5/13: Day 4 at CSU; experience w/benazepril and CKD?

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Holly and Pablo

Holly and Pablo

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Yesterday's Condo

So last night, after maintaining a blood sugar in the mid 200s for days, Pablo suddenly spiked a 319 at PM+6. :shock: He was acting sleepier than normal and didn't change positions during the night very much, and then he was at 330 this morning. This is unusual for him because I haven't seen pinks in a while. Dr. Lunn checked his blood sugar after radiation today (6 hours after Lantus) and it was almost 400, so she gave him 2u of R and some food. He was back down to 233 two hours later. She's mentioned that a couple of cats receiving SRT experienced headaches r/t swelling on the 3-4th day of treatment, so she filled a script for Prednisolone for six days. She said I didn't have to give it, but if he still seems "off" tonight, go ahead. So far he seems okay, but I'm watching him like a hawk!

Another bad bit of news: his urine pro/creatinine ratio is 2.5 (normal is less than 1), indicating that he has some kidney insufficiency. She said that a low-protein diet is suggested for kidneys, but that he obviously needs a high-protein diet for his diabetes. She basically said that she would stick with the high protein diet for diabetes now rather than worry about diet for the kidneys. But she wants to start him on the ace inhibitor benazepril (Lotensin) which should decrease the amount of protein the urine. Anyone have experience with this? I don't know the dose yet since she's giving it to me at discharge tomorrow. I did some reading about diet and the quality of protein being more important than the amount in CKD. I am currently feeding Dr. Lisa's raw diet, which she explicitly states it is NOT for CKD.

So here are my questions:
1. Anyone feeding a raw diet that is appropriate for CKD and diabetes?
2. Anyone had a phone consult with Dr. Lisa about diet for CKD, and how much does a phone consult with her cost? (Considering I am spending about $6,000 this week, my wallet isn't exactly overflowing with cash, if you know what I mean.)
3. Anyone have experience with benazepril?

And since I still don't have cool CT pics, I found a picture that is appropriate for the topic of my thread today:
kidney.png


One more day, then I'm SC-bound! I love CSU. It's too bad it's 26 hours away, or else I'd consider them his new primary vet! But at least Dr. Lunn gets the pleasure of me emailing her frequently with questions for the rest of Pablo's life, whether or not she wants it! :lol:
 
http://www.felinecrf.org/treatments.htm#ace_proteinuria

Bear takes Lotensin 2.5 mg once daily. I am no expert on CKD. I believe that the urine protein creatinine ratio should be repeated 2 to 3 times to ensure a valid result. Was anything mentioned about his blood pressure? His BP should be monitored while taking Lotensin. Watch for lethargy, which could be a sign of low blood pressure. You can read the link for other risks and precautions. Bear takes this and another med for hypertension and has had no adverse reaction.

Were his BUN, creatinine, and urine specific gravity out of range? How about his phosphorus? If his phosphorus is high, you may wish to select foods that are lower in phosphorus. Current thinking is that feeding a high quality protein is more important than reducing protein in early stages of CKD. Was his potassium OK?

As I mentioned, I'm a newbie to kidney disease. There are others (e.g. WCF and Meowzi) who are more experienced with it.
 
Linda and Bear Man said:
Was anything mentioned about his blood pressure? His BP should be monitored while taking Lotensin.
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Ah! Thank you for mentioning that because I forgot. His BP was 160 on Monday, so Dr. Lunn was already concerned about it being too high. He could stand for it to be lower, so hopefully this will help. And she did mention monitoring BP, u. pro/cre ratio, kidney values, etc. after starting it.

His BUN is always close the end of the normal range, bu most everything else is normal. I should have mentioned that. ohmygod_smile Duh. Everyone else who has advice to offer but needs all the info first: I have Pablo's lab results in a google spreadsheet which you can view by clicking the link in my signature. :smile: What can I say, I like charts!
 
Ya know....I really wish I wasn't able to answer so many questions (because that means that Boo has the problem).

Dr. Lunn put Boo on Benazepril last year, after the SRT. It's a very, very cheap drug (like, on the $5 list at Walmart). She takes 1/4 pill (equivalent to 1.25 mg) daily. They are tiny, so pill pockets work wonders. You can peek at my ss if you would like to see the numbers. She was at 5.something in June, then dropped all the way down to 1.something and she's now back up to 2.something. For some reason, Dr. Lunn said that many of the acrocats have proteinurea. How do the rest of Pablo's kidney values look?

I think Dr. Lisa charges $125 per hour, and she estimates that a CKD consult will be about 2 hours. I went back and forth on food for Boo. Since she is completely off insulin (and because acros aren't true diabetics), carbs don't matter as much. There is contraversy on the net about whether kidney cats need low protein or high protein. However, both my vet and Dr. Lunn stated that kidney-cats do better with a low protien diet. Therefore, I finally decided to feed Boo a mixture of 1/2 Wellness and 1/2 KD.
 
