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Kitty Corner: More on Feline Toxoplasmosis

UPDATE ON MISTER C’s STORYMister C_Portrait_Lightened_2013_JBowman 


Last spring, I reported on my cat’s toxoplasmosisan 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

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.

Mister C_Portrait_Lightened_2013_JBowman *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: Toxoplasmosis – Feline Seizures & Human Precautions


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.

Mister C_Portrait_Lightened_2013_JBowman *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.

March 10, 2015 – Tuesday

With winter still hanging on, MISTER C and I were having a quiet afternoon at home. “C” was cap-napping on top of the love seat, sound asleep on his favorite cushion right in the middle, where on a good day he can be straddled by two loving humans. My husband was away, so he had the love seat to himself while I was reading on the sofa.

Engrossed in my story, it took a second or two for me to register that C had suddenly jumped up and started running around in frenzied circles on the living room carpet, just beyond the love seat where I couldn’t see him. When I got up to see what he was chasing (ick)—or, worse, what was chasing him (ugh)—I found him on his side, convulsing and foaming at the mouth. Feeling powerless, I had no idea what to do. Instinctively, I bent down and put my hand on his side to let him know I was there, even though I was otherwise useless. Fortunately, the seizure stopped within about a minute. But he was dazed and couldn’t stand up. In that semi-dreamlike state that kicks in during emergencies—the one that protects us from our emotions  while still allowing us to take action—I called the vet’s office. They told me to bring him right in.

During the exam, C’s pupils were dilated and nonreactive to light or the approach of a finger, so it looked as if he couldn’t see. He also didn’t seem to be able to hear because he didn’t react to loud clapping. The vet held him so that his back legs dangled over the metal exam table to see whether one side or the other was affected by a possible stroke. But when C scrabbled to try to gain purchase on the table, both legs were working. He still couldn’t stand on his own once he was up.

I petted him the whole time and talked softly to him to let him, even though he couldn’t hear, to let him know that his pet parent was there and seeing to it that he got good care. But I needed support as well. With my husband traveling, I was terrified that I would have to make the “big decision” on my own.

The vet shaved C’s neck in the same spot where he had had his partial thyroidectomy last year (see the August 19, 2014 post) to take blood samples. The battery of tests would check his remaining thyroid gland function, his general health, and also whether he had picked up one or more infections—some of which could be fatal (such as leukemia or AIDS) and/or could have been in his system for years, causing slow damage. Despite the lack of paralysis, the vet said he could also have had a stroke. I was, of course, worried and alarmed, because that “big decision” might still have to be made after we got the test results. The vet gave him an injection of cortisone to reduce brain inflammation, and he also gave him a shot of phenobarbital to prevent additional seizures.

I brought him home just over an hour after the seizure, expecting him to be dazed and unresponsive. To my happy amazement, though, as soon as I opened his carrier he pranced right out of it as if nothing had happened. He could see and hear and was walking without difficulty, not at all disoriented. He knew where he was and certainly recognized the hand that feeds him. It was close to his dinnertime, and he started crying for food, which he gobbled up. He also had the strength to jump back up onto his favorite cushion.

Here, a few hours after his seizure, Mister C is looking up at his cushion, ready to return to normal. Post-Trauma Normalcy_2015-03-10He might seem a little depressed, but this expression is quite normal when I ask him to do something—including look into the camera to have his picture taken. 

This was all very weird, but I was grateful I was here when it happened so I could get him prompt care. The vet said that seizures in cats are rare and are always caused by a problem (whereas in dogs, they can be hereditary). The fact that he had serious neurological symptoms and was fine about an hour later was surprising. But the vet said there was no telling whether or when he might have another seizure, so I would have to keep a close eye on him.

March 13, 2015 – Friday

After our ordeal on Tuesday, Mister C continued to be fine. As far as I could tell, he was completely back to normal. Although we were supposed to get the blood work results on Wednesday, we didn’t get them until Friday—all except one titer, which was sent to the University of Colorado for analysis of possible infection. All of the other tests were negative. So, after a terrible fright, a visit to the vet, hundreds of dollars worth of blood tests, and careful monitoring, all the vet could say (before getting the final test result) is that he probably had had a TIA (transient ischemic attack), or mini stroke. In the meantime, while waiting for the final result, the vet advised me to give him 1/4 of a low-dose aspirin twice a week.

Not allowed to go out while waiting for the final blood test results, Mister C is looking wistfully out on the deck and backyard, his former (occasional) stomping grounds, although he is essentially an indoor cat.Pensive & Wistful_2015-03-13

 

March 18, 2015 – Wednesday

A week and a day after the seizure, I finally received the last blood test result on my little buddy. It showed that he has toxoplasmosis. In this test, two immunoglobulins are analyzed, IgM suggesting recent infection, and IgG suggesting chronic infection. The former was negative, but the latter was positive. This means that sometime within the past few years, the little mister got hold of a rodent—or, as I shudder to remember, a baby rabbit—that was carrying the Toxoplasma gondii protozoa. This common parasite affects the nervous system and thus seemed to explain Mister C’s seizure. So we stopped the aspirin and started the antibiotic Antirobe (clindamycin hydrochloride) 75 mg twice a day for a month.

