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Dear Doctor or Owner: Thank you for your inquiry about our Regional Feline Radio-Iodine Center. As noted in our other literature, we are licensed to treat hyperthyroid cats with Radio-Iodine (I-131). Over the past fifteen years, this treatment modality has been refined and simplified by numerous clinicians; and it is now the treatment of choice* for this condition. However, a cat with a poor appetite is not a good candidate for radio-iodine treatment. (Please feel free to share this letter with your clients). Currently one dose of radioactive iodine will cure about 95% of the cases. Please note that it is safe, gentle, and cost-effective. Treated cats do not experience radiation sickness of any kind. Post-treatment hypothyroidism, if clinical signs occur [uncommon; ie., 2% or fewer], is easily manageable with oral supplementation. Please Note: the radioactive iodine "promptly" destroys the thyroid tumor (always sparing the normal thyroid tissue and always sparing the parathyroid glands) and then is rapidly excreted primarily in the cat’s urine. Thus the discussions of radiation safety deal primarily with the possible affects of that iodine on the humans handling the cat litter for only the first 3 weeks post-injection. Your cat does not become radioactive! The I-131 injection is not painful! The I-131 treatment to cure Feline hyperthyroidism is as SAFE and as GENTLE as a standard “distemper” vaccination. If you and your client elect I-131 therapy for their cat, the following guidelines apply:
1. a. Radio-Iodine treatment at our Clinic is by appointment only (Monday-Saturday, & sometimes Sunday ). [Please ask the client to transport their cat in a “small” plastic cat carrier (no wood, cardboard, or cloth carriers please). This carrier will be used only for transporting the cat to & from our Clinic. Please remind them to place an absorbent towel in the bottom of the carrier...they can enhance their pet's trip to & from our hospital by lining its carrier floor with "Dry Fur" absorbent pads (pet carrier disposable inserts, a product available at www.dryfur.com )]. If necessary for travel, low doses of oral diazepam may be prescribed; however, please avoid acepromazine.
1. b. Please Note: the full $685 fee may be paid on the day the cat is admitted to our Clinic (cash, check, debit card or credit card); or, pay $255 on admission, then two monthly payments of $255 each (via post-dated checks). This fee includes the I-131 treatment plus hospitalization in our Radiation Safety Thyroid Treatment Ward. (Typically 6-8 days). This fee does not include any laboratory tests nor any other medications nor any other treatments [However, in most cases your local veterinarian will have completed all recommended pre-treatment testing]. We do not have any hidden add-on fees. However, as the vast majority of clients routinely elect to do their own 14 day home quarantine (after release from our hospital...please see "Thyroid Ward Release Instructions"), the above noted $685 fee does not include the rare case where a client requests that we conduct the "14 day home quarantine" at our facility. As, by regulation, such cats would be hospitalized only in our radiation safety ward; and, as they would thus displace an incoming new hyperthyroid patient, the fee for conducting the "14 day home quarantine" at our facility is $55 per day, and is by advance appointment only. (Yes, we prefer that the "home quarantine" actually be done at your home. Our goal is to release your feline friend from our thyroid ward as soon as radiation safety regulations allow).
2. Due to complex issues with the decay rate of the I-131, plus the requirements of the nuclear pharmacy that dispenses the radio-iodine, any appointments that are cancelled within 72 hours of the scheduled date will incur a $245 fee (this fee also applies even if the client reschedules at a later date; in which case then the client will be paying both the $245 fee plus the regular $685 fee). In other words, I-131 is an unstable radionuclide with a short half-life; plus, its preparation and shipping are subject to a myriad of rules and regulations set by the NRC, the DOT, & the ADH (Arkansas Department of Health). All of which contribute to the cost of a product which is destined to be used once on a specific date at a specific time (otherwise the cat receives the wrong dose and/or the Clinic is stuck with an expensive drug that is unsuitable for any other patient).
3. (ii) If the patient hasn't received a rhino/calici immunization in recent memory, then please boost them prior to their visit to our clinic. Thank you.
The following products can also adversely affect the I-131 treatment and should be avoided for the indicated time pre-treatment: a. Topical Lugol’s iodine or tincture of iodine (4 weeks). b. Oral kelp (4 weeks)...yes, I know that cats don’t eat kelp, but....
c. Oral iodine containing cough
medicines and iodine containing vitamin-mineral d. Topical Betadine (1-9 months...let’s use 4 weeks). e. Water-soluble intravenous contrast media (4 weeks). f. ACTH (8 days). g. Atropine or any anticholinergic (8 days ?).
h. Other general categories to
avoid for @ 2-4 weeks pre-treatment: anticoagulants,
4. Due to radiation safety considerations for my staff & myself, it is helpful if you are able to wean thyroid patients off of any other medications by the date of the appointment so that while housed in our Radiation Safety Thyroid Ward, daily care will be limited to feeding, watering, litter box care, plus TLC. [During the first few days post-treatment you may think of the I-131 treated cat as if it is the head of an X-ray machine that is continuously turned on & firing radiation 24 hours a day. Consequently, while the treatment is indeed very safe and gentle on the cat, it behooves my staff & myself, because of our chronic exposure, to minimize the time spent with each patient; plus, our radiation safety is greatly enhanced if we care for the patients “at arms length”].
