4th April 2012, 05:55 PM
Diuretics - What kinds worked best for you?
My cav Da Vinci is at the later stage of MVD. He's been taking Furosemide (Lasix) 40mg 4x daily, Enalapril 2.5mg 2x and Vetmedin 2.5mg 2x. On top of that, he's been going through abdominocentesis (abdomen-fluid drain) procedures every three weeks to help him eat better and make him feel more comfortable. He has gone through centesis four times already since January this year.
He had a lack of appetite scare (simply refusing to eat) in January, but centesis has helped a lot to restore his appetite. Lately, I've also learned that Omeprazole (Prilosec) (14 tablets, 20.6mg daily, 14-day treatment) helped restore his appetite even more, which tells me Da Vinci has been suffering from gastric ulcers as well. I am assuming that his medications had contributed to ulcers.
I don't know what the maximum threshold for Furosemide would be for him without harming himself. His cardiologist thinks it is OK to take 40mg 4x (160mg) of Furosemide daily considering Da Vinci weighs about 26 lbs. Even with that amount, his abdomen become visibly bloated and his hind legs are spread wide to support the ever-growing abdomen with fluid. By the way, he is not overweight.
Have you tried different kinds of diuretics with more success in a similar situation?
We tried Sporonolactone for a couple of weeks in December last year, but we had that loss of appetite scare in January. So, we stopped it. We never know for certain that Sporonolactone was the sole cause of the scare. Da Vinci's cardiologist mentioned to me about Hydrocholorithiazide, but my dad had a bad experience with it some years ago. So, I am very hesitant about trying it.
So, what water pills are working best for your cav or worked best for your cav before? Has anyone tried 160mg or more of Furosemide daily to clear fluid without causing too much problems?
Thank you so much.
4th April 2012, 06:16 PM
Torsemide (Demadex), is an alternative to furosemide. In a recent research report, researchers compared doses of torsemide and furosemide in treating dogs with stable congestive heart failure (Stage C). They found that "torsemide is equivalent to furosemide at controlling clinical signs of CHF in dogs and is likely to achieve greater diuresis vs. furosemide." Torsemide is approximately 10-times as potent as furosemide in dogs and cats.
Originally Posted by summerwalk
Read a summary of the report at http://cavalierhealth.org/mitral_val...and_furosemide
You might try hydrochlorothiazide (Dyazide) anyway, since humans and canines can react differently, or co-amilozide, which is a combination of amiloride and hydrochlorothiazide.
4th April 2012, 10:57 PM
Sorry to hear about Da Vinci's struggles, it can be very difficult to achieve a balance of medication to control MVD especially in later stages. It's really good that you are working with a cardiologist as they are the best people to manage this, they have the knowledge and experience - a vet is like your GP and can't be an expert in everything.
Rod mentions co-amilozide, which is a combination of amiloride and hydrochlorothiazide.- my cardiologist recommends this, although it is an old fashioned drug it is very effective at reducing belly fluid in particular. It has proven very helpful for several Cavaliers belonging to friends to whom I have recommended the drug over the last 6 months or so - one has a vet who treats many Cavaliers, he was really impressed with the drug and is now prescribing it where he feels it will help. I'm sorry your Father had a bad experience with Hydrocholorithiazide, it does make you reluctant to try these things but we all react differently to drugs.
Sometimes the dogs end up needing 2 or 3 different diuretics at the same time.
5th April 2012, 04:04 PM
Rod and Nicki,
Thank you. Your recommendations are very valuable. I will talk to his cardiologist about those medications next time when we see him.
By the way, I forgot to mention that when Da Vinci was in the hospital for abdominalcentesis with Internal Medicine doctor three weeks ago, Da Vinci's cardiologist recommended either sustained release oral nitroglycerin or topical therapy if the centesis internal is less than 3 weeks. When I searched a word nitroglycerin in this forum, nothing turned up.
I am kind of wondering if anyone has experienced with nitroglycerin for lung fluid (pulmonary edema) or peripheral fluid build-up in a place like abdomen cavities.
5th April 2012, 05:59 PM
I'd be curious about the latter point too.
I am caring for a neighbour's dog in CHF with a lot of abdominal fluid. My own vet feels it can b an ongoing battle to drain it and says he thinks it can be distressing to some dogs to have this procedure, so I haven't opted for it though it clearly can help some dogs. The fluid hasn't increased since I started her on co-amilozide but neither has it decreased. I will discuss torsemide next time I am in.
