Water retention

[starflyte1]

My husband has had CHF for seven years.  He has also had an ICD for those seven years.  He lead a very active life until Feb of this year, but has been hospitalized 4 times due to water retention.  The past three times he would be released from the hospital only to have to return in days.  He has been on a lasix iv drip for almost 72 hours now and is finally feeling better and breathing well.

My question is, how can he keep the water off at home?  Lasix at home is not working well.  His kidneys are ok, not perfect, but ok.  The doctor does not want to increase the oral lasix because of kidney damage, but if something can't be done, what does he do?  Go to the hospital about every 5 days, stay for 3 days while he gets lasix iv, go home and start the cycle all over?

And, this may seem like a really dumb question, but what type of doctors care should he be under?  GP, kidney, or cardioligist?  

[theredjackal]

Sorry to disagree, but the Lasix in the pill form isn't as strong as the Lasix in the liquid form in the hospital.  Unfortunately, you have to do both.  Take the Lasix at home....the fluid retention will slow build up.  And then you have to check yourself into the hospital for about a week of liquid Lasix.

[gmachris518]

My heart, when they installed the ICD, was at 15%, and they haven't checked again since the surgery.   However, I can tell you it has to have went up because of the way I feel.  I will see my Cardiologist Aug. 26th, and he will most likely set me up for an Echo Cardiogram to check my HR.

I, now, only take 12.5 mg of Coreg once a day, along with vitamins, and 160 mg of lasix, once a day, and it's working for me. :)

I hope the very best for both of you!

[jrbon]

If nothing has changed in February, when he started with retaining liquids, has his HF getting worse?

It has been any change in NT-BNP or Ejection Fraction or Heart dilatation?

Be aware that for Lasix to be most effective the stomach should be empty. I take it first thing in the morning.

What has been the doctor recommendation regarding liquid intake?

I guess that he is already following a low protein diet to protect his kidneys.

How is his BP? If it is very low, that also can produce kidney damage.

By the way, since you asked it ... what sort of doctor is treating him.

Jesus.

Jesus

[starflyte1]

Thanks to all for the replies.  gmachrist, what is your heart function rate? Thanks for the pep talk.  It is great that you feel so well and are a real encouragement.  jrbon, 80 mg of lasix is not working to keep fluid from building.  He was in the hospital 5 days, rehab 5 days and back in the hospital for 5 days.  Now he is home. (1 day).  jrbon, in addition to the 80mg lasix, the doctor added metolazone 10mg two days a week.  neurotic, and icd is a defibulator in Burt's chest.

Thanks again for the answers.  We like our doctors, but it is nice to have someone who is experiencing the same thing answer.

[gmachris518]

"And, this may seem like a really dumb question, but what type of doctors care should he be under?  GP, kidney, or cardioligist?"

The answer is all 3.  GP for the small stuff, kidney for the renal problems, and cardiologist for the heart failure.

At home he should be drastically limiting salt(sodium), or anything with salt(sodium) added.  He should try to stay with fresh meat, vegetables, and fruits, with low sodium breads.  EVERYTHING he consumes needs to be low/no sodium.  

If he finds himself thristy a lot of the time, he could suck on crushed ice.  It seems to work better than plain water for quenching thirst. and it takes a lot less to get the job done.

If he drinks alcohol, he needs to quit.  If he smokes, again he needs to quit.  If he has excess weight, he needs to lose it.

If he is sedentary, he needs to get up and move as much as he possibly can, but never to the point of not being able to catch his breath, or carry on a conversation.

And above all the rest, he needs to take his medication everyday, on time, without fail, and keep all appointments with his doctors.

I've been through CHF, have stage 4 heart failure, stage 5 kidney failure, receive dailysis 6 days a week, have an ICD in my chest, and I'm feeling great!  So, you have to know, it is possible.

I hope the best for your husband and you.......

[jrbon]

By the way, I am under control of a cardiologist.

Jesus

[jrbon]

When I suffered my first (and only so far ) pulmonary edema I was told that I should suppress all salt intake and reduce fluid intake. Following that I has been lucky of not having any further problem.

Why do you say that Furosemide (Lasix) at home does not work?  If he is taking it for long time some insensitivity can be developed. I personally had to switch from Furosemide to Torasemide when the Furosemide no longer worked. Other people change to Bumetadine.

In any case we aware that the doses are not the same.

Of course always there is the option of increase the doses or the combination of 2 different types of diuretics eg: Furosemide + Epleronone

In any case it is required close blood monitoring (at least every 3 months) to be sure that sodium and potassium are at the right levels.

It is also important to log your weight every day and report if there is sudden increase for several days.

Jesus

[neurotic]

By CHD...you mean congestive heart failure...Is the fluid around his heart? if it is he should be under the care of a cardioligist and if he has kidney problems he should also be under the care of a kidney specialist.  what is ICD?....I hope they find a solution for him.