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661200 tn?1225483013

Kidney Failure / Congestive Heart Failure

I have a 15 yr old female Pekeapoo who was diagnosed with congestive heart failure 8 yrs ago.  She has been on Digoxin (sp?) 3 X a day, Furosemid 3X and Enalapril 1 X.  Took her in for a health screen last nite.  Bloodwork/Urine finds bad.
BUN - 140    Creatinine  3.1   Phosphorus  8.8  Calcium  13.3
Doc says she is going into kidney failure because of the Furosemid and want me to cut back to 2x daily.  However, this will fill her lungs back up, start her coughing and possible serious heart failure.  We have a follow up on Thursday.

I am scared to death - what should I expect or what symptons should I be on the phone to the Vet for?  She looks fine on the outside.  How much longer does she have?

I'm not ready to let her go    : (
60 Responses
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462827 tn?1333168952
Hang in there.....Yes, normal can return!!!  Once he's on the meds. and gets the fluid off his lungs, you'll probably not have to prop him up...  ;)  They work that good!!!  Dogs can live many many years with heart problems. Sometimes the meds. will need adjusting but you'll recognize the symptoms and know what to do. Let us know about the cardio. visit and thank you for adopting.......Karla
Helpful - 1
1916673 tn?1420233270
Hi. I am so very sorry for your loss. The passing of a friend, companion and family member is always hard, particularly when we have to help them out of suffering. You did all you possibly could to help, and more, so be reassured that if he could say it, he would say a huge thank you to you for looking after him so well ... and for loving him so much.

Tony
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1 Comments
Again, sincerely, thank y'all so very much for everything.
Avatar universal
As an update, at 4pm 11-16, Bit had two seizures (or the last could have been a stroke with the way it looked) and was put to sleep for him to rest without fear.

I thank every single poster in this thread for helping me these past two months in keeping him comfortable and with a better quality of life.
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Avatar universal
thank you ;) he gets whatever he wants within reason. Lately its a lot of sausage, egg, cheese and ham or turkey. He likes nachos. Up until about six months ago I tended to go very easy on what he ate like that, but now, if he wants it, he gets it :)
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1 Comments
I think there is always a time for that kind (literally) of action. The last thing my dog ate 3 yrs ago before she passed was a whole bar of chocolate, the one thing she was never allowed but always wanted.
Avatar universal
My 16 year old teacup Chihuahua was diagnosed years ago with a heart murmur that wasn't severe. On the 13th of this year however, he had a grand mal seizure and I thought he was dying right there in my hands. I lost it and rushed him to the vet where he went over him thoroughly. He was lucid and stable and completely fine there. They gave him some medicine in each ear for a bacterial infection and talked with me about the murmur worsening and we started him on Vetmedin. It's been two and a half days since that visit and i can already see an improvement. His breathing is much less labored. He sleeps better. He's wheezing less. He has tons more energy.

He stopped about a month ago eating any type of dog food. I cook for him. His appetite is alright and he's not lost weight according to vet visits. He's not bloated.

He'll be going back for a followup next week to see how he's doing on the medication and go from there. I know 16 is a lot of years for a teacup chihuahua, but I want his last days/months/year to be comfortable and as healthy as possible. This thread and others like them have been both inspiring and heartbreaking to read. I thank you all for your stories.
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2 Comments
Just a little update, it's nearly three weeks since the seizure. he had a restless night and is sleeping most of today. The doc gave him a month's worth of Vetmedin and we're going to take it as it goes. If he worsens or seizes again, he goes back.
Yes, 16 is a very good age. I think you are doing an amazing job of caring for him.
1916673 tn?1420233270
Hi. So sorry you and your dog are going through this. I have seen this kind of post several times on here and it's always very difficult to know what to say for the best. CHF and CKF are two serious illnesses that are at odds with each other, as far as treatment is concerned. The CHF can often be treated successfully with a range of medicines, but all those medicines do further damage (or at best, exceptionally stress) the kidneys. Take away the CHF medicines and the kidneys can be maintained (sometimes) with other maintenance and treatment regimes, but then the CHF will get worse and probably become life-threatening. It really is Catch-22.

Lasix is often the first drug of choice to treat CHF in dogs. It also has some added benefits for renal failure, so it's certainly likely to be one of the better choices. It strikes me your vet is taking the right approach. But as I'm sure you already know, the kidney disease is going to deteriorate over time and with the complication of CHF, it may deteriorate quite rapidly.

