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Veterinary Information - Cardiovascular Disorders of Dogs   Vetinfo  Vetinfoindex Vetinfo4cats Catindex Vetinfo4dogs Dogindex Q&A Links Subscriber Area (members only) Zoonotic disease Becoming A Veterinarian Your Turn Search vetinfo4dogs Support Vetinfo and Subscribe toVetinfo Digest       Cardiovascular Disorders in Dogs Spironolactone and Enacard for treating arrhythmia Chronic heart failure - could Enacard be causing arrhythmia Heart disease - failure of the mitral valve Treating heart failure Enlarged heart Enacard for early cardiac insufficiency Heart blockage lasix for dog - pacemaker implant Heart problems possible in older Schnauzer Enlarged Heart in Westie Heart disease in Westie Fluid around heart Heart valve problems and Enalapril Syncope (fainting due to heart disease) Heart disease Vascular ring anomaly Heart lasix for dog Related Problems also see Heartworm Disease also see Heartworm Treatment also see Cardiomyopathy also see Heart Murmur also see Respiration also lasix for dog see mast cell tumors Spironolactone and Enacard lasix for dog for treating Arrhythmias   Question: lasix for dog Dr. Mike: I am a new subscriber and think your site is excellent! I will lasix for dog try to make this as lasix for dog short as possible. Muddy is a 15(?) year old spaniel mix.  He looks most like a King Charles - only black.  I got him for 14 yrs ago from a shelter.  He weighs 23 lbs (I can feel his ribs) and until recently appeared perfectly healthy except for a heart murmur.  Although certainly not as spry as when he was a kid - he can still do stairs and a brisk, 2+ mile walk without a problem.  No breathing problems and he never coughs. In checking him prior to surgery for a Sebaceous Epithelioma, my vet sensed an occasional arrhythmia.  X-rays were followed by an echocardiogram.  Basic diagnosis below... 1.  Mitral lasix for dog Valve insufficiency w/ flail carnial mitral valve leaflet. 2.  Concurrent tricuspid insufficiency. 3.  Right and left atrial enlargement.  (Mostly left, right is mild) 4.  Occasional arrhythmia. Suspect atrial premature contractions. He is lasix for dog taking Enacard (.5 mg/kg)  and  1/2 tab of a 25 lasix for dog mg/ 500 myl Spironolactone once a day for about 3 wks now. lasix for dog He is not taking any Lasix at this time. Considering that he had no lasix for dog prior symptoms, I am very concerned about the side effects of this combo of medications.  My research shows lasix for dog the potential for dangerously high potassium levels, as well as a detrimental impact on his kidneys in lasix for dog general.  I think the vet thinks I'm over-reacting. (See www.petrx.com/insert/enacard.html) I would like to hear your lasix for dog opinion lasix for dog on his treatment, as well as what kind of follow up is needed and how often -- if money is lasix for dog no object. What is the real potential for problems?  I would also like to know if you think that lasix for dog a special diet and/or supplements are in order. Thanks so much for your lasix for dog help. lasix for dog Karen   Answer: Karen- The potassium sparing lasix for dog effects of spironolactone, alone and in combination with enalapril (Enacard Rx) are supposed to be much less of a problem for dogs than they are for people. This is the consensus of several veterinary cardiologists based on the information in lasix for dog the texts that I have. So this is probably why your vet is not especially concerned about using this combination lasix for dog in treating Muddy.  Despite this, there is a recommendation in Dr. Fox's text (cited below) to lasix for dog monitor lasix for dog potassium levels lasix for dog when using spironolactone in combination with enalapril and related medications. It is relatively easy to draw blood at regular intervals until it is evident that there is or is not going to be a problem. Among the veterinary cardiologists whose opinions I am familiar with there is not as much enthusiasm  about spironolactone as there is among human cardiologists, though. They still lasix for dog really prefer furosemide when a diuretic is necessary, feeling that it is more effective. The current thinking on spironolactone in people seems to be that its major benefit is inhibiting aldosterone and lasix for dog that low dosages are just lasix for dog as effective, with 0.25 to 1mg/kg/day having this effect. If the intended lasix for dog use of the spironolactone is to lower sodium levels by inhibiting aldosterone then the potassium sparing effect may not be as great as it is when spironolactone is used to produce diuresis, since lasix for dog the dose for this use is 1 to 2mg/kg every 12 hours. It is supposed to be acceptable to use both furosemide and spironolactone when using spironolactone in the lower dosage range  (0.25mg to 1mg/kg/day). Arrhythmias are worrisome and it would probably be best to consider having an examination by a board certified veterinary cardiologist if that is possible to arrange and you haven't done that in the visit to have the cardiac ultrasound examination done. Atrial premature complexes are not dangerous by themselves, according to Dr. Fox's book "Textbook of Canine and Feline Cardiology" but they can be a sign that a more serious problem is present, such as heart muscle weakness or cancer affecting the heart. A cardiac specialist can give you the best idea of the prognosis for the degree of valve failure present and lasix for dog the best intervals for monitoring the progress of this problem.   Mike lasix for dog Richards, DVM 12/4/2001   Chronic heart failure - could Enacard be contributing to arrhythmia Question: Dear Dr. Mike, Our 12 yr. old, 18 lb. mixed lasix for dog breed dog has been under treatment for CHF due to mitral valve lasix for dog failure. He has been taking Enacard (5mg/day) for the first seven weeks and is now also getting Lasix every other day.  He is being fed a low-sodium diet.  During his most recent examination, a heart arrhythmia was noticed.  No lab tests have been performed on him since starting on Enacard.  His respiratory rate is often around lasix for dog 40-45, with shallow breaths. His appetite is still good and no obvious changes in his lasix for dog urination have been noticed.   He no longer likes to be picked-up from under his shoulders, which used to not be a lasix for dog problem.  We can lift him supporting all four legs, which doesn't seem to cause lasix for dog him any discomfort. My questions are: 1)  Could the Enacard be contributing to the arrhythmia? 2)  How will we know if his lasix for dog kidneys are being lasix for dog affected since no lab tests have been performed since the Enacard? 3)  Is the high respiratory lasix for dog rate due to his heart condition, the medication, or a combination of the two? 4)  lasix for dog Is his chest sore from lasix for dog his condition, since he doesn't want to be picked-up in a certain way? 5)  What are safe lasix for dog supplementation dosages of coenzyme Q10 and l-carnitine? Thank you very much for your help and lasix for dog for providing this valuable service for pet owners. Sincerely, Mark Answer: Mark- 1) I did lasix for dog not find any reports of arrhythmia as a side effect of enalapril (Enacard Rx) on the package insert or in the two pharmacology texts I  checked. However, there is mention of a problem with hyperkalemia (too high lasix for dog potassium lasix for dog levels) in some patients who are being treated with enalapril and furosemide (Lasix Rx) and this could conceivably lead to arrhythmias. I suspect that isn't a common problem but it may be something to think about and it is pretty easy to check the potassium levels to make sure they aren't a problem. In addition, in dogs with pre-existing arrhythmia who are on anti-arrhythmia medications there is an lasix for dog increase in cases of sudden death in dogs taking enalapril, even though the survival times overall tend to be longer for these patients. 2) If he stopped eating or you lasix for dog noticed a marked increase in lasix for dog drinking and urinating (which may be hard to detect since furosemide causes this) then you should worry about kidney damage. lasix for dog It is much better to check for kidney damage lasix for dog through a urinalysis and blood chemistry testing after using enalapril, though. The lasix for dog best approach lasix for dog is to check the kidney related blood chemistry values and to a urinalysis weekly for the first month of therapy and then every 3 to 6 months, but few vets do this lasix for dog since many clients would refuse the medication if strict adherence to these testing schedules was insisted on. However, for owners who wish to be cautious, this is the recommended approach. We test after 5 to 7 days of use, when possible, and then try to get a test in one month and then at longer intervals (exact timing depends lasix for dog on the patient and the client). 3) I would lasix for dog suspect that the high respiratory rate is due to his heart problems, although I wouldn't want to rule out an undetected respiratory problem since things like laryngeal paralysis are common in Labradors. I can't recall seeing this kind of increase from the lasix for dog medications being used in lasix for dog our patients. 4) Lots of dogs with heart disease don't want to be picked up by any method that might compress their chest. I don't think this is from pain, lasix for dog I think that they get uncomfortable quickly when there is lasix for dog any compromise in their ability to move air or blood and so they get wary of these types of situations.  I could be wrong, that is just my impression. 5) Dogs are usually given 220mg/kg of body weigh of l-carnitine every 12 hours up to a dosage of about 2 grams per 12 hours.  There are a number of dosages for lasix for dog CoEnzyme Q10 that I have seen but the range is usually between 30 and 90mg every 12 hours. Mike Richards, DVM 8/24/2001     Heart disease - lasix for dog failure of the mitral valve Question: Dear Dr. Mike, I am sorry to hear of your health problems recently.  