Pallina, hyperthyroid cat. Seeking advice

[Antonio]

Last night at around 10 pm, I set up to take Pallina to the usual clinic. The rasping sound from her throat was still audible, in certain moments even with the TV on.
She ate just 40 grams of her wet food, then slept all the time. I thought that having fasted for nearly 24h (she last ate at 9 pm the night before the scan, then they told me not to give her food in the afternoon) she would have wolfed down her food, but she barely licked it in a few sessions.
It wasn't herself, she wasn't purring.

So at 10:30 pm we were at the clinic, the vet heard the same rasping sound and agreed with the fact that the tube could have scratched her throat, hence the lack of appetite.
Her temperature was fine, her breathing at the lungs level was fine, her abdomen was soft and not irritated, so it was down to her throat. The back of her mouth was fine, though, just a slight soreness of the palate. Pallina was also showing a little nausea, probably from the long fasting and the anesthesia (she was sedated and in the CT machine for about an hour!) so the vet gave her a shot of ranitidine. I will have to do the same at home for the next few days. The vet didn't gave her anything else for her sore throat because the cat had gone through too much in a day.
We were home at 11:30 pm.

This morning I woke up to half a bowl of food. From midnight to 6:30 am she had eaten about 25 grams of food.
I gave her another shot of ranitidine.
Today at my lunch break I will give her the pill of diuretic as per CT scan vet instructions.
Pallina was a little brighter this morning, but still not herself.

Waiting for the two reports and some conclusions!

EDIT: Her weigh is still 2.860 kg. No changes since 20 days ago!

[Lilith]

Hi Antonio, she must be exhausted, so I wouldn't worry too much about poor appetite/generally being off it (though I agree it's impossible not to!) I'm glad the vet could give you that reassurance about her throat. You must be exhausted too.

Good luck with the report results - everything here crossed for Pallina and Mousey sends special love and purrs x

[Antonio]

I received two of the three reports I was waiting for in the evening of Friday.

The special test with a difficult name was a flow cytometry. The clinic where I took Pallina for the CT scan don't do that, so I had to take the fluid sample to the Veterinary University. The doctor at the university sent back the report on Friday.
I also received the CT scan report at the same time.
I am still waiting for the needle aspiration report that sould come in on tomorrow, I hope.

The CT scan report says that a slight enlargement of a lymph node behind the sternum is visible, same thing that I had been told before, but it is likely to be an inflammation, though they don't rule out any other issue. They have found a unusual shunt between the spleen vein and the left kidney vein. The right thyroid lobe is slightly larger than the left one (a possible remnant of her hyper-T?). No other anomalous conditions have been detected.

The flow cytometry report for the chest fluid says that the framework is compatible with a reactive situation, according to the test lab vet this should rule out a lymphoma.

The test lab vet told me that given the results we have so far we are "breaded(*)", a typical term that we use here in Italy to say that we are in a difficult situation.
According to him it is likely that Pallina might have an infection or inflammation from a viral condition that shows no other symptoms. He says that the last attempt we could have is the PARR test, but this would mean we have to drain some more fluids from Pallina's chest and this would be no more advisable.

Pallina is fine, eats fine and is alert and playful. I can't see the least strange signal from her, she's just as her usual.

Pallina has been put on a diuretic (Furosemide), 10 mg tablets, 1/4 tablet a day, to help drain the chest fluid, and an appetite stimulant (Cyproheptadine/Periactin), 4 mg tablets, 1/4 tablet a day, because she was a little off food in the hours after the CT scan.
The first results I have noticed are an increased appetite (she eats 50% more than her usual) and an increased use of the litter box.
I'm going to keep a log to have a fluid balance. I'm keeping trace of how much water she's drinking, how much moisture she gets from her food and how much urine she does in her box.

(*)when something is breaded it is also ready to be fried, so it's an unpleasant or uncomfortable situation or position.

[booktigger]

Glad the tests have ruled out lymphoma, even if they haven't provided a definite diagnosis. The important thing is that she is well in herself. If you struggle with the frusrmide, it does come in liquid form, I found it easier

[Lilith]

So, inconclusive?

But very glad she's so well in herself.

All the best with the third report - hope it tells you more, and hope Pallina stays well now, good luck and Mouse sends best wishes too

[Antonio]

The third report arrived today, it seems that the sample was not good enough for the test.
It says that there's a low cell population with some small and medium lymph cells, some erythrocytes, some neutrophils, rare eosinophils.
Non-diagnostic.

