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February 11, 2009

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blend

Nice blog, quite informative and a good resource for pet lovers....

Melissa

Today our 5 year old great dane was diagnosed with right side failure. Unknown cause currently. We took 15lbs of fluid off him today. Very interesting article. Thanks

Sarah Dzinbal

I have an eleven year old maltepoo with congestive heart failure. Our internal vet specialist in Tacoma, WA (Dr Comer) has been fantastic. We have fluid drains every 5 days of between 1-2@Lbs in weight, but his total weight is only about 13lbs. He is on a lot of meds, but Vetmedin (pimobendan) has increased his life span and slowed the disease. He was first diagnosed 2 years ago. He is also on Enalapril. Also two diuretics--furosemide and spironolactone. The latter has really helped with fluid in his lungs. He rarely coughs now; his main issue is the fluid build up in his abdomen. I find that his appetite is seriously affected when the build up gets bad, but he will eat small portions of real meats. His tongue and ears also get cold. If you can afford it, your best friend can still have quality of life with treatment. My buddy still plays and has bright eyes. We still take walks--albeit now in his pet stroller!

Doc

Hello, Sarah,

I admire your commitment to the care of your dog.

Thanks for reading and writing.

mia c

I have started a support site for my dog suffering from this as well. its strange it has baan almost a year since last oct too...and seems like now oct is coming back around her condition is getting intense again. we havent done an at home tap in 2 months, we treat her with fish oil, and a mushroom blend. they say autumn has heart cancer. but in not sure its really causing the ascites... shes Madame Autumn shes a public figure on fb im posting vids of her at home taps and am more than willing to help anyone with questions on how weve delt with autumn..she hasent been to the vet in almost 6 months :)

BD and beezy girl

I've been crying all day, and jus reading your blog and the wonderful comments brought the first smile to my face I've hadn a while, 1love -

Bobbie

Hi, I have been going threw this for 6 years, Had a lot of bad medical advice but Puppy and I have managed to get by, Her top weight was 54 pounds, my last 2 vets told me they could not drain any fluid off because she would go into shock. So it was diuretics potassium pills and vitamins. Then 3 months ago a friend set up an appointment with her vet, They drained off 6 lb's then 3 weeks later 10'lbs 3 weeks later 8lbs. She is doing great, I will take her back next week but shes about 27 lb's now and a whole new dog. I don't mind sharing my experience with anyone, as I went through years of hell. wish I had found this sooner.

Bobbie

Have faith, and realise some vets do not know how to treat this. I have gone threw it for years.

Doc

Hello, Bobbie,

To be fair, it is possible for the patient to go into shock when the fluid is drained off. Some internists really scare you about this, so are sort of afraid to kill the dog. Killing the dog is a bad thing.

However, if the medications are not working to remove the fluid, we will sometimes take the risk of draining it in order to improve the patient's quality of life.

When it works, it's great (even though it's temporary).

Bobbie

Thanks for the quick response Doc, my part j russell has had congestive heart failure for 6 years. By chance I found a vet that would drain her, The meds didn't work that well, shes on 6 different ones, she was up to around 55 pounds, now we have her down to 27 - 29, in about 4 weeks she will get back to about 37 or 38, and this week will be her 4th draining. I do worry about her not waking up but she has a good quality of life and seems to be getting a bit better. As a professional I think you could have left the temporary remark out, we don't know that. ty

Doc

Hello, Bobbie,
By temporary, I mean that it is a treatment that is helpful but not a cure. As you know, one has to keep draining the fluid. I did not want someone to get the idea that all you have to do is just drain off the fluid and you're done. It is a part of a continuing management strategy of a disease that is, unfortunately, progressive.

The goal is for the patient to be as comfortable for as long as possible.

Bobbie

My whole point is, not all vets for some reason will come forward ( liability most likely ) and will let you and your dog suffer through this. I was told point blank that you could not drain any fluid off my dog or she would have a stroke. He also gave her 2 weeks to live 4 years ago and told me there was not any heart medication to help her. But there Are heart medication's, Vetmedin for one. All's I'm saying is I think the owner has the right to know this might be a option.

Bobbie

Here is a update, Friday was the 4th time I had her drained, this time 9 lb's of fluid and they got it all, it will come back but it takes longer now. Shes feeling great my only problem now is the vet wants to put her on a diet with 0 protein, green beans have 0 protein that and rice is about all I could find. I bought some of the special food which of course she won't eat, she was eating good on boiled chicken so now it's the decision / do we let her live her life out with quality life or do we prolong it and make her and me miserable fighting over supper.

Doc

Hello, Bobbie,

It sounds to me like there is some sort of failure to communicate here. We often put dogs with kidney failure on low-quantity/high-quality protein (same amount of digestible, usable protein as regular food, but less waste to deal with).

Zero protein seems unlikely, as a low serum albumin makes fluid loss into the abdomen worse. Protein starvation would keep you from making albumin. That's why the little skinny refugee children have the big bellies.

You need to tell your veterinarian that you don't understand the dietary recommendations. You would like them to write out what you are supposed to do and why. You just want the best for your dog and want to do the right thing.

Even the best diet from medical theory is no good if the dog starves instead. We often have to make compromises.

Please discuss this further with your veterinarian.

Bobbie

Well Doc I had to try it for a week, already her gums and tongue are turning white from a nice pink, Thanks for your honestly Shes back on her old diet.

Kathleen Haselden

My Dutch(appx 10 y.o. labrador/husky mix)has had chronic valvular failure since 8/2013. He is on Enalapril,Dig,Las,Spiro,Vetmedin,Dilacor XR and Mirtazpine. The ascites started 1/2014 with monthly taps of appx 4200 ml. Looking to possibly going to a 3rd diuretic as in this past month the ascites has increased.

Doc

Hello, Kathleen,

Thanks you for sharing your information. I certainly don't feel it appropriate to give you any advice as to medicines, never having seen your dog.

My own cardiology expertise is limited. I would certainly be in consultation with a veterinary cardiologist if I were dealing with such a case.

I am told that the draining of the abdomen is often what helps the most. By this I mean that while the other medications help the poorly functioning heart, you cannot rely on medication to get rid of the fluid.

It sounds like your dog is being very thoroughly managed by your veterinarian.