I lasix for dog surely hope that they do not turn out to lasix for dog be something serious or untreatable. I have a little lasix for dog chihuahua/terrrier spayed ten-year-old  female dog who began to cough several months ago.  After a while when the cough would not go away, I brought her to the vet.  An ultrasound has determined that she has Left Atrium enlargement, and the valve that goes into the fourth chamber has scar tissue lasix for dog on it, causing leakage (back flow) of blood and a loud heart murmur.  In addition, a small quantity of fluid was found in the lungs and her liver is enlarged. Blood work came out well: kidney function is fine, and there is no sign of Cushings disease. She is on Lasix and Elanfronil (sp?), the first to reduce fluid buildup and lower blood pressure, the latter I think to alter the kidneys' signal for more fluid. Also, she is lasix for dog on Pepcid AC to reduce acid because some lasix for dog gastrointestinal bleeding was found I think. Sometimes she collapses suddenly, and the vet has said that's due to the leaky lasix for dog valve and not enough oxygen-rich blood going to the brain. What I want to know is this: 1. How much and what type lasix for dog of exercise can you recommend? 2. What type of diet?  She is finicky.  We are trying to get her down from 14 lbs to about 10.  I changed her lasix for dog diet two weeks ago and she's already lost 9 oz. 3. How serious does this sound to you?  Is her life in danger? Can she have a heart attack?  Can a chamber burst? 4.  Should I have any concern about the medications? This is a very special little dog, highly intelligent, highly lasix for dog charming and humorous.  I'd like to keep her around as lasix for dog long as possible, of course! Any help and insight would lasix for dog be greatly appreciated, Wendy   Answer: lasix for dog Wendy- I am doing well now. lasix for dog I appreciate your concern, though. I feel fortunate that nothing serious was found.  From your note, it sounds as if your dog has failure lasix for dog of the lasix for dog mitral valve, which is the valve located between lasix for dog the left atrium and the left ventricle. This is the most common valve failure in older dogs. Failure of this valve usually eventually leads to chronic heart failure, as the heart becomes less efficient and is unable to pump adequate amounts of oxygen rich blood out to the body. The brain is the most oxygen sensitive organ in the body and some dogs with mitral valve failure will have episodes of syncope, or fainting, due to periods of inadequate oxygen flow lasix for dog to the lasix for dog brain. This is most common after a bout of severe coughing occurs. It is a serious sign because it indicates lasix for dog that there really is a serious lack of oxygen to the brain at times. It is often possible to help the heart a great deal when mitral valve insufficiency is present. The ways this can be done are to lower the blood pressure, making it easier for the heart to pump blood into the circulation, lower the volume of blood the lasix for dog heart has to handle, and increase the strength of the heart muscle. It is also possible to replace the valve in larger dogs but this isn't done very often. Lowering the amount of sodium in the diet lasix for dog to reduce water lasix for dog retention (and blood volume) is helpful. Diuretics lasix for dog such lasix for dog as furosemide (Lasix Rx) also help to reduce the blood volume, as well as having some effect on blood pressure. Furosemide has a minor anti-inflammatory effect, which can also help a little in controlling the coughing. Enalapril (Enacard Rx, Vasotec Rx) and other angiotensin-converting enzyme (ACE) inhibitors have several beneficial effects. Angiotensin II is released by the kidneys (and other organs) and lasix for dog causes the blood vessels to constrict, which raises lasix for dog blood pressure. Kidneys like high blood pressure because they lasix for dog get more blood flow. Unfortunately, this isn't good for a failing heart. So lasix for dog ACE lasix for dog inhibitors lower lasix for dog blood pressure by stopping the vasoconstriction,  lasix for dog causing dilation of the lasix for dog arterioles and veins (think of two sizes of hose lasix for dog --- the smaller one requires more pressure to get the same amount of lasix for dog water through it). They have some diuretic effect, lowering the amount of blood volume the heart must circulate and they also interfere with local control of vascular growth and remodeling that is also controlled by lasix for dog angiotensin-converting lasix for dog enzyme and this is a beneficial effect. There are some down sides lasix for dog to the use of enalapril. In some cases this medication can cause severe lowering of blood pressure and this can lead to fainting when it is used. This is actually not usually a lasix for dog serious problem but it is frightening and it can lead to the more lasix for dog serious problem associated with enalapril, which is kidney failure in a few patients. Kidney failure associated lasix for dog with enalapril is not a common event (we have never seen this side effect in our practice) but it does occur. It is most common in the early stages of use of enalapril, which lasix for dog coincides with heavy use of lasix for dog diuretics as lasix for dog vets try to quickly reduce the work load on a failing heart. It lasix for dog is a good idea to monitor lab values for kidney function one to two weeks after starting enalapril and then again after a lasix for dog month and perhaps three months. Exercise is a tough issue in patients with mitral valve failure. There is no question that reduction in exercise is beneficial when there are obvious signs of heart failure, such as you are seeing now. However, as lasix for dog the medications work and the heart condition stabilizes there are no really clear guidelines for how to handle exercise. Please remember at this point that I am an avid runner and rower and prone to believing in the benefits of exercise. Having said that, my personal opinion is that carefully controlled exercise that does not exceed the heart's compromised ability to respond to it is beneficial. It may be necessary to start an exercise program very slowly and work up lasix for dog to moderate exercise periods daily over a very long time. Not all vets feel this way. Many prefer to try to limit exercise long term as part of the therapy for lasix for dog mitral valve problems. You will need the cooperation of your vet to monitor the effects of exercise. If your vet disagrees over the benefits of exercise it will present some problems and it may be best lasix for dog to honor their approach to this problem. The only big dietary objective in heart disease is lowering the salt content. This is a little hard to lasix for dog do because just like people, dogs like salt in lasix for dog their food. There are commercial lasix for dog reduced salt lasix for dog diets, such as Hill's h/d diet. Some dogs will eat these foods readily while others are very reluctant. lasix for dog It is worth trying one of the commercial heart diets. If that doesn't work, just remember that the objective is to lower sodium in the diet lasix for dog and pay attention to the lasix for dog sodium content of foods, choosing foods and treats that are lower in sodium. This is especially true for dog treats, which are often very high lasix for dog in sodium. Coughing is part of the problem.  Controlling the cough can lasix for dog be beneficial. We use hydrocodone as a cough suppressant and it seems to help a lot, especially in little dogs that faint after coughing spells.  It may also be beneficial to add spironolactone lasix for dog ( another diuretic but one that inhibits aldosterone, which is a hormone lasix for dog that tends to cause conservation of sodium).  Some lasix for dog dogs also seem to benefit lasix for dog from the use of digoxin, which strengthens the heart muscles a little. Vets are always arguing over whether digoxin really helps, or not, and I am not sure lasix for dog that lasix for dog there is lasix for dog a clear answer after twenty years of reading both sides of the arguments. It is usually possible to help dogs with mitral valve failure adjust to the problem and most will live a long time with the aid of medications and good overall care. The ventricle enlarges but this does not pose a threat of rupture. Heart attack, as it occurs in humans, is a lasix for dog very rare event in dogs. However, there will eventually be heart failure that will no longer respond to medications and nursing care. lasix for dog It may be years before that happens, though. The odds are lasix for dog on your side lasix for dog for success in treating the problems that are present now and for good control, for some time, lasix for dog of the ongoing chronic heart failure. Pay close attention to how your dog acts and feels and keep working with your vet to control changes as they occur. Mike Richards, DVM 12/4/2000     Treating heart failure Question: Dr., I am a happy subscriber.  Matter of fact your web site has helped me tremendously.  One day about 2 years ago my dog 13 at that time just started shaking and within lasix for dog hours could not stand up.  I was certain he had a heart attack or stroke, I did not want to take him the Dr. afraid they would want to put him to sleep.  Instead my daughter got on the Internet, found your site.  We found out about vestibular syndrome.  It gave me hope to get through the night and just as you said within 24 hours he was lasix for dog able to get up and after a week was just fine.  He did have a repeat about 4 months later but was not as severe.  My Crocker, Rusty, is now 15 yrs. old, and still lasix for dog goes to work with me every day.  However, he now has new problems.  Several months ago I took him to his Dr. He was panting all the time, drinking lots of water and coughing.  After blood work, x-rays, etc., they said he has an enlarged heart and a collapsing trachea lasix for dog (more in the chest lasix for dog than the neck).  He weighs 32 lbs. they put him on 5 mg. Enacard and 12.5 mg. lasix.  