I've been advised to wait a week and redo a chest ultrasound scan just to check if and how much fluid is in there. If it possible we could take a small amount of that liquid and have it tested with a PARR test and a bacteriological test.
There are no other tests available to determine what Pallina has.
That's unbelievable!

[booktigger]

Sorry that the third test was inconclusive

[Lilith]

Same here

[Antonio]

Later in the afternoon Pallina was lively, rather clingier than her usual and very vocal.
She didn't want to eat much, though, even after her 1/4 pill of Cyproheptadine.

Though she had her Furosemide in the morning, she hadn't produced much urine in her litter box.
After dinner (it means past 8 pm in this part of the world) she was very clingy and wanted to stay with me on the couch, she also kneaded a little on my stomach
She also finished her bowl.
Then, at 10 pm, she started coughing, as she was choking on a hairball, but she wouldn't stop and went on for a long while. We were a bit worried. Nothing was expelled, then she curled next to me on the couch and I could clearly hear that rasping sound from her throat again. I was nearly going to take her to the clinic again, but I wanted to think rationally and wait some more minutes. As a matter of fact that sound stopped and she fell asleep.

Tonight, at 3:40 am, she started meowing loudly, nearly screaming and howling!
I jumped out of the bed and checked what was going on. She was fine, just very playful and started rubbing on my legs. I thought she was hungry, but I didn't feel like preparing her bowl at that time of the night!
So I cuddled her for a couple of minutes and went back to sleep. She meowed and howled two or three times, then silence... too much and sudden silence. So I got up again and found her trying to open a pack of salted crackers. I don't know whether she succeeded in getting one. I cleared the area and went back to sleep.
Her being vocal at night remembered me when she was very local in the late afternoon.

This morning at 6:30 am she was rather active, though less than during the night. At 6:45 am I prepared her bowl, I thought she would wolf it down, but she barely licked it and about 20 minutes later she threw up a brownish liquid, water with some traces of food in it.
She hid in the other room. About another 20 minutes later I gave her a shot of Ranitidine as per vet's instructions and half an hour later she was eating, though not much.
I also gave her the 1/4 pill of Furosemide and soon she ran to her litter box (Pallina doesn't love to be manipulated, she gets easily distressed and when it happens she runs to the litter box to pee and poo ) where she produced some urine and some poo. This was particularly smelly, probably darker than usual, and a small part of it was clearer and softer. Absolutely strange!
I reckon that she ate a bit of those crackers at night and being her intolerant to grains she threw up and had some belly issues later.

At 8 am I left to go to work. During my lunch break I will go back home and see how she is.
To be honest, I don't like this situation.

[Lilith]

Poor Pallina - and poor you, too

Admittedly Mouse has none of these problems (paws crossed) but some of this - erratic appetite, vomiting, generally not quite on form, reminds me of a few episodes Mousey's had since her treatment; mercifully they've been short-lived and she's been fine otherwise (paws crossed!) Also Pallina's had to visit the vet far more and for far longer and may well still be stressed.

I don't know if it's available in Italy but there is a catfood here called 'Encore' (not a complete food) that is very high end ie expensive and comes in tiny tins of various flavoours including plain chicken breast. It really is just plain shredded chicken, very good, tips straight out of the tin. I wonder, if you could lay in a stock of that or something similar, and keep a tin and bowl handy, it could be a good idea to give her a small meal when she gets the midnight munchies. Even if she's got stuff on her stomach to bring up, it will bring it up and she'll feel better - or if she can digest it it will soothe her. The same once happened with Mouse - she was screaming for food, brought it back - and was fine after that.

Poor little girl, I hope she's feeling better soon, Mousey sends special purrs x

[Antonio]

I have done a quick research on the web and it seems that we have the same cat food here.
Unfortunately Pallina has specific needs for her food.
Because of her acquired intolerance that made her vomit frequently, the vet stated that we had to switch to a new diet. We tried pork canned food and she hasn't vomited since (apart the occasions when she chew on grass, or has some hairball to expel).
The vet was clear, no grain or rice in her food and nothing that swims or has feathers
So we are currently stuck to a single canned food diet.

I I didn't feel like giving her food last night because the "bowl process" is quite long over here
I usually warm her can up for a while in hot water from the tap. It takes about 5 minutes, Then I put the food in the bowl, add some fresh water to make it more liquid and give her a higher water intake, then I add half a scoop of taurine. It's very likely that this latter is useless, but I started adding it to the food when I still had Lola, so I think that Pallina is used to this added taste and could refuse to eat if she doesn't taste the small amount of taurine in her food
All this process takes me some 10 minutes, so at that hour of the night I didn't want to do it!

