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Thread: Max test results help

  1. #21
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    Jul 2020
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    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
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    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
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    Jul 2020
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    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
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    Georgia
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    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 weve been seeing. Im so glad to know that hell be monitoring the kidney values and electrolytes after a weeks time. I surely do understand your concern about starting off with the new medication, but it sounds to me as though youre in excellent hands.

  5. #25
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    Jul 2020
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    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!

  6. #26
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    Jul 2020
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    Default Re: Max test results help

    It has been a few months, but I wanted to update everyone on Max. He is holding steady with the telmisartan treatment for proteinuria. After initial work up after starting the medication all bloodwork was fine. He has had not ill effects from the medication. After the 2 month checkup his proteinuria values has not gone up and the remained low. Our internist was pleased and with the fact that Max has not other symptoms of Cushings. We will recheck urine protein to creatinine ratio in January and continue to monitor him closely.

    Merry Christmas & Happy Holidays to everyone!

  7. #27
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    Default Re: Max test results help

    Omigoodness, this is really great news! Im so relieved that Max has responded well to the medication thus far, and well definitely be anxious to read your January update. Since weve only had a few dogs here treated with telmisartan, your experience will really be helpful for us going forward. Thank you *so* much for taking the time to check back in, and truly, please let us know how his labwork turns out next month.

    In the meantime, I hope you guys have a wonderful holiday season, as well!!
    Marianne

  8. #28
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    Jul 2020
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    Default Re: Max test results help

    Hi everyone! Dropping by to update. Max has recently had his UPC recheck and full labs. His internal med dr said he looks great. He’s still responsive to the telmisartan and it is continuing to keep his levels controlled. All bloodwork was great except his ALP went from 700-1100. His dr said this could likely be from Cushings and said we will just watch it. Worries me , but I trust their expertise. He was not overly alarmed as he said many Cush dogs do have higher ALP. He has gained weight since changing his food this time last year. He is showing some hip discomfort and his whopping 89 pounds probably isn’t helping that. So, I’m definitely hoping to help him shed some pounds; which does normally decrease some in the warmer months. He still does not show any Cushings symptoms except on lab work so our specialists still recommend monitoring until he does. He does love food, but it’s not excessive. He only cries for extra food when I’m around and near the food bin. He spends the day with my husband at home and never “asks” him. ����*♀️

    Hope everyone is well!

  9. #29
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    Default Re: Max test results help

    Thanks so much for letting us know how things are going, and Im so pleased to hear how well Max is doing! It really sounds like you guys are staying on the right track, and that is great . Your vet is right that were very used to seeing even much higher ALP readings with Cushpups, so Id encourage you not to worry unduly about that, either.

    I can sure sympathize about his weight gain. Especially when food is being changed, its hard to keep calorie counts consistent. And different foods just seem to be metabolized differently, too. My elderly Lab girl has been having chronic GI issues all winter and weve changed her food several times. Im sorry to say shes gained weight, too, which doesnt help her arthritic legs, either. And now, its really hard to get the weight off since her exercise tolerance is pretty compromised due to her stiffness. Heck, thanks to all my loaves of pandemic banana bread and our short dog walks, *my* own waist has expanded quite a bit, too...<SIGH>

    But back to Max, I think your vets treatment strategy continues to make sense and Im just so glad that things are going well for your sweet boy and for you! Please keep the updates coming, its great to hear from you ;-).

    Marianne

  10. #30
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    Jul 2020
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    Default Re: Max test results help

    Thank you, Marianne! We switched him to Royal Canin HP and he’s done fantastic on it. We too switched due to GI and allergy issues. I fought a “science based” diet for a long time, but it has been very good for him so far. I’m just trying to trust his team and know that they are the experts...while I’ll be there asking lots of questions along the way.

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