Laz has reached the end of the road

[MarkB]

AKA Istin.

Laz is on 1/4 a day but seems spaced out quite a lot of the time. He had his BP checked on Friday and it is 170. The vet said he would ideally like the BP lower, but doesn't want to increase the dose as he is becoming quite wobbly.

I don't know much about BP meds. I know it is a calcium channel blocker.

[Crewella]

Sorry Mark, no experience - I can only offer the lovely Laz a gentle fuss. I was wondering how he was doing. xx

[MarkB]

Thanks Helen,

He seems better than he was, but he isn't the same old Laz any more. We also tested his urine again. The vet said there is still a tiny amount of blood in it, but not enough to justify ABs. He prescribed some and said to start a course if he starts peeing around the house again. He wants to retest BP in 6 weeks. He has more or less said Laz is an elderly cat with lots of health issues and it is a case of juggling. He said on the bright side, he is a good weight (he has gained 600g over 4 months) and generally in good condition - especially given his various health issues.

Apparently Laz is a model cat for having BP tested. The nurses have commented on how unstressed he is and that it is unusual to find a cat that will sit still for 5 minutes while the machine takes 5 readings - The vet said with some cats, he only has to look at them to make their BP shoot up and it is pointless doing measurements.

[sarie]

Hey Mark, I guess he possibly is already but is he on a low sodium diet to help his BP?

My cat Harvey is taking Semintra, an ARB (Angiotensin II Receptor Blocker) to reduce his blood pressure due to a heart problem he was diagnosed with just over a week ago. He's also taking diuretics due to heart failure to keep fluid off his lungs.
He was really dizzy for a few days with the Semintra but his BP seems to have stabilised now and he's back to his old self, albeit a little more sleepy than usual. He's only 5 years old though and has no other health issues; not that he needs any more given how serious his heart condition is.

I'm in the processing of cutting his sodium intake back to below 0.4% DMA too - his dry food is about there but I need to find a wet food with a similarly low content. The vet and I have agreed not to go too low on sodium with Harv but reducing to below 0.4% will definitely help him without taking too much sodium out of his diet.

If only Harv was so good for having his BP tested.. he freaks out so they haven't bothered with him as (like you say) it's a bit pointless. Laz sounds like the model patient Give him some fusses from me too

[Crewella]

Laz is a lucky boy to have found someone to take such good care of him. I'm glad his general health is OK, and hopefully, over time, you can gradually find the right levels to make him a bit more like his old self. xx

[MarkB]

Thanks Helen

Oddly enough, he has turned around like magic today. He has been up & down stairs all day, eating well and is headbutting me for a fuss as I type. He hasn't been like this for ages

[HRHFluffy]

Hi Mark

I have also been thinking about Laz and wondering how he's doing. It's great news that he's had a good day today. I am now learning this with Fluffy, that when they have several health issues, it really can be a roller coaster of a ride. Fluffy is on Semintra for her kidney disease and the side effect of semintra is the reduction of blood pressure. Before taking semintra her bp was 170 and more. Her latest reading was 130. Fluffy isn't on Istin anymore as it would reduce her bp too much. Wonder whether your vet would consider trying Laz on semintra purely for managing his bp. Give him fusses from me and hope he continues feeling good.

Sarie, I'm glad that Harvey is now stabilised with the help of his meds.

[MarkB]

Thanks Sarie & Carol,

I didn't know Semintra was also for heart problems. Laz very nearly went onto it until my new vet discovered that he didn't have kidney disease.

A couple of weeks ago, I asked the vet if we could put Laz back on Benazecare (Fortekor) for his BP as he was on it for a long time when he was misdiagnosed as having kidney disease by my old vet. The vet said Benazecare wouldn't reduced the blood pressure enough. I wonder if Semintra has more of an effect? - in some ways, I would be happier with him on that, as my new vet says that although he doesn't have kidney disease yet, he has 'old cat kidneys' - so if anything was going to happen, I'm sure Semintra would slow down progress?

Anyway, I will ask the vet about it (typical that I only opened a box of 28 yesterday! (112 days supply )

I will also look into cutting back on sodium. Not easy as he will only eat a few foods. He refuses most foods.

