Kitty Goes For I-131 Treatment In Madrid, Spain
The city is abuzz with life.
There are street vendors lined up along the road, their various trinkets on a blanket with a rope attached in case the police come and they need to make a quick escape. A team of folks are offering neck massages on the pavement, while several anothers are selling some kind of blinking, whizzing light thingie that they’re throwing up in the air for attention.
Some rap music just started up in the background and a group of fine young men are break-dancing in the plaza and (whoo whee) stripping with a huge crowd cheering them on. A group of about 40 young children walk by with a few adults to herd them on, likely a school outing of some sort. Lovers hold hands, families are out enjoying the fresh air and old folk are taking a slow stroll around.
It’s an atmosphere ripe with sound and hustle and in any other big city it would be perfectly normal….
Except this is Madrid, it’s midnight and the party is just getting started. Plus I’m wondering around solo and I’m ~750km from home.
Why in the world am I here????
The Cat Made Me Do it….
It all started a few weeks ago when Rand was diagnosed with hyperthyroidism.
We caught the disease early this time since we went through it with Taggart in 2016. So, I knew what to look for and recognized the signs (losing weight rapidly despite eating a ton, acting hyper and restless, howling at night etc.) very soon after they started.
A quick T4 test at our local vet confirmed the diagnosis. Her levels were well above the limit & she needed to be treated immediately.
I started the meds that same night, but I knew right away what I wanted to do. Rand was going to get I-131, I was going to get it done as soon as I could and I was literally willing to go anywhere to get it done right…
What Is Hyperthyroidism In Cats?
For the benefit of those who don’t recall the details of Taggart’s story from 2016, let me just backtrack a bit and recap. Feline hyperthyroidism is the result of a tumor (in most cases, benign) that grows on the thyroid gland. This causes an excess of thyroid hormone to be produced by the body which, if left unchecked, causes all kinds of serious issues from rapid weight loss to high blood pressure, heart disease, organ complications and (eventually) death. For the cat to survive he/she MUST be treated.
Now you can control the disease with a rather horrible medication (Methimazole), but that only keeps the T4 levels in check. It doesn’t stop the slow growth of the tumor or cure the disease. So, not only do you have the constant side-effects of the meds (vomiting, nausea, loss of appetite are all common, with more serious issues such as skin, clotting and liver problems also possible), but you have to keep testing the cat, and over time you’ll need to increase the dose you’re giving to keep up with increasing T4 levels.
You can also surgically remove the thyroid, but it’s a very fiddly operation. So there’s a risk that not all of the tumor is removed and the disease returns later on. Plus if both thyroid nodes are removed, kitty need to be on thyroid meds for the remainder of his/her life. It’s the least expensive “cure”, but it’s not always optimal.
However the good news is that there IS a rather easy cure with a VERY high (>96%) success rate!
Radioactive I-131 is the “golden standard” for treatment (in humans as well as cats, by the way) and the idea is super simple. You inject a specific dose of the radioactive isotope, Iodine-131 into the body which concentrates in the thyroid and emits beta-radiation, killing all abnormal (hyper-functioning) cells. Once the tumor has died, the healthy thyroid hopefully kicks in again, and things go back to normal.
There is a small (~3%) risk that your cat goes hypO thyroid (= thyroid goes too low) after treatment, which will then require life-long thyroid supplement. Plus your cats pee & poo will be radioactive for some time after treatment (so there are some specific steps you have to take to protect yourself while handling the litter), but IMO both of those are well worth it to cure this horrible disease.
Taggart went through the treatment in 2016, was 100% cured and has been perfectly healthy ever since. It was expensive ($2,600 at the time), but has literally saved us thousands in vet bills since. Plus the stress relief of no longer having to pill her 2x per day (and the side-effects of those meds) are all gone.
Rand was definitely going to get the same treatment and she was going to get it as soon as possible.
We Knew THE PLACE For Treatment In The USA
The hard job in all this was finding the right clinic to do the treatment in Europe.
Back in 2016 I did an exhaustive search of clinics in the USA, calling and researching over 25 places across the country. In the end I narrowed it down to the absolute best two in the country, Advanced Veterinary Medical Imaging in LA and Animal Endochrine Clinic (Hypurrcat) in New York City. We were headed East that year, so we chose Hypurrcat and it became one of the best vet experiences we ever had! Not only did it introduce us to New York City (a fab adventure that I recommend to every RVer), but the clinic & treatment were superb.
