From:
Pam Sessoms
Date: 2001-11-05 16:41:00 UTC
Subject: Re: Conjestive Heart Failure
Barb,
(I'm in dangerous waters here, please understand I'm not a vet, and some
of this is at the edge of my understanding and I've only dealt with this
one case so far.)
> --- In Ferret-Health-list@y..., Guszak@a... wrote:
> My Zak, age 5, was diagnosed with CHF the first of last August.
> Since then, we've been using Enacard (ACE inhibitor) and lasix. Both
> have been upped...the lasix 3 times. Last thursday we had another
> x-ray done, and the fluid has not eased from around his heart.
I am sorry to hear you are struggling with this. It sounds like Zak has
actually done well for a good while, with diagnosis over a year ago now...
I just lost one to dilated cardiomyopathy, and fluid was the big thing we
fought towards the end. In my girl's case, though, it was fluid in her
lungs rather than around her lungs or around her heart. So, realize we
are dealing with different presentations here...
But anyway, I believe my vet said that oral lasix worked best on fluid
*in* the lungs but often a tap with a needle was needed to remove fluid
*around* the lungs or heart. Then, after the tap, diuretics are increased
to try to prevent the build-up or slow it down. Maybe someone else can
clarify that...
> The lasix doesn't seem to be doing it's thing. We're up to .25ml twice
> a day
Now, on the lasix dose, much depends on the concentration of the stuff.
The stuff we used was 10 mg/ml, so 0.25 ml would have been 2.5 mg. Most
of the books I read had top doses of lasix at 4 mg/kg two or three times a
day. However, we went far above that, and Sunny was actualy getting 8
mg/kg every six hours towards the end. That's a ridiculous amount, but
what can I say... we did what it took to work. Sukie, if memory serves,
also has used high doses of lasix on at least one of hers. Some tolerate
it and compenstate by drinking a lot, and some don't and just get
dehydrated and you have to cut back.
With Sunny, since the lasix wasn't working out so well even at huge doses,
we also added a thiazide diuretic. It works on a different part of the
kidney, so it gave us a good "nudge" when she was so resistant to lasix.
We were able to cut back the lasix a tiny bit, and she never wheezed at
all after that. Before we added it, she was having about one wheezing
attack (very stressful for her) every two days. The thiazide diuretic was
called Amiloride/HCTZ. We had to be *extremely* careful to monitor her
blood potassium levels, because she was on bunches of meds that had an
effect on them. She was only on this a couple of weeks before she died
(became extremely weak, developed diarrhea), and I don't know if it had
anything to do with her decline. But I do know it made her much more
comfortable for awhile, so I don't have regrets.
She had also been on something called Spironolactone, a mild diuretic from
yet another class of diuretics, for several months before we added the
Amiloride/HCTZ. Spironolactone, as I understand it, has a pretty mild
diuretic effect but has other properties that are shown to reduce death
from congestive heart failure in human studies.
> Doc added 1 drop of Dogixin (sp?) on Thursday.
Probably digoxin... With Sunny, we had to work a lot to get a therapeutic
dose of that. We started kind of low and did a series of blood tests to
measure the level of it in her blood. Think we had to increase it three
or four times before we were in therapeutic range. Probably this was
because I always gave it with food, which slows the absorption of it.
Once you have your system with that drug, ya gotta stick with it, because
it is toxic if the level gets too high, and the margin is small. (tip:
combine lots of tests into one blood draw - kidney function, digoxin
level, potassium level, etc... saves stress and money!)
Anyway, you are being a very devoted owner for Zak. This is a rough
diease, and it has a big impact on your schedule and heartstrings. It's a
juggling act and a roller coaster. You are doing a GREAT job!
Best wishes, and please post updates when you can,
-Pam S.