Dog with congestive heart failure (labs, shih tzu, yorkie, vet)

[hk002]

Hello All,

Just looking for some advice regarding dogs with congestive/chronic heart failure. My 18 year old yorkie/maltese mix has a lot of issues going on right now. He had a small heart murmur last year and upon exam 3 weeks ago the vet said his murmur has become very loud. So we did some blood work and x-ray. On the x-ray we could see his heart was enlarged, trachea collapsed, and pulmonary congestion (edema?). This murmur is caused by a mitral valve issue, forget the exact name though. The only clinical symptom he has is that heart murmur and some coughing with excitement. Though, he's started to cough during rest a few times. His coughs are not bad though, very mild. His breathing is fine and his activity is fine. He has become a picky eater in the last 2 months or so. Despite all this the vet said he is not in heart failure yet but is on his way. So we've decided to start him on medication, we just got the meds yesterday but I'm waiting until tomorrow to administer, I just want to give him and us one more normal day before we start on this medication journey. We were initially prescribed lasix (liquid form), enalapril, and vetmedin. Upon inspection of the x-ray the vet decided to take off vetmedin and prescribed theophylline which I believe is a bronchodilator for his collapsed trachea. Got to get the dog breathing right first. I did want him on vetmedin because I had heard good things about it but it doesn't go well with the theophylline. I know these meds do not cure heart failure or prevent it from happening but would it make the heart return to a somewhat normal size as the meds help it pump better? I would just like to get him off theophylline and on to vetmedin if that happens. Also what are your experiences with these meds and the side effects to your dog? I really am afraid of the decreased appetite. How the heck do you get your dog to eat the meds if they have decreased appetite? Also he's only 11.6 lbs right now, last year he was 12 lbs. I know he's older so he may just have lost weight but it still bothers me. Also how did you deal with the decreased appetite and the type of diet (low sodium) needed for heart failure? My dog does not eat that much dog food which I heard has a lot of sodium anyway and he also is super picky so I don't know what I can make that will make him eat. He's been eating more human food than dog food lately but he's even picky with that. I just want to be prepared for this appetite issue before I start the meds. Any super picky eaters out there that you had success with making your own dog food? Thank you so much and I would appreciate any words of advice/support!

-Helen

[barndog]

Helen -- First, I am sorry about your dog's diagnosis... but happy that you're on the right track with your medical plan!

I had a 15-year old Shih Tzu who had mitral valve disease for years and then went into chronic congestive heart failure and then acute heart failure (with other illnesses besides) last year.

Enalapril, vetmedin, theophylline, and Lasix are all the right meds. My dog was on on enalapril for years; enalapril, vetmedin, and theophylline for the last 5 months of this life; and those three plus Lasix the last 31 days of this life. (He was also on other meds as well.) The main side effect I saw was with the Lasix -- pee, pee, and more pee.


As for how to get him to take them -- I suggest pill pockets. If you have never used these before and your dog ends up liking them, do NOT let him see you prepare the meds in the pockets and wash your hands like crazy so he doesn't pick up the scent transfer from one thing to the other.

(I don't know you'd administer the liquid Lasix -- syringe?)

I'm sure you know this already, but just in case -- some people use peanut butter, cheese, etc for giving meds. Or you could try chopping them all up and putting them in baby food (although my dog could taste them, so this didn't work for us).

In the end, and I hate to say this because I hate to DO this, but you might have to pill your dog. Meaning open mouth, insert pill, close mouth -- all done quickly. I have never liked this method because it feels very harsh to me, but in Barnaby's life or death situation I did do it.

Food/decreased appetite -- I would say try the usual standbys. Grilled chicken, boiled hamburger, rice, baby food, eggs, cheese, a crazy concoction of all of them. When Barnaby stopped eating, I pretty gave him anything that he wanted that wouldn't kill him on the spot. Three chick-fil-a nuggets? You betcha! Fried rice? No problem!

My mother's dog has cancer and is a very picky eater, and she operates under the same theory. Just get them to eat as long as it's not something that is immediately dangerous or will create another problem like pancreatitus.

