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May - chf, hcm, crf

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  • r schu
    May has crf. She s been having fainting spells so we went to the e.r. Tues night and tonight got an echo from the only local and traveling cardiologist. We ll
    Message 1 of 15 , Feb 21, 2013
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      May has crf. She's been having fainting spells so we went to the e.r. Tues night and tonight got an echo from the only local and traveling cardiologist.

      We'll learn more at our vet tomorrow. (we were at the e.r./specialty center as it was the only place his schedule would allow for 3 days)

      He said her heart disease is much worse, she has chf/fluid around her heart, hcm is not worse just different or 'rearranged'.

      Stop fluids for 5 days, start lasix and two other meds to be got tomorrow, then retest to see what kidneys look like, if she's better, start fluids. He was doom and gloom about crf with heart issues.

      Fainting spells might or might not be from hcm/chf. Fainting spells might or might not be arrhythmia. The box animals can wear to detect arrhythmia doesn't usually work well with cats.

      Said: He's seen fainting spells thought to be from one thing but really from another (heart vs neurology vs ? (said we'd probably never know)

      Said: "This whole thing could blow up in your face", treating heart could send her into kidney failure.

      Said: Give her 1/4 lasix tonight when I told him I have some.

      The E.R. doc offered clarification. So I confirmed with her that 1/4 meant 1/4 of a 12.5mg. She said if the fainting is arrhythmia it could be caused by the heart disease or vis versa.

      Cardiologist said spirolactilone (sp) was a weak lasix and did the same thing was just as hard on kidneys, you just need more of it. (also read today that it could work synergistically with lasix.)

      Upshot is treating her heart might stop the fainting and we may be able to resume fluids and go forward. Or...CHF will hopefully clear, but kidneys could go, and fainting might or might not stop.

      Miss May ate up a storm when we got home, and is now sitting on the couch, warm in a sleeping bag, getting regular attention. She is not doing so bad, though breathing is a bit fast.

      I"m hoping to learn alot about this from this list, if May will hang in there while I do, to make sure I'm doing the right things.

      I'll post tomorrow once I see the report from tonight and learn about the meds from our local vet.

      Thank you.

      -Lee and Miss May
    • zan200
      Hi Lee, I can t comment on the specifics of May s condition, as I m fairly new to all this too...but I can tell you a bit about my 19 year old Burmese, Chloe.
      Message 2 of 15 , Feb 21, 2013
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        Hi Lee,

        I can't comment on the specifics of May's condition, as I'm fairly new to all this too...but I can tell you a bit about my 19 year old Burmese, Chloe.

        First as background: Chloe has multiple health issues - chronic pancreatitis, stage II kidney disease, stroke in 2008.

        Chloe was diagnosed with severe HCM/3X normal size heart in November. Her chest was filled with fluid, but her heart was so enlarged the fluid couldn't safely be tapped. Ultrasound of heart was so bad, Dr. gave her possibly days to live...She was immediately put on Lasix.

        Chloe did well for about a week, then went into another crisis - resp. rate up, labored breathing, etc. Lasix dose upped, this worked for about another week, then another crisis. My vet consulted with the specialist who did the ultrasound and was immediately prescribed spironolactone and enalapril along with the lasix. Chloe again bounced back.

        A couple of weeks ago, Chloe went into crisis again - Lasix was upped to 12.5 tab 2X per day, 1/2 tab enalapril, and double her previous dose of "spiro". My vet constantly monitors Chloe's kidney values, but feels the heart is the number one concern - Chloe's kidney values went up on Lasix only, but came down with the addition of the spiro and enalapril. The three drugs in combination saved Chloe's life.

        Chloe's been having many ups and downs - she can't tolerate Sub-q fluids as the fluid builds up in her chest instead of being absorbed into the tissues, and her appetite has always been extremely poor so I've been assist feeding Chloe both food and fluids. Unfortunately Chloe's latest x-ray showed some increase in fluid yet again, but as I said, she's still here 3+ months later...

        Don't give up! It may be just a matter of finding the right combination of drugs for May's specific issues...