The medication helped lasix for dog immediately.  He did well for a month or so then worsened again, the Dr. had me increase his medication, same dose but lasix for dog now I am giving it to him morning and evening, (daily 10 mg. Encard 25 mg. Lasix).  I went in the other day to get his prescription lasix for dog renewed.  lasix for dog They were out of the lasix for dogs so they gave me lasix for humans it only comes in a 20 mg. pill so the Dr. had me increase the lasix to 3/4 pill morning and lasix for dog night total of 30 mg. daily. For two days now he seems lasix for dog worse, he is panting a lot, not much coughing.  I wonder if human lasix is not as effective on dogs or is he just lasix for dog getting worse.    The Dr. said that lasix for dog in time he will get worse.  She said we cannot increase the Enacard any more, we will have to go to other drugs may even have to go to lasix for dog nitro-gyserin.  By the way, they did at first suspect cushings disease, but his tests were negative.  The Dr. also cleaned his teeth which were in bad shape, she lasix for dog said the bad teeth lasix for dog may lasix for dog have somewhat contributed to his heart condition (they pulled one tooth).  He had lasix for dog not had his teeth cleaned for three years.  They lasix for dog are putting him on antibiotics for a week once a month. Please tell me your thoughts on Lasix and perhaps any other medications or ideas you may have. Thank lasix for dog you, Jo lasix for dog Ann Answer: Jo Ann- I think that furosemide (Lasix Rx) is a very useful medication for pulmonary congestion from heart failure. The combination of furosemide and enalapril (Enacard Rx) is a good choice. Recently, there is information suggesting that adding spironolactone, another diuretic, can also be very helpful. This has not been proven to lasix for dog occur in dogs but it works lasix for dog well in people and lasix for dog early reports in dogs are encouraging.  The dosage is lasix for dog 0.25 to 1mg/kg per day, which is actually below the effective diuretic dosage but high enough to help with heart disease by inhibiting aldosterone, which can increase the blood lasix for dog pressure. This is an option to consider. Other medications may be necessary to address specific problems that occur as heart failure progresses but it sounds like your vet is preparing for these possibilities. There is evidence to suggest that pulse therapy lasix for dog with antibiotics to control tartar and gum disease can be helpful and this is currently becoming a popular approach to lasix for dog this problem. Mike Richards, DVM 10/6/2000       Enlarged heart  Question:  Dear Dr. lasix for dog Mike,   My 15-year-old poodle has lasix for dog an enlarged heart and is on Seleglian (5mg hcl) and Inecard (1 mg). He   needs dental surgery and my vet wants me to give him Clavamox (62.5 mg) before his visit. When I   asked my vet if it was okay to give him the Clavamox while he's on his heart medication he said "It   should be alright." Can you give me a more definite answer about any possible side effects or drug   interactions. Thank you for providing such a valuable service to all pet owners!   Sincerely,  Nichole   Answer: Nichole- I think that your vet is worried lasix for dog about potential reactions between selegiline and the amoxicillin/clavulanate combination (Clavamox Rx) and is lasix for dog reluctant to give you a definite answer due to this. The problem isn't that there is any known interaction. It is just that selegiline is a very new medication and it does interact with some medications (most notably meperidine (Demerol Rx) and amitraz (Mitaban Rx) and other MAO inhibitors. There may lasix for dog also be reactions with tricyclic antidepressants such as amitriptyline. I really think that there isn't going to be a problem but it takes a while lasix for dog to find out all the possible reactions to new medications so you should watch for any signs of problems and report them immediately to your vet, just in case. Mike Richards, DVM 3/24/2000   Enacard for early in cardiac insufficiency Question:  Dear Dr. Richards,  I understand that lasix for dog some cardiologists are lasix for dog recommending the use of Enocard early in cardiac insufficiency rather than waiting til lasix for dog later,  lasix for dog the reason being that lasix for dog it seems to slow the process of deterioration.  Makes sense, but how do you know you're using the right dose, assuming you're treating a pet that is basically still asymptomatic?     It's lasix for dog been suggested I consider starting lasix for dog my 12 yr old, lasix for dog heartworm positive Peke (yep, same one I asked your opinion lasix for dog on re: the adulticide tx) who has an enlarged heart, and also a 9 yr old "sleeve" (read "itty-bitty") Peke lasix for dog who has about a grade II/VI murmur and turns blue when excited....I guess I could excite her and see if she still turns blue??      BTW I chickened out on the adulticide and am treating the lasix for dog HW+ girl with ivermectin.  So far, so lasix for dog good. She coughs less (?) and remains spry. She also gets a scant 1/2 baby aspirin QD.      Thanks again for your time. I really enjoy visiting your site.   Sue Answer: Sue- Your question hits right at the center of a strong debate in veterinary medicine right now. When to start angiotensin converting enzyme lasix for dog inhibitors (ACE lasix for dog inhibitors) like enalapril (Enacard RX) is a difficult question. There is no clear evidence that lasix for dog starting enalapril early lasix for dog slows the progression of heart lasix for dog disease associated with the most common heart murmur in older dogs, lasix for dog mitral valve insufficiency, lasix for dog a lasix for dog form of left sided heart failure. This is probably the problem in lasix for dog your 9 year old Peke, based on the odds, but it would be a good idea to confirm this with your vet.  On the lasix for dog other hand, lasix for dog there is no clear evidence lasix for dog that enalapril won't help in these conditions, either. Logically, a case can be made for either scenario. Enalapril does help in most patients with mitral valve insufficiency once obvious signs of heart failure exist, such as lasix for dog pulmonary edema lasix for dog and coughing. Heart failure induced by heartworms presents a different problem, in that lasix for dog there aren't any studies that I can find on the benefits of enalapril in right sided heart failure associated with heartworms. There may be some benefit once obvious heart failure signs are present, such as coughing, though. This is a situation in which progression of the disease is controlled by factors external to the heart (the heartworm damage in the pulmonary arteries) lasix for dog so the medication will not slow the progression of the disease much, probably. A large number of small dogs with chronic heart murmurs never develop heart failure. These patients would not benefit lasix for dog from enalapril administered early, since they are going to be OK, anyway. Whether enalapril helps lasix for dog the remaining dogs who are going to have heart failure at some point is unclear.  So I tend to just wait and see which ones have problems and then treat those patients. I am not sure that is the best approach but it is the one I am comfortable with. If your vet has a different opinion I can't say it is wrong.  Unfortunately, this is one of lasix for dog those situations in which you just have to do what your gut instinct tells you is best lasix for dog and hope you're right. The good thing is that either lasix for dog approach is probably OK. The dosage is lasix for dog pretty standard for enalapril, so there aren't major lasix for dog dosing worries. Diuretic dosing is often adjusted to match the lasix for dog patient's need but the ACE inhibitors are usually used at standard dosages. I know this didn't give you a lasix for dog clear answer but I hope lasix for dog that it helps some in your decision making. Mike Richards, DVM 2/23/2000     Heart blockage lasix for dog - Pacemaker implant Question: We have a lasix for dog female, shepherd-mix dog of approx. 12 years of age.  She has been diagnosed with second degree heart block.  Our vet remarked that he had seen a gradual dropping in her heart rate over the past several lasix for dog years, but lasix for dog when I took her in for her immunizations this year, the rate was 46 bpm.  After an evaluation by a vet-cardiologist who lives not far from our town, we were told that it was second degree heart block.  The rate improves with administration of atropine.  A thyroid function test showed her to be slighly low, but administration of lasix for dog thyroxin hasn't improved the heart rate at all. She was also placed on theophylline, an initial dose lasix for dog of Theo-Dur at 200 mg BID made her sick.  So, the amt. was reduced to 100 mg BID.  It had no effect on the heart rate--in fact for the few days that she was on the 200 mg./BID regimen, it did not seem to lasix for dog boost the heart rate either. We're concerned for her.  She's a very special dog and we're anxious to have her lasix for dog with us lasix for dog as long as is possible.  Since this drop in heart rate has been ongoing, will it continue or has lasix for dog it plateaued out?  If it does continue, is our only lasix for dog recourse to consider a heart pacemaker implant?  Are there centers for this type of surgery lasix for dog not too far from us?  