3/6 Max’s follow up

Max & Lori

Member Since 2021
This is another update on my sweet boy Max. A lot more happened since last week. Max’s vet wanted to start him on Varenzin to stimulate RBC’s trying to help his anemia, so we tried it for three days and then I stopped it. It had listed some scary side effects but the main side effect was vomiting. Max was already having some inappetence and being very picky with food. He did not have vomiting, but it made his inappetence worse, so I stopped it and he seemed to feel a little better. We then had our follow up appointment at NCSU internal medicine yesterday. I’ve listed what happened there.
1. Max had his labs repeated and a renal ultrasound. I decided not to put him through a biopsy of the spleen as recommended from his last abdominal ultrasound. I didn’t see the point because of his late stage CKD. The renal ultrasound still showed mild pelviectasis of one of his kidneys so the vet finally decided to treat empirically for a kidney infection despite a negative urine culture. It may be too little too late but I am hoping and praying it helps. So Max is on Veraflox for that.

2. I don’t have a copy of his labs yet. They will email them to me, but I was told his creatinine was “slightly better” at 5.8 or something like that. His BUN was still 100. His phosphorus decreased back to 4.4. The vet has switched our phosphorus binder to Naraquin because it contains iron. I don’t know how I feel about that because the aluminum hydroxide worked so well bringing down his phosphorus level. Since he couldn’t tolerate the Varenzin she wanted to try Naraquin for iron and phosphorus binding. I’ve read that maybe Naraquin doesn’t work as well as aluminum hydroxide and it can cause hypercalcemia. We will get his labs rechecked in a week. I am wondering if I can still use aluminum hydroxide too, but just not at the same time? She said there are other anemia treatments. Max is already on B complex. I’m trying to figure out which B-12 to get. I asked the vet and she didn’t think it would help. Which B-12 did you use in addition to the B complex @Marje and Gracie ?

3. Max’s blood pressure was 140 at NCSU. The vet said she was concerned that it was going too low at home since it was only 140 there, so she stopped the Telmisartan. So now he’s on no blood pressure medicine. He also had 2+ protein in his urine so I thought the Telmisartan was for that too, but now he’s on nothing. That concerns me too.

4. Max lost less than a pound of weight. I thought it was more. He really has a lot of muscle wasting appearance to him now and his coat doesn’t look vibrant as it always has. It makes me so sad, but I’m trying to stay strong for my boy right now and I’m trying everything I can to keep him happy. I haven’t given up and I hope nobody else does either. I think that’s all. My mind is in a million places so I’m quite scatter brained. Thought I’d update for those who are still interested in Max and also to see if anyone can answer my questions or give any additional advice. Thanks in advance.

Previous https://felinediabetes.com/FDMB/threads/2-28-max-update.287183/#post-3157397
 
Last edited:
Which B-12 did you use in addition to the B complex @Marje and Gracie ?
I used Vita Cost’s methylcobalamin and the dose is one a day of the 500mcg caps along with the multiB. Here is a great discussion of B vitamins for anemia. Following the advice in that narrative, my cat, Gus, never had an HCT below 29% in almost five years of CKD.

I’m glad his P is down but the only binder I’ve ever used is aluminum hydroxide so I don’t know about the other.

With 2+ protein in his urine, they really need to do a urine protein:creatinine ratio and see if he has proteinuria and, if so what kind, and if it’s renal and after doing the appropriate number of tests at the correct interval, use something like enalapril for the proteinuria.

You’re doing a great job, Lori. CKD is not easy. :bighug::bighug::bighug:
 
I used Vita Cost’s methylcobalamin and the dose is one a day of the 500mcg caps along with the multiB. Here is a great discussion of B vitamins for anemia. Following the advice in that narrative, my cat, Gus, never had an HCT below 29% in almost five years of CKD.

I’m glad his P is down but the only binder I’ve ever used is aluminum hydroxide so I don’t know about the other.

With 2+ protein in his urine, they really need to do a urine protein:creatinine ratio and see if he has proteinuria and, if so what kind, and if it’s renal and after doing the appropriate number of tests at the correct interval, use something like enalapril for the proteinuria.

