12/20 Max PMPS 116

Max & Lori

Member Since 2021
Max had a visit to IM at NCSU on this past Monday, 12/18/23 for evaluation of CKD, hypertension, etc. Good news is his blood pressure was good considering the stress of the visit. It was 140. I actually loved the clinic. They have a whole section in internal medicine just for cats with the Feliway going, quiet, no barking dogs, cute room with steps going up a wall for cats to climb, clean litter box in there. I had to mention it, it was so nice. We weren't allowed in the last time we were there because of covid so this was my first time seeing it.
The doctor and the student were great as well. The bad news is his labs were not any better. I was hoping the last labs he had were just an acute thing. The doctor was hoping that as well but that isn't the case. She said he looked really good physically. We were not able to get the ultrasound that day because they had a lot of need in the ER requiring the ultrasound slots. The vet did another urine culture. I asked if a UTI could be missed on a urine culture and show up on an ultrasound. She said that was possible, but in Max's case, she doubted it because his WBCs were normal and cats with pyelonephritis usually had significant WBCs. I still want the ultrasound and she's ordered him to have it anyway to evaluate his kidneys further. I'm waiting on a call for the appointment now. The vet changed his blood pressure meds from amlodipine twice daily and enalapril once daily to Telmisartan once daily. She is shipping that to me from NCSU. I'm not sure what milligrams that is, but I'm kind of anxious about the change because he's coming off a lot of BP meds and changing to only one pill daily. I know its a different med, but it took a really long time to get his BP to an acceptable range. I wouldn't think his kidneys could take much more of that. I just worry though. I'm not giving up on Max, even though it feels like a lot of others have. I posted the lab results on his SS @Wendy&Neko if you have any thoughts to offer.

Previous https://www.felinediabetes.com/FDMB...9-2-158-3-5-76-5-69-6-82.284471/#post-3131645
 
My limited experience with vet school hospital is they are great clinics. Glad to hear NCSU is the same. I know of at least one other acro kitty that went there.

What time of day was the appointment? I see his USG is lower, but it is best if sample is first thing in the day. Also no SDMA listed, so really just going by the creatinine. Did they say anything about him seeming dehydrated or not? I can't say anything about Telmisartan, as it was a new kid on the block when Neko had CKD, and her BP wasn't high. She was around 140 without BP meds. She was on benazapril for her proteinuria. Did the vet say why the switch? Usually there'd be a reason. I have heard of cats on it. The once a day only sounds appealing.
 
Addition: IM vet said she discussed with nephrology and they no longer recommended subq fluids for most CKD cats because it could actually cause a negative effect with the renin angiotensin aldosterone system. I think I understood that she was concerned about fluid volume overload in regards to that. Tanya’s doesn’t say anything about subq fluids not being recommended anymore for most cats. IM vet recommended Purina hydro care which Max does not like. I told her that and she said that if I wanted to give Max sub q fluids, cardiology said it was fine in regards to his heart status right now. I’m kind of confused about all of that now.
 
My limited experience with vet school hospital is they are great clinics. Glad to hear NCSU is the same. I know of at least one other acro kitty that went there.

What time of day was the appointment? I see his USG is lower, but it is best if sample is first thing in the day. Also no SDMA listed, so really just going by the creatinine. Did they say anything about him seeming dehydrated or not? I can't say anything about Telmisartan, as it was a new kid on the block when Neko had CKD, and her BP wasn't high. She was around 140 without BP meds. She was on benazapril for her proteinuria. Did the vet say why the switch? Usually there'd be a reason. I have heard of cats on it. The once a day only sounds appealing.

His appointment was at 10:30 am. There is no SDMA on the results I have. I don’t think it was done. She thought he was pretty well hydrated from her exam. I asked about that as well. She is switching the meds because she said the Telmisartan is the best for proteinuria.
 
That's a change! I wonder if there is a published paper showing that. She says googling and finding the answer. It doesn't talk about fluids but does about amlodipine.

Thanks for that. I had no idea about the amlodipine affecting the RAAS. That explains why she’s probably changing him to the Telmisartan too. I’m going to look and see if I can find anything about the fluids.
 
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