Refusing to eat is a typical sign of nausea associated with the kidney disease. You really need to ask your vet about an anti-nausea medication, which will help encourage eating. The nausea is created by the toxin build-up from the under-performing kidneys.

I wish I had better advice, but this is a very complex duo of illnesses and helping one will invariably cause the other to deteriorate. The best way here is a) to prioritise which illness needs more input on a daily basis; and b) to keep regular vet appointments, check-ups and assessments, so you know whether the prognosis is in rapid decline. I would also suggest trying to look closely at the diet to see if it needs altering, particularly in light of the renal failure.

Tony
Helpful - 0
Avatar universal
hello,  just  found this site last night,  so wish I had seen it  weeks months  back,  
my conner cairn terrier,  has CHF ,collapsing trachea , and now  early stage kidney failure, the vet said there was nothing to do but keep in him comfortable, that was it,  I had taken him in cause he was  vomiting, and I thought was constipation she said no was  diarrhea , gave meds  for that  he is straining so hard, meds  worked,  he seemed almost back to normal, I had made arrangement to let him go,  but canceled after he seemed better over Fri, Sat and part of sunday,  then he stopped eating again,  it is now wed, he is still straining to go, it went from almost  normal back to thin liquidy, still drinking  some but no where near as much as he was, and loosing weight. he is getting 4 lasiks a day 2 morning and night along with 1 1/2  pill for heart each time, plus remidahl for pain no mention was made about cutting or stoping the lasiks
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1916673 tn?1420233270
Hi. Thank you for your post. I agree, your vet is one of the good ones, so hang on to them. They do seem to be treating the kidney failure as a priority, because (as you may know) IV Fluids are not good for the CHF. It's a balancing act, but with the BUN being very high, I can understand why they have gone ahead with IV Fluids in an attempt to bring the BUN back down.

Antibiotics is another problem in kidney failure, because of the toxins produced as a bi-product of this treatment. But again, it's important to treat any UTIs, so (again) someone has to decide which is a priority at any point in time. This will always depend on how each condition progresses ... or when they improve or deteriorate.

Regards

Tony
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Avatar universal
Just stumbled on this thread in my google search "fluid therapy for dogs with kidney failure and congestive heart failure".

My 16 year, 8 months rat terrier currently is at the vet's on IV therapy in an attempt to bring down his BUN (140+). I have done sub-q fluid therapy twice weekly for the past month. My dog is not in pain and he is an excellent patient who tolerates his meds and treatment well.

He has not experienced the vomiting some have mentioned. I don't know if that is because he gets Sucralifat (sp) 3X daily. It coats his digestive tract. I get it thru goodrx.com affordably.

My vet will not do a dental because of the risk of anesthesia now. Therefore, we do pulse antibiotic therapy, only now is simply is daily antibiotics (clavomox rotated with orbax). That vastly improved my dog's quality of life as he would get chronic prepucitis/UTI's.

I commend my vet for going the extra mile with this dog but we both recognize that we are in the final stages and want my best buddy as comfortable as possible. I hope this information helps.
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1916673 tn?1420233270
Hello and welcome to the forum. I think you have the measure of both these conditions - and I also think you have done amazingly well to help your best friend achieve the age he has with such a zest for life. I cannot praise you enough. You are absolutely right in everything you say ... there is a real dilemma between treating these two serious and life-threatening conditions. In a younger dog, compromises are common, as it depends which illness needs the priority treatment at any particular time. At 16, there are many other complications, and I actually think quality of life is the only real priority.

I reckon there is a day-by-day assessment to make, as you probably know. And you are spot-on ... you know your dog better than anyone else ... and when you feel the time is right to cease any particular medication, then that's the time to do it (though you probably would be wise to have a discussion with your vet beforehand, just so you know what to expect). There are also some medications that need to be tapered off, rather than stopped immediately, so whatever you decide, just plan it as carefully as possible.

One thing you could do is get a full blood panel undertaken along with a full urinalysis done, as these combined will let you know what degree of kidney failure is present (if any). This obviously would help in deciding whether or not to withdraw the CHF meds.