        Take Care,
        Suzanne and Chloe





        --- In feline-heart@yahoogroups.com, r schu <rschu92@...> wrote:
        >
        > May has crf. She's been having fainting spells so we went to the e.r. Tues night and tonight got an echo from the only local and traveling cardiologist.
        >
        > We'll learn more at our vet tomorrow. (we were at the e.r./specialty center as it was the only place his schedule would allow for 3 days)
        >
        > He said her heart disease is much worse, she has chf/fluid around her heart, hcm is not worse just different or 'rearranged'.
        >
        > Stop fluids for 5 days, start lasix and two other meds to be got tomorrow, then retest to see what kidneys look like, if she's better, start fluids. He was doom and gloom about crf with heart issues.
        >
        > Fainting spells might or might not be from hcm/chf. Fainting spells might or might not be arrhythmia. The box animals can wear to detect arrhythmia doesn't usually work well with cats.
        >
        > Said: He's seen fainting spells thought to be from one thing but really from another (heart vs neurology vs ? (said we'd probably never know)
        >
        > Said: "This whole thing could blow up in your face", treating heart could send her into kidney failure.
        >
        > Said: Give her 1/4 lasix tonight when I told him I have some.
        >
        > The E.R. doc offered clarification. So I confirmed with her that 1/4 meant 1/4 of a 12.5mg. She said if the fainting is arrhythmia it could be caused by the heart disease or vis versa.
        >
        > Cardiologist said spirolactilone (sp) was a weak lasix and did the same thing was just as hard on kidneys, you just need more of it. (also read today that it could work synergistically with lasix.)
        >
        > Upshot is treating her heart might stop the fainting and we may be able to resume fluids and go forward. Or...CHF will hopefully clear, but kidneys could go, and fainting might or might not stop.
        >
        > Miss May ate up a storm when we got home, and is now sitting on the couch, warm in a sleeping bag, getting regular attention. She is not doing so bad, though breathing is a bit fast.
        >
        > I"m hoping to learn alot about this from this list, if May will hang in there while I do, to make sure I'm doing the right things.
        >
        > I'll post tomorrow once I see the report from tonight and learn about the meds from our local vet.
        >
        > Thank you.
        >
        > -Lee and Miss May
        >
      • r schu
        Hi All, I don t have time to search the archives right now about this, but want to post for any info you can send. A friends from the crf list sent me these 3
        Message 3 of 15 , Feb 23, 2013
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          Hi All,

          I don't have time to search the archives right now about this, but want to post for any info you can send.

          A friends from the crf list sent me these 3 links as well as a pdf from drs foster and smith that I can't attach, all consistent claiming pimobendan is good for chf but bad for and dangerous for hcm.

          May has hcm, not sure how bad, it was mild in june, and re-arranged now, see report summary below.

          I started her on it last night. She seems fine. But I'm probably going to not give anymore.

          We have an appt with a real cardiologist Tuesday morning. They say he will work with me and our vet, ongoing, and be available for questions such as these.

          Here are the links in case you'd like to read them as well as the pdf.

          http://vetmedicine.about.com/od/diseasesandconditions/a/CW-HeartDiseasePimobendan.htm
          http://mysite.verizon.net/jachinitz/hcm/treatmnt.html
          http://www.drugs.com/vet/vetmedin-1-25-mg-capsules-can.html

          What are folks' experience with hcm cats and pimobendan?
          Who is using this for hcm without chf?

          Thank you.

          -Lee and May
        • elfinmyst
          Hi Trixi is using it and has for 3 years after her heart attack when a blood clot stuck in the heart artery. She was given no chance to live and has had severe
          Message 4 of 15 , Feb 23, 2013
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            Hi

            Trixi is using it and has for 3 years after her heart attack when a blood
            clot stuck in the heart artery. She was given no chance to live and has had
            severe HCM for years since diagnosis as a kitten. We tried pimobendan
            (vetmedin) as a trial and a last resort and she pulled through.

            ANd has been on it since with atenolol, fortekor, lasix, plavix, CoQ,
            spiro.

            Lyn

            _www.myfurkids.co.uk_ (http://www.myfurkids.co.uk/)

            [Non-text portions of this message have been removed]
          • r schu
            Thank you for this info Lyn, I m glad Trixi is doing well. -Lee and May Re: May - pimobendan and hcm Sat Feb 23, 2013 4:40 pm (PST) . Posted by: elfinmyst Hi
            Message 5 of 15 , Feb 24, 2013
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              Thank you for this info Lyn,

              I'm glad Trixi is doing well.

              -Lee and May

              Re: May - pimobendan and hcm
              Sat Feb 23, 2013 4:40 pm (PST) . Posted by:
              elfinmyst
              Hi

              Trixi is using it and has for 3 years after her heart attack when a blood
              clot stuck in the heart artery. She was given no chance to live and has had
              severe HCM for years since diagnosis as a kitten. We tried pimobendan
              (vetmedin) as a trial and a last resort and she pulled through.

              ANd has been on it since with atenolol, fortekor, lasix, plavix, CoQ,
              spiro.

              Lyn
            • r schu
              May is hanging in there, doing not too badly at all. Cardiologist is happy crea went from 4.9 last week to 4.3 this, bun down too. Lasix qd (3mg) seems to not
              Message 6 of 15 , Mar 7, 2013
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                May is hanging in there, doing not too badly at all.

