Re: [FH] Wolfgang CHF/Lasix only?
- I read a lot of human cardiology articles for med students and that is how I came to understand the rationale for the drugs our cats are on. I also realized that veterinary cardiology trails human. If we wait for trials we'll all be dead. However there have been lots of trials for humans and there have been animal trials to benefit humans. So we extrapolate from those..
The way I have come to understand it is in an emergency the body has responses that help the animal to survive. One is SNS (sympathetic nervous system) also known as fight or flight. This is what increases heart rate to outrun of outfight a predator. Good in the short term but chronically activated as it is with a failing heart very bad because it causes continuing damage to the heart. Beta-blockers (atenolol) block the SNS chemicals that raises the heart rate.
The other is RAAS (renin-angiotensin-aldosterone system). I think if you were bleeding this system is what kicks in to help you survive. Good if you might bleed to death, really bad if it is chronically activated. ACE-I inhibit the RAAS.
Both these systems are called the neurohormonal response to a failing heart. This is what vets are trying to modulate at the same time they are trying to keep the lungs clear.
Sue at MAGDRL <susan@...> wrote:
Maybe you should consider switching cardiologists? From what I've learned
(see Susan's note) it's not at all good to give them diuretics without
medication to control the heart - either a beta-blocker or an ace-inhibitor.
The fluid builds up because the two halves of the heart are working at
different rates. The fluid backs up and the body compensates by leaching it
into the lungs (usually). The diuretics help to get the fluid out of the
When you use one of the heart meds (above) it reduces the difference in the
rates of the two halves of the heart so that not as much fluid builds up to
begin with. Then you don't have to use so much in the way of diuretics.
The max dose of diuretics is related to weight. At just over 14 pounds, my
Pepper is getting 60mg per day of furosemide (lasix) along with 12.5mg
spironolactone. When we raised her dosage, her kidney values went up for a
week or so and then came back down. The body can adjust.
I don't understand his take on supplements but then again, it's typical.
They study medications and not supplements. Therefore they don't always get
the whole picture. L-carnitine and CoQ10 *DO* help a LOT!!! Taurine helps
more with some types of heart disease than others but it sure can't hurt.
Giving taurine to a cat that has CRF shouldn't make any difference relative
to the CRF.
My family wanted me to put my Pepper to sleep back when she was first
diagnosed in November 2004. I'm sure glad that I didn't listen. Actually,
it made me very angry with them since they felt I'd lost my mind and treated
me accordingly. We've had almost 2 years so far with some ups & downs but
mostly good times. The past couple of days, she's flying up her 5' cat tree
with no issues.
IMO - I would switch cardiologists since I don't think this one is doing the
best for your Wolfgang. Remember that no medical practitioner is infallable
and you are the voice for Wolfgang. Don't just blindly trust them if you
don't think they're doing the right thing. Obviously, what they're doing
isn't working for Wolfgang.
My best to both of you.
----- Original Message -----
Sent: Wednesday, September 27, 2006 2:41 PM
Subject: [FH] Wolfgang CHF/Lasix only?
> Hi there. My cat Wolfgang has had a bad month. I haven't posted in a
while, so here is
> some background.
> Wolfgang went into CHF in January. He was diagnosed with HCM secondary to
> He also had rising creatine levels.
> Wolfgang was treated with radioactive iodine in March, which cured his
> In July, an echo showed no improvement to his heart, so the HCM diagnosis
> secondary to Hyper T. The radioactive iodine, did help this disease from
> Wolfgang was on .05 ml Lasix. It is in liquid form of 10 mg/ml. He was
> 5mg aspirin, one every three days.
> I asked a lot of questions (after joining this group) about supplements,
and other heart
> medicines. His cardiologist told me that what we are doing is working, so
he didn't want
> to change anything. He told me the Q 10 and L-Carnitine "wont hurt", but
not to give
> Taurine, because of his CRF and protein.
> Last month I caught Wolfgang in the early stages of CHF. His breathing
was at 40 resps a
> minute, but not labored. I took him in, and an x-ray showed fluid in his
> cardiologist told me to double his dose of Lasix now. .05 2x a day. He
was due for a two
> week check-up to see how his kidneys were handling this much Lasix.
> Two weeks later (the day he was scheduled for a check-up), Wolfgang went
> again. This time very labored and uneven. His regular cardiologist was
busy with a
> surgery, so I was temporarily assigned a different one. I go to the
University of Minnesota,
> where there isn't a shortage of cardiology students and residents.
> They could not hear Wolfgangs usual grade 3 left murmur, because of an
> They did an echo which showed a slight (1mm) progression of thickening
heart walls, but
> that was it. An x-ray showed fluid in his lungs. They drew blood to
check Creatinine, and
> the good news was even after two weeks of doubling the Lasix, his Creat
went down since
> July! Three cheers! His Creat was at 2.9 (.5-2.1). I was told that we
had "wiggle room" to
> up the Lasix even more. This new cardiologist told me that she was going
> giving an ACE inhibitor (enalapril) with his regular cardiologist.
> His regular cardiologist rushed over after surgery to see what was going
on with Wolfgang.
> They had finally stabilized him with Lasix and oxygen. I was told I could
take him home
> but to increase his lasix for the next three days. .08 ml 3x a day, and
then go to .08 ml
> 2x a day. He was also (on my recommendation) prescribed Renacare
> supplement 2x a day. They wanted to follow up in a week to make sure his
> clear, and check blood for Creat again.
> That was last Thursday. His check-up didn't go as well as I had hoped.
There was still
> some fluid in his lungs, and now his Creat is up to 3.4 (.5-2.1). They
gave him another
> injection of lasix, told me to not change anything, and sent me on my way.
> This weekend was awful. Wolfgang had resps in the 50s, with uneven
> The cardiology dept. is closed on weekends, so I gave him an extra .05 ml
> He is slowly doing better. I spoke to his cardiologist on Monday. He
told me I did the
> right thing, and I can give him extra lasix if I feel fit. I brought up
the ACE inhibitor again,
> and my cardiologist said no. He said he doesn't see enough evidense that
they work, and
> he doesn't want to risk further renal failure.
> Wolfgang is doing better today, but is still not recovered. I just don't
know what to do.
> My family thinks I should PTS. I have asked his vet and cardiologist, and
they think he will
> I have taken this week off from both school and work. I am willing to
lose my job to stay
> with him, and make sure he is eating and drinking.
> I just don't know what to do now. I called his vet and cardiologist today
( I wanted to know
> what the maximum dose of lasix I could give him) but have not heard back.
> I would be so very grateful for any input on this situation. Wolfgang
will be 13 November
> Is just giving him Lasix enough? Am I at the max already?
> Please help.......
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