Deb kluge

we have an 8 yr old female lab, she is beyond the smartest level for her bread, we unfortunately have discovered that she has a tumor in her right side of her heart, the fluid in her abdomin has been drained this weekend 3 liters, the time it has been there is unknown, but her body has learned to adjust, however as the tumor grows, it puts pressure on the right side of the heart and has stretched the webbing around the heart, and has created a strangled effect and bleeding around the heart is present, the tumor is not operable as it will send her body into shock with the open space per say the heart has not known, on top of the fact odds are highly stacked against her making it off the table alive. so we choose not to persue that further, we are being offered to try spironalactalone diuretic it may or may not assist at this stage, waiting to hear if the vet will perscribe with out having to bring her back in creating more stress for her . she is up and moves about slowly at times, pep in her step sometimes too, and she stills jumps on the bed with out being told to. we have changed her diet to all natural meats,bones,and organ meats with suppliments vitamin b, fish oil etc too many to list. we used Milk thistle and vitamin k to lower her elevated liver enzymes and that has returned to normal, that was done because we had not known about the heart issue, she is doing better on the all fresh foods try, we will if we are blessed to have her another week will go back in for tests on the type of tumor it is for possible oral treatment, in addition we are using the 2 teaspoons of organic lemon juice and 1/2 tsp of baking soda and 8 oz of water daily to provide the 10k times greater effects then chemo that has not been offered at this stage yet but we are going to give her every option we have available to us to make what time left with her to be quality! any ideas or additions we should be aware of

Doc

Hello, Deb,

You have an exaggerated opinion of my expertise. I am no cardiologist or specialist of any kind. I probably could not add anything to your treatment regimen even if I had actually seen your dog and her diagnostic workup.

Since I have not, I really cannot presume to second-guess what is being done.

It sounds to me like your veterinarian is being very thorough, and would be happy to address any questions you may have. I don't think you would find your doctor resentful if you have questions. The doctor actually seeing your dog would be the first source, and your best reference to a specialist if you have more questions, as they could give all the pertinent information (to keep from having to re-invent the wheel, so to speak).

Best wishes with this very difficult case.

Shannon

Hi,
I have a little 10 pound dog that was diagnosed in 2009 with congestive heart failure and I was told in 2010 he had a year to live by the vet cardiologist. He takes Lasix, vetmedin, enalapril, and diltiazam and a cough med to help with his cough and also the vet said to relax the blood vessels, just recently his stomach has blown up and the reg vet at first didn't seem comfortable to the idea of draining his stomach due to messing up the albumin balance( I believe). I know some people who take their dog to get drained every few weeks for heart failure so I guess it really just seems to vary according to each vet....what I'm wondering is how painful is it to drain the belly especially since typically this becomes a very frequent procedure and a last attempt to keep our pets alive! As much as I want every last minute with my pet I also don't want him to suffer either!

Doc

Hello, Shannon,
Most dogs are pretty tolerant of the procedure. We usually put a little local anesthetic at the site of the puncture.

Since the process usually takes 20 or 30 minutes, we have the owner sit with the dog while we are doing it. Both owner and dog are usually apprehensive the first time, but not so much the next time. They see that it's not very traumatic, and great relief can be obtained for the dog.

I have been told about that albumin balance thing. The problem is that there is no alternative. I've been fortunate never to see a problem as a result of the drainage. They just feel dramatically better.

You could certainly have some complication, but the alternative is watching the dog in misery.

Often the medications will slow the return of the fluid, so the procedure may not have to be done as often as you fear.

Catalpa Dotson

My boxer mix is 6 1/2 and is usually 80 lbs. He has a mass in the upper right chamber of his heart. He was first seen by our vet, then the internal medicine Dr., then the Cardiologist. They gave him 2 weeks to live on April 4. After his heart sac and his abdomen were drained we had 3 joyful weeks and 1 good week. This week is not so good.

My understanding is this is an aggressive cancer. He has been taking Yunnan Baiyou to slow the blood from filling his heart sac, but his abdomen is severely swollen and his breathing is very labored.

I have brought him 400 miles to my sister’s to have him put down and be buried here because I don’t want him to suffer. My sister found this site, and now I am wondering if repeated “taps” are a viable alternative?

Doc

Hello, Catalpa,

Draining the abdomen can really give a lot of relief, at least temporarily, when the problem is right heart failure. The heart-base tumor makes things more complicated, as the pericardial sac (around the heart) is much more difficult to drain.

The heart-base tumor makes things much worse generally.

I am certainly not in a position to second-guess a cardiologist. The doctor who has seen your dog and treated him would be the best resource for you to ask.

gaurav

hi.
i have 5 years old st. bernard. He got the same problem. His docter took out the fluid and he was on regular treatment and medicine but his stomach is again in the stage of fluid , is it safe to take his fluid out again for the second time. He's facing this problem from the last four months, plz do suggest

Doc

Hello, Guarav,

While I have been told by some internists that there is risk involved with the sudden loss of the fluid, I have been fortunate never to see any bad reaction with this procedure.

The bottom line is that if you cannot control the fluid with medication, then it must be drained or the animal is miserable and non-functional.

There may be some element of risk involved in doing so, but leaving the patient blown up with gallons of fluid will certainly not be satisfactory.

Talk with your veterinarian about your concerns. The doctor seeing your dog is the person best equipped to advise you.

Chandrika

Can you please tell me how often the fluid should be drained? My dog's medication has been increased and that has helped but his abdomen is huge and not going down. For the past two days he is also vomiting.

thanks Chandrika

Doc

Hello, Chandrika,

Every case is different. I have had patients that could go a month or more between drainings, and some that re-accumulated fluid much more rapidly.

My rule of thumb has been to do it before the patient is in a lot of distress.

You should discuss this with the doctor seeing your dog.

Kevin

I have a 13 year old am staff and he has right sided congestive heart disease. We have had fluid drained twice already but the vet only took 1 and a half liters each time and stressed that it is not beneficial to keep draining the fluid as it takes all his nutrients etc. He ha been doing OK but the extra weight is hard on his joints as he also has arthritis. He is on Vetmedin and Lasix but the fluid still builds up. He has had to minor strikes since the drain and his good days are still out weigh the bad. The vet told me I should expect a rapid decide and a tough decision will have to be made. I am heartbroken over this as I have had him 13 years. I am still wanting to continue draining his abdomen if I can but I am unsure as my vet recommends otherwise. I am at a loss hear. His appetite is here and there. Sometimes he eats all and sometimes he eats very little and that is even with cutting down his potions. Any thoughts would be greatly appreciative

Doc

Hello, Kevin,

I am not in a position to second-guess your doctor, as I have not examined your pet.

That being said, there are some things to consider generally. The fluid accumulation with right side heart failure doesn't respond so well to medication as the fluid problems in the lungs with left side failure.

