muscle loss and CPK off

[daisyfayis]

Is there anything I can do or further testing regarding this muscle loss. He was a healthy 14 yr old cat that vet thought looked like he was 8yrs old. He had teeth cleaned end of April  2009 and then became constipated and seemed to be losing his appetite. He was then diagnosed with hypertyhroidism. He had been on Wysong uretic dry formula for many years because of urinary problem when he was younger. I know now that this was not the best thing to do long term.Vet thought food might have made him too acidic especially at an age when his body is naturally becoming more acidic and maybe this was causing potassium deficiency. He is now eating  Wellness canned food and probiotic and a little bit of ground turkey thigh. He doesn't eat large amounts at a time but is hungry quite often-every few hours. I'm leaving some dried food out at night.We aren't sure what to do to get cpk back to normal. He also has gingavitus again after recent teeth cleaning. Otherwise he is acting normal. Did throw up yesterday and today too. Any suggestions would be greatly appreciated. I would like to try herbal immune strengthener and /or chinese herb thyroid calmer both from Only Natural Pets website. Thank you so much. Maria

[Aleda M Cheng, D.V.M., C.V.A]

Have your vet give you a prescription for Hyper Jia Bing, which is the Jing Tang Herbal Company's version of Jia Kang Fang.  The web site is: http://www.tcvmherbal.com, or do a search for Dr. Xie's Jing Tang Herbal.

The dose for Hyper Jia Bing is one capsule orally twice daily, or 2 teapills orally twice per day.  The advantage of the capsule version is that the capsule can be opened and mixed with food, or mixed with a liquid such as clam juice and squirted in the mouth by eyedropper or dosing syringe.  The advantage of the teapill is that it is very small and easily disguised by using pill pockets, or just forcing it down.  *Herbal medicine should not replace Methimazole, but should only be used as an adjunct.

25mg of CoQ-10 is a good dose.

I think that the reason that you cannot identify a heat or cool pattern is because your cat has so much fat and muscle loss that heat regulation is impided and that he is cold however, the hyperthyroid disease causes excessive heat.  In your cat heat and cold are artificially balanced.  

I would consider Iodine 131 if your cat has no latent kidney disease.  This can only be determined once your cat has been on the correct dose of Methimazole for 2 weeks or more of diligent monitoring for kidney function.  Additionally, once he is on the correct dose of Methimazole his cachexia should resolve, and CPK will be normal (unless there is another underlying illness that has not as yet been identified).  It may take more than 2 weeks for the muscle atrophy to resolve, however.

Hope that helps!

[Aleda M Cheng, D.V.M., C.V.A]

Hyperthyroid disease is the most common  auto-immune disease in the older cat. The precise etiology is unclear, but current theories include: exposure to goitrogenic substances from the environment, cans, certain types of kitty litter,  among other factors.

The thyroid gland produces hormones that have two primary functions: enhancement of protein synthesis and oxygen utilization. When thyroxine is elevated it over stimulates these  functions causing catabolism of muscle such as cardiac muscle, thus elevating the CPK levels.  Inflammation, tissues and tumor necrosis can also elevate CPK.  Too low a dose of Methimazole could account for under-control of your cat’s hyperthyroid disease and over-catabolism continues, thus elevating CPK.  

Potassium is an electrolyte lost from vomiting, diarrhea, or excessive urination.  While the most common cause of low potassium is chronic renal failure,  low potassium is also associated with hyperthyroid,  however, the etiology is unknown.  

I believe that the protocol that your cat is currently on is a sound one.  He is currently on a good food, potassium supplementation and a Probiotic.  I think that the catabolism will decrease as the dose of Methimazole is increased.  The dose is a bit low at 1.25mg. once per day.  The most valuable Thyroid function tests in the feline are the T4, and free T4 tests.  These tests are used to monitor and correct the dose of Methimazole.  

“Only Natural Pets,”  Herbal Immune Strengthener would be a good supplement for your cat.  Please add an additional 25 to 50mg of Co Q-10 temporarily (for one month or so), which will help with the muscle loss and gingivitis.

“Only Natural Pets,”  Chinese Herb Thyroid Calmer would not hurt, but I believe that the following herbal formula would be better for Hyperthyroid: Jia Kang Fang.

Excellent Chinese herbal formula’s for muscle wasting include: Bu Yang Huan Wu (if your cat is heat seeking-sleeps in the sun, etc), or Bu Qi Zi Yin Tang (if your cat is cool seeking-sleeps in the sink, etc).

A good herbal formula for gingivitis is Bing Peng San.  This is used as a topical gently rubbed into the affected gums twice daily using a kitty finger tooth brush.

Your cat should also be tested for Bartonella disease which can contribute to gingivitis.

Chinese or Western herbal remedies cannot replace Methimazole or Iodine 131 treatment for hyperthyroid!  I have found that the herbal remedies can help to decrease the dose of  Methimazole over time, but it cannot be eliminated.  Iodine 131 treatment is curative.

Please post again if you have additional questions.  Thanks!

[daisyfayis]

Thank you very much for your time and suggestions. I'm following up with my vet regarding Baronella and other T4 tests. Hope you don't mind further questions. If money wasn't an issue would you be suggesting Iodine 131. My only fear is since he has muscle loss the 5 day hospital stay would cause him to deteriorate. I suppose the cpk would have to be normal before he would qualify for procedure. I'm assuming the muscle loss is because of thyroid condition. I think I'm going to start with immune strengthener and CoQ-10. Is it 25mg in addition to CoQ -10 that is already in immune strengthener?  I can't figure out wether he seeks heat or not.

Where would I get Jia Kang Fang? I found Bing Peng San at Holipet. Also, I've been trying PetzLife Oral Care Gel on gums and I'm not sure if it's doing anything. He also hates it. I know there is the vet recommended oral liquid but I am trying to avoid as many chemicals as possible. Thank you again for your concern.