[sarie]

Hey Mark, I'm glad to hear Laz is a bit more his usual self at the moment !

The rule with sodium (I guess it's not rocket science so excuse me for stating the obvious haha) is that it's better for them to eat a diet with a higher than desired level of sodium and maintain a healthy body weight than turn their noses up at low sodium food and lose body condition if they're already not at 100% health so I guess if Laz is really fussy and won't accept a cut in sodium to his diet then I wouldn't worry too much about it.

I've cut out all cat treats and replaced them with some cheap cuts of cooked chicken that I keep in the fridge - I just cook a batch up at the start of the week and chop them into little squares and give him a bit as a treat when I would normally have given him a normal treat like a Dreamie. He's also completely banned from eating any and all human food now as a lot of it is high in sodium, particularly pre-packed hams, cheese, hot dog sausages etc.

I've ordered him some Lily's Kitchen Organic Fish Dinner to try as although it's not classed as low sodium it contains about half of the sodium levels of most normal wet cat foods and has the added bonus of additional omega-3 which he needs for his heart. It's quite pricey though so it's going to be an expensive change but if it keeps him healthy then I'll have to find the money from somewhere! Hopefully he likes it... knowing him he won't

I've found this website very helpful while looking into treating the blood pressure side of Harvey's condition... you might find it helpful too. It's a few years old so not all of the information is up to date but it gives good guidance and I found it was useful to point me in the right direction so I could do further research myself.
http://www.felinecrf.org/hypertension.htm" onclick="window.open(this.href);return false;

Semintra isn't normally used for treating heart conditions but it looks like it can be used off-label for congestive heart failure as it's an ARB (similar to an ACE inhibitor). In Harvey's case it was prescribed as it comes in a liquid and he's almost impossible to tablet. It's been wonderful as he just licks the Semintra right off the syringe.. ideal really as minimising stress is vital to him so moving from Benazapril onto Semintra has been fantastic!

Good luck with Laz and Fluffy Keep me updated!

[MarkB]

Thanks - I will take a look at it. If anything, he has got fussier. At one time he would eat Felix senior and AGAIL senior. He now flatly refuses to eat Felix senior. As he likes fishy foods, I tried a box of fish AGAIL doubly delicious last year - they don't do a senior version so I bought the adult. Possibly a mistake as he won't eat much else now. He won't touch any kind of pate/supermeat, no whiskas etc. I have tried various premium foods, but again, he just won't touch them. He has to have RC fibre response dry for megacolon and he has that mixed with JWB senior fish dry. He doesn't eat any kind of treats or human foods (he won't even touch real meat or fish). The only treat he does have is a knob of butter a couple of times a week - even then, only Lurpak (slightly salted) - I tried a block of unsalted butter but he didn't touch it. Still worth a look in case I can tweak his diet over time.

There is a bit of juggling going on. He has DDAVP for diabetes insipidus to control his water balance. I info says that the hormone also controls blood pressure. I mentioned this to my vet but he said he doubts the DDAVP is affecting Laz's - even if it is, he needs it to control polydipsia/polyuria (the reason my old vet assumed kidney disease without further tests)

[Kay]

have you ever tried him with John West Dressed Crab, Mark? it's very expensive, but my Trigger goes crazy for it, and I think it's useful to have something they love in the house, just to test whether they are off their food or just being ultra fussy

it's such a compromise, isn't it - I'm giving a pinch of curcumin twice a day to Trigger now in addition to his Metacam, which I've cut down by a third - but can only get him to take it mashed with a drop of olive oil and a piece of lamb's liver - am I doing more harm than good? only time will tell

[MarkB]

I haven't tried it Kay, but I will get some in just in case. He was off his food again this morning. Oddly, the only thing he would eat was some regular Felix shrimp flavour. I was thinking that the last time he would eat that was when he had a URI. Half an hour later e started sniffling and did a snotty sneeze - it was opaque, so I'm hoping he doesn't have another infection. Such a shame after him being so bright yesterday.

I would like to steer him away from fishy foods as apparently they aren't good for HyperT cats?

But oddly, when he was upstairs yesterday, he helped himself to Kylie's JWB turkey senior biscuits. He will never touch them usually.