It seems to me that all these troubles started with the first fluid draining a month ago, and it definitely went worse after the CT scan last week. It seems that the anesthesia for the scan has broken a delicate balance. She was very fine before last Thursday!

[Lilith]

Pork! Wow, never heard of that. And yes, with that ritual I too would 'chicken' out of it at that time of night.

What about preparing a small bowl for her (without warming as it will come to room temp) and covering with clingfilm just in case she needs to eat during the night? Though I realise she may be 'training' you in this respect as Mouse did me before her HT treatment. But, just while she's fragile? A small snack might settle her and the stomach.

I've read reports of venison (of all things) being very good for sensitive feline stomachs too - but never cooked this, either for me or cats, so don't know - perhaps someone out there could advise further?

All the best with her and fusses to her, good luck

[Antonio]

Lilith,
This is what I feed Pallina
https://www.novafoods.com/trainer/en/ca ... -soft-pate
It says Lamb, but is mainly pork.
Pallina loves it, fortunately. I had tried other brands but she was a bit unhappy with them.

I couldn't prepare a small portion for the night hunger. Pallina has a strange, very strange attitude.
She wants to see a whole can into her bowl. A can and a half, or just half a can, gets her suspicious and she won't eat!
Sounds crazy but it's true!!!

[Lilith]

Typical! The little madam!

Well, the tins are 80g ... a bit extravagant but I'd be inclined to leave her an extra, unwarmed, dish down before you go to bed, just to see what happens. It's a very good cure for nausea and vomiting, snacking little and often, maybe worth a try?

Perhaps your ferals could mop up any leftovers?

Cats! What do they put us through eh? Lots of love to her and good luck

[Antonio]

In the last two nights Pallina was quiet.
Being the apprehensive person that I am, now I think that she might be unwell during the night
As a matter of fact she's just sleeping.
She's eating three cans a day. One is given at 7 am, then I go back home during my lunch break (I have skipping my lunch for several months now!) and her bowl is usually empty, or nearly empty, so I give her another can. She starts eating and I leave to go back to work. At 6 or 7 pm I give her the third can. This is usually eaten before midnight, or just a spoonful rests in the bowl for the night, so I think Pallina is rather satisfied and happy

What I see, though, is that she's not the same. She's slow and sleepy, not very active or playful or interested in what happens around her. It also seems that she feels the cold more than in the past.
My opinion is that the anesthesia for the CT scan has changed her, it seems that Pallina didn't tolerate it well
I also think that she has and feels some fluid in her chest and has troubles. My opinion might be biased, but it seems to me that I've never seen her sleeping in a curled position anymore since last week.

We'll have a new visit on Monday morning. A new chest scan and tests on that fluid.

[Kay]

'What I see, though, is that she's not the same. She's slow and sleepy, not very active or playful or interested in what happens around her. It also seems that she feels the cold more than in the past.'


this sounds very like a cat with an underactive thyroid, Antonio, which is quite possible as the climb back to normal levels after the radioactive iodine treatment can take several months

[Antonio]

this sounds very like a cat with an underactive thyroid, Antonio, which is quite possible as the climb back to normal levels after the radioactive iodine treatment can take several months

Well, you're right, I almost forgot this aspect of the treatment. It sounds consistent with what I'm seeing. It is strange, though, that this situation became more evident right after the CT scan.
Pallina has still some fluids in her chest, and I don't want to underestimate this issue, because the vets haven't found out what the cause is.

I'm still giving her the Cyproheptadine pills. The vets advised me to give her this pill for 4-5 days, now it's a week and I wouldn't like to suspend it because at the moment, with this pill, she is eating an amount of food that resembles what she was used to eat in the past.
I wouldn't like to stop administering the Cypro and find that Pallina stops eating...

[Lilith]

Hi Antonio, that sounds convenient if she'll leave a bit in her dish overnight ... she is being naughty, and as I understand it there's nothing, no dry food or fresh treats such as cooked meats she'll snack on as an alternative to that particular tinned food just to put her on? There again it could have been just a freak result of the cypro.

That's a good point of Kay's about temporary hypothyroidism. I think that however marvellous this radio-iodine treatment is (and it is! Never regret it one moment for Mouse) it does shake up their systems and they're bound to take a while to settle down afterwards. Plus Pallina has these added problems - and has had to wait a year before the radio-iodine. Quite an ordeal for a cat of her age; really she's coped with it marvellously.