The vet said that humans who handle cat feces that has been sitting in a litter box for three or more days, or who eat plants from gardens where the feces has been parked, can become infected and will need antibiotic treatment. As stated at the top of this post, toxoplasmosis is especially dangerous for pregnant women or women who may become pregnant, as well as for immunosuppressed people. So good feline-human hygiene is necessary to prevent cross-contamination.

April 18, 2015 – Saturday

A month later, having completed his course of antibiotic treatment on Friday, April 17, Mister C was doing well and showed no signs of impairment. The next afternoon, however, again while sleeping peacefully on his favorite cushion, he suddenly jumped up, ran around in circles, and fell to his side in another convulsion.

This time my husband was home, and we both stayed with him during the minute or so that the seizure lasted. It was Saturday, and the vet’s office was closed. I called the emergency number and was told I would have to take him to an animal clinic several towns away. But when we checked little mister, we saw that he had recovered very quickly, and within minutes he showed no signs of deafness, blindness, or weakness. So we decided to wait it out and contact the vet on Monday.

Here’s the little guy asleep post second seizure in his favorite place behind my shoulder.

Post-Trauma Normalcy 2_Cropped_2015-04-18

I told the vet I was afraid that toxoplasmosis had not been the cause of Mister C’s seizures or that the antibiotic hadn’t worked. At C’s age of almost 15, I said I was not inclined to put him through a lot of difficult and expensive tests. But the vet said this latest seizure didn’t mean a failure of diagnosis or treatment. The antibiotic can’t undo old neurologic damage, but it will halt progress of the disease. These protozoa cause severe neurological damage and dysfunction, and it is possible that he will have more seizures. The vet said that if he has more than one seizure a month, or if the seizures become severe, we can consider putting him on phenobarbital, which is inexpensive and has few side effects other than temporary lethargy, although in some cases it affects the liver. His advice, though, was to just monitor him for the foreseeable future.

May 4, 2015 – Monday

Now that we are into spring and experiencing some lovely days, it is heartbreaking to see my little guy staring out the deck door or gravitating toward any open window for a breath of fresh air. He still thinks of himself as a wild man, although he had only a few misadventures in the past (including two baby bunny attacks, for which he is now paying). Most of the time, we didn’t ask questions about his escapades.

Mister C_Wistful_Cropped & Outlined_2015-05-04

Sadly, though, the fear of his picking up another infection—or worse, having a seizure outside where we can’t find him—means he will need to adjust to a window-peering version of experiencing nature.

Our job is to keep him safe and as healthy as possible for the rest of his days, which we are happy he is spending with us.

Kitty Corner: Feline Hyperthyroidism – Update

Mister C_Portrait_2013_JBowman

“Mister C” – Photo © 2013 J. Bowman

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

Felimazole 5 mg

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.

*The total cost of two blood tests (about $200 each), pre-operative visit and thyroid pills (about $100), and unilateral thyroidectomy with hospital stay (about $550) came to about $1,050.00. The cost of medical treatment only (no surgery) would have come to about $600 per year for two visits with blood tests and prescription refills. All thyroid-related costs are in addition to the annual checkup and vaccinations. I never thought about pet insurance before, but may look into it. See the resources below.

RESOURCES

Medical Information

Advanced Veterinary Medical Imaging (AVMI) – Feline Hyperthyroidism

American Society for the Prevention of Cruelty to to Animals (ASPCA) – Hyperthyroidism

CatInfo.org – Feline Hyperthyroidism

Cornell University College of Veterinary Medicine – What is hyperthyroidism?

Feline Hyperthyroid Treatment Center (FHTC) – What is feline hyperthyroidism?

VCA Animal Hospitals

– Hypocalcemia or Low Calcium Levels in Cats

Thyroid Hormone Testing in Cats

Washington State University College of Veterinary Medicine – Hyperthyroidism in the Cat

WebMD – Hyperthyroidism in Cats

Insurance & Credit Information

ASPCA Pet Health Insurance

Embrace Pet Insurance

TruPanion Medical Insurance for Your Pet

Veterinary Pet Insurance – A Nationwide Insurance Company

CareCredit Healthcare Financing Credit Card for the Whole Family (people and pets)

Kitty Corner: Feline Hyperthyroidism

Mister C_Portrait_Lightened_2013_JBowman In a temporary departure from human concerns, today we take a brief look at a health issue for older cats—overactive thyroid. 

I need to decide whether to keep my little buddy on meds or take him in for a thyroidectomy.What would you do? Cast your vote.


ALSO SEE: Kitty Corner: Feline Hyperthyroidism – Update

AND NEW INFORMATION: 

Just before my husband and I went to Vancouver and Seattle in June, I took myself to the gynecologic oncologist (see my latest post) and my buddy Mister C to the vet. While away, I received calls from both doctors.