Sometimes combinations of drugs are more effective. We are currently dealing with a case that the cardiologist recommended the Vetmedin, Lasix, benzazepril (an ACE inhibitor), and spironolactone (another diuretic). Recently we had to replace the spironolactone with aldactazide. The dog still requires periodic drainage.

I have often heard the caution about depleting the dog's plasma proteins by repeated drainage. Against this, I have the alternative of the dog being totally miserable and having difficult breathing due to the fluid build-up.

With cases in this "between a rock and a hard place" situation, I have had several that we drained repeatedly. The dogs did not appear to have obvious problems from this, and we appeared to prolong the number of good days.

Again, I haven't seen your dog, but if he is miserable with the fluid, and feels better after drainage... consider asking your doctor what have you got to lose?

Lokesh P

I'm lokesh from Bangalore,India I have a Male Labrador , he is 5 years old . Recently he had fluid retention in his abdomen , i took him to the doctor and the doctor scanned and had a ecg and confirmed that his heart and liver had enlarged .Initially i thought this could be cured . He prescribed medications including tablets to drain out fluid and syrups to improve heart and liver functions. He is been treated since 2 months , even if he skips the medication for two days the fluid accumulates and now it has really scared me. I'm really worried about the coming days . He is active , eats well , does not show any signs of pain or vomiting . Can you please help ?

Doc

Hello, Lokesh,

I understand your worry. If your dog has right sided heart failure, this causes secondary liver problems.

If the heart failure can be managed, then the liver should be able to improve.

Congestive heart failure is a gradual weakening of the heart muscle. This is a progressive disease that we do not know how to cure. We try to manage it by making the heart's work easier with medications. It sounds like this is what your doctor is doing.

They only help the weakened heart to do its work, and give it less work to do. If you stop giving them, the heart loses its help, and doesn't function well. The outward signs of problems then return.

You should talk further with your veterinarian about the diagnosis, treatment, and long-range plans. The doctor who has actually seen your dog is your best resource.

Lokesh P

Thank you doctor , you were really helpful .

Shayna

Okay, so my bulldog was diagnosed with right-sided heart failure. My vet said that using such things as pimobendans like vetmedin will not work since it is on his right side. Is this true, or should I consult another vet?

Doc

Hello, Shayna,

I'm no cardiologist, but the cardiologists have told me that the medications are not likely to be helpful in right sided heart failure. I have used them anyway, but have been disappointed with the results, for the most part.

Sometimes such a patient does respond to medications, so I think it's worth trying. Most of them require periodic drainage of the fluid.

Jacqueline

My dog is a a 10.5 year old approx 24lbs female dachshund mix with congestive heart failure. She had heart valve disease which lead to the chf. She was diagnosed with chf in Nov 2014. She has been on vetmedin, enalapril, diltiazem, lasix and spirotolactone hctz daily for many months.She has suffered from sudden collapse, & coughing. I have given her cpr several times to save her. By June her abdomen became very enlarged and I feared she was filling up with fluid. The vet said no it was not fluid according the X-ray and that it was only gas and food. Two months later, I brought her back in because she was uncomfortable, getting even bigger, eating less and coughing more. I felt even more certain this was fluid. The vet performed an abdominal paracentisis and removed 1.5-2 liters of fluid from her. She now looked emaciated but seemed to feel better. This was last Sunday. Sunday night she had a severe collapse episode and appeared to be dying. panting then losing consciousness, loss of bowel control, suffering and struggling for maybe 45 minutes until she recovered. She was fatigued but recovered. This happened again the next day and I realized maybe her meds were lowering an already low blood pressure due to the fluid removal and she was crashing. I spoke to the vet. She said to stop the spirotolactone but to continue the lasix. She was taking 12.5 mg of lasix 3 times per day and I expressed concern with that and she said to reduce it to twice a day. I tried but if I gave her a whole pill she would collapse within an hour. So I reduced it to half pill twice a day and she seemed fine. As the week went on she seemed to be getting bigger so I started to increase the lasix slowly. She was fine until today. After only receiving 1/2 lasix pill x3, a total of 1.5 pills (12.5mg each) she collapsed horribly, suffering as before but worse, pale tongue and gums now and the intestinal distress was worse. After about an hour when she began coming to but the intestinal distress continued although the volume was reducing. At this point there is some blood residue in the diarrhea. She won't drink the pedialite but will drink water. I gave her a small amount of pepto and I'm hoping this episode will end. She gets so stressed going to the vet and I don't like to bring her unless absolutely necessary because her heart can't take it and the vet completely agrees with this. (Also no doctors are available this time of night). What is your professional opinion on this? I believe she can no longer handle lasix (& spirotolactone) and now I am concerned about her becoming severely dehydrated. Thank you

Dre

my dog has congestive heart failure, we drained 5-10 lbs on 1st day, the vet drained 20 lbs 2nd day, and 5 lbs the 3rd. has anyone heard of a "drain line" being inserted from the abdomen up through the skin? so that it can continuously drain . . .

Doc

Hello, Jacqueline,
I am concerned that your dog is having heart-related fainting spells or seizures due to low oxygen to her brain.

These are very difficult cases, and there is no one "recipe" that is good for all of them.

Removal of fluid by paracentesis (needle in the abdomen) shouldn't cause dehydration. There are reports of dogs that go into circulatory shock because of the sudden fluid loss, but I have done this quite a few times with no complications.

I am afraid that your dog's problems are due to the severity of her heart disease, rather than her medications. Short of referral to a veterinary cardiologist, I really don't have any new recommendations for you.

Talk to your veterinarian about your concerns.

Doc

Hello, Dre,

Continuous drainage like that could be accomplished by the use of the type of catheter they use for peritoneal dialysis. However, these catheters require a lot of maintenance, and are somewhat difficult to keep working.

This sounds like an amazing amount of fluid build-up. I would ask your veterinarian about getting a consultation with a veterinary cardiologist.

Dick B.

I have an almost 16 year old dachshund with right sided heart failure. He was drained yesterday and today of 2 pounds total from his abdomen. He definitely seems more comfortable not being bloated but he still doesn't have any appetite. I thought after being drained and not being bloated he would start eating again. He was 13.5 pounds, now is 11.5. He is on 5 mg Benazepril 1/2 tablet once a day; 12.5 mg Furosemide 2 tablets twice a day; and 25 mg Spironolactone 1/2 tablet twice a day. Can all these prescriptions cause him to loose his appetite? Last 3 to 4 days I have been syringe feeding him Iams max calorie plus canned food and Supplical paste twice a day when he gets his pills, giving him some nourishment plus hoping he will get his appetite back. How long do I keep syringe feeding him hoping he gets his appetite back? He doesn't fight the syringe feeding but he doesn't like it either. Any suggestions? Thanks so much for your time and your forum you have.