                Cardiologist is happy crea went from 4.9 last week to 4.3 this, bun down too. Lasix qd (3mg) seems to not be doing major kidney damage. Though her phos was 6 yesterday at retest, the highest it's ever been! So her kidneys are taking a hit here.

                As a result of lowered crea, he's instructed to start benazepril, 1.25mg qd.

                May does not have high bp, has tapered off atenolol, is not on any bp med. Cardiologist is not using it as a bp med. She also does not have proteinurea. Protein in urine was 1+ in Feb and upc totally normal.

                From what I've asked, he says benzazepril should be given with lasix. Says it's to prevent the raas system from being activated: "Treatment of heart failure involves diuretics and angiotensin converting enzyme inhibitors to increase elimination of water via the kidneys. This helps pull fluid out of the tissues into circulation to prevent edema formation."

                Angiotensin converting enzymes constrict intraglomerular blood vessels. So benazepril stops this constricting.

                I'm not sure how we know May's intraglumerular vessels are constricted? But making sure they are not, will help prevent fluid build up. But making them too unconstricted can really do MAJOR damage to the kidneys with too little blood flow. So...

                May currently weights 9.7 lbs, down about a third of a lb since all this. (<4.4kg)

                Only meds were:
                ondans 1mg bid
                ranit 9.3mg mostly bid

                we added:
                plavix 18.75mg qd
                lasix 3mg qd

                now adding:
                benazepril 1.25mg qd

                My questions are:

                Would you use benazepril in this instance?

                Is this a safe dose of benazepril?

                If she seems to be holding her own with the low lasix, reduced sub q (50 down from 100) plus oral water ~20+cc's qd, why rock the applecart and add benazepril? In other words, why think renal bp is too constricted?

                This cardiologist seems like an extremely thoughtful, detailed, and capable dr. So I'm inclined to go by what he says. Though of course he's focused on heart and simply looking at bun and crea is not the whole picture regarding the kidneys.

                Thank you if anyone has any info to share.

                -Lee and May
              • tourtaney
                Hi Lee and May, Sounds like you ve done some research on top of the info from the cardiologist. I m going to tell you what I have learned through this process
                Message 7 of 15 , Mar 7, 2013
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                  Hi Lee and May,

                  Sounds like you've done some research on top of the info from the cardiologist. I'm going to tell you what I have learned through this process in lay-men's terms.

                  The benazepril will limit the amount of fluids the body will produce and the lasix will remove the excess amount of fluids from the body. Using the 2 medications together is a good way to balance the fluids and the levels. If you are treating only with lasix and you have to keep increasing, then you run the risk of reaching deydration faster and that's when you start affecting the kindeys, etc.

                  The way my vet has explained it, in her experience, the longer you can keep your cat stable and balanced the better your chances are of maintaining health. Once you hit a high level of lasix, you start to reach that level of dehydration, that's when cats are more apt to spiral downward and hard to get back on track.

                  So I think your cardiologist is hoping to find that balance by adding the ace-inhibitor to prevent upping the lasix.

                  3mg qd of lasix is a pretty low dose and 1.25mg qd of benazepril sounds like a fairly low/average dose based on weight too. My Maggie weighs 13.4 lbs and can get up to 3.3 mg qd of benazepril but she has been on 2.5 for 3 months.

                  I hope some of this helps.
                  Courtney & maggie
                • r schu
                  Courtney and Maggie, Benazepril will limit the amount of fluid and wastes dumped by the kidneys? And the lasix will pull it to dump? I what you are saying is
                  Message 8 of 15 , Mar 7, 2013
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                    Courtney and Maggie,

                    Benazepril will limit the amount of fluid and wastes dumped by the kidneys? And the lasix will pull it to dump?

                    I what you are saying is accurate and trust that they are good to be used together. I just can't really make sense of it though.

                    Why not just lower the lasix instead of lowering fluid production with benaz then increasing it with lasix?

                    Thank you for this addition to my puzzle!

                    Purrs to Maggie.

                    -Lee and May

                    --- On Thu, 3/7/13, tourtaney <tourtney17@...> wrote:

                    > Hi Lee and May,
                    >
                    > Sounds like you've done some research on top of the info
                    > from the cardiologist.  I'm going to tell you what I
                    > have learned through this process in lay-men's terms.
                    >
                    > The benazepril will limit the amount of fluids the body will produce and the lasix will remove the excess amount of fluids from the body.  Using the 2 medications together is a good way to balance the fluids and the levels.  If you are treating only with lasix and you have to keep increasing, then you run the risk of reaching deydration faster and that's when you start affecting the kindeys, etc.
                    >
                    > The way my vet has explained it, in her experience, the
                    > longer you can keep your cat stable and balanced the better
                    > your chances are of maintaining health.  Once you hit a
                    > high level of lasix, you start to reach that level of
                    > dehydration, that's when cats are more apt to spiral
                    > downward and hard to get back on track.
                    >
                    > So I think your cardiologist is hoping to find that balance
                    > by adding the ace-inhibitor to prevent upping the lasix.
                    >
                    > 3mg qd of lasix is a pretty low dose and 1.25mg qd of
                    > benazepril sounds like a fairly low/average dose based on
                    > weight too.  My Maggie weighs 13.4 lbs and can get up
                    > to 3.3 mg qd of benazepril but she has been on 2.5 for 3
                    > months.
                    >
                    > I hope some of this helps.
                    > Courtney & maggie
                  • tourtaney
                    Lee & May, Again, this is my lay-man interpretation, but here s my understanding of heart failure: Heart disease or an underlying disease that affects the
                    Message 9 of 15 , Mar 7, 2013
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                      Lee & May,

                      Again, this is my lay-man interpretation, but here's my understanding of heart failure:

                      Heart disease or an underlying disease that affects the heart, causes the heart to funtion improperly. When heart is struggling to funtion, the blood builds up. When the blood builds up, the fluids within the blood begin to leak into the chest cavity (plueral effusion) or lungs (plueral edema) or even abdomen (ascites). Lasix is used to remove this excess fluid from the lungs/cavities. The benazepril is used to reduce the amount of fluid the body creates in order to prevent it from 'leaking' and building up.

                      Again, this is strictly my general understanding and my description but when I explain to my vet this is my understanding, she says I have it right.

                      I'm pretty new to this board, so this was the first post I've read about May. Can you share May's diagnosis and experience with me?

                      -Courtney & Maggie

                      --- In feline-heart@yahoogroups.com, "tourtaney" <tourtney17@...> wrote:
                      >
                      > Hi Lee and May,
                      >
                      > Sounds like you've done some research on top of the info from the cardiologist. I'm going to tell you what I have learned through this process in lay-men's terms.
                      >
                      > The benazepril will limit the amount of fluids the body will produce and the lasix will remove the excess amount of fluids from the body. Using the 2 medications together is a good way to balance the fluids and the levels. If you are treating only with lasix and you have to keep increasing, then you run the risk of reaching deydration faster and that's when you start affecting the kindeys, etc.
                      >
                      > The way my vet has explained it, in her experience, the longer you can keep your cat stable and balanced the better your chances are of maintaining health. Once you hit a high level of lasix, you start to reach that level of dehydration, that's when cats are more apt to spiral downward and hard to get back on track.
                      >
                      > So I think your cardiologist is hoping to find that balance by adding the ace-inhibitor to prevent upping the lasix.
                      >
                      > 3mg qd of lasix is a pretty low dose and 1.25mg qd of benazepril sounds like a fairly low/average dose based on weight too. My Maggie weighs 13.4 lbs and can get up to 3.3 mg qd of benazepril but she has been on 2.5 for 3 months.
                      >
                      > I hope some of this helps.
                      > Courtney & maggie
                      >
                    • r schu
                      Courtney and Maggie, I have the same understanding of hcm; left ventricle stops processing as well, due to less elasticity or scar tissue or something, so left
                      Message 10 of 15 , Mar 7, 2013
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                        Courtney and Maggie,

                        I have the same understanding of hcm; left ventricle stops processing as well, due to less elasticity or scar tissue or something, so left atrium, which is the ante chamber to the ventricle (ventricle is the ante chamber for the aorta and circulation to the body) fills up, like a traffic jam, with the excess blood the ventricle can't process.

                        This build up of pooled blood can coagulate and get clots causing stroke/thrombosis.  (I'm no doctor, and barely understand this).  This is why they take plavix, or anti coagulant, to prevent clots forming in this pooled blood.

                        So it makes sense what you say, that the build up can leak into heart or chest cavity or lungs or abdomen.  So lasix removes the built up fluids.

                        Hopefully the amount of lasix meets the amount of fluid build up, preventing it from getting into the heart/lungs/abdomen, yes?

                        You said: "benazepril is used to reduce the amount of fluid the body creates in order to prevent it from 'leaking' and building up."  My guess is that this is done via lowering the kidney bp.  But I don't understand how that reduces the amount of fluid?  Unless lower kidney bp means lower kidney function?? which would be very very bad for May.

                        The body doesn't create fluid, it all comes in via the mouth, or sub q.  So I'm still confused on exactly how this aspect works.

                        If benaz reduces fluids going to the heart and lasix flushes fluid via the kidneys, then how do we know when enough is enough?  Crf cats need fluids to keep up with all the fluids their kidneys are dumping to begin with!  So this sounds like a nightmare for a crf cat.

                        I'm not doubting you or your vet, just not really understanding.  I'd like to understand.