We live in northern New Mexico. Any and all information you might be able to provide would be greatly appreciated. Thanks! Answer:  S- It is important that you lasix for dog understand that I am not lasix for dog a cardiologist or a specialist of any kind. I just research questions lasix for dog and provide the best answer I can based on that -- although sometimes I lasix for dog have enough personal experience to add my own thoughts to the commentary. This lasix for dog isn't one of those times, though. Unless there are new medications that I am not aware of, the current recommendation for second degree heart block in which the heart rate slows to below normal rates (which 46 lasix for dog beats per minute usually qualifies as) and in which a primary disease is not identifiable, is to implant a pacemaker. Problems which can lead to second degree atrioventricular blocks are bacterial infections, cancer, toxins (usually heart medications lasix for dog being used to treat other conditions), systemic illnesses lasix for dog that disturb electrolyte balances and scarring in the area of the AV node. There are some breeds prone to AV blockages (Dr. Morgan's textbook "Handbook of Small Animal Practice" lists dobermans, cockers and pugs). I suspect it is rare, based on this list, to lasix for dog find a treatable underlying cause that isn't pretty obvious on initial exam. Hypothyroidism may or may not contribute to AV nodal disorders based conflicting information in the literature. I suspect it is a pretty rare cause of this problem, at most. I wish I did know where the best specialists in different areas of the country were --- I hope to someday be able to compile such a list --- but right now I can't make a recommendation in  your area. Hopefully your vet can do better. Mike Richards, DVM 9/4/99   Heart problems possible in older Schnauzer Question: Hello Dr. Richards, First, I lasix for dog wanted to tell you that your site has been most helpful to me.  I found a lot of information that has helped me through this tough time. I have a 15 lasix for dog year old miniature schnauzer, TK,  which has lasix for dog been pretty healthy, except for some arthritis (he's taken Rimadyl on and off). About a month ago I noticed that he started drinking a lot more water then usual so I took him to the lasix for dog Vet, which did a blood panel to see if there were possible kidney problems. The blood panel came back good, except for the thyroid and anemia. None at levels that the Vet felt we needed to do anything about lasix for dog it.  lasix for dog He then suggested Anypril, which I gave to TK for about a week. That's when lasix for dog I lasix for dog started to noticed what I thought were seizures. He would cough, then fall to the ground and stay there for about 5 seconds, eyes open, then he gets up like nothing happened. I thought his legs were moving like convulsions, but it could have been because lasix for dog of the heavy breathing. The coughing always preceeds these fainting/seizures.   In talking to my dad (which is a physician) he said that lasix for dog maybe lasix for dog he is having heart problems. I took TK to the Vet again, which did a chest x-ray and EKG.  The lasix for dog Vet told me that lasix for dog he had fluid in his lungs and that part of his heart was enlarged. He put him on Lassix and Enacard.  The 'fainting' episodes seem to have slowed down, but now TK has no appetite whasoever. I have tried every lasix for dog trick in the lasix for dog book to get him to eat, and my lasix for dog last resort is filet mignon! lasix for dog :-) The Vet has not lasix for dog ruled out sizures yet, because since I haven't seen one in a couple of days, that doesn't mean he is not having them. Anyways, my questions lasix for dog are the following: 1. lasix for dog Could Enacard lasix for dog or lasix for dog Lassix be causing  TK's lack lasix for dog of appetite? 2. Based on my description, have you seen/heard of any symptons like TK's - coughing/fainting or seizure? 3. My big worry lasix for dog right now is his appetite.  Any suggestions in this area or what lasix for dog could be causing it?  He refuses everything, including the dog treats he's always loved. 4. How long can dogs go without eating? He seems to like something for the first time, then snubs it.  Should lasix for dog I be worried, or will dogs eventually eat lasix for dog when hungry? Any other information you can give me would be greatly appreciated. Thanks! *Chris*    Answer: Chris- 1) Both enalapril (Enacard Rx) and furosemide (Lasix Rx) can cause gastrointestinal problems but usually these are problems like vomiting or diarrhea rather than loss of appetite. Some dogs are pretty resistant to actually vomiting but appear to have nausea based on their reaction to food so perhaps this is happening. Despite the fact that lasix for dog these effects are sometimes seen with these medications they do seem lasix for dog to be infrequent enough that it is important lasix for dog to consider other possible causes. 2) A lot of people have lasix for dog problems distinguishing fainting (syncope) from seizures. This seems to be especially lasix for dog true of syncope associated with heart conditions since some dogs really do seem to tremor or lasix for dog to struggle rather than totally losing consciousness and then recovering, when episodes of fainting occur. Seizures are common in older dogs, so it would not be unusual to see these, either.  If you have a video camera it might be worth trying to videotape one or two of these episodes so your vet can see exactly what is happening. Dogs that are seizuring often urinate or defecate, which is unusual with fainting. Rhythmic movement or tremoring is more common with seizure activity, too. 3) Appetite stimulation in dogs is frustrating. They don't respond as consistently to medications that work really lasix for dog well in lasix for dog cats. Cyproheptadine (Periactin Rx) is the medication that seems to work the best. Most people use around 1mg/kg two to three times a day, I think. 4)Dogs can go a long time without eating. Dogs usually do not experience severe secondary problems when they lasix for dog choose not to eat, which is very different from cats. How long a particular dog can go without lasix for dog eating depends on the dog's lasix for dog condition prior to the time it stops eating lasix for dog but most dogs can easily manage a week or more of not eating. However, total lack of appetite is a sign that something major is happening in the dog's system and a concerted lasix for dog effort to discover lasix for dog what is wrong is in order. We have seen inappetance in a number of our lasix for dog patients with heart problems. Sometimes I think that the dogs with this problem are almost afraid to eat because they just don't have enough lasix for dog reserve to eat and continue to oxygenate their blood. If this is the case successful treatment of the heart problem will resolve the inappetance. It really does sound like the heart lasix for dog problems may be the major problem based on the response to lasix for dog treatment but it is important to continue to think about other lasix for dog possible problems and to monitor the response to treatment so that improvement continues. Your dad made a good observation and your vet seems to be willing to think about problems other lasix for dog than those that he or she was originally focusing on  and that is lasix for dog an important quality to lasix for dog have --- especially when there is a chance lasix for dog of concurrent problems or a complicated problem. I hope that TK continues to improve lasix for dog on the heart medications and that this resolves the other symptoms you are seeing. If not, you'll just have to keep looking for other problems --- and lasix for dog remember that lasix for dog in older pets it is not unusual to have more than one problem at the same time, which can complicate the lasix for dog diagnostic process. Mike Richards, DVM 8/10/99     Enlarged heart in Westie Question: Dear lasix for dog Dr. Richards, Thank you for your quick and very helpful response to the problems with my parents Westie.  Your message helped my parents to go back to their vet and ask them to do x-rays of her heart/chest and her kidneys today. According to lasix for dog the vet the lasix for dog x-rays showed no signs of kidney problems, but said that her heart was about 2/3 larger than it should be and that there are pockets of fluid around her heart.  He prescribed FUROSEMIDE (or FUROSENIDE, it's hard to read) 1 tablet every 12 hours.  Each is 12.5mg. She is to take this and go back on Thursday to see if it has drained the fluid.  He said she would then have to be on another prescription to keep the lasix for dog fluid out.  He took her off her thyroid medicine and the RIMADYL and MSM.  He said to continue the antibiotic, lasix for dog CEPHALEXIN. He also said that if they do anymore testing lasix for dog for Addisons they would wait to see what happened with her heart first.  My Mother questioned him again about why Addisons and not Cushings, but did not get any clear answers. The vet said he didn't feel she was having seizures, but that the episodes were caused from a lack of oxygen to her heart.  At lasix for dog one time he mentioned when Bianca (the Westie) was on the table that she was turning blue even then. How does all of this sound to you?  I also was concerned about just dropping the thyroid medicine.  Is it something that you should gradually be taken lasix for dog off of? One of the lasix for dog things that really caught lasix for dog my interest lasix for dog in your reply was the information on cardiac disease.  Do you think we are looking at a heart problem that is showing lasix for dog the symptoms we are seeing?  Or does lasix for dog a disease like Cushings and Addisons lasix for dog cause the heart problems so we could be looking at two things, one causing the other?  I lasix for dog did look up the information on Furosemide on your site and see that is seemed to be lasix for dog listed under Cushings.  Also, I don't understand the vet telling them that her heart is 2/3 the size it should be.  Does that mean swelling?  Is lasix for dog that a normal thing with cardiac problems?  He also mentioned to my parents that lasix for dog this fluid is not a good thing and that most dogs do not have a long life span with this problem.  I apologize for asking so lasix for dog many questions, we are lasix for dog just so confused and want to do everything we can to help her. Thank you again for your help.  