Doc

Hello, Dick,
These cases are very difficult to manage. It is possible that the meds are affecting his appetite, but without them, he will probably have more trouble with his heart and more rapid fluid build-up. It is more likely that his disease problems are affecting his appetite.

It has only been one day since the excess fluid was drained, so I would certainly continue the nursing care. His appetite may take a day or so to recover.

If not, you might ask your veterinarian about adding an appetite stimulant like mirtazapine.

There isn't really "one right answer" on these cases. You try what you have to in order to make them comfortable.

Jenny

I have a 14 yr old lab with a tumor on her heart. She has begun to accumulate fluid in her abdomen. We had the vet drain it off once when she started to look uncomfortable. I was hoping we could go acouple of weeks before another drainage but 2 weeks looks like the max. After her first drainage she had a lot of pain at the drainage site and could not sit or lay down for 2 days without acting like it was painful. Is there anything that can prevent the pain at the drainage site?

Doc

Hello, Jenny,
I have not experienced this problem with the few cases I have had that required repeated drainage.
I use a small amount of local anesthetic at the drainage site, but this wears off in a few hours.
I believe that if you inform your veterinarian of this problem, he/she can dispense pain control medicine for you to give our dog. There are several different options. Please do NOT use over-the-counter pain medications for your dog, as many are not safe for dogs.

Chandrika

Have you had any cases where a dog has gone into shock as a result of draining ? Also my vet said they drained one dog who continued to drip from the site where the needle is inserted - and they had to wrap him up in thick bandages. I am taking mine to be drained by a cardio vet next week for the first time. His abdomen is 75 cm now - he is only a small cavalier.

Doc

Hello, Chandrika,

I am no expert in this. My own experience is limited to about six or eight patients. None of them have experienced any difficultly whatsoever.

I always put a light bandage on afterward to protect the site, usually leave it on for 24 hours.

I am sure that if you are seeing a cardiologist that he will give you proper care. That would be the best place to be if there were to be any complications (and there probably won't be).

Again, the person best equipped to advise you is the doctor who is actually seeing your dog. My experience may not be applicable.

Indiangie

I have a 10 lb rat terrier that has fluid build up and our vet doesn't want to drain her. He says it just comes back, but why can't we just keep draining it? Should I take her somewhere else? She's on 2 diuretics, vetmeden and other drugs. Also, her appetite is voracious! She will look for food all the time and when she eats, we have to give her a bit at a time or she will just wolf it down and then she has major gas problems. Please advise.

Chandrika

My little Karo was drained a month ago - they drained 4 Litres of fluid that was more than a third of his weight. His appetite increased dramatically but alas he is filling up again. What is the longest a dog lives with repeated draining episodes?

Doc

I have treated some patients for more than one year. I don't know that there is any rule of thumb on this. Some patients certainly have not been as successful for me, and I am sure that some have done better for others.

Stephanie

I really appreciate your candor and careful advice. My 12+ year old lab-chow mix has been on Vetmedin and Sotolol and lasix for several months D/t rt side failure, and just recently had a paracentesis for ascites. My decision to have this done was purely palliative, as I know it will not cure him. But the difference in his quality of life has made this worthwhile. The decision will be difficult to stop this if it becomes too frequent, but my vet is treating him with palliative intent and respects my decision to do so. It is very interesting to read the different experiences others have had. I am an oncology nurse and see the positive effect on patients when we are able to give them palliative treatment, if only to give their limited time on earth more quality to enjoy with their families.

Thank you for your service and welcomed advice,doc!

Doc

Hello, Stephanie,

Thanks for your kind words. We have treated several patients with periodic paracentesis for six months or longer.

I have heard warnings in the past about this causing some kind of hypo-proteinemic crisis, but have never had any difficulty at all. The dogs feel so much better afterward. I guess you could have a problem, but the alternative is sitting there struggling to breathe.

Heather

My chihuahua has chf, and a heart murmur. He takes lisinopril, vetmedin and lasix 2x daily and is doing well so far since bei g on them since last august. He also has arthritis. What, in your opinion would be a safe pain reliever for him to take? The prescription ones i have researched seem to risky for his kidneys for me to even consider. Thank you in advance for any advise you can give!

Doc

Hello, Heather,

You should really consult with your veterinarian about this. Prescribing for a patient I have not seen, particularly one on several meds, is not something I am comfortable with. It is a recipe for trouble.

Sonta

My dog os a 14 year old silver lab he has heart worms i just found out two days ago he has swollen twice his size N vet put him on fluid pills but they r not working he is getting bigger im so sad an worfied he is also in early stages of heart failure i just want him to be comfortable im so sadden by this i dont know how to keep it down um so scared he is going to smother in my bed

Doc

Hello, Sonta,
If the diuretics ("fluid pills") are not working, you can talk to your veterinarian about draining the abdomen. Sometimes it refills rapidly, but other times the fluid pills will really slow it down, even though they won't drain it to start with. You usually have to add other drugs, as well, like enalapril or pimobendan. Let your veterinarian know that you aren't seeing the improvement that you hoped for.

Kevin

My dog has been undergoing care for a Chemodectoma on his Aorta as well as other cardiac issues and has recently been accumulating fluid in his abdomen. We had it drained last week (1.5L) and he did great for a few days but unfortunately appears to have regained the fluid quickly and his symptoms have returned.

Do you know of any reason to preclude the insertion of a catheter that we could use to drain the fluid on a more regular basis?

This seems to be a fairly common procedure in humans, but I'm having a hard time finding any literature for it in the veterinary space for anything smaller than a horse.

Doc

Hello, Kevin,
I don't have any experience with this issue, personally.

There is a procedure called peritoneal dialysis, where the abdomen is filled with sterile fluids, then drained later in the day to remove waste from the body. A catheter is surgically placed, and is left in place for this.

My understanding is that they can be somewhat difficult to maintain, as they can clog up with fibrin (the protein that constitutes a blood clot) or other debris.

In the case of the dialysis, you are instilling a large amount of fluid, flushing it out, and diluting fibrin and other proteins in the abdomen.

With your situation, it could be more difficult to maintain.

Again, I do not have any personal experience with doing this.

