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Ask Dr. Michael Salkin Your Own Question

Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat
Satisfied Customers: 27379
Experience:  University of California at Davis graduate veterinarian with 44 years of experience.
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My 15 year old cat has been poorly. Hes stopped eating. (Usually

Customer Question

My 15 year old cat has been poorly. Hes stopped eating. (Usually voracious) vet has checked for blockages lumps n bumps. Blood tests revealed better than average liver and kidney function. Slight elevation in bilirubin levels. Another blood test suggested t4 levels really high and prescribed carbimazole
How long can the cat be humanely syringe fed with convalescence food. How lomg should carbimazole take to kick in if it is the hyperthyroidism thats causing the problem?
Oh and hes displaying atypical signs of hypthy like depression, loss of apetite. Not passing stools
Thanks
Submitted: 1 year ago.
Category: Cat
Expert:  Dr. Michael Salkin replied 1 year ago.
I'm sorry to hear of this with Foggy. There's usually a 1-3 week lag time between starting carbimazole and a significant reduction in serum T4 (total thyroid). You might need to continue force feeding for quite some time. Yes, a percentage of hyperthyroid cats show atypical signs in which hyperexcitability or restlessness is replaced by depression or weakness. Although weight loss is present in these cats, it's accompanied by anorexia instead of increased appetite. Most studies have recognized these atypical signs in 5-10% of hyperthyroid cats but one (smaller) study found 20% of hyperthyroid cats to be lethargic and 28% to be inappetent. Along these lines, although cardiac changes in hyperthyroid cats usually result in tachycardia (rapid heart rate), right bundle branch block and incomplete atrioventricular block resulting in bradycardia (slow heart rate) have been observed. These disparate signs emphasize the need for vets to carefully auscultate (listen to) the heart of cats such as Foggy.Please respond with further questions or concerns if you wish.
Customer: replied 1 year ago.
Hoe long would you feel as a veterinarian it os himane to force feed the cat? His quality of life is hugely reduced ;(
Customer: replied 1 year ago.
He is sniffing food but refusing to ingest it.
Expert:  Dr. Michael Salkin replied 1 year ago.
In this case, up to 3 weeks of force feeding would be acceptable to me. I do understand that quality of life is paramount, however. This is a difficult decision for you and only you can decide if continuing to force feed is warranted in the hopes that the carbimazole will kick in sooner than later. Consider presenting him with a high fat convalescent food such as the prescription Hill's a/d. Many inappetent cats will dive into that diet. Please continue our conversation if you wish.
Customer: replied 1 year ago.
(Posted by JustAnswer at customer's request) Hello. I would like to request the following Expert Service(s) from you: Live Phone Call. Let me know if you need more information, or send me the service offer(s) so we can proceed.
Expert:  Dr. Michael Salkin replied 1 year ago.
I regret that my state board of veterinary examiners doesn't allow my speaking with customers by phone in this venue. Please stay in this conversation if you wish.
Customer: replied 1 year ago.
Ok. Well i was gonna give u the full historyThursday he had an episode where he was sick quite a lot of kibbles ( he often gorges)Then his back end seemed to give way and his breathing increased he wee'd n pooped on the floor. Which is something he would never do. His breathing returned to normal with some strokingSince then he has only urinated and not pooped at all and literally eaten nothingHe sniffs the food but wont take that bite. And he is interested in it but wont eatVet has administered a shot of broad spec antibiotic for good measure and hes having thw hills convalescence food ( dunno if its a good thing but hes getting meaner with each feed)
The blood panel she said was excellent for a cat his age and the only exceptions were slightly elevated glucose ( adrenaline type response) and this bilirubin