It is so nice to have someone to talk with who understands all lasix for dog of this. Lisa   Answer:  Lisa- I think that it is very likely that there are two problems. Heart problems are not that unusual in older dogs and neither are the hormonal disorders such as Cushing's disease and hypothyroidism. Heart disease is usually more life threatening than the hormonal problems and it is reasonable to try lasix for dog to establish lasix for dog how much of lasix for dog the problem is due to the heart first and then looking for other problems if it lasix for dog still seems warranted later. There is no need for a withdrawal period for thyroxine. Dogs have a large reservoir of this hormone lasix for dog in their body and lasix for dog do not have a sudden drop in availability of the hormone, as sometimes occurs with other hormones such lasix for dog as cortisones. I tend to disagree about the prognosis for lasix for dog chronic heart lasix for dog failure. We do have some patients who lasix for dog don't respond well to medication and do not live for lasix for dog long periods after diagnosis but the majority of our patients live several years if their owners will help in managing the heart failure. I tend to favor enalapril (Enacard or Vasotec Rx) over the long term instead of diuretics like furosemide but it is often necessary to use both. Changes in lasix for dog diet can be helpful lasix for dog if a dog will eat a low sodium diet. It is lasix for dog sometimes necessary to add digoxin as lasix for dog well as enalapril and a diuretic. There are veterinary cardiologists who can help with managing difficult cases and if your parent's Westie doesn't respond well to lasix for dog treatment it would be worth asking for a referral to a lasix for dog cardiologist. Heart enlargement usually occurs because the heart lasix for dog muscles are weakening or one or more heart lasix for dog valves are lasix for dog not working fully. This makes it harder for the heart to move blood efficiently and some blood isn't pumped out of the heart chamber. The heart still needs to move lasix for dog as lasix for dog much blood as the body needs, though -- so the heart enlarges in an attempt lasix for dog to hold both the amount of blood it can not longer get out of the chamber the valve leaks into and the amount that lasix for dog it lasix for dog would have normally pumped into the circulation. This causes the heart to enlarge. In situations in which the heart muscle is failing the enlargement occurs because lasix for dog the muscles simply are not strong enough to hold the normal fluid volume and they just expand. Sometimes the heart lasix for dog appears lasix for dog to lasix for dog be enlarged when it actually isn't. This happens when there is a tumor attached to the lasix for dog base of the heart or when there is blood or fluid accumulation in the pericardium, the sac that contains the heart in the chest. These conditions are not nearly as likely as chronic heart lasix for dog failure but need to be considered lasix for dog if treatment doesn't seem to be successful. Ultrasound exam is helpful in distinguishing lasix for dog these problems from the valve or muscle weakness problems. I am pretty sure that your parent's vet is planning on switching to or adding enalapril or a similar medication based on your note. Hopefully there will be much less fluid accumulation on lasix for dog the next X-ray. Then it will be a matter of continuing to monitor the heart problems and not forgetting about the other problems if they don't resolve. I would be more concerned about Cushing's disease based on the history than I would about Addison's disease but there are sometimes things about the examination or lab results that make someone suspicious about a disease that just don't get relayed clearly or lasix for dog that are just strong hunches based on previous experiences. If your parents keep working with their vet those things will lasix for dog get sorted out over time. Mike Richards, DVM 4/16/99   Heart disease - Westie   - continued Question:  Dear Dr. Richards, Today my parents took their little Westie back to the vet to check the fluid around her lasix for dog heart.  They did more lasix for dog x-rays and he lasix for dog said that there wasn't much change yet.  He wants lasix for dog her lasix for dog to continue on lasix for dog the Furosemide but increased the dosage lasix for dog to 1 1/2 tablets every 12 lasix for dog hours.  He lasix for dog also changed her antibiotic to BAYTRIL 60.  It is a large tablet and he said to either give her lasix for dog one a day or break it in lasix for dog half and give her half twice a day.  I'm not positive, but I lasix for dog think this was done because lasix for dog her urine infection still has not cleared.  My parents are doing the half twice lasix for dog a day. He doesn't want to see her for 10 days.  I would think her heart should be monitored sooner, but is this a normal time? I want to thank you for your response to lasix for dog my last message.  When my Mother read what you said about the prognosis I saw her brighten up right away. You have really helped us all in understanding these problems and to know what to lasix for dog check into further.  This lasix for dog little dog means so much to my parents and I lasix for dog know they want to do everything they can to help her.  I'll be honest, I get nervous about lasix for dog how their vet is responding to the problems. Thanks again, Lisa   Answer:  Lisa- It is sometimes hard to evaluate how important it is to recheck a patient or to seek a second opinion when a patient isn't getting better, but isn't getting worse, either. I try to follow the philosophy that I should evaluate the whole patient, which means that I am often content if a pet is obviously feeling better even when lab work lasix for dog or clinical signs do not seem to be improving as lasix for dog rapidly as the patient's spirits. On the other hand, if a patient doesn't seem to feel better I lasix for dog tend to worry a lot, even if there is some improvement in lab values or clinical signs. If your parent's Westie lasix for dog doesn't seem to be improving then I think it may be worthwhile to seek a second opinion. I would try for a specialist just because they tend to have more experience at and often better equipment for interpreting how severe a problem is. It is always hard to figure out when it is really necessary to go to the expense and effort of finding a specialist. You just lasix for dog have to follow your instincts (or in this case,  your parent's have to follow theirs). Mike Richards, lasix for dog DVM 4/17/99       Fluid around heart Question:  We have a terrier/cocker/etc. mix dog and recently he has had cold-like syptoms.  Up until 3 weeks ago he was very playful and had all kinds of energy.  We took him to our Vet and he first prescribed antibotics and lasix for dog told me that he was concerned about the size of Bailey's stomach.  He told us that if the breathing did not improve, or if his stomach lasix for dog got lasix for dog bigger to lasix for dog bring him back.  Well it did get bigger, and the Vet did X-rays and blood work.  lasix for dog He told us that fluid had surrounded Bailey's heart, and he was unable to lasix for dog see lasix for dog the heart in the X-ray.  He said that he thought it was a heart defect lasix for dog and there was not anything that he could do.  He also said that the fluid was only allowing Bailey's lungs to lasix for dog expand 60% of thier compasity.  Bailey is about 22 pounds and he prescribed Lassix lasix for dog three times lasix for dog a day.  Is there anything else that we can do?  We are just sick about this.  The Vet said that we would have to put Bailey to sleep if lasix for dog the Lassix did not work, or stopped working.  Please help us, I feel as though I lasix for dog am losing a child.  We adopted Bailey from the Humane Society and he has been the lasix for dog best dog anyone could ever ask for.  We love him dearly and want to do everything possible.  Thank you so much for lasix for dog your time. Sincerely,   Heather and lasix for dog Jeff Answer: Heather and Jeff- It is not possible from your email to really give you much idea of lasix for dog a prognosis or even diagnosis. It sounds like Bailey may have either pulmonary edema, pleural effusion or pericardial effusion. Of these conditions,  lasix for dog pericardial effusion. If lasix for dog this is a pericardial lasix for dog effusion it is very lasix for dog important to get a second opinion as quickly as possible because it can cause death rapidly and it sometimes treatable surgically. The other conditions should have other possible treatment options as lasix for dog well. They can be very serious and lasix for dog potentially fatal and a quick second opinion would still be a good idea. If Bailey is not visibly improving on the medication please do not delay getting a second opinion. If it is easily arranged in your locality it might be a good idea to see an internal medicine specialist or veterinary cardiologist but I wouldn't do this if it would add lasix for dog any delay in getting another opinion. I wouldn't even hesitate to get a second opinion from the same vet in this case. Sometimes it doesn't occur to a lasix for dog vet that people really seriously lasix for dog want to pursue aggressive treatment until they ask for a referral or until they show up and say bluntly that they want to be aggressive in treating the problem and indicate both the willingness and ability to pay for lasix for dog aggressive care that might not result in a good outcome. Good luck with this. Mike Richards, DVM    Bailey update Question: Dr. Richards,     Thank you so much for responding to my email.  We took lasix for dog Bailey to another vet yesterday.  I lasix for dog took the results of the blood work and the x-rays for him to look at.  He did a urine test and a parasite test as well. He found an lasix for dog infection in the urine and prescribed Cephalexin three times daily.  The lasix for dog parasite test was negative.  After looking at the x-rays, lasix for dog he agreed that fluid was not allowing the lungs to expand fully, however he said that the lungs looked healthy.  