Quote Originally Posted by Brian M View Post
We have a conundrum over medication he commented that she needs no medication but he is not happy she is on frusimide as that stimulates certain hormones to over produce some items which may affect the heart so he is considering if he should prescribe an Ace Inhibitor to counteract the frusimide but he doesnt know if that is the right thing to do .So he is going to approach many other cardiologists both in the UK and the US to ask them and then arrive at a majority decision and then tell me which way we will go.
Well, thank you Simon Swift!!! I have long been concerned about dogs receiving furosemide (US spelling) long-term for SM. I have made a few mild comments here that I would never give this drug long term for SM because of the side effects. The drug activates the RAAS (renin-angiotensin-aldosterone system) - a very complex compensatory neuro-hormonal system that I'm not going to try to explain here. The RAAS is compensatory and helps with an acute problem but it becomes maladaptive over the long term so this is something that you don't want to activate. This is why furosemide alone is never given for dogs in heart failure but an ACE-I is always added. (Any vet that gives furosemide only to a dog in heart failure is sadly out of date.)

I personally would not want my dog on furosemide for SM, and I'd certainly not want to prematurely add an ACE-I simply to compensate for the furosemide for a dog that is in the early stages of MVD. Since cimetidine and omeprazole are also drugs given to reduce CSF, I would opt for one of those drugs and not use the furosemide. I also know what furosemide does to kidney function, so I would not use that drug long term unless it was necessary to control symptoms of CHF.

All of this is of course my own opinion, but I feel somewhat vindicated that Simon Swift has voiced the concerns that I've had for a long time about this drug in the SM treatment protocol. I've also not been happy with the monitoring recommendation for dogs on this drug - I'd monitor much more aggressively.

Brian - would you consider talking with the neurologist about using one of the other drugs that is reported to reduce CSF and just skip the furosemide and the ACE-I? Then you would start those drugs when necessary for CHF from MVD, but that may well be years down the road.