Hyperthyroidism and Dental Problems

After putting off regular check-ups for my cats for financial reasons, in December 2009, I took Max, my 16-year-old male tuxedo cat, in for an exam after noticing that he would drool from the right side of his mouth after eating.
I thought that this would simply require the basic dental thing--bring him in the morning, pick him up in the afternoon, pay $350. His initial labwork all looked excellent--except for this thyroid thing. Which probably explains the increasing incidences of loose stools over the past few months. (I thought this was because he was eating a lot of supermarket canned food.)
Doc prescribed the usual Tapazole. Half a pill twice each day. After about a week, Max started pulling his fur out around the anal/genital area. Doc reduced the meds to half a pill once each day. After about a week, the fur-pulling is still happening, but not so much or so often. I don't think this is a reaction to the meds--I think the oral discomfort is preventing normal grooming.
Here's the big problem: The dental problem is making eating increasingly difficult--and I believe it's making grooming difficult, too. It seems that around the time that I noticed Max was having trouble eating is when I noticed his coat started to get really matted, especially on his underside. Doc says that until the hyperthyroidism is controlled with the meds (about 3-4 weeks with the typical dosage), anesthesia for the dental work is too risky. Doc has prescribed liquid pain-killer and liquid antibiotic for the oral situation.
I'm very concerned that Max is not eating enough. So far, he seems to be urinating normally and I think he's making one bowel movement per day (sometimes real loose, sometimes semi-formed). Sometimes it's hard to tell who's doing what when I cannot keep the 2 cats completely separate.
I want to go back to the original dosage of Tapazole to speed things up, because the 3-4 week waiting time until the second lab test is an awfully long time to go with this dental condition. And by the way, the Pill Pockets worked great at first, but I think Max is getting tired of having things shoved in his mouth.
It's heartbreaking to see 2 problems that are, by themselves, readily fixable, together creating a worrisome situation. All because I lost a good-paying job a few years ago and have had to take lesser-paying survival jobs since.
I would appreciate any wisdom you might have. And, more specifically, can the Tapazole pills be ground up and mixed with some tasty liquid that can be administered with a feeding syringe? Would it be helpful to use a feeding syringe to get more food in Max? Would brushing his teeth be helpful? Is there a way to roughly estimate the risk associated with anesthesia beforehand (like using an echocardiogram to check for cardiomyopathy)?

Your questions are more suited to your vet. But I can sympathize with you. I had a thyroid cat that passed away last year and have one now, just diagnosed in December also. He didn't pass due directly to thyroid but was getting very old and his time had come.

Hopefully, someone can help you here. It is so worrisome, I know. that you can get his teeth done asap.

Number one thing you'll want to do here: ask doc TODAY for transdermal Tapazole. It's effective, very easy to use, and completely solves the pilling problem.

Please, do not be in a rush to get the thyroid problem under control with the medication because the medication can have several adverse effects that you want to avoid or at least minimize as much as possible. Go back for a CBC and BUN/creatinine plus a liver enzyme test every week or at least once every two weeks to see how the medication is effecting the kidneys and liver and whether it's causing any anemia. (Very important for many reasons, but especially when preparing for a dental.)

A heart ultrasound would be very helpful. Make sure it's done by a heart specialist. The report will include whether anesthesia is safe. Even better, tell doc you'll want to stay with Max when he has the ultrasound so the specialist can talk to you about the findings right there and you can ask all the questions you need to ask.

Tooth brushing at this point wouldn't be helpful at all and it would just stress Max even more.

Work very closely with doc and try to start with the lowest amount of transdermal dosage that should be effective. Increase the dosage (if necessary) very carefully and do a BUN/creatinine one week after you've started on the increased dosage. Very, very important safety precaution. Then keep a very close eye on kidney function for the next few weeks. If no problems develop, Tapazole can be safe longterm.

One of my cats stopped eating completely when she had a painful dental problem and so the dental we had planned for later became an emergency. It had to be done right away. If you find yourself in the same situation with Max, all the blood work you can do in the meantime and the heart ultrasound will assure that he'll be safe if the dental can't wait. Also, vets take special precautions will kitties his age to make sure they come through the procedure unharmed.

Thank you, farleyv, for your concern and sharing your experiences. Thank you, Violet, for that detailed information. I will get started today.