You’re doing a great job, Lori. CKD is not easy. :bighug::bighug::bighug:

Thank you Marje. I just ordered it for him. I always ask for the UPC to be done but for some reason they didn’t do it last time. Idk why they just don’t go ahead and do it anyway if he has protein in his urine. I don’t know if it’s just me, but sometimes I feel like I’m the one who’s calling the shots and I am not a vet. It’s so stressful and emotionally draining. I sure am thankful for what I can learn here. Thanks again. I will ask about the UPC again. I have the enalapril here that he was on prior to then switching him to the Telmisartan. Honestly I am tempted to give it to him, but I suppose I should ask first.
 
Thank you Marje. I just ordered it for him. I always ask for the UPC to be done but for some reason they didn’t do it last time. Idk why they just don’t go ahead and do it anyway if he has protein in his urine. I don’t know if it’s just me, but sometimes I feel like I’m the one who’s calling the shots and I am not a vet. It’s so stressful and emotionally draining. I sure am thankful for what I can learn here. Thanks again. I will ask about the UPC again. I have the enalapril here that he was on prior to then switching him to the Telmisartan. Honestly I am tempted to give it to him, but I suppose I should ask first.
They won’t usually do UPC if you don’t discuss with the vet because it is expensive and many CGs would be upset at that charge on their bill without the vet mentioning it. And no, I would not give enalapril without the vet approving it. It does control the BP so it must be used under supervision. When they did the BP, did they take at least five readings?
 
They won’t usually do UPC if you don’t discuss with the vet because it is expensive and many CGs would be upset at that charge on their bill without the vet mentioning it. And no, I would not give enalapril without the vet approving it. It does control the BP so it must be used under supervision. When they did the BP, did they take at least five readings?

Yes, they did do five readings of his blood pressure. I’m just going to wait and see what the vet says next week.
 
@Marje and Gracie I emailed the IM vet and she emailed me back about Max’s UPC there in December which was 0.6 so it increased from 0.3 on November 16 to 0.6 on December 18. She answered my question about the enalapril. I understand her rationale but I’m anxious about things getting worse. It is really hard not to be.

upload_2024-3-6_15-53-2.png
 

Attachments

  • upload_2024-3-6_15-53-2.png
    upload_2024-3-6_15-53-2.png
    112.1 KB · Views: 275
(((( @Max & Lori ))))) I know this wasn't the report you wanted to see, but it does seem like the internal medicine specialist has a plan. I'm sorry the Varenzin wasn't working for Max, all these drugs have side effects it seems. :nailbiting: I remember reading about a drug like Varenzin-CA1 back when my Tiger was diagnosed with CKD but it was not available, only Epogen and that too, had scary side effects and it was very,very expensive. You are doing a phenomenal job managing this, I continue to send my strongest vines for strength and calming for you and Max, prayers too, if that is okay. I have heard many people say that with feline diabetes, the caregiver has to be proactive as the vets don't learn too much in school, other than how to push their prescription foods. It sounds like your IM and vet are on the ball. Max is blessed to have you and your team. Will wait to see the labs and please keep us updated. You are a super hero!! :bighug::bighug::bighug::bighug::bighug::bighug::bighug:
 
@Marje and Gracie I emailed the IM vet and she emailed me back about Max’s UPC there in December which was 0.6 so it increased from 0.3 on November 16 to 0.6 on December 18. She answered my question about the enalapril. I understand her rationale but I’m anxious about things getting worse. It is really hard not to be.

View attachment 69410
The thing is, there is a testing protocol for proteinuria that she should do. At 0.6, he might not have proteinuria but she needs to do the correct testing. It’s detailed in the info I linked. I’d read up on it and then you have a basis to push a bit.
 
The thing is, there is a testing protocol for proteinuria that she should do. At 0.6, he might not have proteinuria but she needs to do the correct testing. It’s detailed in the info I linked. I’d read up on it and then you have a basis to push a bit.

Yes, I read it. Thanks for that. I’m on it for sure.
 
Back
Top