chf and diuretic question

[Debster]

Hi Everyone! My mom had mitral valve replacement last year. She has chf issues and is on Lasix-40mgs 2x a day. However, this is hard on her kidneys.(increased creatine and BUN levels) She is seeing a kidney specialist on Friday-anyone have these issues and how are they handled? Thanks for any input! Debbie ps The Lasix has really helped with her fluid-not sure if she can go down in dosage....

 

[Ross]

Hi Debbie

When it comes to CHF, they have to do whatever it takes to get the body to lose the water. What your mom is on now is nothing in comparison to me. I'm on 40mg Lasix X2 a day, 12.5mg Hydrochlorathiazide, 7.5mg Zaroxolyn and 25mg Aldactone. All of these will affect BUN/Creatinine and kidneys and chew up your potassium levels too. Unfortunately, there aren't any choices in the matter. I'd like to know what your moms Kidney Doc has to say after the consult.

 

[Nancy]

It is a very rough situation when kidneys start to complain about diuresis.

My husband is on the "horns of the dilemma" right now.

His kidneys were/are in chronic and then acute failure. His diuretics were reduced drastically to try to save his kidneys, and then he was switched to Demadex. He was formerly on a huge dose of Lasix and Aldactone, and still not excreting enough. His docs thought he had become refractory to Lasix.

The Demadex is clearly not doing ANYTHING for his fluid retention. He has rigid edema with cellulitis from feet to knees and above that, soft edema w/o cellulitis. He can hardly move his legs, they are so congested and is in Stage 3 CHF.

We have an appt. today with one of his doctors, and I will be asking about going back to Lasix.

It is a balancing act. And there are many potholes along the way. CHF is tricky to manage, especially when the kidneys are not happy.

In my husband's case, his kidneys usually come around after a little rest.

I think they have had enough rest now, and it's time for them to start working.

If further diuresis does not work, I'm not sure what the alternatives are. Dialysis has been mentioned, but I don't think we are at that stage yet.

Kidney failure from CHF can also lead to anemia.

So make sure that she is being monitored very. very closely.

By the way, Joe is on a very strict sodium restriction of no more than 500mg per day. And he weighs himself each morning. Plus, now we are monitoring input and output.

So we are doing everything we can possibly do at home to help with the issues. But they still ebb and flow. Wish I knew why.

 

[Debster]

Thanks Ross-will let you know what he says-Deb

 

[Ross]

I know I'm still working on my worst round of it ever. Even with all that I'm taking, I'm not putting out any more then I'm taking in. What's worse, is not knowing the specific cause of it. You just blow up and that's that. I couldn't breath it was so bad.

 

[Debster]

Hi Nancy! You are so right-my mom is fortunate not to have some of the issues Joe has, but it is such a medical tightrope to be on! She is on low sodium too, and keeps a log of weight, blood pressure and heart rate every day. We shall see what Kidney man has to say-but as Ross said-that fluid has to stay off. Good luck at dr today-keep us posted Deb

 

[Nancy]

Deb-

There are heart meds that can actually make CHF worse. My conversation with the cardiology NP this morning made some changes in Joe's meds. One of those was to stop his Cartia (calcium channel blocker). One of its side effects is peripheral edema and worsening of CHF. And it was right around the time that he was started on it that he started to develop worsening symptoms. She told me that she had other patients who had developed the same thing.

So we'll see if this makes any difference.

On the brighter side of things, Joe has been in very extreme CHF situations, and has always been able to weather them and have his symptoms improve. So we never give up on CHF.

I do have to remind medical people from time to time to not give up on Joe either. They do get frustrated, because his treatment margin is limited, like dancing on the head of a pin. But he's still here and still needs to be treated. It always surprises them when I mention that, since I don't believe that they realize that it sounds like they're giving up. They just have to dig deeper in their bag of tricks.

 

[Mary]

Debbie,
Nancy mentions that Joe is on a sodium restricted diet of less than 500mg a day. This is very low! Sometimes, unless a person tracks the amount of sodium, I don't think they realize how much they are actually ingesting. I know that I didn't!
Since I"ve followed Nancy's advice, my fluid retention level is back under control. However, I've learned that all it takes is one or two days to undo the good I've done, if I don't watch the sodium.
Best of luck to your mom at her appointment.
Mary

 

[Nan]

Hi Debbie, hope that the kidney doc has some help for your mom. I will also be interested in what s/he has to say...my bun and creatinine are creeping up, have to go for another test this week.

Ross and Nancy(Joe), sorry to hear that you are struggling with this also. Both of you have had to deal with so much. Enough already! It's an awful feeling not being able to breath.

 

[bvdr]

Deb-

There are heart meds that can actually make CHF worse. My conversation with the cardiology NP this morning made some changes in Joe's meds. One of those was to stop his Cartia (calcium channel blocker). One of its side effects is peripheral edema and worsening of CHF. And it was right around the time that he was started on it that he started to develop worsening symptoms. She told me that she had other patients who had developed the same thing.

So we'll see if this makes any difference.

On the brighter side of things, Joe has been in very extreme CHF situations, and has always been able to weather them and have his symptoms improve. So we never give up on CHF.

I do have to remind medical people from time to time to not give up on Joe either. They do get frustrated, because his treatment margin is limited, like dancing on the head of a pin. But he's still here and still needs to be treated. It always surprises them when I mention that, since I don't believe that they realize that it sounds like they're giving up. They just have to dig deeper in their bag of tricks.

Nancy, I can not tolerate calcium channel blockers for the very fluid issues that you mention. I have been on them three or four different times and it is always the same. Maybe coming off of them will also help his PH. I sure hope so!

Deb, I'll be real interested in learning what helps your mom. My cardiologist really wants me to take an extra of my non-lasix diuretic when necessary rather than go right to lasix. I think more is being learned about lasix and how it affects neuro-hormonal levels and may have other not necessarily positive effects on our natural continual attempt at homeostasis(the basic response of our systems to keep everything in balance).

 

[Debster]

Thanks so much for the input everyone-will post after mom sees Dr Kidney

 

[twinmaker]

I can relate to this senario. I'm on 80 mg of Lasix 1 x day and 25 mg of aldatone 1 x day. I try to watch my sodium intake and feel like I keep it pretty constant. But some days, I run to the bathroom every 15 minutes and other days it just seems like I don't lose any fluid and I feel and look like a balloon. It's a mystery. I've been on different diuretics since 1974. My doctor just started the lasix a year ago because my dyazide wasn't doing the job. I hope they can get things straightened out with your mom. I know it's frustrating.

 

[Debster]

Hello all-thanks so much for your input. Mom saw Dr Kidney today-he says her kidneys are not terribly bad and wants her to stay the course on her meds. He says probably the biggest impact on them is th high bp she had for years before valve surgery. Thanks to Coreg and ACE Inhibitors, he bp now averages 100/55 or so. Anway-she is supposed to have some kind of kidney test in March-not sure what it is but will get more info out of her soon. I still think Lasix must be hard on the kidneys too...more info as I get it-you guys are awesome Deb