Dr Peterson is one of the leading researchers of I-131 and hyperthyroidism in the world, and conducts a very tailored treatment plan that includes a pre-treatment thyroid scan (thyroid scintigraphy), and the use of super small (often only 1-2mCi), specifically calculated I-131 doses that are highly individualized to each cat*. Plus he offers top-notch kitty accommodations with spacious 2-level kitty condos and 24-hour web cams.
The net result is a treatment that’s low-stress on the cat, with high success rate and very low risk of kitty going hypO after treatment. Taggart received a minuscule I-131 dose of 1.85mCi and was back to her “old self” within days of her short 4-night stay at Hypurrcat. It was amazing!
However when I asked Dr Peterson back in 2016, he said he hadn’t shared his specific methods with anyone else. So what in the world was I going to do with Rand here in Europe??????
*Note/ In comparison most clinics in the USA don’t do a thyroid scan, and even those that do just use a “standard” ~4 mCi dose of I-131, with maybe a smidgen of variation for tumor size.
European I-131 Clinics -> Standard Dosing & 2 WEEK Stays???
I had to admit that the first places I researched on this side of the pond were not very promising.
I-131 treatment for cats isn’t as common in Europe as it is in USA, so there are simply not many places that offer it. Plus the ones that do generally all do some kind of “standard dosing” and (worst of all) require that cats stay confined at the clinic for up to 2 WEEKS before they release them back to you. Noooo!
I called several clinics in Europe with a similar result each time. There is only one clinic in France (Oncovet), one in Austria (Veterinärmedizinische Universität), one in Holland (Lingehoeve), one in Belgium (Veterinary University Of Ghent) and several in the UK. They all offer the treatment, but only a few do thyroid scans, most use a standard dose of ~4mCi and all want to keep the cats 1-3 weeks for observation.
The most promising of the lot seemed to be the Hyperthyroid Cat Center in Weatherby, UK. Their website was impressive and when I talked to their head vet Dr Bodey, I was impressed. They don’t do a thyroid scan, but they do tailor the I-131 doses (although they wouldn’t divulge exact numbers to me), cat accommodations are lovely, and they release cats as quickly as 5 days after treatment (although they did mention the stay can be longer if radiation levels haven’t dropped enough). It was going to cost £2,200, not to mention the hotels & drive back/forth to UK but it was the best option I’d found so far.
Still I wasn’t completely sold…..
But Then I Find THE PLACE!!!!
As a last ditch effort I decided to e-mail Hypurrcat in NY and ask them if they knew anyone they would specifically recommend in Europe. I mean maybe, just maybe there was a place I’d missed in my own research, and if there wasn’t maybe I’d fly back to the USA with Rand?
A day after I sent my e-mail I got the response.
Absolutely YES , there was a place they’d recommend. Iodocat in Madrid was a top-notch clinic and the head vet Dr Pilar Xifra had trained personally under Dr Peterson and was using his exact methods in Europe.
Whaaaaaaaaat?? Could it really be?
I looked up Iodocat right away, called and e-mailed them and within hours I had made my decision. Not only was Dr Pilar Xifra using the exact same treatment methods as Dr Peterson (thyroid scans and specifically-tailored, super low I-131 dosing), but she also had the exact same super-plush set-up (kitty condos and webcam!) as well as the same deliberate care and monitoring of the cats. Plus Rand would be able to go home after only 4 nights, and even less if the radiation levels dropped faster. As an added bonus she happened to have an opening for treatment in less than 2 weeks time. Oh and total cost for the treatment? EUR 1650, totally reasonable for what it is.
This was BEYOND my hopes and expectations!
I booked Rand in right away and e-mailed Dr Pilar to let her know I was super excited to have found her. I hadn’t even met the lady but I was already a huge fan, and I knew we’d found the right place and the right vet. Also Paul would need to stay in France with the dog (she had just had her TPLO surgery) so it’s was going to be a solo expedition, but that was fine with me. Madrid, here I come…..
The Long 8 Hours Drive To Madrid
I can’t say that I enjoy driving 8 hours anywhere. When we RV’d in the USA we rarely ever drove more than 3 hours at a time, and even then we’d want to rest for a few days before moving on again. 8 hours is a loooing drive, especially solo and especially with a cat.
Thankfully Rand is a well-traveled nomadic feline. Of course we both traveled with our Passports (she just received her Pet Passport a few weeks ago, the details of which I’ll write about some other time) and the car was loaded up with her food, litterbox and litter. I also bought along all my usual cat calming supplements (those ZEN Licks came in handy, once again), but other than a bit of fuss at the beginning of the drive, she handled it all with ease. Plus it was good weather and surprisingly pretty (Basque country is BEAUTIFUL I tell you).