As always, fusses to sweet Pallina and good luck

[Antonio]

This morning Pallina had an appointment for a new ultrasound scan and a blood test.
The appointment was at 9:30 at a different practice, very close to home. The staff is partly the same of the clinic where I usually go and they have some kind of connection between them.
I was there at 9:30, the vet came into the waiting room and said they would have been with me in a minute.
But after 25 more minutes without a sign of life I left for good.
I was very angry
I know that a dog was being visited while I was there (absoluetly routine, not emergency), but they were three doctors in and I had an appointment.

I had taken an hour leave from work to have Pallina visited and I wasted half of that time in the waiting room. But even worse it's that Pallina fasted for this visit and nothing happened!!!

I weighed her before going there, she's 3.120 kg, about 250 grams more than 10 days ago. Don't know how much of this weight gain is real and how much is possible fluid in her chest. If the diuretic is working fine she shouldn't have much fluid, hopefully she shouldn't have any. She's eating 3 cans a day since 10 days ago, so I hope that an increase of 50% in her daily food intake has given some result.
She's also fine, quite lively and curious. She purrs a lot and kneads on my belly as usual, but her voice is still rough and occasionally I still hear that rasping sound from her throat...

Do you struggle as well when you have an appointment? How does it work in a more civilized and respectful country than mine?

[booktigger]

I would have spoken to a receptionist and asked what was happening before leaving - I often wait for appointments, the vet that has just left was notoriously late, you could often be 20-30 mins late going in.

[Antonio]

I would have spoken to a receptionist and asked what was happening before leaving - I often wait for appointments, the vet that has just left was notoriously late, you could often be 20-30 mins late going in.

No reception in there. It's a small practice, the vet that does the visit then gives you the bill. They also take the calls.
Sounds strange, but it has been working this way for decades. The vet that opened the practice is now retired, new vets have taken over.

I usually understand waiting, especially when there's an emergency. But this morning there was just one dog, three vets and I had an appointment. The vet who showed up in the waiting room could have told me "sorry, we have a situation here, would you mind waiting some more minutes?". But he told me "we'll be with you right away". That sounds different.

I was referred there by my vet who works at the clinic in another town and knows these vets well. He sent me there mainly because it's close to home and for a follow-up ultrasound a long trip was useless.

I'm going to call him an let him know.

[booktigger]

Wow, that sounds odd.

[Lilith]

That's terrible.

Decades ago I used to use a vet who had a tiny auxiliary surgery here - people used to queue up the street before opening time because he was so cheap and good (Philip Richmond of Wakefield - marvellous guy.) No appointment system, no receptionist, nurse if he had one handy, otherwise not, first come, first served, so you expected to have to wait. But a decent vet, or his sidekicks who were keen young people straight out of college and efficient - only ever met a poor one once.

Nowadays I've never experienced much of a wait in a vet's. The UK NHS is a bit different - you'll be kept waiting till kingdom come, pack 'em in tight and treat 'em like s**t, in fact a friend of mine made a long journey for an appointment and TWICE she waited till the end of the afternoon and was told to make another appointment because they'd run out of time ...

Vets are better than docs over here. (Sorry for rant, and I'm so thankful for the good vets!)

Commiserations and to poor Pallina too

Errm, a little edit - how come the UK is more 'civilised and respectful' than Italy lol? Italy - food! (my only Italian, save for a few bars of Puccini, is 'fusilli' and errm well I forget but delish anyway.) Music! And sun and la dolce vita (well, when you're on holiday.) And I know there's mundane stuff like industry and cars but ... Italy ...ohh and Venice ... my mate Adrian is over there just now for the bicentenary ... lucky guy!

The UK is grey
Well we had a red sun today
But it doesn't make up for the boringness
And the grey!

I've never visited Italy but I do think it sounds ULTRA civilised ... save for a vet or two grrrrr!

[Antonio]

At the end of the day I decided not to call my vet to tell him what happened at the small practice where he sent me to, neither did I schedule another appointment with him in the next few days.
In three weeks time Pallina will have a new thyroid levels check (60 days check), so I thought that in a single appointment I will have her checked for chest and all.
She's fine, hungry, loving and alert, so I do not think she's in a situation that requires a prompt intervention. Furthermore, I wouldn't like her to fast again, say, tomorrow and then again in three weeks time. Once is more than enough, right now that she's eating like a wolf

Here she is yesterday, right after sunset, during her last walk out in the courtyard
She's never too happy or cooperative when it comes to being photographed.

[Antonio]

Errm, a little edit - how come the UK is more 'civilised and respectful' than Italy lol? Italy - food! (my only Italian, save for a few bars of Puccini, is 'fusilli' and errm well I forget but delish anyway.) Music! And sun and la dolce vita (well, when you're on holiday.) And I know there's mundane stuff like industry and cars but ... Italy ...ohh and Venice ... my mate Adrian is over there just now for the bicentenary ... lucky guy!