Tony
Helpful - 0
13914306 tn?1432045883
These posts have been so helpful! My Shiba Inu will be 16 in August and was diagnosed with mild CHF last April. At the time, the vet warned about the "long term effects" on kidneys of heart meds, but we agreed that long-term for a 15 year old dog was not really a concern. My boy is so hearty and happy. He has terrible arthritis in his back legs but powers through it if it means playing or going for a walk. Since being on enalipril and vetmedin, his coughing and breathing have improved significantly.About three months ago, he started vomiting and refusing his pills (Trust me, I tried EVERYthing). The vomiting would last a day or two then go away for weeks at a time. We had another episode last week that lasted a few days, so we went to the vet. I got the same thing as far as what to do. "You know, he's in his 90s now... we can run all these tests, but..." I appreciate her honesty, so we just put him on amoxicillan (sp) and Metacam and continued heart meds. His appetite came back after a couple days, and he has been eating and playing like a kid again. This morning--more vomiting. I really think after being on heart meds for a year, his kidneys are failing. He is my kid and my best friend, and I'm waiting for the vet to call me back. After reading all of these posts, I think the best thing for him is to just stop the heart meds and give the kidneys a break. I know it means his CHF will progress faster, but everything I've read said that CHF is not necessarily painful, just difficult in other ways. Kidney failure can cause painful stomach cramping and loss of appetite. I'd rather spend my last months or weeks with him quietly, letting him eat whatever he wants, until the time comes. Forcing all these meds on him just doesn't seem right any more. Again, I am so grateful people took the time to write about their own furkids. It really helps. For those wondering if they made correct decisions, I say that if you love(d) your pet, you most certainly did. I don't think there's any right or wrong answers. We give them a good quality of life, including the end of it. That sure beats would they would have faced without us. Despite all the well meaning advice, you know your pet better than anyone and they know you. I honestly believe they tell us stuff, as my dog is telling me now.
Helpful - 0
1916673 tn?1420233270
Hello. I am so very sorry. Dot's kidney disease was truly compromised and complicated by the CCF. It was always going to be an uphill struggle to treat both of these conditions with any success. Seizures are a strong indication that things had deteriorated quickly and to a point of no return. Although it is heartbreaking, at least Dot is at peace now. No more suffering or stress. She will always have a safe place in your heart and memories.

Please stay with us on this forum if you want or need to talk about her and share some of the wonderful things you did together. My heart goes out to you during this very difficult time.

Run free Dot.

Tony
Helpful - 0
Avatar universal
Thanks for replying again Tony!

Dot deteriorated and ended up having seizures so obviously my little girl isn't with me any more. Our vet came to our house and put her to sleep.

It was very traumatic and I hope that I didn't leave it too long. I had decided that if she didn't eat the following day then I would have to do something but the decision was made for me really.

Heartbroken

Thanks again
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1916673 tn?1420233270
Hi. Ok, it's good that you have a diagnosis. After you speak to the Internal Med please come back and let us know what is said. The BUN is of great concern. It's extremely high. Alum Hydrox as a phosphate binder is good, but not necessarily the best or most appropriate. I'll comment more after you get back to us. Also, Metronidazole is an antibiotic for bacterial infection - presumably this has been given for a limited course only, maybe there are signs of infection or tooth decay, which has the vet think there's an issue with the intestines, thus creating the mucous-stools? Proviable is a supplement much like some probiotics, which is intended to assist the digestive tract and intestines.

When you say kidney food ... what is it and has it been supplied by the vet? Either way, please give the name and whether it is dry food or canned.

Please consider joining our User Group ... the CHRONIC KIDNEY FAILURE IN DOGS user group. It is a useful forum specialising in this disease.

Hope to see you as a new member in due course.

Tony
Helpful - 0
13602926 tn?1458503960
Thank you Tony. I did go to ER and had another blood test. He now has definite Kidney Failure. Phosphorus is up so they prescribed Alum. Hydrox, Creatinine is 3.5 (same as week earlier), the BUN is now 244, up from 169 week before. He is on kidney food only. And now taking Metronidazole and Proviable in addition to the Alum. Hydrox and Pimo.

I finally had someone tell me the truth and not skirt around when I asked about his kidneys. I have appt tomorrow with Internal Med. to advise on his "severe azotemia".