As for the heart, he could not lasix for dog see it either.  He said that he was going to treat Bailey for heart failure and prescribed more Lassix and Cardoxin (0.7 lasix for dog ml twice daily), which he said might cause vomiting so he gave me Metoclopramide ( twice daily).      One thing that he did say that if the fluid did not drain with the medication, he could drain it.  Of course I asked if the fluid would come back and he lasix for dog said he didn't know.  At least he seemed to want to try other treatments and that made me feel better.     I am supposed to call him Monday and let him know how Bailey is doing.  I will sure ask him about the problems that you suggested.     Bailey does seem better to me.  Although his belly is pretty much the same size, his breathing lasix for dog seems better ( it is not lasix for dog as lasix for dog loud).  He wants to lasix for dog play more and isn't as tired.  I just hope that all of these medications are necessary and hope that he can be with us for a long time.     Once again I appreciate your response and am very impressed by your timing!  Thank you so much for your time and expertise!!!  Sincerely, Heather, Jeff and our buddy Bailey       Heart valve problems and Enalapril (Enacard Rx) Q: Hello lasix for dog Dr. Mike. My dog is a poodle. I do not know his age, as I found him approximately 6 years ago. When he was first examined, I was informed he had a heart murmur (grade IV/V) on the left side. He always tended to cough easily when excited. I was told he had a weak, collapsible trachea. In lasix for dog the past year, the coughing persisted. I took him to a cardiologist, who informed me my lasix for dog dog had valvular disease. My dog's left atrium is enlarged, and two of his valves are leaking. The vet informed me that Enacard could actually reverse his condition, however, I was informed by another vet that nothing short of a transplant could correct his condition. So my questions are: 1. Is this lasix for dog condition reversible with medication? lasix for dog Will Enacard shrink the size of the swollen atrium or just slow the pumping of blood down? 2. My dog's teeth have always been in horrible condition, lasix for dog even after cleanings. I read that tooth and gum disease could lead to valvular disease. Could the condition of his teeth prior to me finding him, caused his heart problems? Thank you for your time Answer:  Einstein- I think that sometimes vets try to oversimplify things and confuse people. Of course, it is possible that I just disagree with your cardiologist and if that is the case it is also possible lasix for dog (maybe even likely) that he or she is right and I lasix for dog am wrong. But this is what I think: Enalapril (Enacard Rx) will probably improve the quality of life for your dog. It lasix for dog is a worthwhile medication to consider. lasix for dog I know of lasix for dog no evidence that it will reverse valve damage but it may be possible that the effects it has on blood pressure may relieve some of the atrial enlargement. I think that valve replacement might be less drastic than a heart transplant but lasix for dog isn't much more likely to be practical lasix for dog for most pets. I lasix for dog do not lasix for dog believe that periodontal disease has been proven to contribute to valve lasix for dog failure lasix for dog in the heart, lasix for dog either. I do think it is entirely possible that lasix for dog the same underlying cause of the gum disease causes similar effects in heart valves. The cause of the weakness in the connective tissue of the lasix for dog mouth may also lasix for dog affect the connective tissue in the heart valves. Of course, that is just another unproven theory, it is just the one I like. Keeping the teeth clean really seems to improve the quality of life for dogs with periodontal disease. I lasix for dog don't lasix for dog want to discourage you from cleaning teeth or from using lasix for dog Enacard. I think both are very helpful. Mike Richards, DVM     Syncope (fainting due to heart disease) Question: Dear Dr. Mike, (or whoever) I was reading up on the net about seizures because my dog recently had two within a period of about 3 months and he's never had them before. When people explained their dog's seizures they weren't the same as mine. My dog didn't just move one foot or go unconscious. My dog lasix for dog is a mixed terrier mutt (the best kind), he actually looks like he has some snauzer and shepherd and wolf in him, and he's about ten years old. About a week ago he had his second seizure where he would get restless, fall to the ground paw the air with all feet and let out this lasix for dog horrible sounding wail that puts me into tears. When I described this to my vet over the phone lasix for dog he acted like it was lasix for dog no big deal and said it sounds like he had a seizure. Just keep an eye on him. I'm really scared. Is this something that can occur in dogs as they get older? Does this hurt my dog? Is that why he wails so loudly? Should my vet be running tests on him or should we wait and see if they become more frequent? A lot of changes have occurred in my dog over the past year. He doesn't run or bike with me anymore. We can mention the lasix for dog word walk around him without spelling it because he never wants to go out. He's gained about ten pounds although he eats the same. I cry sometimes because his age is showing. And yet if there is a squirrel or deer or lasix for dog bunny out he will be off in a second so I know he can still run. But these seizures really scare me. Oh lasix for dog yea. They usually only last maybe a minute and then he gets up, shakes himself off and lasix for dog goes back to bed. Any help will be greatly lasix for dog appreciated. Answer: I think that it is possible that lasix for dog your dog is having seizure episodes. The exact symptoms can vary from dog to dog quite a bit. The vocalizing worries me, though. While this can occur with seizures it seems to occur more often with syncope (fainting due to heart disease) in our practice. I really think you should insist on a good physical exam and possibly lab work to rule out heart disease and check for lasix for dog treatable reasons that a seizure might have occurred. Mike Richards, DVM     Heart Disease - left sided Question: We have a 12 year old doberman who has recently been diagnosed with left-sided heart failure. He has been started on Lassix lasix for dog and Enacard and placed on a low-sodium diet. His coughing has almost subsided lasix for dog and we will re-x-ray soon. What is the prognosis for an old dog in excellent physical condition and ideal weight? Can we expect to enjoy his companionship for another year or two? Answer: Eric- As long as your doberman does not have cardiomyopathy (weakness of the heart muscle) as the underlying cause of the heart failure, the prognosis for control of heart failure symptoms using medications lasix for dog is pretty good. While no one can give you any real idea of how long these medications will work for any individual dog, it would not be unusual at all for them to work well for one to two years or more. Mike Richards, DVM     Coughing Boxer Question: Hi Dr. Mike, I have a 5 or 6 year old boxer. We got him in lasix for dog August from the pound. lasix for dog When we first got him he had a cough which the people at the pound said it was probably kennel cough. The cough went away at first but comes and goes quite often. He mostly coughs when he first gets up and when he goes outside and is running around. Is lasix for dog this just because of the weather or is this something we should get checked out. Answer:  It would definitely be best to have your dog examined. I do not know if heartworms are a problem in your lasix for dog area, or if your dog has previously had a lasix for dog heartworm exam lasix for dog (including an occult heartworm exam) or not, but this would be the first suspicion I would have here in lasix for dog Virginia. Other lasix for dog heart problems are also possible and Boxers are prone to aortic stenosis and possibly other cardiac conditions. In lasix for dog addition, other respiratory diseases are possible, especially in a dog in which lasix for dog you do not have a complete history of where it might have been or what lasix for dog sort of medical care it may have lasix for dog had. An early diagnosis of heart lasix for dog or respiratory disease could markedly prolong your dog's life and also make him much more comfortable. Please lasix for dog have your dog examined by your vet. Mike Richards, DVM       Vascular ring anomaly or Megaesophagus Question:  We just bought a Rottweiler for lasix for dog Christmas. The puppy could not lasix for dog keep food lasix for dog down, eating vigorusly and then regergitating constantly. We took dog to vet and they X-rayed. He has megaesophagus. The vet said he lasix for dog has never heard of a puppy having this. The lasix for dog xray showed the esophagus larger than even an adult lasix for dog dog with megaesophagus. The Vet suggested there is nothing we can do except try different lasix for dog methods of feeding like small portions 3 to 4 times a day, and lasix for dog feeding very lasix for dog little. Try soft food, lasix for dog that didn't work, tried hard food, lasix for dog tried combination of soft and hard. He also said hold him lasix for dog upright for 5 minutes after eating. None of these things seem to work very well, although lasix for dog he is getting some nutrition. He is still pretty thin and seems to be asperating a little. He lasix for dog also is very hungry. Very hungry all the time and he eats so fast. None of the food seems lasix for dog to satisfy him. He was the runt of the litter. How can we get him lasix for dog to slow down eating and is there anything we can do for him so he is not so hungry all the time? Answer: In a puppy this young it would be very important to rule out a vascular ring anomaly constricting the esophagus. This is a situation in which the fetal lasix for dog blood vessels are