12 hours ago
Tuesday, November 10, 2009
I am probably the absolute queen of procrastination. At the moment, there are at minimum five other things I should be doing that are more important but I am, instead, posting on this blog. When I'm finished here and before I start the other things I'll probably draw some "Maybes" and by that time it'll just be too late to start so I might as well just go to bed, right? See what I mean. I'm quite good and that is just a sample of an easy scenario.
Today, I diagnosed my 17 year old cat with hyperthyroidism. Veterinarian's pets tend to be like cobbler's children in that we really procrastinate doing diagnostics and treatments for as long as we possibly can and for various and sundry reasons... To tell the truth, I didn't diagnose her today, I only confirmed with rock-solid bloodwork results what I already knew. I mean, how many other diseases would explain an old cat who is not overweight and suddenly exhibits the atypical (for her) behavior of trying to eat food literally out of my mouth? I've noticed this change for at least 6 weeks (probably more) and have been putting off pulling blood and making the confirmation then having to make decisions about treatment. For whatever reason today I brought blood tubes and syringes home at lunch, took her to the bathroom, sat in the floor, and pulled a blood sample. I didn't want to take her in because I was afraid it would stress her out too much. And, no, I didn't have help. I just have an extra hand that no one can see and I only use it when no one else is around;)
It's funny the things you retain well from vet school. I always struggle with endocrine test results. Do I do a free T4 with dogs or cats or when??? Suddenly, today, it made sense. With me, it usually takes either someone saying something in just the right way or my own little mind with its one puny brain cell thinking of it in such a way that it clicks. Duh! You can have euthyroid sick syndrome that causes a low total T4 without true hypothyroidism therefore a dog with a low total T4 would require a free T4 test to confirm hypothyroidism. With that fact, it then logically follows that if euthyroid sick syndrome causes decreases of total T4 but there is nothing that will falsely elevate total T4, then if a cat has a high total T4 you don't have to perform a free T4. The only time to perform a free T4 in a cat would be if total were high normal with suspicious clinical signs because it could be falsely decreased and appear normal. Finally! Check! Got it.
So, my cat has an elevated total T4 with a very mild elevation of her BUN and normal creatinine. We always worry about renal and cardiovascular function in hyperthyroid cats. I have to check her urine specific gravity because I was trying to play ostrich and hoped I would be wrong therefore did not obtain urine. Likely, I'll not have an echocardiogram done either just because of the procrastination issues... Why am I unhappy? After all, hyperthyroidism is usually fairly easy to treat. The problem is that I can't afford I131 (radioactive iodine) therapy which is the best, definitive treatment killing all the abnormal thyroid cells but leaving the normal, functioning cells. Additionally, I need to know that her kidneys will work okay once the thyroid hormone levels go back to normal before I can make that decision. What does this mean? It means that the queen of procrastination is going to have to give her cobbler's child medication twice a day, every day. Know how likely that is to happen??? Yep, you guessed it--not very! I'm gonna have to work hard to get this done. One more thing to add to my lovely to do list that just keeps getting longer. I am very proud to note, however, that she received her first dose tonight! (Wow, this should be recorded in the annals of history somewhere.)
On a different note and in closing for now, I have cajoled, begged, and threatened Can'tSpell to try to get her to post. I even asked if she was just bored with the blog. Her excuse is that she's been either too busy to post or too bummed out by bad cases. I've been trying to come up with a good enough threat to get her behind in gear and the best I've come up with that would work from long distance is to tell her that I'm going to stop sharing my "Maybes" with her. The next step, I figure, will be to tell her I'll stop sharing them with anyone and then all of y'all (yes, I said all of y'all, I am from the south you know!) that get them can yell at her too. Not sure if it will work, but I am trying!