                        As for May's diagnosis: crf 9/09, creatinine 3.1 then and higher threes til last summer when an infection threw it up.  Vet said to double fluids, which possibly, (combined with pred for kidney mass) threw her into chf.  After temp lasix she was fine, echo said mild hcm, and crea came back down to 3.5! in Feb when I took her in for fainting spells, which started this all over again.

                        Once sub q was reduced from 100 daily to 40, crea went up (4.9), but last week down to 4.3 after going to 50cc sub q and 15-20cc oral.

                        Her meds are as stated in my original post. I try to minimize meds. I hate putting drugs into her!

                        So that is her story and where we are. She's 21.

                        Yesterday afternoon she was miserable, seemingly nauseous with standard crf stuff. I gave 5cc oral water and soon after assist fed 14ml food. Heart rate was 168, breathing calm at 27, so ??? is this heart or kidneys? Then...25 minutes later she perks up and eats 20ml on her own! 50 minutes hence I gave her the anti nausea/acid blocker and an hour later she eats again! I didn't give lasix til 830 based on all this other activity.

                        Today, same thing, awful feeling...so I fed her a bit at 6, then gave heart meds, an hour later anti nausea/acid and 45 minutes later she perks up and again eats!

                        This isn't corelated with either the lasix or the anti nausea/acid???? I'm just happy she comes out of these down times and seems her happy self the rest of the day.

                        Sorry this is so long, but at 21, alot of history can build up.

                        Why are you here with Maggie? Does she have heart issues?

                        -Lee and May
                        ================

                        Lee & May,

                        Again, this is my lay-man interpretation, but here's my understanding of heart
                        failure:

                        Heart disease or an underlying disease that affects the heart, causes the heart
                        to funtion improperly. When heart is struggling to funtion, the blood builds
                        up. When the blood builds up, the fluids within the blood begin to leak into
                        the chest cavity (plueral effusion) or lungs (plueral edema) or even abdomen
                        (ascites). Lasix is used to remove this excess fluid from the lungs/cavities.
                        The benazepril is used to reduce the amount of fluid the body creates in order
                        to prevent it from 'leaking' and building up.

                        Again, this is strictly my general understanding and my description but when I
                        explain to my vet this is my understanding, she says I have it right.

                        I'm pretty new to this board, so this was the first post I've read about May.
                        Can you share May's diagnosis and experience with me?

                        -Courtney & Maggie
                      • Karen Plasket
                        Hi, First, I apologize for not trimming the message, but don t think I can in order for this to make any sense. I agree with Courtney in her lay terms...she is
                        Message 11 of 15 , Mar 7, 2013
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                          Hi,
                          First, I apologize for not trimming the message, but don't think I can in order for this to make any sense.
                          I agree with Courtney in her lay terms...she is right. I'm not sure I can add anything to make it easier to understand, but the bottom line is Benazepril is used in chronic renal failure to decrease proteinuria. The degree of proteinuria is a direct prognostic indicator of survival. Benazepril appears to decrease this, and thus, increases survival times and slows the progression of disease. ACE inhibitors selectively dilate the efferent artiole of the glomerulus.
                          Another increase in survival is the change to a renal prescription diet...these diets reduce the amount of protein, phosphorus, and sodium (all detrimental in normal amounts for a cat in renal failure/compromise).
                          Benazepril is also used in heart failure as a vasodilator. Because it decrease blood pressure, studies show that it results in renal vasodilation which causes a decrease in renal filtration pressure and therefore a decrease in renal proteinuria. It also increases renal plasma flow and glomerular filtration rates, which ultimately help compromised kidneys. Some studies show it also increase appetite in cats, which in renal failure can also be a problem.
                          Ultimately, a cat with heart disease and renal failure is in a delicate balancing act...you should be very judicious in giving a heart cat any fluids, as you can easily overload the heart. However, the heart trumps the kidneys...treat the heart first, and try to balance out the needs of the kidneys...it's not easy, and no easy answers.
                          We typically use lasix to remove excess fluid from the heart and lungs...the mechanism of action doesn't really work on abdominal fluid build-up (or any fluid build up in body cavities). I know it may seem counter-productive, but a lot of medications work in synergy (or work better when used together).
                          I hope this helps...let me know if you have any questions...it's late, and by now I am usually brain-tired :-)
                          Finally, 21 is an amazing age for a kitty...you are definitely doing something right!
                          Karen Plasket, DVM

                          -----Original Message-----
                          From: r schu <rschu92@...>
                          To: feline-heart <feline-heart@yahoogroups.com>; tourtaney <tourtney17@...>
                          Sent: Thu, Mar 7, 2013 8:25 pm
                          Subject: [FH] Re: benazepril dangers





                          Courtney and Maggie,

                          I have the same understanding of hcm; left ventricle stops processing as well, due to less elasticity or scar tissue or something, so left atrium, which is the ante chamber to the ventricle (ventricle is the ante chamber for the aorta and circulation to the body) fills up, like a traffic jam, with the excess blood the ventricle can't process.