The main thing I would say is try to keep his stress level low and keep him out of the heat. And just love on him like crazy.

And you don't want to wait too long to start the meds (although the reason that you're waiting until tomorrow is perfectly understandable). As I learned, with heart failure, the condition can change quickly and abruptly.

I don't feel that I've helped you much, but these are the things that occurred to me off the top of my head in response to your questions.

Best of luck! I hope you have many more days, months, and years left with him!

[barndog]

Oh, I'm sorry, I forgot to answer your question about whether the meds make the heart return to a normal size. This is something you should ask your vet about your dog. However, in my case what it did for Barnaby was help open his vessels to pump blood out of the heart to reduce how hard the heart was working and keep fluid off the heart. It did not make his heart return to a normal size; it simply made it work less hard.

[hk002]

Thank you for your support and advice. I really appreciate it. One additional thing that concerns me that I just thought of was he has increased BUN already. His bloodwork from 3 weeks ago showed this although at the time he had a bout of enteritis so not sure if that was what caused it. So I am afraid to give him lasix and enalapril which can increase his BUN and send him into kidney failure. I'm so frustrated on what to do. I will have to call my vet and see what we can do. This is a new vet so he doesn't have the results from 3 weeks ago but we did a new blood test on Saturday and the results come out today so I'll see what he says.

[barndog]

Hang in there! Dogs with complicated medical histories are tricky.

Barnaby had a situation (bleeding ulcer caused by arthritis meds) that sent his BUN level into the 80s back in 2008, and he successfully took enalapril the whole time with no issues. Short story: he took sucralfate to treat the bleeding ulcer and the BUN level dropped back to just above high normal, although he did have to be re-tested ever three months to make sure the values remained stable. My point with that is a high BUN level doesn't have a be-all/end-all situation. I also used a probiotic with him specifically for kidneys called Azodyl.

Lasix -- I'm not sure about Lasix with kidney damage because of how hard it works the kidneys.

If you have a vet you trust -- cardiologist or internal medicine specialist or just regular vet who has extensive experience with dogs with complicated histories -- this process will be easier. If you are in NC by any change, I would be happy to recommend some vets to you.

Barnaby's internal vet specialist saved his life numerous times and made the quality of his life the very best until his death, and I'm talking about two bouts with Rocky Mountain Spotted Fever to kidney damage to seizures to two ruptured discs to dementia to heart failure. He really wore his body completely out in almost 16 years of life and was happy until the very end.

I wish that for all dogs.

[runswithscissors]

I medicate alot of clients' dogs.

I tried compounding my OWN dog's meds at a pharmacy into a liquid but sometimes the taste is so awful they foam it out inadvertently.Even IF you add flavors like beef, bubble gum, etc. I tried it myself and I had the same reaction! Foam and numb mouth for an hour. This dog had a bleeding ulcer, gi infection, acid reflux, and megaesophagus so he was certainly not typical and had a regimen that had to span hours.

Anyway, I have a few tricks. With megaesophagus you have to find any way possible to get fluids, food, meds down. Example: One clever one we use is making chicken broth gelatin cubes. Then "throw" them down the throat while in an upright position shoulders level/perpendicular with neck. (these dogs can't swallow). But for "normal" meds once or twice a day there are easier ways. (and nothing here works for sucralfate so nobody do these things with that med - no food or gelatin you will create a blockage as barndog knows!) And yes dogs can seem like they're on their last legs and you freak out then they can have a miracle recovery.

Anyway, The newest one I do with a 15 year old 11lb dog on enalapril actually, and proin 2x day...is I found she loved chicken/turkey. Her diet is Hills ID. Turkey based. I tried with a piece of lunchmeat and it was great.

The former sitter pilled her when she started rejecting her pills in Hills ID meatballs. That is not my preference, I always try and engage the dog into moving FORWARD, wanting to participate in the meds. Not force it. The owner lives in an assisted living facility with mild dementia. I also have the challenge of stopping the owner from overfeeding Milkbones or contraband like NUTS and crap. But even the dog is sick of them by now LOL.