He has lost his "sparkle", he walks slowly and doesn't seem interested in anything. Only thing that sparks him are car rides and sitting outside.
Helpful - 0
1916673 tn?1420233270
Hi. CHF is not really my area of speciality, so I'm hoping others will respond to your concerns. I just wanted to say that being told to wait 3 days for your regular appointment is probably not helping you, because I can tell you are extremely concerned and anxious about the night time events. If you become concerned, just go to the ER ... you know your dog better than anyone and your worries are very real. This is a serious condition, so if you think emergency intervention is needed (or even just some reassurance for yourself), then I wouldn't hesitate. Better to be safe than sorry.

Tony
Helpful - 0
1916673 tn?1420233270
Hi. She's probably not eating due to toxin build-up in her stomach. You could try giving a suitable anti-nausea medication, which should encourage her to eat. Not eating is typical of kidney failure. It's because the toxins make dogs feel sickly - and like all of us, if we feel sick, we don't want to eat anything.

The deterioration is likely to continue, I'm sorry to say. You are truly caught between a rock and a hard place. Helping one problem will almost certainly cause the other to get worse. I would tend to treat the kidney failure as a priority, but only because it is in stage 3, which gives you a chance of controlling it (albeit for a short time).

While she is interested in "pottering about" and has a reasonable quality of life, I think the time is approaching but not necessarily here yet. It really is a day-by-day assessment you need to make, along with any advice your vet might give you. In the end, you know her better than anyone, so you will know when that time has come.

My thoughts are with you.

Tony
Helpful - 0
Avatar universal
Thank you for replying Tony
Things have deteriorated since I posted as she's not eating at all now albeit only 2 days but cant see her regaining her appetite. Consequently, the only tablet she takes ie frusemide she hasn't had for 2 days and I'm not prepared to fight with her to take it.
She had some diarrhoea yesterday and was incontinent  - this is not her at all! And I'm so sad to say that I do think she has that look in her eyes!!? She is still pottering about - mainly to check where I am.
My heart is breaking as I write this because I suppose I know what happens next.....
Helpful - 0
13602926 tn?1458503960
Hello,
So much information, I am so scared. I am glad I found this site.

My 10 year old 4 lb Yorkie had a fainting episode 3 wks ago while I was on vacation and then started to hyperventilate. I rushed him to ER where he was placed on oxygen and blood tests and xrays were taken. They said he had CHF. His BUN was elevated but he had just eaten so they were not concerned, otherwise his blood work was good. He did show signs of fluid in the lungs but he was not coughing. I took him to a cardiologist the next day and had an ultrasound done. They confirmed the CHF and wanted to start treatment immediately, they were worried about his flight home in 6 days.

They placed him on .6 ml Furosemide (lasix) and ½ tablet of 1.25mg Pimobendan 3x day for 3 days when I would have a follow up visit. The new xrays 3 days later showed improvement in his lungs but his kidneys were not doing so well. His creatine was 3.2 and his BUN was 184. They immediately dropped the dosage of  Furosemide to .4ml 2x day, Pimobendan ½ tab 2x day.

When I returned home, I followed up with a cardiologist at a veterinary school/hospital near me (8 days ago) and his creatine and BUN are still severely elevated but they chose to continue with the .4ml Furosemide 2x day. The next day he started having diarrhea and vomiting.

I spoke with the cardiologist and we agreed I could lower the dosage of Furosemide in small increments and monitor his breathing. She said I may have to accept that he has kidney failure from the high dosage of Furosemide he was given at the start. In one week I dropped his dosage down from .4ml 2x day to 1.5ml 1x day in the morn. His breathing is 18 while sleeping and 35 when awake. The cardiologist said the diarrhea was probably due to the change in his diet to canned kidney/heart dog food.

His diarrhea became mucous/bloody yesterday and very smelly. The veterinary/school hospital is open 24 hours so I called late last night and explained everything to the vet on staff. She did not seem concerned and encouraged me to make a regular appointment which the earliest I can get is in 3 days.

The days are better, he eats/drinks well, urinates, sleeps most of the time. He walks slowly and stumbles a bit. I make his dog food now. The diarrhea is not so mucousy, just soft but still bloody. But the nights are the worst. After getting his afternoon dose of Pimobendan, he vomits, and the diarrhea is more frequent. He usually make it to his pee-pads, sometimes just barely.