[Kay]

I wonder if his sense of smell and taste are impaired, Mark - it happens with age anyway, but if he's a bit blocked it would make it worse, and might explain why he goes for smellier food

in which case he will love the crab, and you might be able to use a drop or two of salmon oil on top of less smelly food to tempt him

I don't know how long Trigger has with this tumour, but I am past worrying about what is good or bad for him - as he is having quite a lot of anti-inflammatories keeping food in his stomach seems to me to be the best way to avoid further complications

though funnily enough his long-standing digestive problems seem to have been solved by the Metacam - must have been inflammation of the gut causing most of them, rather than food intolerances

[MarkB]

Quick update. I took Laz to the vet on Thursday. His BP is down to 150, but he was still dazed and Lethargic. I told the vet about Carol's experience with giving Fluffy Semintra. He wasn't convinced it would reduce BP enough, but said he was happy to try it alongside Benazepril (generic Fortekor) for 10 days and retest BP. He said if Laz is still confused and lethargic after a change of meds, it is likely to be neurological, which is harder to treat. Anyway, pleased to say, he seems more relaxed (he is sound asleep next to me rather than staring into space and looking around) - We have also taken him off liver meds for 10 days and will retest liver function then. The vet said that sooner or later we would have had to put him on Semintra anyway, so if this works it will be a good thing

Hard for me to measure. The vet said Laz is 3kg (I thought he weighed more) so he has 0.75ml a day. The increments are in 0.5ml so I have to judge the half way point on the syringe.

[sarie]

That's such good news Mark! I've got everything crossed the change of meds works out for Laz and he starts to feel a little better

When you say hard to measure, do you mean the Semintra is hard to measure? If so, I had a syringe that had increments for per/kg on it so it was dead easy to measure out - that syringe came with my Semintra.

Like this:

http://vetgrad.com/uploads/Semintra_pack_shot-1.jpg" onclick="window.open(this.href);return false;

[MarkB]

Hi Anna,

I should have checked. It seems I have been given duff info by the vet. Yes, the syringe is marked in Kg (similar to the Metacam syringe), but he said the dose is 0.25ml per Kg, so dose him to 0.75 on the syringe - whereas the dose should be 3 on it! - I know I am no mistaken as he said the syringe marks are 0.5, 1, 1.5 etc and that I would have to gauge it between the 0.5 and the 1 - what is worrying is that he prescribes this stuff all the time. I hate to contradict vets, but I think I should point it out to him as cats could be underdosed! - I will go in later and have a word.

[sarie]

Hi Anna,

I should have checked. It seems I have been given duff info by the vet. Yes, the syringe is marked in Kg (similar to the Metacam syringe), but he said the dose is 0.25ml per Kg, so dose him to 0.75 on the syringe - whereas the dose should be 3 on it! - I know I am no mistaken as he said the syringe marks are 0.5, 1, 1.5 etc and that I would have to gauge it between the 0.5 and the 1 - what is worrying is that he prescribes this stuff all the time. I hate to contradict vets, but I think I should point it out to him as cats could be underdosed! - I will go in later and have a word.

Yeah my vet made exactly the same error - I don't think they're aware of the type of syringe in the box so definitely speak to them ASAP as Harv was being drastically underdosed too!

[lilynmitz]

Sorry, missed this post. Lily's on 1/4 Istin a day, but as she's so far away with the fairies on a normal day anyway, I can't say we've seen any changes in her, or certainly none that became more apparent around the time we started her on them. If anything, lately she's even noisier and more vacant than usual (yes, only Lily could pull that contradiction off!), but I suspect her HyperT is ramping up again, plus deteriorating senility.

[MarkB]

It is so hard to tell what is causing symptoms. I went next door. The vet was operating, but I spoke to the senior nurse. I showed her the line he told me to dose to - she said "That's wrong, it is done n Kg" - she will put him straight. I wonder how many other cats are being underdosed!

Stupid really, I should have realised and checked. I normally do check doses online. Once, someone on Purrs had been told to give their cat a certain dose of Baytril. I had just been reading about it so knew it was wrong. A slight overdose of Baytril can cause blindness!