I found prilactone (spirolactone) to be a complete miracle drug for my cavalier who passed away last year from MVD. She was collapsing regularly and having breathing difficulties and starting her in prilactone immediately stopped all of that for many months and gave her about 4-5 months of decent quality life before she passed away in her sleep.
As others say, different things work for different dogs.
In memory: Lucy
6th April 2012, 07:16 PM
Thank you for the info on co-amilozide. It's good to know a different perspective on that medicine. Obviously, Spironolactone had worked in your case.
For the abdomenocentesis, they drew about 450cc (1st time), 1,000cc (2), 200cc(3), 450cc(4th). In the last procedure, they had to use catheters to drain fluid in the abdomen cavities. I am sure these are very stressful procedures to dogs. At that time, I didn't have a lot of choices because the centesis helped his appetite back. During the last visit with an internal medicine doctor, I mentioned about the status of his stools (soft, black and tarry). She told us to administer omeprazole suspecting gastric ulcer. Omeprazole really really helped. It's been four weeks since we did the last drain, but his appetite remains strong and his stools have improved although his belly bloated.
We're hoping different kinda of diuretics might help Da Vinci so that we could avoid the draining procedure (also very costly procedure).
9th April 2012, 11:29 AM
It is very hard to know what to do and we can all only go on a case by case approach -- as with SM individual dogs can have very different experiences with different drugs and it often is a lot of work to find the right 'cocktail'.
The neighbour's dog, one of my former rescues in Irish Cavalier Rescue, I try to manage as cost efficiently as possible (I cover her meds costs as he's a pensioner) while keeping her comfortable -- she has already hung in there far past what my vet and I believed would be the case! She's a determined little girl -- ex puppy farm breeding dog. One of the issues for us in considering draining the fluid is that her heart has always been extremely bad -- grade 6 when she came into rescue nearly three years ago! So we have never done anything requiring anaesthesia (eg she remains unspayed) and would avoid anything that could be stressful for her. So that is a big part of the consideration.
The neighbour lost his much loved elderly collie last November after long kidney illness and I truly thought Susie the cavalier would go well before him. I also doubted she'd make Christmas much less January... and now we are in April! My vet thinks she is a bit of a miracle dog. No walks and she has a quiet life in the house, but still -- amazing she just hangs in there.
They can really surprise.
I also was sure Lucy was in days of needing her wings, twice -- and the second time is when we put her on prilactone and she really bounced back for several months before slowly declining again.
Rod's site is very good on all the treatment options: http://www.cavalierhealth.org/mitral...htm#Treatment_
In memory: Lucy
9th April 2012, 07:14 PM
One thought - I'd consider another trial with spironolactone. DaVinci is taking a really huge amount of furosemide so I'd think seriously about adding an additional diuretic in order to lower that furosemide amount.
Originally Posted by summerwalk
Nitroglycerin is a venous vasodilator rather than a diuretic. From "Manual of Canine and Feline Cardiology" -
"These nitrate vasodilators are excellent preload reducers. The development of nitrate tolerance limits the continuous use (i.e., more than 36 hours) of these agents. Tolerance may be avoided by intermittent use (24 hours on and 24 hours off) and possibly concurrent use of ACE inhibitors."
Some members in the canine chf yahoo group have used nitroglycerin and Isordil for their dogs - often when the dog has been hospitalized - so I do know of situations where the drug was used.
9th April 2012, 07:19 PM
Forgot to ask - what is he eating? I've done home cooked diet (and/or combination of home cooked and commercial) for dogs in late stage disease because it is more palatable and they usually eat better.
30th May 2012, 05:52 PM
Thank you for your info. Sorry for my late response. I've been away for a while.
For your suggestion on Spironolactone, I would like to reconsider it and start administering to see how it would change the fluid buildup. The unused bottle of tables are still sitting on the shelf...
For his diet: (100% home cooking)
Breakfast: Very lean beef with rice and a combination of vegetables such as (carrots, sugar snap peas, apple, and zucchini. Always finely minced)
Dinner: Salmon with rice and the same combination of vegetables
Time to time, I also mix in well-cooked ground turkey, depending on the amount of beef and salmon I use. So, I control the amount of his salt intake.
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