Expert: Jessica - 7/13/2010

Question
Thank you Jessica you have helped me a lot not only on my previous question but also every time I read your posted answers to other questions.

Three months ago my 16 years old Orange Tabby was diagnosed with hyperthyroidism. Vet told me about the different options, suggesting that the Iodine Radiotherapy  ( i -1 31 )  was the best one to choose.  Before taking the decision I had to take care of  a family issue out of town then decided to leave Lorenzo with the boarding services at the Vet’s.
A week before I left, the Vet put him on  Felimazol and Norvasc to treat thyroid and high blood pressure.
When I picked the cat up from the vet’s, after 15 days of boarding, on the first day at home he started sneezing , in the beginning I didn’t think it was important but next day it got worst.  His symptoms after being on Felimazol for almost a month and had his hormone levels checked up on blood tests, were : Constant sneezing,  constant water drinking, constipation, many visits to the bathroom to pee  laaarge amounts of urine, low energy, lethargic, his hind legs didn’t hold him up, his front legs worked right, he had all the symptoms that he had before been  treated for hyperthyroidism . Besides that, he was loosing weight like crazy  because he didn’t want to eat the Kd food the Vet. prescribed …and on top of all this,  his breathing had a sound like  a Darth Vader’s voice .…it was hard for me to believe that the day before, I pick him up and according to the Vet’s staff he was doing very well…???
I took him back to the vet, he examines him again and says Lorenzo may have a problem in his trachea he suggests an endoscopy  procedure . After some more blood work and the endoscopy,  the results show that Lorenzo has an inflammation of his trachea with big pus nodules, vet. takes a biopsy and culture that reacts to amoxicillin, so Lorenzo gets 7 days treatment with clavamox . From Blood work  the results show he has a kidney failure. Medication: Lotensin .
Comment from the Vet about Lorenzo’s trachea problem, he says he never has seen something like this , it is not a tumor but might be a chronic inflammation of the tissue around the trachea with a very aggressive bacteria. Lorenzo responds well after 7 days of Amox treatment.  
15 days with lotensin and Lorenzo is still peeing laaarge amounts of urine very often
He seems in distress, he constantly leaks his genitals and it looks reed and irritated.
Vet says that is also a symptom related to high levels of hormones from the thyroid.
I wasn’t familiar with the i-131 treatment then I did some research and all the comments about it were positive, based on that I decided to go for it.  After all the pertinent studies my cat underwent an i-131 procedure.
Last picture of the results. After a month of the i-131: Lorenzo’s Darth Vader breathing noise is back, he still pees laaaaarge amounts of urine very, very often, he is very loud and curls his body in a way that his head will be making pressure against the wall, the back of the couch, my stomach, his bed or even sitting down he rests his head against the wall!!  Does it means that he has headaches ?
He doesn’t want to eat  the Kd formula and was loosing a lot of weight again. I decided to get him the proplan regular  wet food and boil chicken breast for him. What else I can cook for him ?  is there any other medication or supplement I can give to him ?
Please help me ,  the vet wants to do another ultrasound to check up his trachea again and honestly I doesn’t seem that what he is doing has helped Lorenzo so far.
His current medications are: Lotensin and Norvasc and three days ago he just finished 14 days of Clavamox treatment and his heavy breathing didn't get better.

Jessica, Your advice will be very appreciated.
Thank you

Answer
Hello again!

I'm sorry for poor Lorenzo, this is a very strange story.  I'm afraid I don't have any more answers than the vet, and I would have to advise proceeding with the ultrasound.  I would have to wonder if the pus nodules are being fed by something larger.  The endoscopy looked at a small area from the inside, but an ultrasound is a great way to get a look at a bigger picture from the outside in.  So much can be told from an ultrasound, including the shapes, sizes, textures and even colors of the tissues the vets are examining.  An experienced ultrasonographer will be able to gather an amazing amount of detail using specialized probes, with no intrusive procedures.  So you won't be limited to the knowledge of just what's going on in his trachea, but what's going on surrounding it - his heart, his lungs, and even in his abdomen, if necessary.

As for his kidney disease, I would really recommend asking the vet about a supplement called Azodyl to help him rid his system of toxins, which the kidneys are failing to get rid of now.  It works great for lots of cats, to help them feel better.  Another product called Epakitin would also be ideal.  This can help to reduce serum phosphorous levels - enemy #1 for a cat with renal failure.  There are other phosphate binders (the same type of product as Epakitin), such as Alternagel, that your vet may recommend.  But since Lorenzo doesn't like the k/d, it would be good if you could supplement his diet with a phosphate binder to try to get rid of some of the harmful phosphates.  Also, see if your vet carries other brands of renal diets.  There is also Purina NF, and my cats seem to prefer Royal Canin's Renal LP Modified.  Nevertheless, if he won't eat, let him eat a regular diet of canned food.  Keeping him fed is the most important thing, now!

Oh, and that Pet-Tinic I mentioned for Casper - that is ESSENTIAL for cats with renal failure.  Later in kidney disease, cats will have trouble producing red blood cells.  The Pet-Tinic helps them build red blood cells.  Lorenzo probably won't like the taste of it, but it will be good for him to start getting the Pet-Tinic now.  If I mix it with just a dab of turkey baby food, my cats like it just fine.

Best of luck!

Jessica