Jacqueline

Although many months have gone by I just saw that my questions & your reply were posted. I wrote to you about my dog Lulu (a dachshund mix) who was suffering from heart valve disease, CHF, & collapse. Thank you for replying.
Unfortunately with a broken & grieving heart I'm sorry to report that I lost Lulu in October. She had her abdomen drained on a Monday in Oct & was gone by the following Thurs morning. At that Monday visit the doc said her lungs were crystal clear. She was doing well & we left the office in great spirits. The next few nights I was giving her ringers lactate subcutaneously as directed by her vet as a therapy. 2-3 days after being drained she became extremely weak, cold & began having intestinal cramps again. This had happened a few other times after she was drained. It always seemed like shock or a circulatory collapse. She went back to the vet on Thursday morning. The vet said she needed to be drained again. This time they said it was blood that was drained. They gave her a lasix injection, fluid therapy but not ringers lactase because her potassium was extremely high, they also gave her a steroid injection & then sent her home. She didn't make it out the door of the vet's office. She collapsed in the waiting room. Althoug I gave her cpr many times over the last year of her life, Cpr was performed by the vet but she never regained consciousness & passed away. The vet told me her potassium was so high. I asked why & she said maybe from kidney failure.
The loss has been devastating. I loved her so much. She was an incredible soul & I miss her more than I can explain. It's been 6 months but I still go over everything & feel so much uncertainty & guilt as I look back in hindsight. When she was given 6 months to a year to live her vet said I could bring her to a cardiologist. I asked if there was anything they could do for her & the vet said no. Since my dog was so anxious & was suffering from collapsing & fainting, I did not want to drag her to the city to put her through tons of tests & stress that she could not handle if there was nothing more that could be done for her. I worried I would lose her prematurely if I put her through this. With her vet, my dog had ekgs, heart sonos, wore a heart monitor for 2 weeks, was on tons of heart meds that were adjusted when needed, in the last 3 months had her abdomen drained several times & I gave her subcutaneous fluid therapy at home. I hope I did what was best for her. Missing her so much now & am re-thinking & doubting every choice I made for her. At the time her vet said I was doing all I could for her. I remember calling often & asking if she was a candidate for a pacemaker or if there was heart valve replacement or repair available. The vet always said no & said she needed a heart transplant & that type of surgery wasn't being done by anyone in dogs now. I know this is a tough question but do you think I made mistakes? I loved her so much & its so hard to live with thinking maybe I could have made better decisions for her. She was just 11 & despite everything was amazing & full of life. Thank you again for listening.

Doc

Hello, Jacqueline,
It sounds to me like you made an amazing effort and left no stone unturned.

I certainly think that you have nothing to feel guilty about. You gave her good months that she would not have had without your commitment.

I know that you miss her, but you need not feel any regret about having failed her in any way.

Jacqueline

Thank you so much for kind, professional & reassuring words. I read your response last night & I believe I slept better after reading & taking your thoughts to heart. When you love someone so much being responsible for their health is very difficult. It is especially difficult when their state becomes such a delicate balance that is so hard to maintain. People like me count on the opinions & guidance of doctors like you to help us do the best we can for our loved one. I have a lot of respect & admiration for you & others in your profession. In the end all we can do is love them & try the best we can to do what seems right. Thank you again for trying to put my mind at ease, for sharing your knowledge, & for all you do to help us help those we love.

Shelley

It's been so helpful reading all the posts. My Cav is 10 years old and has right sided CHF. Second time drained him today. First time was 3 weeks ago. 2 lbs of fluid were drained. He is so much better! I realize it's palliative but it makes him so much more comfortable. I will continue to have him drained for as long as it makes him feel better and I can afford it.

Doc

Hello, Shelley,
Thanks for sharing your experience. Best wishes with your buddy.

jonathan

I lost my best friend for heart failure of 16 years. After reading a lot of these posts I have so many feelings of regret in putting my dog down. He has been battling this for 2 years and has been on enalapril, vetmedin, furosimide. My vet mentioned a tap into stomach once but said it is very risky and could cause a whOle bunch of more health risks. I should have gotten more opinions as I see many of you saying this operation worked out or has help tremendously. On my puppy's last day he was not able to sleep, he couldn't lay down on his stomach or his side. His heart was pounding and he was gasping to breath and his head was nodding back. I rushed him to the ER and they said there was nothing they could do. I wish they wouldve tapped his stomach and released the pressure I would still have him by my side. I hate this regret, I gave up on him to easily I should've said to do something that there had to be something they could do. I am torn inside and I wish to go back in time everyday.

Doc

Hello, Jonathan,

There is no way to know how things would have worked out if the treatment had been different. I often think I wish that I could go back and change something, yet the results might as easily just be a different kind of bad.

Don't beat yourself up. You did the best you could with what you had.

JH

My dog is a rescue pittie boxer mix who was treated for HW at about 5 yo. He has exercise induced synscope so we wouldn't allow running. Signs of CHF appeared at about 8 1/2 yrs with quick fill in abdomen. He is vet phobic due to a traumatic first few years. He was given strong sedative and first drain was able to yield only about 6 ozs. Vetmedin, Lasix, Enalpril and a managed diet have been lifesavers to keep more fluid at bay until 7 mos later. In that timeframe we worked to develop a healthy relationship with another vet so he could eventually be treated again. We took him for several visits and the staff became his friends. His next drain procedure was done without muzzle or sedative and yielded 24 oz. By the next one, 10 days later, he caught on and became agitated and air snapped twice. Only 9 oz was drained. His heart rate has gone from 240 bpm to about 160 bpm though, a marked improvement. Vet has said he is not a candidate for being fully sedated for the procedure. I will not put him under stress of the muzzle in his condition as it will work against him. I am relunctant to try a 3rd drain. What are the options for dogs that are vet phobic besides
managing diet and meds? He is quite large, can not get into car on his on own any longer, still eats and drinks and has short very slow walks at night to encourage marking. His spine is very protruded and he is just starting to get raspy when he walks. I don't want him to suffer with plueral effision.

Doc

Hello, JH,

I wish I had a good answer for you, but I do not. This dog is approaching the end stages of congestive heart failure. Even if he were cooperative with the draining procedure, there comes a point where it no longer works. There just isn't enough function left to work with.

You could ask for referral to a veterinary cardiologist, but this is just a bad situation.

