Does Radioiodine Therapy Cause Hypothyroidism? And Why Can't Clients Take Home Injectable Medications?
photo 2008 Steven Depolo | more info (via: Wylio)
Laura, as she often does, made a couple of good points in the comments section of the recent Vet Blog post on administering long term medications to cats.
I recommended treating a cat's overactive thyroid gland with radioiodine in order to eliminate the need to administer medications. Laura asked:
I was under the impression that treating hyperthyroidism with irradiation (at least in people) always led to hypothyroidism? No? Hypothyroidism, itself needs daily treatment but I assumed that was the better outcome, as compared to hyperthyroidism.
I do not know the statistics for people (they never taught us that species in vet school), but the majority of cats, in my experience, that undergo radioiodine therapy end up with ideal thyroid levels. This means that they require no medications whatsoever. A small but significant number of cats that undergo radioiodine treatment end up under-treated and require a second treatment in order to reach ideal thyroid levels. A very small (I can only remember one individual) proportion of cats is over-treated. These cats do require thyroid supplementation, but Laura was right that if one must choose between the two evils, hypothyroidism generally is better than hyperthyroidism. However, a good outcome is the norm when radioiodine is performed competently.
Laura proceeded to bring up another interesting subject. She wondered why so many drugs are administered at home only by the oral route, rather than via injection.
Or is it our antidrug laws that prohibit giving pet owners IM/SC meds/antibiotics to take home?
Some drugs only are effective when they are given orally. But many others can be given by injection. Most cats and dogs tolerate injections really well. If the client does not balk at the notion, why not send home syringes full of the medicine to be administered at home?
There are many reasons why this practice isn't common. Some injectable medications require very careful handling. Others react with the plastic in syringes. But in the past it was not uncommon for vets to send home injections. This practice is becoming less common for the same reason that swing sets, diving boards, and venetian blinds are becoming less common: frivolous lawsuits.
If I send home an injectable medicine and the client gets drunk, then accidentally injects himself, then pretends to have an adverse reaction to the medication, I can get sued. And I can lose. It's crazy. I hate it. Frivolous lawsuits are ruining America, and especially California. But it's the way things are.
I recently read about a client who sued her vet for (and won from him) many hundreds of thousands of dollars in emotional damages after she was pricked by a needle at the vet's office (the needle was intended for her cat, and from the way the article read it sounded like the client didn't follow instructions and got in the way as the vet attempted to sample a mass). The lesson, according to malpractice insurers: do not allow a client and a needle to be in the same room. That obviously means that sending needles home with clients is a malpractice no-no.
If your pet requires antibiotic therapy, ask your vet whether Convenia would be appropriate. It is an injection (given by veterinary staff, away from clients if we listen to our lawyers) that lasts 7 - 14 days. Otherwise, you can follow the tips in the original article (and its comments section) to smooth the process. And either way, contact your local and federal representatives and tell them you support tort reform.