My daffodils have finally bloomed. Another Vineyard spring. Like last year. And the year before. Maybe you’ve noticed my column’s absence. We’ve had a bit of a sabbatical, but will be back now with occasional musings from the veterinary world. So I am musing.
This spring is different for me — the first since my mother passed away. Oddly, what I am noticing is not just her absence, but how life continues, how things circle back, how, especially here in our off-season community, we are connected.
A phone call late one afternoon: A young woman I know has found a robin with an injured leg. I don’t have time to do much wildlife rehabilitation any more, but try to help when I can. At least I can assess the damage and whether the bird has a chance for recovery. “Put it in a box and bring it over,” I advise. The phone rings again. A young man. His family’s neutered male cat is having trouble urinating. I explain that urinary obstructions in male cats can become rapidly life-threatening. He knows. In fact, his mother is already en route to the ferry to head to Cape Cod Veterinary Specialists. I ask for her phone number and email. Blocked cats can often be treated on-Island by local veterinarians, but extenuating circumstances suggest it might make sense for this one to go off. I will connect with her, discuss options, and, if needed, email a letter to facilitate travel.
We will circle back to robin and blocked cat later, but first, the story of Penelope, an elderly feline, adopted about a year ago. Initially, Penelope was extremely shy, but, with loving patience, her new owners coaxed her out of her shell. She soon showed her affectionate nature, becoming deeply attached to her humans. And vice versa. Then, this spring, Penny came into my office for lethargy, poor appetite, and significant weight loss. On exam, she was thin and dehydrated, had an elevated heart rate, a heart murmur, and a palpable thyroid nodule — all symptoms consistent with the most common endocrine abnormality in older cats, hyperthyroidism. This disease is caused by a usually benign but hormone-secreting thyroid tumor. The excess hormone raises the metabolic rate, causing a range of signs that can include excessive or reduced appetite, increased thirst, behavioral changes, rapid heartbeat, arrhythmias, and weight loss. Diagnosis is usually straightforward — a blood test to measure thyroid hormone levels.
The recommended treatment to cure hyperthyroidism is an injection of radioiodine (a.k.a. I-131), which destroys the thyroid tumor without damaging any other organs. This is done at a specialty facility with a required two- to four-day hospitalization, until radiation levels drop to a safe level. Then there are precautions that need to be taken for a few weeks after the patient returns home, but once it’s done, it’s done. Cured. Not every owner chooses radioiodine therapy, however. In most cases, we at least begin with a different option — a medication called methimazole, usually given as a pill once or twice daily, which lowers thyroid hormone levels. It is a treatment, not a cure, so pills need to be given every day for the rest of the cat’s life.
Penelope’s thyroid levels were dangerously high, so we started her immediately on oral methimazole to stabilize her while her owners considered I-131 treatment. I have treated hundreds, probably thousands, of cats this way for 40 years. Serious side effects are rare. The most common is vomiting, which often resolves as the cat acclimates. I have seen a handful break out with bad skin rashes, and one that developed a serious hematological abnormality, but most have no problem taking methimazole pills, often for years on end.
Not Penelope. Although her thyroid hormone levels dropped, so did her appetite, and her whole demeanor worsened. She was barely eating, vomiting frequently, and hiding under the bed, miserable. Her owners were distraught. They reduced, then stopped, the methimazole. We discussed referral to a specialist, but I was confident the main issue was hyperthyroidism. “Cats who can’t tolerate oral methimazole can sometimes be treated successfully with transdermal gel,” I suggested. This methimazole gel can be rubbed into the ear and absorbed through the skin. It has to be made at a compounding pharmacy, and can take a week or more to get shipped here. I was worried about the wait. Penelope was rapidly declining.
But it’s the Vineyard. We are connected. I called another client whom I remembered had been using compounded transdermal methimazole for her cat to see if she had any to spare. “I’ve been meaning to call you,” she said. Turns out her sweet 15-year-old cat had recently passed away at home. She would be happy to share the leftover medication with Penelope’s owners.
Circling back, I called the woman with the blocked cat. Did she want a letter for the SSA? I got her email address. I won’t share it here other than to say it included two words: Gone Fishing. I paused and took a deep breath. These were the last two words my father wrote to me. He left them on a pink index card on his pillow in his hospital room when they came to take him for the procedure from which he never returned. I told this story to the woman on the phone. Then she told me she remembers hearing me read a poem, 40 years ago, about my father’s death. I felt like my dad was sending me a message. I felt connected.
The young woman with the robin arrives. She has a friend with her. It turns out he is the same young man who called about the blocked cat, whose mother I just spoke with. Sadly, the robin has a broken leg and is euthanized, but the blocked cat does well. Penelope is responding beautifully to transdermal methimazole, while we decide if she is a good candidate for radioactive iodine. Another Vineyard spring. The daffodils are blooming.