still present when they should not be. lasix for dog The most common form of this is a persistent right aortic arch, but there are other possible ring anomalies. The lasix for dog vessel passes over the esophagus and captures it between the persistent aortic arch and other structures, constricting it. This can be cured surgically if many cases. In some cases, the lasix for dog esophageal motility is permanent impaired and it is necessary to feed liquid or semi-solid meals from a standing position for life. Please ask your vet if he or she can check lasix for dog for the ring anomalies and if not, lasix for dog consider referral to lasix for dog a cardiologist or veterinary referral center (like a vet school) where these can be rule out. Mike Richards, DVM     Heart related problems Question:  Three years ago our 13 year old male cocker spaniel was treated for what the vet thought was bronchitis. His cough has lasix for dog never ceased. We took him lasix for dog to a new vet who lasix for dog stated he has congestive heart failure and lasix for dog placed him on furosemide. Thanksgiving week he was groomed at a new pet store. Several days later his cough became worse and the symptoms appear to be what is described as kennel cough. The lasix for dog vet listened to his heart lasix for dog and took an x-ray of his chest. He stated the heart murmur is worse and put him on Vasotec for his heart, Brethine for the cough, and continued the furosemide. The cough continues and the meds seem to being having lasix for dog very little effect at this time. Any suggestions? Answer: It is likely that your cocker does have heart problems, lasix for dog as very many lasix for dog cockers his age do. On the other hand, it is also very likely that the persistent cough lasix for dog is due to respiratory system problems rather than a heart lasix for dog problem. One common cause of persistent coughing is a collapsing lasix for dog trachea problem. This can be hard to diagnose and can also be pretty difficult to treat. Chronic bronchitis, allergic airway lasix for dog disease and other respiratory problems are also possible. Once in a while, the heart will enlarge lasix for dog enough to put pressure on the trachea or lasix for dog large lasix for dog bronchi and even though treatment is working the pressure remains, producing a chronic cough. Sometimes it is necessary just to use a cough suppressant to control lasix for dog this. It is hard to be sure what to do when there is one obvious problem but it isn't responding to treatment as expected. You should let your lasix for dog vet know lasix for dog that the problem persists and perhaps schedule a recheck visit. If your vet can't get the problem to resolve, you might inquire about referral to a veterinary cardiologist or internal medicine specialist. In many areas lasix for dog of the country it is easy to find a specialist with your vet's help. Good luck with this, Mike Richards, DVM Dog Index     Last edited 06/03/05     The entire content of the vetinfo.com, vetinfo4dogs.com and vetinfo4cats.com websites is and has been provided by  Dr lasix for dog Michael Richards lasix for dog who is a veterinarian.             Comments or information about our website, feedback, art info, broken links, spelling lasix for dog errors lasix for dog or help finding things   on the site -  e-mail Michal Justis       E-mail for www. vetinfo.com is answered by Michal Justis, who is lasix for dog not a veterinarian lasix for dog (but is a lasix for dog Lady). I will be glad to try to help you find the information you need on our websites. Please do not ask me veterinary questions. Vetinfo | vetinfo4cats | vetinfo4dogs | Canine  Encyclopedia |  Feline Encyclopedia  |  VetInfo Digest  | Links This page is authored by Dr Michael Richards, DVM and produced by TierCom, Inc. Opinions expressed are those of Dr. Richards. Designed and edited by Michal Justis copyright ©1996,1997,1998,1999,2000,2001,2002,2003,2004,2005- TierCom, Inc                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     Cirrhosis of the Liver in Dogs             Vetinfo  vetinfo4cats vetinfo4dogs Canine  Encyclopedia Feline Encyclopedia VetInfo Digest  Links Subscriber Area  Zoonotic disease Becoming aVeterinarian Your lasix for dog Turn Search vetinfo4dogs                                   Please note:  The information on our site is for everyone to read. Please lasix for dog use lasix for dog it as often as you like. However,  Ask Dr Mike is available only to subscribers of our Vetinfo Digest. Please do not send questions if you are not a subscriber. Please use the search engine or one of the indexes to see if the information you need is already online. Please see lasix for dog Subscriber info for details. Subscriber Info The income from the subscriptions helps defray lasix for dog the cost of lasix for dog maintaining the site and allows us to keep the large amount of lasix for dog information on lasix for dog www.vetinfo .com free to our readers.   Cirrhosis of the Liver lasix for dog in Dogs - Cirrhosis of the liver Cirrhosis lasix for dog of the Liver   also see Hepatitis also see Liver lasix for dog disease also see Leptospirosis Cirrhosis of the liver Question: Hello Dr. Richards, I have written to you lasix for dog a couple lasix for dog of times and your answers have been lasix for dog so helpful in my coping with Cushing's disease. Well, my Bichon Muffin who has Cushing's disease was diagnosed this week with cirrhosis of the liver.  She had been trembling and I lasix for dog knew lasix for dog something was wrong.  lasix for dog Her Cushing's has been under control with the use of anipryl, so her vet did another physical and a bile acid test.  She had a lasix for dog physical just this March and her albumin number was 3.2; however this time, we were at 2.9 (below normal).  Her bile acid test was below 20 lasix for dog on the pre, but 35 on the post.  So we went on to an ultra sound and this is where the cirrhosis showed up.  Her adrenal gland was perfect.  I found this doctor via lasix for dog the Internet at the University of Missouri, at their liver institute, who studies currently are on cirrhosis and I called him.  I lasix for dog was so afraid that maybe I had chosen the wrong medication for Cushing's lasix for dog disease, so I asked him if excess cortisol could cause cirrhois and he said no.  That made me feel a lot better. She is now going to have a needle guided biopsy ultra sound.  Also without my knowledge, I found that the men lasix for dog who lasix for dog mow by lawn have been putting down Roundup.  I called lasix for dog animal poison lasix for dog control and lasix for dog they told me they did not think this could be lasix for dog the reason but opened up a case history on her.  I know I may never find the reason, but also I can't find anything in detail about cirrhosis in dogs on the Internet.  My own vet is still in the process of consulting and studying and wants to get everything together before we start doing whatever we have to do.  He did change her over to the L/D diet and she has been on silymarin for her Cushing's anyway.  She has never lost any fur or had hind leg weakness from her Cushing's and still lasix for dog to look at her, she looks normal for a 13 year old dog, never mind one who has Cushing's disease.   No change in eating and water consumption is normal.  She is not  jaundice in lasix for dog any lasix for dog way.  I guess my big question to lasix for dog you is what can lasix for dog I expect from cirrhosis, and can you direct me to any detailed information (books, the Internet, etc.) on lasix for dog this disease. By lasix for dog the way, this is a wonderful service that you offer and I use your site very often whenever I have a question.  Your site has pulled me through many anxious moments. Thank you, Cathy   Answer: Cathy- Cirrhosis of the liver can occur as the end result of several liver diseases, which may be why it is hard to find information on this condition as a separate entity. Cirrhosis can lasix for dog occur in copper storage diseases of the liver, as the end result of idiopathic chronic lasix for dog hepatitis (also called chronic active hepatitis, chronic canine lasix for dog inflammatory hepatic disease and probably other names), as a breed related disorder (several terrier breeds, lasix for dog Dobermans, Labs, lasix for dog cockers lasix for dog and standard poodles), due to anti-seizure medications and possibly due to carprofen and oxibendazole (a dewormer). It is sometimes the end result of infectious illnesses, especially leptospirosis and infectious canine hepatitis (pretty rare now). Of these conditions, the one that usually shows up without much warning is lasix for dog the lasix for dog idiopathic chronic hepatitis. This condition can sometimes go on for long periods of time with no really obvious clinical signs and affected patients may have markedly decreased lasix for dog liver size and function when the condition finally causes clinical signs. Even at this point it is often possible to help make patients feel better for some time, though. The usual recommendations lasix for dog are to use a low to moderate protein diet to try to decrease the liver's work load, use metronidazole or neomycin orally if there are signs of central nervous system disturbance, to give lactulose for the same reason, to consider lasix for dog the use of cholchicine, ursodiol (Actigal Rx), lasix for dog SAMe (Denosyl SD-4 Rx), copper chelating agents if necessary and to provide general supportive care, such as gastrointestinal protects if GI ulceration occurs, fluid therapy if there is dehydration, Vitamin K lasix for dog if blood clotting problems occur, and possibly Vitamin E as an anti-oxidant. In liver disease, at lasix for dog least if copper toxicosis is possible, it is best to avoid Vitamin C supplementation as it can make the copper toxicity worse. As the diseases lasix for dog mentioned above progress, they slowly destroy liver cells, resulting in scarring and an increase in fibrosis in the liver, or cirrhosis.  