Since last year, Mister C had lost almost a pound, yet he seemed to be hungry all the time. One of his cues to eat is when I enter the house, which, often for coincidental reasons, is just around his dinnertime. But recently, no matter when I left and returned, he thought my arrival meant chow time.

I casually mentioned this to the vet when I took him in for his annual exam, and her interest perked up. After a short exam and discussion, she said that older cats—Mister C just turned 14—often develop overactive thyroid (hyperthyroidism). She explained that cats have two thyroid glands, and sometimes only one is enlarged, as it is in Mister C’s case (likely from a benign tumor called a thyroid adenoma). The increased thyroid hormones, thyroxine (T4) and triiodothyronine (T3), but primarily T4, were ramping up his metabolism so that not only was he eating more, he was losing weight. (Oh, for that problem! My situation is directly opposite—I’m hypothyroid, like many women of a certain age.) In addition, his heart rate was too fast (tachycardia).

So, out came the shaver, a syringe, and an assistant to hold Mister C’s head still while the vet shaved his throat and drew a blood sample. The test results came back quickly (unlike for us humans, as I have described in my recent posts) and showed increased hormone levels and also increased platelets. Because I was away at the time and came home on a holiday, the vet left his medication in a pickup box, and I started Mister C on Felimazole (methimazole) 5 mg tablets twice a day on July 4.

Felimazole 5 mg

It hasn’t always been easy getting the pills down him. They are bright orange and, although they are coated, probably have a bitter taste. After finding pills carefully removed and lying next to his bowl, or licked clean of their orange coating but remaining in his food, I finally found that taking one can of Friskies paté and embedding a pill into each serving (now a third, formerly a half) near the top seemed to work most of the time. His appetite markedly decreased, and he was gaining weight (both a good and a not-so-good thing, I guess).

We returned to the vet last week for a repeat blood test and got the results the next day—decreased thyroid hormone levels and decreased platelets, which is good. And he gained about 3/4 of a pound, which the vet said is good (it just isn’t pretty as the skin sort of dangles in the wind). Plus, he had a regular, normal heart rate.

So now comes the treatment decision. Not treating him isn’t an option as the disease would be fatal, leading to heart and possibly kidney disease. Because his metabolism has adjusted to the medication over the past six weeks, he’s ready for either more pills or surgery if we decide to go that route. (Some sources cite other options, such as radioactive iodine, but our vet didn’t offer anything but meds or surgery. Also, after scanning through the resources listed below, I started to become a little more alarmed and a little more confused, but I offer them here as objective sources of information.)

I asked the vet to explain the risks and benefits of each modality (as well as costs), and this is what she said:

Medication

  • Medication manages the problem, but doesn’t cure it; so he would need pills twice a day for the rest of his life (they cost about $35 per Rx)
  • Repeat blood tests would be needed every six months to monitor the thyroid hormone and platelet levels (the tests cost about $200 a pop)
  • The medication wears off after about 10 hours, and during the interim before the next dose his heart and blood pressure could be stressed, possibly leading to heart disease (probably congestive heart failure) and decreased longevity

Surgery

  • Surgery “cures” the problem, leading to possibly increased longevity; a unilateral thyroidectomy (removal of only one gland) requires a one-night stay and costs about $400; a bilateral procedure (removal of both glands) requires a two-night stay and costs about $600
  • After a bilateral thyroidectomy (if he needs to have both glands removed), he would have to stay the extra night to have his calcium levels checked because the tiny parathyroid glands could be removed accidentally during surgery (100:1 chance); if this happened, he would need to take calcium supplements for the rest of his life to prevent seizures and other problems
  • A repeat blood test would be needed about a month after surgery to check his thyroid hormone levels (another $200); even with both glands removed, cats usually do not need supplemental thyroid medication (unless too much tissue is removed) because some thyroid hormones are produced by other tissues and glands (I will be looking into this a little more)

So, it’s decision time. The vet said that her clients’ decisions are split 50-50. We have that exact split in our household—I favor surgery (despite the costs) to take care of the problem once and for all, and my husband favors continued medication to spare Mister C the trauma of surgery (if it is indeed a trauma—it may not be—and despite the costs, which may in time become equivalent to the surgical costs). The vet herself recommends surgery.

We’re running out of pills, so I need to make a decision pretty quickly.

What would you advise Mister C to do?

RESOURCES

Advanced Veterinary Medical Imaging (AVMI) – Feline Hyperthyroidism

American Society for the Prevention of Cruelty to to Animals (ASPCA) – Hyperthyroidism

CatInfo.org – Feline Hyperthyroidism

Cornell University College of Veterinary Medicine – What is hyperthyroidism?

Feline Hyperthyroid Treatment Center (FHTC) – What is feline hyperthyroidism?

VCA Animal Hospitals

– Hypocalcemia or Low Calcium Levels in Cats

Thyroid Hormone Testing in Cats

Washington State University College of Veterinary Medicine – Hyperthyroidism in the Cat

WebMD – Hyperthyroidism in Cats