Sandy Brown, MD

Disclosures

April 09, 2007

Ginger, our 14-year-old yellow Labrador, had a bad case of the dwindles. It started with a loss of stamina; she became winded with shorter and shorter walks. Then she developed a chronic cough. Finally, she just ballooned, seemingly overnight. Even getting up was an effort for her. It was time for a visit to her doggie doc, Chris the vet.

"Ginger's in heart failure," Chris proclaimed, after an abdominal ultrasound confirmed massive ascites." Dogs are different from people that way. When they're in heart failure, fluid moves into their bellies. They may also pant. I'm going to give her some IV furosemide (Lasix) and see if we can get her to pee the fluid out. You can continue with oral Lasix at home."

Despite the diuretic, Ginger didn't improve. She could hardly walk, and we had to swaddle her with a large towel just to help her up and outside. She didn't seem to be urinating more than usual and had lost her appetite. Her color was ashen and, when I listened to her chest, her heart sounds were rapid, distant, and muffled. It was hard on Ginger and on my wife too; Ginger was her favorite of our 3 dogs and rarely left her side. Clearly, it was time for more aggressive therapy -- people medicine. Sue was reluctant; she had been reading a holistic dog book in which they discussed homeopathy, herbs, and acupuncture treatments for heart disease. "What if the drugs kill her?" she said. "Then she won't linger and suffer," I said.

What do I do for my patients with congestive heart failure? I thought. After clearing my treatment plan with Chris, I started Ginger on 80 mg of furosemide twice daily, 25 mg of spironolactone (Aldactone), and 20 mg of enalapril. I had wanted to use metalazone (Zaroxolyn) instead of spironolactone to get diuresis going, but Chris couldn't find the drug in his doggie Physician's Desk Reference, so I kept that idea as a last resort. We put all the medications into a tablespoon of cat food, gave it to Ginger with her morning meal and waited to see what would happen.

Nothing happened during the first week. She didn't seem to be peeing more often or longer and we still had to help her up and out. Then, Ginger slowly got better. She lost weight, her appetite improved, and she could get around alone. After 3 weeks, she had a waistline! By the end of the month, it was clear she was going to make it. We had our old, arthritic dog back.

"Better living through chemistry," I told my wife.

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