JH

Thank you so much for your response. I actually had not seen it until now and it gives me comfort in knowing we did the right thing. We did try a 3rd procedure under light sedation. The drain relief was great for about 2 days and then the fluid immediately returned thereafter plus some in just 7 days time. Throughout my vet had been consulting with a local cardio vet and getting the best tips possible, especially which sedative to use. Given the fluid came back with a vengence, I knew I needed to let
him go peacefully. That was on Aug 20. First dog I've ever lost to a medical condition. Tough to take and I work with hundreds of senior shelter dogs yearly. I learned a ton. And I'm grateful for your support of this condition because owners like me and others really
need this expertise in support and guidance. Thank you.

Doc

Hello, JH,
Thanks for your kind words.
I am sorry for your loss.

Samantha

Have an Boston terrier who is 11 with chf and Cushings. Was diagnosed in 1/2016 and was given 3-6 months. In June he started to get fluid in the belly. Was drained but time between draining had increased to weekly where vet was taking at worst 2800 ml. Added sprimonalactone hcz and fluid build up slowed to now biweekly belly draining. I use south shore animal hospital a vca hospital( Staten island,NY) and they are wonderful!! The vets there and I have seen most of them
Since my baby is a regular and they have explained to me that as long as the procedure is not causing more harm than good for my boy they will continue to drain. I see the progression of chf espically with muscle mass loss but as long as my Boston isn't done on life neither are we. Keeping our fingers crossed for as long as he his ok with procedure and happy with his life.
He has a strange episode at the vet the other day. Was there for regular belly draining and blood work when he lost mobility of hind quarters. Vet expressed he was pretty sure there was a clot near the base of spine. We agreed to start heparin and what the vet believes to be purely coincidental that 1.5 hrs after shot he got up and just started walking again. Vet was astounded but did tell me that as fast as that happened it could happen again. We have at vets recommendation started on 1/4 pill plavix daily instead of heparin along with his other meds of lasix, pimobenden, sprimonalactione. Fortunately when he had this episode he was at the vet.
To anyone going they this it is so hard but if you have the right animal hospital and vet care where they will do continual belly drainings and ur fur baby handles it well than hopefully you can enjoy the remaining time with you baby as we are. Keeping our fingers crossed he continues to be happy. Finding a vet that does not stress you pet I feel plays a big part in their quality of life. My furry kid gets dropped of on my way to work and hangs out there until
I get home on the day of his appointment. He has become comfortable going since they care for him Like he is there baby and he knows they make him Feel Better. Thank you to my wonderful vets. I hope everyone else in this hard situation has as wonderful medical
Care as we do.

Doc

Hello, Samantha,
Thanks for sharing your story.

Emma

Hello,
I have a FIVE year old Boston Terrier. We adopted him at 9 months old and were told right away he had a heart murmur. 2 years went by with supervision of his murmur and nothing too serious happened. One day he became very lethargic and he ended up in a 24 hour emergency vet. I thought that was the end. We were recommended to a cardiologist down state. He was diagnosed with right side congestive heart failure. For the past 3 years we have been able to control it with Pimo, furosemide, Sildenafil, and enalipril. Recently, he became very bloated and we learned it was fluid in his abdomen. We went back to the cardiologist down state and she explained his condition is now severe. He has added another medicine and all went from 2 times a day to 3 and higher dosages. This hasn't been cheap but my dad and I love this little boy. We have had him tapped once but as I've read, it did come back and now he is even bigger. Trying to communicate with the vet downstate, the local vet, and no longer living at home with Brody and my dad has been difficult and frustrating. We aren't sure what to do at this point. We have tried several med changes and he just seems to be getting less comfortable with no appetite and weight loss. I contacted both vets today and determining what else there is to do and if at this point we need to let nature take its coarse. This feed was extremely helpful, I feel like I have a lot more knowledge and comfort in the situation. I do want to try another tap to the abdomen. Thank you all.

Doc

Hello, Emma,

In my limited experience, when medication is no longer controlling the situation, tapping the abdomen is the only alternative. While this can be a time-consuming procedure and is invasive, it can buy days (maybe weeks) of decent quality of life.
It's not ideal, but the alternative is slow death.

Emma

Hi Doc,

I appreciate the insight. We have an appointment tomorrow to tap his abdomen. I hope it can buy us some time. Yesterday we were told he is at the end of his heart failure. We are going to enjoy the time we have with him.

Thank you,

Doc

Thanks for the update. Best wishes.

sharon

Can someone give me an idea of the cost to perform abdominal paracentesis to drain the abdominal fluid caused by right-sided heart failure? My vet has not mentioned this, but I am considering asking him - if it will bring some relief to my beagle, and if I can afford it. Thank you for any information.

Doc

Hello, Sharon,

Different doctors will have different operating expenses to cover. The procedure can take 30 to 45 minutes or longer. Average cost in my hospital has been around $110. This covers the materials used, as well as the time required.

JoAnn Halleran

My 13 year old Boston Terrier also has fluid drain once a week for ascites due to congestive heart failure. Although he is 13, we still want him around as long as possible. He is on pimobendan, furosemide, spironolactone, and a couple of others that help aid in the hard work on his heart. He was diagnosed 4 mos. ago and is still with us. My vet charges $110 for each fluid drain and at first he was very reluctant about going but now I believe he realizes that it helps aid his comfort level and he goes willingly. Each time the vet removes from 4 to 5 lbs. of fluid and he has a good 2-3 days of moving around easier and his appetite is awesome but then he starts to swell and move slowly and his appetite diminishes upon the fluid gain. It is so sad to see him going through this. I keep telling myself that we had 13 wonderful years with him but it is common nature and the love we have for them that wants more.

Doc

Hello, JoAnn,

Thanks for sharing your story. It sounds like your veterinarian is treating your baby as well as possible.

Susie

Our 15 year old Lhasapoo has been battling congestive heart failure for the pass 1.5 years. In the last month, his abdomen looked as if he had swallowed a basketball. His meds were no longer working to pull the fluids off. He had stopped eating and was barely able to walk. My husband wasn't ready to have him put to sleep, so he asked the vet to drain the fluid from his abdomen. A total of 3 liters were taken off. Unfortunately, when he came home, he became very lethargic and passed away the next day. I believe his was just too weak with not eating for almost a week. Glad to see this has helped other dogs survive longer.

Doc

Hello, Susie,
Thanks for sharing your story.
I am sorry for your loss.

Donna Donna

Sorry if I'm being nosy here but I'm curious to know what your vets are charging per drain of your pooches? I see that some have had it done quite a few times. I love my dog so much but oh my goodness he starting to cost me a lot of money 😢.