I did think that it seemed a fiddly amount to measure out for an average cat!!!!

[HRHFluffy]

Hi Mark. Just catching up with this. I'm relieved you got the dosage sorted out. Wonder where your vet got the info from.

Fluffy is about 3.6kg (possibly slightly more now) and my vet said to measure up to the 4kg mark. Hope you see some improvement in Laz.

[Crewella]

Wow, that's worrying that that could happen - I'll take a leaf out of your book, Mark, and check dosages in future!

Hopefully, now he's on the right dosage, he'll start to feel a bit better. Give him a fuss from me.

[MarkB]

I can only think that it was a blip and he forgot that it isn't a regular syringe. So basically he was getting 1/4 of the correct dose - which I guess is better than 4 x the correct dose

I just hope his BP hasn't been going up.

He didn't like the full dose and seemed to choke on it. Maybe it was because I gave him 2 tablets seconds before?

[sarie]

Ah I'm glad you got him sorted Mark! I think it is just confusion over the syringe as the same thing happened to me but it's not ideal when he's so reliant on the meds to manage his BP. Hopefully he'll be OK now you've sorted his doseage out

Harv had to take a dose from the 6kg mark on the syringe so it was quite a big dose; he tended to gag a little if I went too fast so I just gave him it slowly in very small amounts, probably 1kg at a time and that seemed to solve the problem. Good luck

[MarkB]

I took Laz to the vet on Thursday for a BP test. it has gone up from 150 on Amlopidine to just under 170. The vet said he took 14 readings over 15 minutes as his BP was going up & down quite wildly. He said it is a bit higher than he would like, but given that I said Laz is a bit more 'with it', we have to balance quality of life with ideal readings. He said just bring him back in 6 weeks and he will retest. Luckily I live next door to my vet and yet again, he didn't charge me - just as well as I needed £200 worth of meds for him! (£50 for Felimazole, £50 for 56 Benazepril, £9 for a prescripton for 6 bottles of DDAVP + it will be £88 for the DDAVP from PharmacyU (vet price would have been £240)

The vet said he thinks the Semintra will help his kidneys. He also said that if he is still acting oddly, it is likely to be neurological, which can't really be treated. He isn't the old Laz, so there must be an element of that. We have stopped the liver meds but will retest soon.

Anyway, he is slightly more active. He has been exploring a little bit and even went into the room where Dom (the stray we have at the moment) and pinched some of his food and went close to him. There was no aggression on either side (Laz pinched some of Domino's Purina salmon biscuits )

[Crewella]

You are lucky indeed with your vet-next-door!

Glad lovely Laz is a bit perkier, and I hope he enjoyed his stolen contraband biscuits!

[MarkB]

Thanks Helen

He apologized for giving me wrong dosage info. He said he should know better, because he has one of the surgery cats on it - I didn't know they had surgery cats! - they must live in the flat upstairs.

[Crewella]

They couldn't be some of your regular visitors?

[MarkB]

No Helen. They don't let their cats out - in fact, when I took Alice in, he said he recognized her as one of the torties that was always lying on the vets' cars - I pointed out that she wasn't capable of climbing a fence 6 years previously when I adopted her and more recently, jumping on the sofa was a feat.

[Crewella]

Ah, just a thought - I know you do get quite a few 'visitors'.

I still look at your pic of the lovely Alice and think of her, by the way. xx

[HRHFluffy]

Mark, I'm glad that Laz seems a bit more lively and with it. I remember a few years ago when I first joined CC, (after Fluffy's diagnosis of CKD), that you said it was more important to treat the cat, not the numbers. I think that Laz is demonstrating this to be very true. His behaviour is what you are going by and thankfully your vet is listening to you.

I'm beginning to wonder whether a true reading of their BP can ever really be done at the vets. Maybe an accurate reading can only be taken if done at home by their owner. I've never heard of this happening so probably is highly unlikely to be practical. You will never know how Laz' BP is at home so you can only go by watching how he is. Signs of being inquisitive about the new stray (and taking his food) and coming out of his shell are all positive.

I hope he continues to get as much quality of life as he possibly can. He's in the best hands!! Give him lots of fusses from me.

I still think of Alice too.