Last spring, I reported on my cat’s toxoplasmosis, an insidious parasitic disease that causes neurological problems. (See the May 4 & May 5, 2015, posts.) To control his seizures, the vet put him on ¼ grain of phenobarbital (a barbiturate), which, tiny as it is, I split with a pill cutter, giving him half in the morning and half in the evening.

Unfortunately, on September 7 he had another seizure while on the medication, which was unexpected and dismaying. As before, he woke up from a sound sleep on the upper sofa cushion, falling onto the sofa seat and then jumping up and running around on the floor madly before falling on his side and seizing.

He recovered fairly quickly, within about 3 minutes or so, and I called the vet immediately to report the problem. I also complained that the pills were not cutting cleanly, causing a concern that he might not be getting his full dose. I took the pills (but not Mister C) into the vet’s office, and the tech checked them and so did the vet. Although they had the same problem cutting the pills, the vet advised me to just get another pill cutter, which I did, not completely happy with that recommendation. (I have now gone through three pill cutters.)

Things seemed to be under control until about two weeks ago. On November 4, he had yet another seizure, again waking from a sound sleep on the upper sofa cushion and falling onto the sofa seat. As before, he ran around on the floor wildly and then convulsed for about a minute. As the episode subsided, I called the vet and reported the seizure. By this time, the convulsion was over, and he was sitting up and seemed to be able to see and hear me, although the recovery took a minute or two longer than the last time. For a short while, he walked around in circles and then remained subdued for another few minutes. Then he was back to normal.

The vet said this could be caused by more neurological damage from the toxoplasmosis, or it could be something else, such as liver, kidney, or heart disease. Because his last blood test in the spring showed fairly normal kidney function, the vet advised me to double the dose to ¼ grain twice per day (a whole pill in the morning and a whole pill in the evening). His previous blood test showed that he was well within the therapeutic and nontoxic range of the medication, so I didn’t hesitate to give him the increased dosage (which also relieved me of worrying about splintered tablets). I put the pills in Greenies Pill Pockets®. I used to give him one in the morning with his dry food and then crush the other half of the pill into his wet food in the evening, but now he gets two Pill Pockets a day—and loves them.

The vet further said that if the seizures were happening every three months or more, he wouldn’t be too concerned. But the last two occurred within two months of each other. If he has another seizure on the increased dosage, the vet wants to see him. (Another concern is that he may have a convulsion when I’m not there to see it.) I also watch him carefully to be sure he isn’t having any adverse effects of the increased medication—so far, I don’t see any.

Mister C_2015-11-16_Cropped

As I write this, he’s sleeping soundly on his cushion over my shoulder, snoring softly. At age 15, Mister C still has good quality of life despite his seizures (and former thyroid problem), so I’ll hang in with him as long as health and happiness are possible.

FRESH STEP® CAT LITTER TOXOPLASMOSIS WARNING

Kitty Corner: Toxoplasmosis – Update, Feline Seizures & Human Precautions

May5

UNEXPECTED UPDATE ON YESTERDAY’S POST

FRESH STEP® CAT LITTER TOXOPLASMOSIS WARNING:

We would like to remind our customers, especially pregnant women and immunosuppressed persons, that cat feces can sometimes transmit a disease called toxoplasmosis.* Therefore, always remember to wash hands thoroughly after handling used cat litter. For further information, consult your doctor. Unused cat litter poses no toxoplasmosis threat.

*Toxoplasmosis, an illness characterized by cold or flu-like symptoms, can be transmitted by cat feces. It is especially serious in pregnant women because it can cause birth defects. Immunosuppressed persons may also be susceptible to toxoplasmosis.

May 5, 2015 – Tuesday

I was not expecting to update yesterday’s post on my cat’s toxoplasmosis for quite some time. But this morning at about 8:00, Mister C had his third seizure—or at least the third I have witnessed. And if this had been a typical day, I would have missed this one. But I had trouble sleeping last night and got up hours earlier than normal today. And that’s when it happened.

This seizure was not as bad as the first and not as easy as the second (of those I observed). This time, although the seizure itself lasted less than 60 seconds, for a few minutes afterward C seemed to want to walk around in slow circles, following his own tail. Otherwise, he recovered fairly quickly with no residual effects in hearing, sight, orientation, or appetite. As noted yesterday, the vet said we should monitor C over the coming months. But considering that this seizure was a bit more severe than the last, and especially because I have no way of knowing whether he has seized when I haven’t seen him, I aborted the monitoring plan.

I called the vet, and he readily agreed to start C on phenobarbital, which he will have to take this for the rest of his life. So I went and picked up the pills, not needing to take C with me—no need to put him through that.

Mister C's Phenobarbital Setup_2015-05-05 (1) The green label on the blue pill bottle says “BLOOD WORK REQUIRED BEFORE NEXT REFILL.” The vet said that it may take four to six weeks to build up the needed level of medication in the brain, so we will do a blood test next month to see whether the dosage needs to be adjusted. We started with a low dose of 15 mg (1/4 grain) tablets, which are scored—and very small. Fortunately, I have a pill cutter that slices through the pill when it is placed properly in the trough. The photo shows the remaining half of this evening’s initial dose sitting in the cutter’s blue tray. He’ll get the other half in the morning.