Doc

Hello, Donna,
This is going to vary with the operating costs of different hospitals in different areas. The problem is that it requires sterile prep, sterile apparatus (use once and destroy), at least one assistant, and a doctor to do the procedure, and it can take nearly an hour to do. In that time the doctor could see several patients.

Monique

Rescued chihuahua female, intact, in July. She seems middle age to older. No information on her history. Had tests run for her huge belly and it seems she's heart worm positive, has a heart murmur, right side of heart is enlarged, had little fluid in lungs, and probably hasn't been vaccinated in years if ever. We hit the jackpot with this old girl. Lol She just wants to sit by us and sleep with us. I'm so in love with this old sweetie. I'm using advantage multi on her, enalaptil, furosemide, and, vetmedin just started yesterday. They said if the vetmedin doesn't help the fluid they will drain her next week.

My major concern for her is one vet recommends fast kill heart worm treatment and one says she wouldn't suggest it. I've been debating and reading and still can't find info to convince me one way or the other. I'm just looking for advice or possibly other things to consider in order to make an informed decision. Should I just be making her comfortable for a few months, or risk treating her and her throwing a clot and dying? I want what's best for her and trying to make the decision that's in her best interest and not my selfish want of having her with us.

Any suggestions for diet, meds to ask vet about, supplements, etc will be greatly appreciated.

Doc

Hello, Monique,

The doctor best equipped to advise you is the one seeing your dog.

Speculating here, based on the information I have, I would guess that removing the fluid will be necessary (using a needle), and sooner would be better than later.

I'd be wanting to do the treatment as safely and effectively as possible, realizing that even when the worms are gone, the dog will still be a heart patient. That will not recover. Getting rid of the worms will give the failing heart less work to do, though.

I'd start with Doxycyline for one month.

Sometimes prednisone will really open up the pulmonary arteries, giving the heart less resistance to pump against. The down side is that it can make the patient retain fluid, so could make things worse instead of better.

The standard treatment plan is one month of doxycycline, one month off, then one injection of melarsomine (immiticide or diroban), one month wait, then two injections of melarsomine, 24 hours apart.

I'd start the doxy now, with maybe a trial of prednisone. However, I must caution you that I am speaking only theoretically here. I have not seen your dog, and I could be way off base as to what would be best for her.

Seriously, "Dr.Google" may be worth looking at, but you need to ask your doctor your questions directly.

Natalie

Hello,
My husband's family dog just passed away. Because I didn't speak the language of the vet and heard everything second hand, I didn't really understand everything so I wanted to ask some questions. From what they said, the ascites was due to some kidney problem (they didn't mention anything about the heart). He was very big around the middle for some time but the vet said there was no point draining him as it's be back in two days. He seemed ok and was still walking around. One day he was having trouble getting up (could still do it but with difficulty) and then he died that night (the vet was going to come and see him again the next day and probably put him to sleep as he said there was nothing more he could do). What do you think caused the death in this case? Kidney failure? He seemed ok except for the last day.

Doc

Hello, Natalie,

Kidney failure usually doesn't cause ascites. You could have a leaking kidney or ureter that caused urine to pool in the abdomen. You could have problems with kidney function in tandem with other things that might cause excess pressure in the abdominal blood vessels, causing them to seep fluid.

Sometimes the kidneys lose a lot of protein into the urine (that should be retained in the blood). If serum albumin (a protein) gets too low, the blood vessels tend to seep fluid. This is why you see the huge bellies on those starving children.

I really cannot speak to this case as I don't have enough information about what else was going on.

Fluid on the abdomen is most commonly caused by low albumin, poor function of the right side of the heart, pressure on the big veins in the abdomen, infection in the abdominal cavity, tumors in the abdominal cavity.

The doctor who has actually seen the dog would be your best resource.

Lisa

Does a dog have to be sedated to drain off fluid? I have a dog that is in desperate need of it, but the local vets aren't willing to do it. They say "euthanize", and neither me nor my dog is ready for that. Is there any advice for doing this at home? I really need to get this fluid off, and I am not financially able to take him to another town to try to locate more vets. I've already had him going to two vets locally... and they are even both 30 minutes away. I was a registered nurse in an intensive care setting for over 10 years, so I do have equipment and skills of assisting physicians do this on people. We never sedated a person for this... they always sat up on the side of the bed. Can you offer any advice at all to help me out? I am so distraught, because I know this needs to be done, but I do not want to do anything wrong. Thanks. :(

Doc

Hello, Lisa,

Holy mackerel! I really don't know how to advise you. We typically do not sedate the patient.

I usually use a six inch 16 gauge I.V. catheter so that I can manipulate it in the abdomen without piercing something I don't want pierced. I do a surgical prep. drape and gloves. I put local anesthesia in a spot on the midline where the belly is the biggest. I make a small nick in the skin, then punch through with the catheter, withdrawing the stylet after insertion.

The dog is lying on his side, and the owner is at his head talking to him, while a tech holds the hindquarters.

It usually takes about 30 to 40 minutes to milk the fluid out. It comes out under pressure at first, but then you have to keep manipulating as the omentum gets in the way and plugs the catheter temporarily. I keep a sterile syringe in the field so that I can puff a tiny bit of air to unblock the catheter if I can't just roll the dog a little to do it.

It's not rocket science, but I cannot leave it to a tech, either.

Even though I have given you the procedure I follow, I can't really recommend trying this at home without help and support.

I am sorry that your local veterinarians are reluctant to do the procedure.

Marie

Hi Doc! And everybody else :).
We have 3yo French Mastiff, Sam. He is momma’s boy. A year ago he was diagnosed with a fib and CHF secondary to cardiomyopathy.
When first diagnosed his vet put him on Lasix, Vetmedin and Diltiazem. They tapped him (only were able to drain about 2.5 l before he became restless). We did good until Harvey (walks, home cooked food) and relatively good after Harvey (only back yard exercise when time allowed and more canned food) This whole time I was fighting his lack of appetite. He has always been picky eater, but his condition and the meds made it hard for us to keep his weight. I got him some multivitamins since we did mostly home cooked meals and for most he was eating and had good energy level.
Then slowly we saw his tummy getting bigger and about six weeks back he almost stopped eating. He would devour his favorite snacks and table scraps, but only nibble on his dog food (be it home cooked or store bought). At that point I decided to call the vet (after researching the internet) and asked for appetite stimulant. The vet gave him Mirtazapine and it took about three weeks for it to take affect. I am so happy to see him hungry again.
Two days ago he went for his check up. His labs are good (only BUN little elevated and K on the low side of normal). They tapped him again. This time he stayed still long enough and they were able to pull out 9.5l (I can’t go in with him, he is overprotective and doesn’t like strangers around me. He is a lover when I’m not there, lol). We managed a whole year between taps. So far he has no coughing or labored breading. and after his tap he is more energetic and hungry then ever.
I also have a question: Yesterday (day after his tap) a lump the size of my fist showed up on his chest, behind his front leg. Today it spread and it’s almost half way down his belly. It seems to be edema it is cold to the touch and it doesn’t seem to bother him. And even though it spread it stays on the right side. Any ideas what it could be?
Also, I see lots of dogs has two diuretics. When should we start thinking about second diuretic??
Thank you for the answer. And thank you for your blog.
Marie

Doc

Hello, Marie,

I wish that I were able to give you some helpful information or advice, but I haven't seen anything like this. I think it will take an in-person examination by your veterinarian to assess this new swelling.