                          This build up of pooled blood can coagulate and get clots causing stroke/thrombosis. (I'm no doctor, and barely understand this). This is why they take plavix, or anti coagulant, to prevent clots forming in this pooled blood.

                          So it makes sense what you say, that the build up can leak into heart or chest cavity or lungs or abdomen. So lasix removes the built up fluids.

                          Hopefully the amount of lasix meets the amount of fluid build up, preventing it from getting into the heart/lungs/abdomen, yes?

                          You said: "benazepril is used to reduce the amount of fluid the body creates in order to prevent it from 'leaking' and building up." My guess is that this is done via lowering the kidney bp. But I don't understand how that reduces the amount of fluid? Unless lower kidney bp means lower kidney function?? which would be very very bad for May.

                          The body doesn't create fluid, it all comes in via the mouth, or sub q. So I'm still confused on exactly how this aspect works.

                          If benaz reduces fluids going to the heart and lasix flushes fluid via the kidneys, then how do we know when enough is enough? Crf cats need fluids to keep up with all the fluids their kidneys are dumping to begin with! So this sounds like a nightmare for a crf cat.

                          I'm not doubting you or your vet, just not really understanding. I'd like to understand.

                          As for May's diagnosis: crf 9/09, creatinine 3.1 then and higher threes til last summer when an infection threw it up. Vet said to double fluids, which possibly, (combined with pred for kidney mass) threw her into chf. After temp lasix she was fine, echo said mild hcm, and crea came back down to 3.5! in Feb when I took her in for fainting spells, which started this all over again.

                          Once sub q was reduced from 100 daily to 40, crea went up (4.9), but last week down to 4.3 after going to 50cc sub q and 15-20cc oral.

                          Her meds are as stated in my original post. I try to minimize meds. I hate putting drugs into her!

                          So that is her story and where we are. She's 21.

                          Yesterday afternoon she was miserable, seemingly nauseous with standard crf stuff. I gave 5cc oral water and soon after assist fed 14ml food. Heart rate was 168, breathing calm at 27, so ??? is this heart or kidneys? Then...25 minutes later she perks up and eats 20ml on her own! 50 minutes hence I gave her the anti nausea/acid blocker and an hour later she eats again! I didn't give lasix til 830 based on all this other activity.

                          Today, same thing, awful feeling...so I fed her a bit at 6, then gave heart meds, an hour later anti nausea/acid and 45 minutes later she perks up and again eats!

                          This isn't corelated with either the lasix or the anti nausea/acid???? I'm just happy she comes out of these down times and seems her happy self the rest of the day.

                          Sorry this is so long, but at 21, alot of history can build up.

                          Why are you here with Maggie? Does she have heart issues?

                          -Lee and May
                          ================

                          Lee & May,

                          Again, this is my lay-man interpretation, but here's my understanding of heart
                          failure:

                          Heart disease or an underlying disease that affects the heart, causes the heart
                          to funtion improperly. When heart is struggling to funtion, the blood builds
                          up. When the blood builds up, the fluids within the blood begin to leak into
                          the chest cavity (plueral effusion) or lungs (plueral edema) or even abdomen
                          (ascites). Lasix is used to remove this excess fluid from the lungs/cavities.
                          The benazepril is used to reduce the amount of fluid the body creates in order
                          to prevent it from 'leaking' and building up.

                          Again, this is strictly my general understanding and my description but when I
                          explain to my vet this is my understanding, she says I have it right.

                          I'm pretty new to this board, so this was the first post I've read about May.
                          Can you share May's diagnosis and experience with me?

                          -Courtney & Maggie









                          [Non-text portions of this message have been removed]
                        • tourtaney
                          Hi Karen, Thanks for the answer. I read a little bit yesterday about the benefits of benazepril for CRF but I couldn t tackle the answer. I only know a
                          Message 12 of 15 , Mar 8, 2013
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                            Hi Karen,

                            Thanks for the answer. I read a little bit yesterday about the benefits of benazepril for CRF but I couldn't tackle the answer. I only know a little bit about the heart failure. This helps makes sense for both senarios.

