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Thread: Max test results help

  1. #21
    Join Date
    Jul 2020
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    16

    Default Re: Max test results help

    I received an email on his UP:C which showed some protein loss. They want to start him on telmisartan to help control the loss of protein. I’m off to do research now as I’ve never heard of this. Dr will call me tomorrow to discuss.

  2. #22
    Join Date
    Apr 2009
    Location
    Georgia
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    14,431

    Default Re: Max test results help

    Elizabeth, thanks for all these updates! I’ve really been mulling over Max’s situation and that partially accounts for my delayed reply (along with some darn internet issues...). For the most part, I cannot argue with your new internist’s recommendation to hold off on Cushing’s treatment for now. Given Max’s age and lack of outward symptoms, his comfort and quality of life are paramount. So if he’s not visibly suffering from ill effects that are hampering him in his daily life, I understand why the vet is not rushing you into treatment that requires careful monitoring, frequent vet visits, risks of side effects, and of course not insignificant financial expense.

    My only reservation relates to the proteinuria. Again, I am not a vet, so my thoughts are totally that of a layperson. But over the years, hypertension and/or proteinuria are two specific conditions which we’ve seen triggering Cushing’s treatment in their own right, even in the absence of significant outward symptoms. I believe this is because, if Cushing’s is the cause, these two problems may be difficult to manage if the underlying root cause is not addressed as well. From what you’ve learned from the vet, it’s clear that he’s aware that Max’s proteinuria may be associated with Cushing’s. However, it sounds as though he wants to see whether it can be managed sufficiently without leaping into Cushing’s treatment.

    Again, I cannot argue with that recommendation since he has Max’s full picture in front of him. I’m confident he’s weighing the various considerations as they currently present themselves. But if it turns out that Max’s proteinuria significantly worsens over time, Cushing’s treatment may well be back on the table (which you probably already know).

    In the meantime, I hope the telmisartan will help. I’m afraid I don’t know much about the medication myself, but I do know that we’ve had at least a couple of Cushpups here who have indeed been given it for treatment of proteinuria. So good luck, and do continue to keep us in the loop!

    Marianne

  3. #23
    Join Date
    Jul 2020
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    16

    Default Re: Max test results help

    Thank you, Marianne. I am nervous about the Telmisartan especially since his blood pressure is great with not signs of hypertension...all blood chemistry values are great as well. Here is his response...I didn't have time to attach last night:
    The urinalysis for Maximus returned with mildly elevated urine protein levels. We see this in association with endocrine
    disease like Cushing's or even a "pre Cushing's" state as we discussed for Maximus. Historically we didn't treat this mild of
    a degree of protein loss in the urine, but recently it has been recommended to do so. I would consider starting telmisartan
    (20mg tablet- 1 and 1/2 tablets by mouth once daily) to help reduce the protein loss in the urine. This medication usually
    has minimal side effects and isn't expensive. We do recheck the kidney values one week into therapy to make sure there
    is no increase and that the electrolytes are still normal. Most of the time this degree (very mild) of proteinuria doesn't
    always resolve, but we can keep it from progressing and causing a problem with this medication. In theory, once started,
    this medication would be used indefinitely with adjustments based upon response with regard to urine protein levels
    I am interested to see what the value of the proteinuria is. I do feel like this is the first step to make sure we "control" the loss of protein. He mentioned it may not resolve it, but hopefully keep it from getting worse. I am encouraged by the several mentions of "very mild". Now I remember that he wanted to do the UP:C test and see how his urine was and treat if needed. Very glad he ran that test! So I am guessing like you were saying, what he wants to do is see if the Telmisartin keeps the proteinuria stable. Perhaps if we notice an upward trend then he may decide to begin treatment for Cushings? All great points...thank you!

  4. #24
    Join Date
    Apr 2009
    Location
    Georgia
    Posts
    14,431

    Default Re: Max test results help

    I think your vet is “right on” with this assessment. It does make his plan of action clear, and it does indeed reflect the treatment trends we’ve been seeing. I’m so glad to know that he’ll be monitoring the kidney values and electrolytes after a week’s time. I surely do understand your concern about starting off with the new medication, but it sounds to me as though you’re in excellent hands.

  5. #25
    Join Date
    Jul 2020
    Posts
    16

    Default Re: Max test results help

    I am so appreciative. I hope over time I will be able to contribute more to others. Just having someone who is positive and supportive is so helpful. Reading others' posts, I see how helpful everyone is. Thank you for giving your time to others!
    Will report back soon!

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