Of course sometimes you HAVE TO force it, pilling them. Period. The way to do that is not surprise them and PATIENCE sitting a long time and showing them what you're doing. And try and find a positive reward like massage or even a piece of food "chaser".

Here's my routine for this dog, I stopped pilling her the 3rd day i had her when I decided to try chicken and it worked:

I poach chicken breast strips (tenders) at home in the microwave and save the poaching liquid and make small ice cubes like 1/4 of a normal cube to be used later in her food/on her plate. I include the tiny shreds of bits of chicken on the bottom of the pan in the poaching liquid for the ice cubes. (I microwave, actually for like 5 minutes on half power to cook).

I freeze the pill size pieces of chicken. Large enough to be an envelope for the pill.

Before serving her two meals a day, I defrost the chicken and make my own "pill pockets" out of chicken. Be careful you don't nuke it HOT and burn the dog! Only thaw temp. I use a drop or two of Easy Cheese or Cream Cheese as the "glue" to hold the pill inside and "seal the envelope". At first I used alot and cut back. I've also tried turkey meatballs (tiny) but they can crumble of they're too firm so you need more "glue".

Some people get away with just Easy Cheese or other things but not this dog. I don't use Liverwurst, or beefs or chicken liver (yet) because the higher protein or fat foods can cause a gi upset or acid reflux in some dogs so I save these things for more tough times. The more bland the food the better. Even if I made an oatmeat ball but all dogs will come for meat, usually.

Anyway:

(Sometimes I walk her outside first to get her in gear, eliminate and sniffing - also my version of "working" for food haha)

NO FOOD unless she does pills first. Not a problem she's not a chow hound (except NOW, ok, she is LOL)

I prepare all three pill pockets of chicken at once to be ready to give one immediately after the other. (sometimes there's a third for Rymadyl or Flagyl).

I have her walk TO ME about one foot away...to take a piece of chicken. Plain tiny shred of chicken. (actually I only did this in the beginning now I don't have to even offer plain chicken...just sayin.) She has limited vision and it does not impair her and I want her to WANT the chicken, not sit there and not "work" for it. I will NOT put her on my lap or coax her. I say her name if anything. I want her to use her brain and get excited not be "weak" and "catered to" even though she is catered to LOLOL. I want her to make the choice and decision to get that chicken and it becomes something SHE's doing not something being done TO her. A challenge.

I offer one pill pocket and she wolfs it down. WHILE she is taking the 1st pill pocket I hold the 2nd one right in front of her as incentive to not detect or care about the pill in the 1st. Then I give the second with the 3rd pill pocket right in front of her face, or just another shred of chicken. I mean SHRED not PIECE. Like the size of a hairpin or your pinky nail. TINY. Then I give that.

Now we're finished pills and she can eat. I have the chicken smell still on my hands and the countertop with the food I've gotten out. To be honest, she's expecting and praying for more chicken but no, I have a trick for that too. AND now her appetite is stimulated.

THEN, I have already thawed an piece of "chicken water ice cube" and put it on the plate smeared around like a sauce then add the Hills ID. I don't mix it I want her to smell it on its own. I may or may not put a couple of chicken shreds on it.

She knows exactly what I'm doing, her nose can detect cancer she certainly can detect a pill. But she has been EXCITED and doing this for a solid month now 2x a day 7 days a week. She comes FLYING to me and sits in a strong attentive pose and won't move till she gets her meds in pill pockets. I can even LEAVE THE ROOM and she is still sitting under the sink where I left the food in progress waiting patiently LOL.

I discovered the love of chicken and the chicken water incentive to eat the Hills because I PLACED the chicken pill pocket on her plate for 5 seconds before giving the pill. THEN, when I put the food plate down with the Hills ID on it...she focused STRICTLY on the tiny spot where the chicken was. It was so CUTE. So I was like Ah HA!

Now I spread the poaching liquid on the plate of food and she eats happily where she was down 3 lbs before.

This will likely change and I'll have to come up with something else. But as long as she is moving FORWARD to sniff grass, then sniff food then take it I will keep finding new things to hide pills in.

BTW TWINKIES work, too. The cream in the center holds the pill in there.