As far as taking two diuretics, I would start that if using only one weren't working. Going a year between abdomen drainings is phenomenal. In my limited experience, my patients required draining every few weeks.

Marie

Hi Doc,

Thanks for your response. I did call his vet and we will be monitoring it and they will see him next week if needed.
I am so happy to find Ginny’s story. Reading other people’s and pet’s stories is helpful in so many ways and all your advice is well appreciated.
Marie

Molly Raymond

My Yorkie was 12.5 years and diagnosed w right sided CHF a few weeks ago. I took her to a Cardiologist and she confirmed dx. We tweaked some meds and added others. She was on 4. She had a great week and seemed happy. Then on Thursday she would not eat her food so I hand fed her some baby turkey/rice. She drank her water. She slept a lot. She usually was 4.5-4.10 Pounds and after her first lasix shot she went down to 4lbs. Then a week later she was 3.8lbs. Thursday night she started breathing rapidly and heart rate way up. She was restless and could not sleep all night. I took her to the vet hospital and they gave her lasix but her little heart rate was 240 and her R were 120 on O2 and she was really struggling to breathe. I held her and she could not breathe. I made the decision to let her go. At 3.8 pounds her heart was giving out. She would not of wanted to be in a cage hooked up to IV and possibly die alone. She died in my arms but I am beyond crushed. I have beaten myself up that maybe I could have done more. But they were very worried when her HR was 120 and it was up to 240/minute. I never want her to feel I gave up on her. I wanted her to still be w me. I had hoped I would feel better 10 days later w my decision but I miss her so much. The vet had just been thru this w her cardiac dog and had been given 3 years and she put her to sleep at 3 weeks in last stage. She said it was aweful.

Doc

Hello, Molly,

As I suspect your cardiologist told you, right sided CHF is not as responsive to medication as the left side CHF.

It sounds to me like everything that could have been done for her was done for her.

You don't need to feel guilty or beat yourself up about this. There comes a point when you aren't prolonging life, but merely creating a slow death.

You did the right thing.

Phillip

My Labrador is 11 years old, she has ascites, no diagnosis on what's causing it yet.
She has high WBC (31.9 x10^9/L),
high granulocyte (27.6 x10^9/L - 85.1%),
low MID% (1.1%),
low RBC (4.6 x10^12/L),
low HGB (87 g/L),
low HCT (29.6),
low BUN (2.17 mmol/L).
Lymphocytes, PLT, SGPT, Creatinine are all within normal levels.

She still has her uterus so one possibility is an infected uterus but the sample fluid extracted was clear, probably just water. She probably has 4-5kg of water inside her belly. She's still eating and drinking well but she already had 2 shots of furosemide and her belly is still growing. The vet prescribed oral furosemide, antibiotics, iron supplements. Our vet seems reluctant on draining her belly. I'm not sure if it is because her pulse is weak.

I might just be overreacting but I'm really worried for her, I can't sleep or eat well. I know she's old and right at the average lifespan of labradors but I don't think I can let her go just yet. And it doesn't help that my dad already wants to put her down.

I want to know your opinion on her condition.

Doc

Hello, Phillip,

The high WBC and the anemia make me wonder about that infected uterus. You usually don't see ascites with that (the abdominal enlargement being the big uterus instead), but an ultrasound exam would really help to sort that out.

Right sided heart failure doesn't usually result in the high white blood cell count. The anemia can be non-specific, just due to chronic illness.

With ascites you worry about the right-sided heart failure, cancer, liver disease (liver can't make albumin, so low albumin in blood makes for fluid seepage from the veins), low serum albumin for other reasons (can't absorb properly from intestine, simulating starvation, even though plenty of food).

If no evidence of uterine enlargement on ultrasound, and no obvious tumors, it would seem like draining the belly to make the dog more comfortable wouldn't hurt anything. Also with a larger sample of fluid, you might see more cells for analysis.

The prognosis for a case like this is guarded (meaning, lots of potentially bad reasons for it, maybe some good that are more treatable).

Phillip

Hi Doc,

Thanks for the quick response.
Her condition isn't getting any better. Our vet says to observe for a couple of days.
But I feel uneasy, I'm afraid she might drop any second now. She's been stumbling already, I'm trying to convince myself that that's because of the weight in her belly but what if she's really getting weaker day by day?

How big can her belly get before it becomes too much? Is it ok to give her parsley? I read it's diuretic.

We don't have emergency clinics here in my area so if anything happens to her in the middle of the night, we can't help her.

She's a strong-willed dog, even now I can say that she's fighting this but is she suffering? Should I just let her go? I just want her to be as comfortable as possible.

Doc

Hello, Phillip,

I hate to be negative, but this sounds pretty bad.

As the condition progresses, it is likely she will begin to have trouble breathing, just shifting that weight of fluid with every breath. Not so much painful as exhausting.

Parsley is harmless, but I also doubt it will do much.

I wish I could give you better advice, but I don't have anything else to add.

Britt M

Hello doctor, the vets here have refused to perform a tap so I have ordered the supplies to do it at home because I have no other options. I managed to drain a few ounces from my 13 Boston Terrier with CHF before she walked away and the needle slipped out. When I tried to reinsert the needle, she flinched before penetration. The amount I've drained improved her mobility somewhat but the fluid has come back so I want to try again. I'm very worried about hitting something important. Can you tell me the best place to drain her from (perhaps using the nipples as reference point)? I'm using an 18g 1.5 inch needle and 60ml syringe. I know it's not ideal to do at home, but my equipment is sterile and it's my only realistic option.

Doc

Hello, Britt,
I would like to help you, but I cannot really teach you to do this safely.

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