As I learned during C’s thyroid treatment last summer and his antibiotic treatment last month, getting foreign objects (pills) into a cat isn’t one of life’s easier tasks. But this is important medicine, so I pulled out my mortar and pestle, which did a fine and quick job of pulverizing the half-tab. This was easy to mix in with his wet food. The problem is that he gets dry food for breakfast. However, he loves milk and cries for it when he sees me making my tea, so I think I’ll try sprinkling the powder in his “tea” tomorrow morning.

My dearest hope is that I will not see any more seizures. They are quite upsetting, and it is heart-wrenching to see a beloved pet in the control of what seems to be a malevolent force. However, the vet warned that because we are starting on a low dose that may not achieve the desired therapeutic level at the outset, I could still witness more seizures until the medication is stabilized.

But for tonight, I think I can rest more easily knowing we have C under good care.

As for the little man himself, he is sleeping peacefully, quite unaware that he is ill.

Final Cautionary Note

At the beginning of today’s post, I repeated the Fresh Step warning about the potential for certain vulnerable humans to contract toxoplasmosis from handling used cat litter, especially if it has been soiled for three or more days. At risk are pregnant women and immunosuppressed people. Of course, I have a less than zero-percent chance of becoming pregnant following my hysterectomy for endometrial adenocarcinoma,* but as a cancer survivor I may (or may not) be immunocompromised. I had internal radiation and no chemotherapy, so I probably am not at any particular risk. Nevertheless, I urge pregnant women and anyone with a compromised immune system to be particularly careful caring for pets who venture outdoors and who may get into who-knows-what kind of mischief.

*For more on my story, see the Uterine (Endometrial) Cancer–My Story & More page.

Kitty Corner: Feline Hyperthyroidism – Update

Sep12

As mentioned in the August 19, 2014 post, we are taking a temporary departure from human concerns with a brief look at a health issue for older cats—overactive thyroid.

I needed to decide whether to keep my little buddy on thyroid meds or take him in for a thyroidectomy. So I solicited votes to see what others would advise. . . .

See recap and outcome below.

And see new information from the New York Times – May 16, 2017:

The Mystery
of the
Wasting
House-Cats

RECAP FROM ORIGINAL POST

When I took Mister C in for his annual checkup and vaccinations in June, I reported that he seemed to be hungry all the time; yet when the vet weighed him, she saw that he had lost almost a pound. These symptoms, plus a slightly rapid heart rate, led her to believe he was suffering from a problem that is fairly common in older cats (he just turned 14)—an enlarged thyroid gland, causing overproduction of thyroid hormones. Hyperthyroidism was confirmed by a blood test.

We tried Felimazole (methimazole) 5 mg tablets twice a day between July 4 and early September, with unsatisfactory results. One problem was getting Mister C to ingest the pills. I tried inserting them in wet food and also in soft “pill pockets,” but I’d find them lying on the floor half the time. Irregular dosing

can create havoc with metabolism, placing stress on the heart and other organs. The second problem was that when he did manage to eat the pills, they artificially dampened his appetite—yet he rapidly put on weight. The pills also seemed to depress his mood, and he just wasn’t himself.

A repeat blood test about five weeks into treatment showed decreased thyroid hormone levels and also decreased platelets, which was good. Also, he had gained about 3/4 of a pound and had a regular, normal heart rate. This further confirmed that he had hyperthyroidism because the condition was responding to the medication. But I was concerned about maintaining Mister C on this artificial regimen for the rest of his life.

OUTCOME

Because not treating him at all would be fatal (hyperthyroidism leads to heart and possibly kidney disease), and because our vet did not offer any options (such as radioactive iodine) other than meds or surgery, I took Mister C in for a thyroidectomy two days ago. (See the previous post, as well as the resources below, for the benefits, risks, and approximate costs* of each modality.)

The vet herself had recommended surgery because it would cure, rather than just manage, the problem. And now that it’s over, I think she was right.

I picked Mister C up from his overnight stay yesterday, and he seems pretty perky and has almost a normal appetite again. As described previously, cats have two thyroid glands, and only one of his was enlarged. This was good news because the remaining gland, which shows no evidence of disease, will keep producing the needed amount of thyroid hormones. If both glands had been removed, though, he still would not have needed supplemental medication because cats have nodal glands, usually in their chest, that produce enough thyroid hormones for normal metabolism.

Other than a big bald patch around the 1-1/2-inch superficial incision in his throat area (the sutures are underneath and will dissolve on their own), and a smaller shaved patch on his leg (the IV and injection site), Mister C looks fine and is acting more like himself. He will need a recovery period and won’t be able to wear his collar for a while, so he’s not quite 100 percent yet. But he seems to be well on his way. I don’t see any ill effects from the surgery thus far and expect my little guy to make a full recovery. He doesn’t need any follow-up. Plus he had a complimentary pedicure and dental cleaning while under anesthesia.

Thanks to those who shared their votes and advice.