I just did a phone consult with Dr Lisa. It was 1.5 hours and it cost me $229. I feel your pain with the vet expenses! It's sad when a bill under $1500 doesn't phase you - you're like, oh, that's not so bad! :lol: I'm laughing b/c otherwise I would be crying!

Good luck with your last day tomorrow and drive safely!
 
No advice to offer, just caling in to say watching how you guys are doing and wishing you all the best.
Scritches to Pablo :mrgreen:
 
Hi Holly

I can't open the link in your signature. What is Pablo's urine specific gravity? You could, before starting this, catch another sample and give it to your vet for urinalysis and another UPC, just to confirm. Did Pablo have an abdominal ultrasound as part of the workup?

Benazepril has been shown to extend life in cats with CKD when there is proteinuria [protein in the urine] (not with "regular" CKD that most cats get) meaning that it is appropriate for Pablo in this case. It is generally well-tolerated, but you should recheck a blood chemistry about 10-14 days later. Low blood pressure is listed as a side-effect, but it really seems to do bupkis for the BP so continue to monitor this in the future.

Dr. Lisa probably labeled her diet that way because of the phosphorous content. Personally I'd probably do moderate protein and low phosphorous, if possible, with a cat with CKD. I know the arguments for not altering protein, but I'm not convinced either way. There have been controlled studies showing beneficial effects from lower-protein kidney diets in cats but the diets were also low phos, low sodium, and increased potassium, IIRC so it's not clear what role each factor played.

Glad to hear Pablo is doing well after his treatment! Have a safe journey home.
 
Jess: Try the link again...I think it's fixed now?

Anyway, THANK YOU for everything you do on this board and taking the time to think about Pablo. I'm just a lowly, house-trained vet assistant with a vet/boss who is less-than-ideal. If I didn't work for him, my cats would go elsewhere. Actually, a few of them do. :roll: I say that to explain that he is useless when it comes to dealing with kidney failure or really anything other than giving vaccines and surgery. Between you, Heather, all the other people on the board, AND Dr. Lunn, I feel like I'm getting good answers and help.

Pablo's urine specific gravity last week was 1.023. Previously, it was as low as 1.019.

No abdominal ultrasound was done; we don't even have digital radiographs! Dr. Lunn said it wasn't necessary to do prior to starting SRT, so I didn't do it since I had so much else to do. She did mention the follow-up chem after starting the benazepril, and he'll basically be getting a CBC, Chem, and Urinalysis with UPC every three months for the rest of his life. Dr. Lunn said that since he's already having IGF-1 and GH drawn every three months, we might as well send out the rest too. And I'll be checking BP too, though that isn't routine at our clinic either. We just have an automatic blood pressure machine that is a part of our anesthesia monitoring during sx, so I'll hook him up to that every couple of weeks after starting? Then monthly? I'll talk to Dr. Lunn today I guess. I'll also run another urinalysis and UPC when I get back to SC before starting the ace inhib.

To make my life easier, I might have the benazepril made into those flavor chews that BCP offers (the same company that has the compounded PZI). They offer lots of meds in flavored chew form, so I might get ingredients on those and check prices. I know it's dirt cheap from the pharmacy, but chews are so eeeeaaasy.

I'll do some more research on the diet when I get back home. I really want to stick with raw, and one of those websites above has a book written by a vet that says it has a raw diet for cats with CKD. I really don't have $250 for a phone consult with Dr. Lisa, even though I probably trust her more.

grr_red Why is everything so complicated? Pablo's lucky I love him this much...I take way better care of him than myself! I'll post an update later, though it may be tomorrow or even Sunday before I'm rested and in a place to do it. Thanks again, guys!
 
Be safe on your way home! I'm so glad that everything is over and now, hopefully, things will work quickly.
 
Holly and Pablo said:
I'm just a lowly, house-trained vet assistant
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Oh, don't say things like that. You're striving to learn, and that's more than (let's face it) a lot of vet techs and DVMs do!

We just have an automatic blood pressure machine that is a part of our anesthesia monitoring during sx, so I'll hook him up to that every couple of weeks after starting?
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This machine isn't so accurate with cats and wee dogs, but if it's all you have, go for it. If you can let him sit in a cage and run it a few times (while he's relaxing), that's helpful. You *really* need to look out for hypertension when you have this type of CKD.

I'll also run another urinalysis and UPC when I get back to SC before starting the ace inhib.
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Honestly, given his acromegaly, I'll be the UPC was true, but it's always good to confirm a UPC.

To make my life easier, I might have the benazepril made into those flavor chews that BCP offers (the same company that has the compounded PZI).
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I got my cat's prednisolone from VPA, and we also have a bunch of cats on them for various drugs and they seem to be pretty tasty. (My dog once ate a bunch while I was at work and peed like a racehorse for three days afterwards :roll: ) BCP sent me some samples of their chews and they were received less enthusiastically--they seemed drier or something. VPA also charges less if you have it sent to the clinic. Anyway, I agree, it's far better to spend a little more and not have a fight over giving meds. Earl loved his chewies, even when he didn't want much else to eat.
 
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