                            -Courtney & Maggie
                          • Mary Sue Rubin
                            Hi Karen, Thank you for this explanation. Everything I read helps me get a better understanding of my 18 year old cat s newly diagnosed restrictive-like CM (I
                            Message 13 of 15 , Mar 8, 2013
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                              Hi Karen,



                              Thank you for this explanation. Everything I read helps me get a better
                              understanding of my 18 year old cat's newly diagnosed restrictive-like CM (I
                              think there were some signs that weren't clear cut) and right sided CHF. One
                              thing I might have misunderstood or for which I could benefit from more
                              information is the last half of this statement in your post:



                              "We typically use lasix to remove excess fluid from the heart and
                              lungs...the mechanism of action doesn't really work on abdominal fluid
                              build-up (or any fluid build up in body cavities)."



                              My cat was prescribed Lasix for ascites. She did not have fluid buildup
                              in/around her lungs or heart, however her liver was slightly enlarged and
                              had some nodules, which we aren't addressing at this point. Her abdominal
                              fluid was gone in fewer than 10 days with the Lasix. (She's also taking
                              Vetmedin, benazepril, and aspirin). What am I missing from that statement?



                              Thanks,

                              Mary Sue



                              From: feline-heart@yahoogroups.com [mailto:feline-heart@yahoogroups.com] On
                              Behalf Of Karen Plasket
                              Sent: Thursday, March 07, 2013 11:41 PM
                              To: rschu92@...; feline-heart@yahoogroups.com; tourtney17@...
                              Subject: Re: [FH] Re: benazepril dangers



                              ...We typically use lasix to remove excess fluid from the heart and
                              lungs...the mechanism of action doesn't really work on abdominal fluid
                              build-up (or any fluid build up in body cavities). I know it may seem
                              counter-productive, but a lot of medications work in synergy (or work better
                              when used together).
                              Karen Plasket, DVM

                              -----Original Message-----
                              From: r schu <rschu92@... <mailto:rschu92%40yahoo.com> >
                              To: feline-heart <feline-heart@yahoogroups.com
                              <mailto:feline-heart%40yahoogroups.com> >; tourtaney <tourtney17@...
                              <mailto:tourtney17%40hotmail.com> >
                              Sent: Thu, Mar 7, 2013 8:25 pm
                              Subject: [FH] Re: benazepril dangers






                              [Non-text portions of this message have been removed]
                            • Karen Plasket
                              Hi Mary Sue, You aren t missing anything :-) Some vets will try Lasix...but, traditionally, it doesn t do a lot of good for fluid build-up in body
                              Message 14 of 15 , Mar 8, 2013
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                                Hi Mary Sue,
                                You aren't missing anything :-) Some vets will try Lasix...but, traditionally, it doesn't do a lot of good for fluid build-up in body cavities...the way Lasix works is to remove fluid from tissues. A more accepted method with ascites is to remove the fluid manually (syringe and catheter) which also removes the pressure from abdominal organs. It also depends on the amount of fluid in the abdomen. I'm glad in your case the Lasix worked.
                                Karen Plasket, DVM


                                -----Original Message-----
                                From: Mary Sue Rubin <msrubin@...>
                                To: 'Karen Plasket' <slammerfold@...>; feline-heart <feline-heart@yahoogroups.com>
                                Sent: Fri, Mar 8, 2013 11:37 am
                                Subject: RE: [FH] Re: benazepril dangers



                                Hi Karen,

                                Thank you for this explanation. Everything I read helps me get a better understanding of my 18 year old cat’s newly diagnosed restrictive-like CM (I think there were some signs that weren’t clear cut) and right sided CHF. One thing I might have misunderstood or for which I could benefit from more information is the last half of this statement in your post:

                                “We typically use lasix to remove excess fluid from the heart and lungs...the mechanism of action doesn't really work on abdominal fluid build-up (or any fluid build up in body cavities).”

                                My cat was prescribed Lasix for ascites. She did not have fluid buildup in/around her lungs or heart, however her liver was slightly enlarged and had some nodules, which we aren’t addressing at this point. Her abdominal fluid was gone in fewer than 10 days with the Lasix. (She’s also taking Vetmedin, benazepril, and aspirin). What am I missing from that statement?

                                Thanks,
                                Mary Sue


                                From: feline-heart@yahoogroups.com [mailto:feline-heart@yahoogroups.com] On Behalf Of Karen Plasket
                                Sent: Thursday, March 07, 2013 11:41 PM
                                To: rschu92@...; feline-heart@yahoogroups.com; tourtney17@...
                                Subject: Re: [FH] Re: benazepril dangers




                                …….We typically use lasix to remove excess fluid from the heart and lungs...the mechanism of action doesn't really work on abdominal fluid build-up (or any fluid build up in body cavities). I know it may seem counter-productive, but a lot of medications work in synergy (or work better when used together).
                                Karen Plasket, DVM

                                -----Original Message-----
                                From: r schu <rschu92@...>
                                To: feline-heart <feline-heart@yahoogroups.com>; tourtaney <tourtney17@...>
                                Sent: Thu, Mar 7, 2013 8:25 pm
                                Subject: [FH] Re: benazepril dangers








                                [Non-text portions of this message have been removed]
                              • r schu
                                Thank you Karen, Thank you very much for this information. Our cardiologist is using it for heart, but I realized that slowly over the last year her urine
                                Message 15 of 15 , Mar 8, 2013
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                                  Thank you Karen,

                                  Thank you very much for this information.