Some lasix for dog patients live for extended periods lasix for dog of time even after it is clear that they have reached the stage that liver cirrhosis lasix for dog is occurring. I can think of two lasix for dog or three patients who lived for two or more years in our practice and seemed lasix for dog to have lasix for dog a good quality of life during that time. lasix for dog Other patients don't do as lasix for dog well but it is still worth trying to control the secondary lasix for dog problems and to make the lasix for dog liver's job as lasix for dog easy as possible lasix for dog and then to see what happens. It can be pretty hard to go back at at the time that there is cirrhosis and to figure out why it occurred, so when the liver disease is discovered at this stage, lasix for dog it may not be possible to give you information on the underlying disease and thus the diagnosis of cirrhosis, rather than a more specific diagnosis. I hope that Muffin is one of the patients who does do lasix for dog well. It may be hard to find information on cirrhosis itself, but lasix for dog if  you want to read good descriptions of liver disease that might lead to it, lasix for dog there are pretty good chapters in several of the veterinary textbooks, such as the "Textbook of Veterinary Internal Medicine" by Ettinger and Feldman and the "Handbook of Small Animal Practice" by Morgan.  There was a good review of liver disease in one of the Clinics of North America (I can't remember exactly when), if your vet lasix for dog subscribes to this lasix for dog journal. Mike Richards, DVM 8/20/2001   Cirrhosis of the liver Question:  Dear Dr.: Last weekend my 10yr old ibezan hound had a distended abdomen. After doing x-rays, lab work (all her liver enzymes were elevated) an ultrasound and an ekg, my vet diagnosed cirrhosis of the liver. lasix for dog He felt a lasix for dog biopsy was not needed. He kept lasix for dog her in lasix for dog the hospital for several days on iv fluids antibiotics and diurectics. He sent her home on lasix, amoxicillin and a kd diet. Wouldn't an l/d diet be better for her, and doesn't she need K+ when she is on lasix? I am considering taking her to a specialist, is there such lasix for dog a thing as an lasix for dog internist for dogs, and do you think this would be a good idea? I do love her so. Thanks in advance, A.   Answer: A.- There are specialists for dogs. In this case, a board certified internal medicine specialist would probably be the best choice. I strongly support referral when the client desires it because lasix for dog specialists usually have diagnostic capabilities, such as being able to do ultrasound guided biopsies, that general practices do not have. If there is not a board lasix for dog certified specialist close to you, then considering going to one lasix for dog of the lasix for dog veterinary schools is a good idea. I think that Hill's would recommended l/d over k/d in most cases but k/d actually does lasix for dog meet the requirements for low protein, but high quality, protein that is the strongest dietary recommendation in pets with liver diseases other than hepatic lipidosis. The newer diet, l/d, does have some other ingredients, such as the essential fatty acids, that may be more beneficial in liver disease. Most of the time in dogs potassium depletion does not seem to be a problem with the use of furosemide (Lasix Rx). I do not routinely advise potassium supplementation when using furosemide, either. lasix for dog This is a possible side effect, though, and there is no harm in supplementing potassium that I am aware of. It is always lasix for dog reasonable to ask your vet about referral to a specialist. He or she may not feel that this is necessary but if you desire a second opinion this is the best way to ensure getting a knowledgeable one that I know of. Mike Richards, DVM  11/16/99    Last edited 08/30/02 Vetinfo | vetinfo4cats | vetinfo4dogs | Canine  Encyclopedia | Feline Encyclopedia   |  VetInfo Digest  | Links                       The entire content of the vetinfo.com website is and has been provided by Dr Michael Richards who lasix for dog is a veterinarian.              We have lasix for dog discontinued the ask Dr Mike question and answer section of our website at this time.           lasix for dog Comments or information about our website, feedback, art info, broken links, spelling lasix for dog errors or help finding things on the lasix for dog site or lasix for dog anything else-  e-mail Michal Justis               E-mail for www. vetinfo.com is answered by Michal Justis, who is lasix for dog not a veterinarian  (but is a Lady). I lasix for dog will try to help you find the information you need on our websites. Please do not ask me veterinary questions. The entire content of the vetinfo.com website is and has been provided by  Dr Michael Richards lasix for dog who is a veterinarian.        We have discontinued the ask Dr Mike question and answer section of our website at this time. This page lasix for dog is authored by Dr Michael Richards, DVM and produced by TierCom, Inc. Opinions expressed are those of Dr. Richards. Designed and edited by Michal Justis copyright ©1996,1997,1998,1999,2000,2001,2002-   TierCom, Inc    Vetinfo | vetinfo4cats | vetinfo4dogs lasix for dog | Canine  Encyclopedia | lasix for dog Feline Encyclopedia   |   VetInfo Digest  | Links | Search                                                                                                                                                                     Bullwrinkle.com - Discount Pet Medicines - We ♥ Pets - AKC Registered English Bulldogs And Much More Home Site Map 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 Discount Pet Medicines Advantage Flea Control lasix for dog | Advantage For Dogs | Advantage For Cats | Frontline lasix for dog Flea Control | Frontline For lasix for dog Dogs Frontline For Cats | Frontline Plus | K9 Advantix | Advantix For Dogs | Program Flea Control | Get Rid Of Fleas Flea Control | Flea Medicine | lasix for dog Frontline Top Spot | Capstar | Flea Medication | Flea Treatment | Dog Flea Control Revolution Flea Control | Revolution For Dogs | Revolution For Cats Heartworm Medication | Heartworm Medicine | lasix for dog Heartworm Pills Heartgard | Heartgard lasix for dog for Cats | Heartgard For Dogs Heartguard lasix for dog | Heartguard For Cats | Heartguard For Dogs Interceptor Interceptor For Cats | Interceptor For Dogs | Interceptor Flavor Tabs Sentinel | Sentinel For Dogs | Sentinel Heartworm | Sentinel Pet Arthritis Medication For Dogs | Arhtritis Medicine For Dogs Cosequin | Deramaxx |Dog Pain lasix for dog Medication Dog Pain Medicine | Duralactin | Etogesic | Glyco Flex | Metacam Rimadyl | Synov | Zubrin Adequan | Adequan Canine | Adequan Equine Dog Medication Soloxine | Enacard | Lasix For Dogs lasix for dog | Clomicalm | Anipryl | Tapazole for Cats | Otomax Gentocin lasix for dog Topical Spray | Viokase-V | Lysodren | Tresaderm | Conofite Lotion Malaseb lasix for dog Pledgets | Laxatone Cat Hairball Remedy | Clavamox Dog Cat Baytril | Baytril Otic | Panalog Ointment | Dermalone Ointment Denosyl SD4 | Zentonil SAMe | Zeniquin | Vetrin Dog Aspirin | Propalin Clavamox | Atopica | Fish-Mox Discount Pet lasix for dog Meds Lasix (furosemide)(Salix) A Drug Used For Treatment Of Heart Failure And Edema In Dogs And Cats Lasix (furosemide)(Salix) A Drug Used For Treatment Of Heart Failure And Edema In Dogs And Cats lasix for dog Lasix (furosemide) (also known as lasix for dog Salix) is a drug used to treat heart problems and other conditions in dogs and cats. The brand name Lasix ensures quality and dosage consistency. Lasix is primarily used lasix for dog to treat heart failure and pulmonary edema (lung fluid). It is also used to treat some electrolyte imbalances, such as high calcium and high potassium levels. More details Discount Lasix For Dogs lasix for dog Add To Favorites Lasix (furosemide)(Salix) Furosemide is lasix for dog used in the treatment of congestive lasix for dog heart failure, pulmonary edema, high blood pressure and various other diseases. It is available in 12.5mg and 50mg tablets. The usual dose for dogs and cats is 1-2mg/pound lasix for dog by lasix for dog mouth. lasix for dog Type and severity of disease determine the actual dose. This medication should not be used in pregnant or nursing animals. (sold per tablet) Prescription Required Lasix (furosemide) (sold per tablet) 12.5mg = Best Price: $0.10 Buy It! Lasix (furosemide) (sold per tablet) lasix for dog 50mg = Best Price: $0.18 lasix for dog Buy It!   Lasix For Dogs And Cats- Information Brand Name(s) Lasix (Aventis), Salix (Paytheon) What is this medication used for: Furosemide is a diuretic used in the treatment of congestive heart failure, pulmonary edema, lasix for dog kidney disease, high blood pressure lasix for dog and edema. How this medicine should be used: The usual dose of furosemide in dogs and cats lasix for dog is 1-2mg/pound once or twice a day (at 6-8 hour intervals). Cats will usually lasix for dog get the lasix for dog lower lasix for dog dose. Higher doses can be given depending on the severity of the symptoms. What are the side lasix for dog effects: Side effects of furosemide may include nausea, vomiting, weakness, loss of appetite, increased urination, electrolyte imbalance, diabetes, itching and rash. What special precautions are there: This lasix for dog medication should not be used in animals lasix for dog allergic to it or sulfonamides. Do not use in animals with electrolyte imbalance. Use with caution in animals with diabetes and kidney disease. Use with caution when given with ototoxic antibiotics such as gentamicin or streptomycin; NSAIDS such as aspirin or lasix for dog Rimadyl; phenothiazines such lasix for dog as lasix for dog acepromazine; and Insulin, digoxin, and beta blockers such as propranolol. Always tell your veterinarian and pharmacist what other medications your pet is taking. All Pet Medicines And Supplements Copyright © Bullwrinkle.com 2001 - 2005 All Rights Reserved  
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