5. Due to radiation safety requirements for the public (including cat owners), the thyroid patients are not allowed outside visitors until the measured radiation levels are suitable for their release from the Clinic...usually seven days or less (however, some cats will need to stay up to 14 days). [Also, please alert your clients that, due to radiation contamination issues, it is strongly recommended that they not bring cat toys nor bedding nor utensils (as all such items will end up in our 90 day “decay-in-storage” facility; and, thus will not be returned to the owner). HOWEVER, clients are encouraged to bring with their cat a seven day supply of the pet’s favorite food & treats (again note that none of it will be returned to the owner, as any leftovers will also end up in our 90 day “decay-in-storage” facility)].
6. The pre-treatment diagnosis of Feline Hyperthyroidism is up to you, the referring veterinarian; however, we strongly recommend that it be based on values from an outside veterinary lab and not via an in-house kit (ie., “real” numbers will be more helpful than “greater than” numbers when we calculate the dose of radio-iodine). For the patient’s safety, we ask that you fax (or mail) us the results of a complete chemistry panel (with T-4) taken within the last two months prior to I-131 treatment; plus, a copy of the panel done when the original diagnosis was done. (fax: 501-327-4240).
7. If your “hyperthyroid” patient is not losing weight, Dr. Johnny Hoskins recommends confirming the diagnosis via a Free T-4 test. Always have the Free T-4 test run via Equilibrium Dialysis. Always interpret the Free T-4 value in conjunction with the Total T-4. [Antech has an excellent protocol for “borderline” cases. If the Total T-4 is in the “high normal” range; and, if the concurrent Free T-4 (by E.D.) is above normal, then this supports a diagnosis of Feline Hyperthyroidism]. In addition to blood tests, it is recommended that your work-up include chest radiographs (to rule out concurrent non-thyroid diseases). 8. At the time of release from our Clinic, the cat’s owner will be given detailed instructions regarding radiation safety for the following two weeks. (a copy of that info sheet is enclosed). Practically speaking, it primarily involves special handling of the litter box for two weeks. After that the cat is just as safe as normal!. [Please note: these Thyroid Ward Release Instructions contain some detailed radiation safety requirements which are mandated by State regulatory authorities. These radiation safety requirements should be treated as absolute. Their purpose is human safety. I can promise you that as far as the cat is concerned, I-131 treatment is safe, gentle, & benign].
9. At the time of release, we will be recommending to the owner that they have you (the referring veterinarian) do a blood panel (or at least a T-4 and creatinine) three weeks after release from our Clinic. Please fax (or mail) us a copy of that test (fax: 501-327-4240).
10. We also recommend that you monitor T-4 levels again at 3 & 6 months post-treatment. However, if you see hypothyroidism on the blood tests, we recommend that you do not treat this condition unless you see actual clinical signs. (severe lethargy, anorexia, or dermatologic signs…see p. 143 of Feldman & Nelson’s Endocrinology text, 3rd Ed.).
11. Please alert your client that there are similarities but also some significant differences between human and Feline hyperthyroidism. Therefore, if you have any “net surfers” please ensure that they only view the Feline literature.
12. Also, it bears repeating: In spite of all the information on radiation safety, I-131 treatment is indeed safe & gentle for the Feline patient! Treated cats do not experience radiation sickness of any kind!
Sincerely,
P.S. Conway, Arkansas, is just a brief 35 minute drive northwest of Little Rock on Interstate 40.
What does my
Local Veterinarian Need to Know if my Cat needs
Emergency Veterinary Care
during the 14 Day Home Quarantine
(following release from the Radio-Iodine
Radiation Safety Ward)???
*(1) VCNA, Small Animal Practice, September 2001, Behrend & Kemppainen Eds., pp. 977-978. *(2) VCNA, Small Animal Practice, May 1994, Ferguson, Ed., pp.582-584 & 600-603. *(3) Kirk’s Current Veterinary Therapy XII, Small Animal Practice, Bonagura, Ed., pp. 372-377. *(4) Textbook of Veterinary Internal Medicine, Ettinger & Feldman, Eds., 4th Ed., pp. 1466-1483.
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