[1969351]

My dog does not have CHF, but is at risk for it and has DCM. He is on most of the meds you mentioned plus many more. the one he is not on is theophylline, but he is taking pemo(vetmedin).

He is a very picky eater and finally found a food he loves, Orijen Senior formula, not the cheapest by any means but very good quality and low sodium, I also put a little pumpkin mixed in with it. Actually his cardiologist wants him to stay as thin as possible, 150 is where they want to see him as less stress on the heart. Try getting a 175 lb dog to diet....

For giving him the pills I have found he is happiest with them rolled in turkey sliced from the local deli, pill pockets did not work for him, trying to force the pills didn't work, but the turkey was the winner.

Side effects, I do find him sometimes just looking of into space, and there are times he seems a bit unsteady on his feet. And he does seem to sleep a lot, I think he sleeps more than the cats I have. The one thing we do have is lots, read 3-4 per year, bladder infections, probably from the Lasix and not getting out often enough.
Couple things we have been told. Try to avoid extreme heat and cold, no running outside, in fact not allowed off leash in outside. Plenty of water available at all times.

Best of luck..

[1969351]

One thing forgot to mention. The meds can sometime upset stomach, cause GI issues, at least they do with my guy. What has helped is I give him Pepcid AC, 2 tabs AM and 2 PM. His cardiologist recommended that and he has been on it for 4 years with no issues. Might want to run that by your vet in case you dog gets some GI issues, and for the proper amount.

[joycebrown]

Originally Posted by barndog

Hang in there! Dogs with complicated medical histories are tricky.

Barnaby had a situation (bleeding ulcer caused by arthritis meds) that sent his BUN level into the 80s back in 2008, and he successfully took enalapril the whole time with no issues. Short story: he took sucralfate to treat the bleeding ulcer and the BUN level dropped back to just above high normal, although he did have to be re-tested ever three months to make sure the values remained stable. My point with that is a high BUN level doesn't have a be-all/end-all situation. I also used a probiotic with him specifically for kidneys called Azodyl.

Lasix -- I'm not sure about Lasix with kidney damage because of how hard it works the kidneys.

If you have a vet you trust -- cardiologist or internal medicine specialist or just regular vet who has extensive experience with dogs with complicated histories -- this process will be easier. If you are in NC by any change, I would be happy to recommend some vets to you.

Barnaby's internal vet specialist saved his life numerous times and made the quality of his life the very best until his death, and I'm talking about two bouts with Rocky Mountain Spotted Fever to kidney damage to seizures to two ruptured discs to dementia to heart failure. He really wore his body completely out in almost 16 years of life and was happy until the very end.

I wish that for all dogs.

In the post above you mention you could recommend vets in NC - I am in the Winston Salem area.
Do you know someone you recommend here as we rescued a 6 y/o Pom in Sept. 2013 and we've had her to our vet multiple times w/what we perceived to be bladder/kidney issues and in the end he determined she had bladder stones which he removed. During all the visits I would ask about the coughing/choking she would do and he said he checked her for a collapsed trachea while she was under for the bladder stone surgery and it was fine. after reading the post you responded to where the lady's dog had a cough that worsened and the diagnosis was heart issues i'm beginning to worry about Lizzie.
Any suggestions would be appreciated. Joyce

[XmbsX]

Hi JoyceBrown - yes, do not ignore the cough/choking. Our Shi tzu developed the cough & choking and we were unsure as to why this would have developed. We waited to take him to the vet for it, thinking it may have been "allergies" or "dry air" when the weather turned colder. We were wrong. After a month & nothing we were doing was helping the cough, we took him to our Vet. They knew immediately (& any capable Vet will too) to take X-rays, b/p, & labs for the true cause = cardiomyopathy, a precursor to CHF.
Our Shi tzu has been on a multi-medicine treatment regime for 6 1/2 months now. The last 2 have been the most difficult for him & us, as his CHF is acute at times. Sadly, it's clear to see that we are nearing the end with our special little guy. I am glad for the medicine & good vet care, which has helped us to have as much time as possible with our little angel.
Good luck with your Pom.