Tapazole is very bitter--grinding it and mixing it with food might cover the taste, but it might still be too strong. I found that putting the pill in an empty gel cap made administration very easy. Giving more medicine will not speed up the time before testing--it takes a few weeks for consistent blood levels to be achieved and therefore testing has to wait in order for the results to be meaningful. I would suggest talking to the vet about how often you give the medicine--Tapazole has a relatively short half-life and typically should be given twice per day. I'd ask the vet whether giving a quarter pill twice per day would create more steady blood levels than half a pill once per day. The transdermal medication is another option (the dosing schedule should still be twice per day) but make sure you are committed to thoroughly cleaning your kitty's ears between doses.

Thank you for your response, cloud_shade. Just got off the phone with the Doc. She OK'd going back to the original dosage of Tapazole (1/2 pill twice each day). I told her that my gut feeling is that the fur pulling and face pawing is the result of difficulty in grooming caused by the dental problem, rather than a drug reaction. The face pawing and scratching happens almost entirely on the right side--where the drooling occurs during eating and drinking. Max's fur gets really grungy on the right side of his face, so I'm trying to step up my efforts to keep the area clean and combed.
Meanwhile, Doc is trying to get in touch with her dental specialist. And meanwhile, I'm going to try the empty gel-cap method. It's getting harder to get Max to accept having a Pill Pocket shoved in his mouth and swallowing it.

Fivecorners, please read. Very important info.

http://www.veterinarypartner.com/Content.plx?P=A&A=510

I hope you don't mind if I ask why your vet didn't let you try the transdermal form of the medication. (Since it would be so much easier on your kitty- and you.)

I use gel caps for pilling too, it's a wonderful thing.

However not all meds can be given that way. Some pills need to dissolve immediately in the stomach and a gel cap can interfere with that so check with your vet before using the gel caps for the methimazole.

The transdermal method is great, but expensive. And compliance is absolutely essential, to be sure the kitty gets to correct dose each time. It now comes in a little pen, with an applicator tip. No measuring required, just turn the pen until the proper dose comes out, and rub into the ear with the sponge applicator.

I know it is difficult waiting for the dental, I've been there. Feed him a high quality food. Hand feed if he'll accept it. Even pate style canned food can be hand fed. Warm up the food.

What is the pain med your vet has prescribed? That will help with his eating too, feed him about 45 minutes after dosing with the pain med.

Welcome to the forum, and please keep us updated on your beloved Max.

Wow...your situation sounds a lot like mine this past summer when Cotton needed most of his teeth pulled and got his Hyperthyroid diagnosis. You've gotten some great advice here, but as far as the pain meds go, don't be afraid to ask for a different one if you don't see an improvement in a few days. I had to go through several different ones with Cotton because his teeth were in such rough shape and he built up a tolerance to the meds.

As for the Tapazole in the pill pockets, I found giving the pill pocket as a treat with 1 or 2 other types of treats helps with the variety, so they don't get bored with it as quickly (and if he decides not to want his pill pocket, I stick a treat he can't resist to it so that he eats it by default, )

It will take about 3 weeks for the Tapazole to alter Max's thyroid levels, so you'll probably be in an out for blood tests to check his levels a few times before you settle on a dosage. Until then, I found that really smelly canned food was a necessity, and warming it up a tiny bit can relaly help making it smellier and more appetizing.

Good luck. I hope you get Max sorted out as soon as possible.

Thanks again for all of your responses. Here's where we're at with Max:
He is still eating a little bit on his own, mainly between 10PM and 6AM. He struggles to eat as the food gets pushed down in the bowls, so when I'm present, I help him by pushing the food back into a pile so he can take a couple more bites. As of Dec. 31, I began syringe feeding him. I looked everywhere for liquid food (CliniCare, Formula V, etc.) to no avail. So I bought a blender and liquified some canned food. Max will take, at most, 10cc per session. I've been feeding him this way multiple times per day during the holiday weekend to give him a head-start when I go back to work and have to leave him on his own for 9 hours.
Violet, to answer your question, the Doc told me about transdermal Tapazole. She said it was more expensive and took longer to work. Once the dental issue is solved, transdermal might be the way to go for the long-haul.
I've gotten fairly adept at pilling. The Pill Pocket method became increasingly difficult, and my other cat, Sally, showed me why. She gulps down those things, which made me think that shoving a Pill Pocket in a cat's mouth is not the right approach. And the empty gel caps--forget it, nobody carries that in stores. At the pet shops, I get the "Huh?" response, and the health food stores have only big ones, like #0 or #00. I would have to mail-order the #3 or #4 sizes. So, I made a homemade pill-shooter out of an empty 1cc syringe. I cut the tip off the syringe, put a blob of butter in there and stick the 1/2 pill into the butter. I push the plunger and deposit the blob on Max's tongue. I hold his mouth shut while I give him a couple of cc's of chaser water. No more bitten fingers!
For the dental problems, Max is getting Chlorhexiderm 2% as a mouth rinse, clindamycin as an antibiotic and Buprenorphine--that I try to get on his gums for pain reduction. The next lab test is scheduled for Jan 9. But I'm pushing hard to get the dental work scheduled on the first available time slot. I know it takes time to find the optimum dosage of methimazole, but what I'm hoping to see on Jan. 9 is a significant reduction of the hyperthyroidism to reduce the anesthesia risk.
Because of the holiday, the heart specialist hasn't responded yet. It would be great if she tests Max and gives the go-ahead or a proceed-with-caution. But I don't want to drag this thing out if it takes too long to get an appointment.
Ms. Freya, how controlled was Cotton's hyperthyroidism at the time of his dental work?