I want to take him to ER but the vet I spoke with yesterday made me feel like I was needlessly worrying. He looks at me and I feel his pain, he wants me to make him better and I don't know how.
Helpful - 0
1916673 tn?1420233270
Hi. Your post is a really tough one to try and answer. Stage 3 kidney disease means that, with appropriate intervention, you may gain a few months to a year or so of good quality time with your best friend. However, given her age and the complication of CCF, that outcome is unlikely.

It's Catch 22 ... removing the CCF medications will increase the likelihood of the heart disease progressing, but will actually help the kidneys, because they won't be under additional toxic by-product stress. Giving the medication will improve the CCF, but will adversely progress the kidney disease.

This is a case where I would take each day as it comes, and deal with the fact that sooner rather than later, you will need to consider the obvious. When her quality of life deteriorates, and when you see "that look" in her eyes, then you'll know what needs doing.

For additional support on the kidney disease, you might consider joining our User Group - the CHRONIC KIDNEY DISEASE IN DOGS group, which s on MedHelp.

My thoughts are with you.

Tony
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Avatar universal
Hi
I've stumbled across this site whilst looking for answers .
My 14.5 Jack Russell was born with a heart murmur and eventually developed CCF. She has been on medication for years: Vetmedin, Prilactone, Fortekor and Frusemide.
Several weeks ago she became unwell and refused her normal food. I spent weeks trying various foods to tempt her to eat with minimal success; this was a very stressful time for me since the only way she takes her medication is with her food.
Our vet did a blood profile which showed that she was also in stage 3 renal failure.
At that I decided that I wasn't going to fight with her to take get tablets so I stopped them - all but the Frusemide and within 2 days she was back to eating normal food, pottering about outside and barking at passers by!! Nobody can understand it!!
However, in the past 24 hours she has started to refuse her food again, is having tremors, smells uraemic (which had improved somewhat) and sleeps all the time.
There is no cough, she is opening her bowels normally and passing urine. She does have polydypsia but that isn't new.
My great dilemma is how do I know she Is not suffering? How will I know when to call the vet to put her to sleep? I want her here but I don't want to prolong her stress.
I am spending all my time with her since February and rarely leave the house. She has been beside me at the worst times of my life and so the least I can do is be with her so I don't want her to suffer.
With hindsight I kept all of my other animals far too long clearly for my selfish reasons but it's so hard!!
Any words of advice would be appreciated
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Avatar universal
Years later, I appreciate your comment.  Thank you.
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Avatar universal
Do you know what her levels were?  Specifically BUN and creatinine?  

For a 15 year old dog, I would not go through with the anethesia for the surgery.  I tend to worry too much and would be scared to put my baby under for a dental procedure at age 15.  Too risky if you ask me.  

Moving forward, I would treat the heart and kidney problems.  Although CRF can elevate the blood pressure so upping her dosage of enalapril might be an option.  

I'd ask the vet about giving SQ fluids daily, depending on her levels.  They can really help flush out her kidneys.  Rather than epikitin for phosphorus, substitute Tums.  It's cheaper that way.  

Diet - can you give her KD canned?  It has more water and will help keep her hydrated.  Otherwise, if she is losing weight, pasta might be a good alternative.  

I'm sorry, I know how frustrating it is and scary not knowing what to do.  It may be time to find a vet who will treat your pet not just her number.  What worked for Daisy might not work for every dog.  
Helpful - 0
Avatar universal
I feel so terrible for you. I did get a second opinion and let me just say...he really has not helped. I am now overwhelmed with trying to decide between the two treatment plans and hope that I make a wise decision...
Emma is 15 in August. Young in the mind, healthy, energy...overall in excellent shape. she was dx with an enlarged heart two years ago, placed on enalapril 2.5 mg twice daily and Lasix 12.5 mg twice daily. I reduced her lasix on my own to 12.5 mg total daily...thank God. No labs were ever drawn in the five visits she was seen since being placed on medication and nothing about kidney failure was mentioned.
I requested labs to see if she could handle anesthesia for a dental and discovered my precious is in kidney failure, right CHF and collapsing trachea. So...confused....
treatment plan
Vetmedin
1/4-1/12 the dose of lasix
Epikitin- supplement -supposed to bind phosphorus
fluids SQ when necessary
I still do not know what is the best for her.
new diet--rice and turkey
Just hoping anyone out there can give a treatment plan that worked for their dog in a similar situation.
Helpful - 0
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