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Dr. John
Dr. John, Texas Veterinarian
Category: Dog Veterinary
Satisfied Customers: 11377
Experience:  Over 14 years of clinical veterinary experience
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He has been diagnosed with Congestive Heart Failure and renal

Customer Question

He has been diagnosed with Congestive Heart Failure and renal failure. Renal Failure dx was about 2 years ago. CHF 3 weeks ago. I had him in ER 3 wks ago due to coughing and difficulty breathing. This is when he was dx with CHF. I gave him medication for the fluid and he did better for a week, eating again, etc. A few days ago he stopped eating most anything, will drink water, has started having seizures at night. I was told what will help his heart will do more harm to his kidneys and what will help his kidneys will do more harm to his heart. His numbers for his murmur is 1-2 which tells me his heart is pumping ok. I believe what he is experiencing has to do more with is kidneys. The KD diet did well for the past couple of years but since he won't eat, I have given him whatever makes him happy, now he has no interest in food. He is 14 1/5 yrs old. I was told he could see a cardiologist for meds which will help balance his kidney and heart diseases, however that means many labs, echoes, and other tests the doctor mentioned. It is so stressful for him to go to the dr. now. I don't want him to feel the anxiety of all the tests wondering if this will even be helpful at this point. I love him so much and don't want to see him suffer and would do anything for him. I don't know what is the right thing. If I knew all these tests and medications would make him well or give him much more time, I would do it without hesitation. I am doing what I can to make him comfortable. A/D diet, pedialyte, fluid medication for his CHF. If you have any suggestions, I am open to them. I want him comfortable and happy for the remainder of his time.
JA: I'm sorry to hear that. Seizures always look scary. Let's get you talking to the Veterinarian. What is the dog's name?
Customer: Casper
JA: Is there anything else important you think the Veterinarian should know about Casper?
Customer: He's a fighter and very important to me. :)
JA: OK. Got it. I'm sending you to a secure page on JustAnswer so you can place the $5 fully-refundable deposit now. While you're filling out that form, I'll tell the Veterinarian about your situation and then connect you two.
Submitted: 1 year ago.
Category: Dog Veterinary
Expert:  Dr. John replied 1 year ago.
Hello. Thanks for writing in. My name is***** and I would be happy to help you. I am not set up to do phone calls but would be happy to answer any questions you do have online. You are definitely in a very difficult situation here. Managing two different problems at the same time is not easy. There is a fine balance, but there is never a perfect way to manage both. You just have to do what is going to cause the least amount of harm. While is may seem so, the severity of the heart murmur is not always correlated with the severity of the heart disease. If the heart disease is bad enough to cause fluid build up in the lungs, it is bad. I am assuming that the fluid medication is a diuretic. Any diuretic is not ideal with a chronic kidney disease, but furosemide would be the best choice and should have the least amount of effects on the kidneys. You just have to make sure that plenty of water is always available because it will make him urinate more. If water is not available, and he gets dehydrated, that can be very bad for the kidneys. The goal of giving a diuretic is to give as little as possible to control the fluid buildup. For some dogs, that may be twice daily. For others, that may be every other day. It just requires adjusting dosage as needed. Medications such as enalapril and benazapril that we use for heart problems have to be used with caution with kidney problems, but lower doses are actually used to treat some kidney problems, so they are not contraindicated, but those values do have to be monitored. A medication like pimobendan will have a stronger effect on the heart and less effect on the kidneys, so that may be an option. With any of these medications, drug monitoring is necessary to make sure there are no serious issues developing. That may mean rechecking in 1 months, 3 months then every 6 months; so it shouldn't be very often, unless problems develop. It is difficult to predict how well these medications will help. Of course, getting an ultrasound done on the heart by a cardiologist would probably help to give a better idea of prognosis with these medications. As far as eating goes, it is more important for him to eat the wrong diet than not eating the right diet. Make sense? You can also try the H/D or G/D diet from Hill's that can help with both kidney and heart disease. If he is doing very well on what he is on now, it would be hard to argue against just letting him be happy with no other treatment, until he starts to become worse, and the decision to euthanize is made at that time. Even just one echo and consult with a cardiologist may help to steer in the right direction as far as medications that may be absolutely necessary. If he was mine, I would probably continue the diuretic at the lowest effective dose, put him on pimobendan to improve heart function, continue the fluids under the skin for his kidney issues and even consider using some thing like Azodyl (not a prescription medication) to help with elimination of toxins in the blood that the kidneys may not be filtering out well enough. If in congestive heart failure, that will probably kill him faster than chronic kidney disease will, so getting control of the heart disease would probably be my main goal. I hope this makes sense. Let me know if you have further questions or concerns. My goal is to make sure that you get all your question answered and all the information you need. If you are satisfied with my answer, PLEASE RATE IT. Rating it is the only way I get credit for helping you. If you feel like it is not helpful to you, or if there is more information you need, please respond back to me before rating. Realize that our conversation is not intended to diagnose or treat a condition. There has to be a valid veterinary-client-patient relationship established with an exam, according to law. You should always follow up with your vet.