                                  Our cardiologist is using it for heart, but I realized that slowly over the last year her urine protein has gone from none to 1+ and now 2+, though upc is low normal.  So if she doesn't have proteinuria now, she may be heading for it, which would add another benefit to benazepril use.

                                  "ACE inhibitors
                                  selectively dilate the efferent artiole of the glomerulus." - yes, this is the tight rope walk, too much dilation is bad, not enough is bad, getting it just right is key, yes?



                                  As for May's diet, she gets renal kibble and mostly homemade food, (not raw), that I've been making for 12 years and altered for crf.  It has taurine, calcium carb, and most of my crf therapy has been nutrition and supplements (fish oil, methycobalamin, mirilax), and fluids. The food is quite watery, like a thick soup. Only meds are ondans and ranitid.  crf diagnosis 9/09.



                                  "Benazepril is also used in heart failure as a vasodilator.  Because
                                  it decrease blood pressure, studies show that it results in renal
                                  vasodilation which causes a decrease in renal filtration pressure and
                                  therefore a decrease in renal proteinuria.
                                  It also increases renal
                                  plasma flow and glomerular filtration rates, which ultimately help
                                  compromised kidneys. "  -----------the crf site that the crf support group uses says ace inhibitors can be dangerous with lasix in kidney cats, per mar vista vet.  But this is the only source saying that.

                                  I know this is a delicate balancing act.  May is my one and only and I am doing everything I can to support her desire to keep living with quality of life.  So far, she is keeping on and happy, except for occasional feeling bad spells in the afternoons that don't seem to correlate with anything.

                                  I am not going to get a better understanding of this because I'm not a vet! and this is complicated.  What you have said is really helpful!   So after much research, and opinions from a friend vet, yourself, and our cardiologist who I really trust, I gave her the first dose last night, a bit lower than 1/4, and will give 1/4 tonight and going forward.  I assume the cardiologist will want more blood from her little old veins in a week or two, to make sure it still looks good.  (potass and phos are mid range)

                                  My only other question is what signs might I see that the benaz is doing harm, other than what one would expect from ailing kidneys; nausea, inappetence, etc?
                                  (I assist feed more than half her calories right now, so would be thrilled to see her appetite go up)

                                  Thank you.

                                  - Lee and Miss May




                                  --- On Thu, 3/7/13, Karen Plasket <slammerfold@...> wrote:

                                  Hi,

                                  First, I apologize for not trimming the message, but don't think I can in order for this to make any sense.

                                  I agree with Courtney in her lay terms...she is right.  I'm not sure I can add anything to make it easier to understand, but the bottom line is Benazepril is used in chronic renal failure to decrease proteinuria.  The degree of proteinuria is a direct prognostic indicator of survival.  Benazepril appears to decrease this, and thus, increases survival times and slows the progression of disease.  ACE inhibitors selectively dilate the efferent artiole of the glomerulus.

                                  Another increase in survival is the change to a renal prescription diet...these diets reduce the amount of protein, phosphorus, and sodium (all detrimental in normal amounts for a cat in renal failure/compromise).

                                  Benazepril is also used in heart failure as a vasodilator.  Because it decrease blood pressure, studies show that it results in renal vasodilation which causes a decrease in renal filtration pressure and therefore a decrease in renal proteinuria.  It also increases renal plasma flow and glomerular filtration rates, which ultimately help compromised kidneys. Some studies show it also increase appetite in cats, which in renal failure can also be a problem.

                                  Ultimately, a cat with heart disease and renal failure is in a delicate balancing act...you should be very judicious in giving a heart cat any fluids, as you can easily overload the heart.  However, the heart trumps the kidneys...treat the heart first, and try to balance out the needs of the kidneys...it's not easy, and no easy answers.

                                  We typically use lasix to remove excess fluid from the heart and lungs...the mechanism of action doesn't really work on abdominal fluid build-up (or any fluid build up in body cavities).  I know it may seem counter-productive, but a lot of medications work in synergy (or work better when used together).

                                  I hope this helps...let me know if you have any questions...it's late, and by now I am usually brain-tired :-)

                                  Finally, 21 is an amazing age for a kitty...you are definitely doing something right!

                                  #yiv1482415575 #yiv1482415575AOLMsgPart_1_72d2bad8-66df-41fc-a14f-5b6dd35c97a6 td{color:black;}Karen Plasket, DVM















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