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Re: [FH] Re: benazepril dangers

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  • 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 1 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








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    • 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 2 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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