All lfts and kidneys were goodThe carbimazole was started just today as a result of 2nd panel showed hightened t4I know ive probably exhausted the conversation. But shes siggest scan and things and having lost my other cat earlier this year im worried for himI need to remain humane and have his best interests at heart i fear ill have this lab work done and have no cat ultimately if he doesnt eat.Are there any apetite stimulents? Im trying pungent foods. Tuna, premade processed pouches ( which i abhor) just anything to interest himEating aside he is a little vacant when sat. But when dtroked and fussed he is still treetrumming quite happily!Oh to be a cat owner! I thank you for you time and expertise this evening. Any final words would be appreciated
Expert:  Dr. Michael Salkin replied 1 year ago.
Thank you for the additional information. Yes, mirtazapine has been useful as an appetite stimulant and is available through his vet. The Thursday episode suggests a syncopal ("fainting") episode. This can occur secondary to thyroid cardiotoxicosis and arrhythmia (irregular heart rate) as I alluded to in my initial response. It's a negative prognostic sign and I believe why a scan (X-rays and ultrasound/echocardiogram) of his heart would be suggested by his vet. Do you recall what his T4 (total thyroid) or fT4 (free T4/if performed) blood levels were?
Customer: replied 1 year ago.
To be honest she announced some figure like 160?? Butthat doesnt make sense to me? I thought it was a range of 2-6 or whatever?
Expert:  Dr. Michael Salkin replied 1 year ago.
At Foggy's age any T4 over 2.0 ug/dl is worrisome for hyperthyroidism. That would be equivalent to 25.7 nmol/L which is the usual unit used in the UK. You're correct, 160 wouldn't make sense.
Dr. Michael Salkin, Veterinarian
Category: Cat
Satisfied Customers: 27379
Experience: University of California at Davis graduate veterinarian with 44 years of experience.
Dr. Michael Salkin and 3 other Cat Specialists are ready to help you
Customer: replied 1 year ago.
Do other blood discrasias alter t4 level? Fiv? Leukemias cancers etc??Ive checked his neck for lumps and no sign
Customer: replied 1 year ago.
Thank you so much how do i sign off ?
Expert:  Dr. Michael Salkin replied 1 year ago.
Yes, there are many nonthyroid disorders that lower the T4. None that elevate it. Thank you for your kind accept. I appreciate it. You've effectively signed off for now. I can't set a follow up in this venue and so would appreciate your returning to our conversation with an update at your convenience.
Customer: replied 1 year ago.
Sorry one further question. Ive looked online at symptoms i know a dreadfulunuseful thing to do. But tick poisoning was suggested. Searched him for ticks and no evidence of such. But he fits the bill. Woozieness unstable lost apetiteAm i right that this would not ater the t4 and the t4 is specific to thyroid and nothing else.
Expert:  Dr. Michael Salkin replied 1 year ago.
Tick-borne diseases aren't recognized in cats in the UK. There are tick-borne diseases in dogs that like other non-thyroid illnesses will lower the T4.
Expert:  Dr. Michael Salkin replied 1 year ago.
I should have mentioned that 160 nmol/L is equivalent to 12.5 ug/dl and I do see severely hyperthyroid cats at that level. Hypertension becomes a consideration when a cat is that hyperthyroid. It would be prudent to have Foggy's blood pressure checked if that 160 nmol/L is accurate.
Customer: replied 1 year ago.
So update....
Bizarrely he still
Womt eat and isbwig forcefed convallescence food. However his bowels are functioning. Fistly by a micropoop and yeaterday a proper sized one.Today he is accepting cat treats from hand and eating will fully. But extracting feom plate or bowls he seems unwilling/unable to do. Hes licking the gravy if the chicken but not biting? Does that sound dental? Or just psychological?
Expert:  Dr. Michael Salkin replied 1 year ago.
I would choose dental.
Customer: replied 1 year ago.
Hi againJust an update. A month on and I have my baby back!! Less one necrotic nasty tooth!Still the hyperthyroid problem. But eating and strong and healthy as a 15 yr old cat can beThank u for all your help x
Expert:  Dr. Michael Salkin replied 1 year ago.
What a good update! Thank you for taking the time to let me know. Give Foggy a kiss for me.

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