The UK is grey
Well we had a red sun today
But it doesn't make up for the boringness
And the grey!

I've never visited Italy but I do think it sounds ULTRA civilised ... save for a vet or two grrrrr!

Yes, Lilith, UK might be grey, dull, boring, but I always felt to be in a pleasant place. And the kindness of people in your country is something that we only can dream of. And the respect for rules, it's something that we hardly know.
I and my wife have been to UK twice, the first time for over three weeks, and really liked it.
We spent our holidays in Ireland every year and travel to Northern Ireland too (does it count as UK? ) just because we like the kindness and friendliness of people and the beauty of the landcapes.
The weather is just a detail when all around things are pleasant. Food, yes, we have a good cuisine, but nothing that can't replicated elsewhere. Music, if you take classic music away, not much is left to listen to nowadays.
We have art, fashion and history, but it isn't something you have to deal everyday with.
There are things here that no country in the world would like to trade in with theirs

[Lilith]

Ummm well, I suppose there's good and bad in every country. Honestly I've come across some dreadful Brits - but also some great ones Ah, Ireland - one set of my grandparents came from Dublin

Aww Pallina looks very sweet, posing next to the cyclamen. Yes, I agree, if she's happy and lively and eating well, I'd just give her a break until her next blood test. Mouse's is due at the same time - it'll be interesting to see if both their TAs have risen a bit. Mouse is using the psyllium you recommended and it's having good results

Purrs from Mouse to Pallina and all the best

[Antonio]

Mouse is using the psyllium you recommended and it's having good results

Purrs from Mouse to Pallina and all the best

I'm very glad that psyllium is working alright, in the last 30 months it never failed here

Pallina says thank you and purrs back to Mouse

[Antonio]

Hi all
On Sunday I suspended the Cyproheptadine (Periactin), the pills that was scripted by the vet to improve Pallina's appetite following the CT scan, when she had a sore throat for the tube during the anesthesia.
I should have given her this pill for 4-5 days, but when I saw she had developed a very good appetite I kept giving it to her for about 2 weeks.
Last time she had the pill was on Sat night, yesterday she was still pretty hungry, I think it's kind of a "carry-over" effect of the med.
This morning she wasn't as hungry as in the last few days.

With the pill she was eating 50% more than her usual and I was noticing that she was gaining some weight.
I wonder if I should consider giving her Cypro every now and then.

[Patricia]

Hi Antonio,

I've been following Pallina's story as I also had a cat with thryroid problems, among others, so I am missing your updates. I do hope Pallina is progressing well.

[Antonio]

Hi Antonio,

I've been following Pallina's story as I also had a cat with thryroid problems, among others, so I am missing your updates. I do hope Pallina is progressing well.

HI Patricia,
Thanks for asking

Pallina is doing rather fine, she's lively, alert, sometimes playful and loving.
She eats her usual two cans a day (160 g in total) and drink around 60-70 ml of water a day from the bowl. Considering the humidity in her wet food and the water that I add to the wet food, she's taking 200-220 ml of water a day.

She had a follow-up visit on last Thursday. She had a chest ultrasound scan to check on the fluid in her chest, and a blood test to check on her liver, kidneys and thyroid.
The scan said that some fluids had built up in the last 4-5 weeks, 55 ml were drained, but some of it had been sent for analysis. I asked the vets for a bacteria test, a citology, a cytofluorimetry and a PARR test, so to assess the nature and origin of this fluid as best as possible.
I do hope they can come out with something clear, or I'm planning to go to the Veterinarian University and have Pallina visited by a specialist.
Pallina is taking a diuretic every morning, if it wasn't for the med the fluid could have double or triple!

So far I had the reports for the ultrasound scan: heart is fine, one of the lobes of the right lung has a hepatization, a sternal lymph node is slightly reactive. The vet says not to worry about yet.
The cytofluorimetry says that the fluid is consistent with a reactive situation (an inflammation).
The blood test revealed a worsening in her liver and kidneys. For her liver she's taking a supplement everyday, but it seems it's not working... In September her kidneys were fine, her liver was not too bad.

Despite all this, Pallina has never showed difficulty at breathing. And she doesn't show any symptoms of a bad liver.

I'm still waiting for the report for the bacteria test (should come in a couple of days) and the PARR test (probably on next Friday or Monday).
The thyroid level report is due by the end of this week.

I would have updated you all when I have all the reports in my hands.
Thanks for asking!