The Perfect Storm

Yesterday was Smoky’s drop off day for his I-131 treatment.  Per the instructions for his admission, he’d been off of his methimazole for a week.  Over the last week we’d been monitoring him carefully.  He’d been more heat sensitive than usual, he’d been breathing a bit heavier than normal, and his skin was getting drier and itchier.  On Sunday night I had to clean his ears and treat the driest of his skin with petroleum jelly because it was just so itchy and flaky that he was scratching it until it bled.

When we dropped him off at Angell yesterday we met with one of the wonderful vets who runs the I-131 program, Dr. Duddy.  She’s so compassionate and caring and so good at what she does, I can’t say enough good things about her.  Smoky, who never likes car rides, was so distressed that he panted the whole ride there and for most of the meeting with Dr. Duddy.  He was patently not a happy kitty.

After we left Smoky with Dr. Duddy and her veterinary student, we went out front to make payment arrangements.  We knew that this was probably going to cost us somewhere around $2,000.  That’s money we don’t have, but money that we’re working on getting.  I’ve sold off a good chunk of my jewelry and Geoff is going to sell some of his books and other things.  A friends of ours, the one on whose blog we met, has been fundraising for us, and has managed to raise almost $300 for us.  Every little bit helps, though when we left for the hospital we had under $20 in our checking account.

It took a while to get through all of the financial paperwork.  There were credit checks to run and people to talk to and such.  We were almost done when Dr. Duddy came out to get us.  She asked the financial person to please hold everything up and then took us back into the ward.  We went into a screening room and looked at Smoky’s x-rays.

X-rays are the first thing they do to I-131 cats when they are admitted.  It allows the vets to rule out any other outstanding problems that might be causing the hyerthyroidism.  On day 2 they do a scan and titrate the right amount of I-131 to give, and on day 3 they give the I-131 injection.  The x-rays also allow the vets to see if there is anything that might keep the cat from being able to be treated with the I-131.  Therefore, having Dr. Duddy appear and ask us to come with her to see the x-rays was, in my mind, a bad sign.

She showed us the x-rays and immediately we knew something was wrong.  I could see gray streaks where I knew, even with my limited veterinary knowledge that there shouldn’t be any.  She told us that Smoky is in heart failure.

That sounds terrifying.  And here’s the thing, for a split second I panicked.  But Smoky has had hypertrophic cardiomyopathy since he was about 3.  He’s 11 1/2 now.  He’s been living on borrowed time for years.  I knew there was probably more to “heart failure” than the initial diagnosis.  It turns out that I was right.  He had fluid around his heart and some around his lungs.  Dr. Duddy said that it wasn’t the worst case she’d ever seen, not by a long shot, and that she’d treated cats for their hyperthyroid with I-131 with worse heart problems than Smoky.

Phew.

After discussing the order of operations and making sure that we were not going down a road where the rest of Smoky’s days would be filled with me chasing him around with syringes or hooking him up to IVs or anything, we agreed to have him treated for the congestive heart failure.  We thanked Dr. Duddy, finished up our paperwork, and left.

Dr. Duddy called us last night and this morning.  Smoky ended up spending last night in an Oxygen tent and on Atenolol and Lasix.  Atenolol is a beta blocker and Lasix is a diuretic that helps get rid of the fluid around the heat and lungs.  So far it looks like his lungs are clear.  He’s had a cardiac echo and a cardiac blood panel.  But, there’s bad news.  He’s in a Thyroid Storm.  A thyroid storm, or thyrotoxicosis, is often fatal in cats.  He’s back on his methimazole and we’ve made the decision that if he lives we’re going to give him a dose of I-131 that will ablate his entire thyroid.

This is a common procedure in humans.  My brother had his thyroid ablated when he was in high school.  I was born with the better half of the left side of my thyroid missing and I will take a thyroid supplement for the rest of my life.  In human medical terms, tinkering with the thyroid is fairly common and easy to maintain.  Human thyrotoxicosis is still no picnic, but it is much more widely understood and treatable, though it still can be fatal.

From what I understand, feline thyrotoxicosis is often fatal about 80% of the time.  If Smoky lives through the next 24 hours or so, he’ll go on to get the I-131 treatment another day and will live out his golden years with us happily gobbling down generic medications in pill pockets and cuddling with us on cold New England nights.  But, we won’t know for at least a day, maybe more.

If you have good thoughts, energy, prayers, or anything else to spare, we’ll take them.  Geoff is in his 3rd interview with this company that seems very interested in him as I write this and Smoky is in Dr. Duddy’s care.  We’ll take any good vibes we can get.

Here’s Smoky as a baby, in case you want to see the little pipsqueak I brought home from the shelter.

Thanks, everyone.

~Kelly