Fivecorners, empty gel caps.

Check here first for a Vitamin Shoppe store near you
http://www.vitaminshoppe.com/content...ores/index.jsp

If there isn't one, check with your local pharmacies. Normally they all carry empty gel caps, in fact, in different sizes. (Size 0 is the best size for cats. Not too small, not too big.)

You can also get empty gel caps from the Vitamin Shoppe online
http://www.vitaminshoppe.com/store/e...jsp?id=SO-1001

Originally Posted by Fivecorners

Ms. Freya, how controlled was Cotton's hyperthyroidism at the time of his dental work?

Click to expand...

He was probably about a 3-4 weeks into his hyperthyroid treatment when he went for his dental. Cotton's diagnosis was fairly early in the game, so while his levels were high enough to warrant treatment, they weren't astronomical and our vet was more worried about getting Cotton's mouth infection under control before removing the teeth. Since it was the last infection in a running history of dental problems, our vet felt it was more urgent to get the dental problems sorted.

We also got lucky with the Tapazole dosage and didn't really have to play with it after the start-up, so when Cotton's 3-week blood test showed his levels back in the normal range, we went ahead on the teeth.

Looking back on my posting dates, it looks like we got his lab results and then had his dental done in the same week.

After 2-1/2 weeks on methimazole, Max had another blood test. The Doc wanted to speed things up because of the dental problem. She was surprised to see that, with only 1/2 the typical dosage, Max's hyperthyroidism came down to the acceptable range. And no other problems surfaced, like liver or kidney failure. I was very pleased
On Friday, Jan. 8, he went in for the dental work. But after a full oral exam, the Doc found that Max had a large tumor under his tongue, making his tongue stiff and pretty much non-functional. That's what was causing the eating difficulty. She told me that it was inoperable--there was nothing that could be done to even provide some temporary improvement. She recommended the humane thing.
While Max was still groggy from the anesthesia, I held him and took some quiet time to say goodbye. Then with sympathetic hands to comfort him, Max peacefully crossed the Rainbow Bridge.
I'm still stunned. From perfectly OK to the end of the story took only one month. I am just heart-broken.
I want to thank everyone who responded here for your suggestions, encouragement and caring thoughts. I received a crash course in giving medications to a cat, special diets, syringe feeding and the importance of regular wellness exams. I hope I can put that knowledge to good use by helping others who also care a lot for their companion animals.
Peace,
Mike

Oh, Mike, I'm so sorry. So terribly sorry. I'm sitting here with tears in my eyes and I don't know what to say. This is such a shock. Many prayers for comfort and my deepest condolences and sympathies to you.

Oh no!
Oh Mike, I'm so sorry to hear this. You have my deepest condolences.

Oh no, I am so sorry for your loss. How terrible and shocking for you. And yet, it's good that the dental was not put off, and this was found, so your precious Max was saved more suffering.

Thank you for letting us know. We care, very much.

xo

Thank you, Violet, Ms. Freya and Otto for your caring thoughts. After I stop moping around so much, I'll try to find a photo of Max that I can post here.
Peace,
Mike

I'm very sorry for you loss It's hard enough to lose them when you expect it, but so suddenly is always so much more difficult.

As this kitty has crossed the bridge, we are closing this thread. Mike, we encourage you to start a memorial thread in the Crossing the Bridge forum. There you can post his picture.