I-131 Referring Vets

Castle Rock Cat Hospital Pre-Treatment Protocols

Starting April 2023, we will be more selective with regard to patients that qualify for treatment. We are finding that on intake, several of our candidates have comorbidities that would likely be best addressed prior to I-131 treatment. We want the I-131 treatment to result in the best possible outcome for all our patients. Since we do not require a prior treatment consult for referred patients, we rely heavily on referring practices/veterinarians to pre-screen for us. Listed below are the required recommendations before we will evaluate for selected I-131 candidates. Our I-131 patients need to be self-sustainable without the need for frequent medical intervention. We will continue to provide any oral medications for any pre-existing issues, however, if during the patient's stay with us, any semi-emergent new medical issues present, we will still provide supportive medical care (anti-nausea/anti-diarrheal medications/ fluid hydration/appetite stimulants/anti-anxiety). Overt emergent medical conditions will need to be transferred to CSU or Powers Pet Emergency and Specialty. We would call the client and have them transfer the patient. 

• CBC
• Full chemistry panel including T4/Free T4 by ED.
• If a patient's thyroid values are within the grey zone (T4 less than 4.0), then a TSH is required to fully evaluate thyroid function (Hyperthyroid patient's TSH will measure <0.03ng/mL).
• Ideally, a complete urinalysis should be performed-but minimally urine specific gravity with UP:UC for any USG <1.035.
• Heart evaluation including Heart rate/Rhythm/Murmur/Blood pressure. We STRONGLY encourage cardiac echos and thoracic radiographs be executed in light of any cardiac abnormalities. We do not have advanced clinical faculty or support staff to take on cardiac emergencies post I-131 treatment.
• Any newly diagnosed cases of hyperthyroidism should be treatment challenged with 30 days of either oral/transdermal dosing of Methimazole/Felimazole OR Y/D (exclusive-no other dietary offers), or a combination of both. Rechecking of blood chemistry and cbc parameters along with T-4 30 days later, provides profound amounts of information regarding the patient's body response (renal, kidney, bone marrow, clinical signs) to reducing the circulating thyroid hormones. Cardiac changes should also be noted.
• Any uncontrolled vomiting/diarrhea should also be addressed prior to I-131 treatment.  Hyperthyroidism is a huge factor in V/D, however, several of these kitties will have concurrent diffuse GI disease, such as IBD:SCL: Chronic Pancreatitis:EPI:B12 deficiencies. Diagnosing and addressing any of these disorders helps improve I-131 treatment success.
• Filled out I-131 Hyperthyroid Patient Referral Form 

We will no longer schedule any cases without reviewing the above-listed information first. Please provide this information via email at CRCHI131@gmail.com with client and patient information, OR provide a copy with the client when referring for I-131 treatment.

If you would like any medical recommendations regarding specific concerns, please do not hesitate to contact us. We can be reached by phone: 303-663-2287 and/or email at CRCHI131@gmail.com

Thank you for your time, consideration, and trust in our care!
-Dr. Audrie Walkup, DVM, COS, MRSO