I listened to a half dozen podcasts, stopped several places to top up on fuel and coffee, rested a wee bit for lunch and got into Madrid by late afternoon. We checked into our pet-friendly hotel (Hotel NH Leganes, only 10 mins from the clinic), I set up kitty with her litter and food in the room, and then I treated myself to a VERY generous helping of wine.
I was totally exhausted, but we’d made it and now treatment was only a night away.
Admission Day At Iodocat
The day of admission I was a nervous wreak, as I usually am whenever our paws go through any medical stuff. But as soon as entered the clinic I knew everything was going to be OK.
The staff were all amazingly welcoming and Dr Pilar herself was just as lovely as I imagined. She greeted me with a friendly Spanish beso (a kiss on each cheek) and exuded a competence and calm which immediately put me at ease. Once inside the examination room, she explained everything she was going to do in detail and answered all my nervous kitty questions with patience and care. Rand was handled with loving tenderness by everyone, they took detailed notes of her likes & dislikes, and they told me they would report back regularly during treatment.
By the time I left I was feeling pretty darn good. It was going to be a few tough nights (mostly for me), but I knew without a doubt that I’d found the right place.
Thyroid Scan & I-131 Treatment
Rand received her scan and first dose of I-131 later that morning.
The thyroid scan is used to verify the hyperthyroid diagnosis, measure the specific size and characteristics of the tumor and ensure that it has not metastasized beyond the thyroid (= an indication of cancer). Rands scan showed she had moderate-sized tumor with enlargement of both thyroid nodes (although the left one was larger) and no indication of metastasis. So far so good!
Dr Pilar then used that information, together with T4, T3 test results and a bunch of other details to calculate a specific I-131 dose and perform the initial I-131 injection. Rand was then placed back into her luxury 2-level kitty condo and monitored overnight for updake (= how much I-131 is absorbed versus eliminated in the pee). She showed great absorption (51%), so she only needed a teeny extra dose of I-131 the next day to complete the treatment. All in all, she received 1.64 mCi of I-131, a dose so small that Dr Pilar told me she could probably come home a day early.
Treatment was done!!
Rand Spends Only 3 Nights At The Clinic!
Over the next few days Rand was monitored closely on water & food intake, poo/pee elimination and radiation levels.
Dr Pilar spoke to me personally several times, and the staff called or e-mailed me everyday with general updates on how Rand was feeling and doing. Everyone was super responsive and their attention to detail went above and beyond. For example when I dropped Rand off, I told them I was worried about eating (she doesn’t tend to eat when she’s scared or without me), so the very next morning I got a video from the staff showing her munching down on breakfast. How cool is that????!
Rand’s kitty accommodations were top-notch too. She was in a spacious 2-level kitty condo with a kitty bed area on the bottom, a shelf and box on the top (nice for shy cats to hide in) and a separate litter area. Plus it was SOOOOO nice to be able to see her anytime I liked on the Kitty Cam. I had the app “live” on my phone the whole time she was being treated, and seeing how relaxed she was online was super comforting. It gave me the support I needed to go out and explore Madrid (and actually enjoy myself a bit) while she was in the clinic.
A mere three days later they called me to let me know she could go home early. Yipeeeeeee! I picked her up that morning, thanked Dr Pilar and her staff profusely and then made the long (but happy) drive home.
Home Care & What’s Next
Just like last time with Taggart’s treatment, I knew there would be precautions to take with Rand once we got home.
After your cat undergoes radioactive I-131, the cat pee & poop remains “hot” for some time, so for 2 weeks following treatment you have to scoop carefully and store that litter for discarding later. In the RV this was a bit of a hassle, but in a regular house it’s a breeze. We’ve not had any issues with this at all.
The next step is then post-treatment bloodwork to see if the thyroid levels have normalized. She goes in for her first post-treatment blood test at 1 month, then subsequent blood tests at 3 and 6 months. We should know within the first test if the treatment worked, but in some cats it does take a little longer.
That’s really it!
Overall I could not have asked for a better I-131 treatment place or experience! Dr Pilar Xifra and her staff are amazing, so if you’re in Europe and looking for a top-notch clinic to treat your cat for hyperthyroidism then this is absolutely the place I would recommend (and no, I’ve not been compensated or discounted in any way to say this. I’m simply sharing the best as I see it!). We truly had a wonderful experience and give it 2 thumbs and 4 paws up all round.
So there you go. A successful kitty voyage, a fab treatment and a very happy kitty mom.
So what about those 3 nights in Madrid? What was it like and what did I get up to wondering those streets at night? That little story coming next….