I don't want to complicate things, but in the earlier stages of congestive heart failure (CHF), when the cardio starts prescribing a diuretic and an ACE-inhibitor for our cavaliers, we tend to give more holistic medications instead. But when the cavalier approaches the end stage, we go with what the cardio prescribes. The only exception has been Vetmedin/pimobendan. We are particularly cautious about that drug, because if the dog's heart is still strong, despite the CHF, it can do more harm than good. So we watch our dogs very carefully when they are on Vetmedin.