 4.8 (3.9-5.3)
HCT = 40.5 (29-45)

On top of this, Dr. O says Don's heart might be a little enlarged. She showed the X-ray that was taken on Saturday to Dr. L, the board certified cardiologist at the clinic. He told Dr. O that Don's heart seems a little larger than normal size, and he wants to do echocardiogram to find out what is going on. Dr. O is worried that Don might have started showing some heart problem such as hypertrophic cardiomyopathy (HCM). The little murmur she noticed on Saturday, and Don's fast breathing a couple of days ago might be due to this, she said. I made an appointment to see Dr. O and Dr. L on Friday for echocardiogram.

With all this, Don is still acting fairly normal. He is not on fluids yet. He drinks a lot of water; his peeing is not too excessive. He doesn't have much interest in the homemade diet, but eats dry food (with no corn or gluten) well on his own. (I assist him with the homemade diet when I give him pills.) His stool is usually on the loose side, but since we started on Norvasc, it is more formed than before. One of the side effects of Norvasc is constipation, so may be it's making his stool harder. We continue our daily backyard outing when I come home from work. He is a happy cat.

September 5, 2003 - The result of ECG is that Don's heart shows only mild wall changes and he doesn't need heart medication. However, his blood pressure is still 200. Don is a very easy-going guy, so I don't think it's from "white-coat" syndrome. I would think he would have settled down by the time they took the blood pressure. He'll be on 1.25 mg of Norvasc once a day. I'll discuss the details with Dr. O tomorrow.

We had a shorter version of blood panel without T4: BUN 54, creatinine 3.7, phosphorus 5.3, and potassium 4.0.

September 24, 2003 - Don went to the vet last Saturday (9/20) to recheck his blood pressure and T4. The blood pressure was 160 (down from 200 two weeks ago). His Norvasc was increased to 1.25 mg after the blood pressure stayed at 200 for a week with 0.625 mg. His methimazole was also increased to 2.5 mg AM and 1.25 mg PM on 9/2. This time, his T4 value came down to 2.5. I hope his T4 stays around this level for a while. His creatinine is 3.7, BUN is 48. His potassium was 3.3 and Dr. O says to start on potassium supplement. Blood potassium would be higher than what is actually in the body, so it is better to start supplementing when the blood potassium goes below normal. Don will be taking the widely available potassium gluconate rather than Tumil-K, which you get from the vet and which is more expensive.

He is eating well, drinking well, active and perky. He is a very well-behaving gentlecat. An Excel spreadsheet of Don's values is now available.

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