Caring for Dog with Congestive Heart Failure


I’ve got a Cavalier King Charles Spaniel with a heart condition.  It is a very common, if not universal complaint, that Cavalier King Charles Spaniels develop heart murmurs once they reach around 5 years old.

These little dogs are fantastic companions and mine has stuck with me through thick and thin.  Always with a wagging tail and a licking tongue that won’t stop.

She developed a heart murmur around the age of 5 or 6, but it was always very minor.  The vet would mention it at regular check-ups but there was nothing really needing done at that stage.

Around the start of this year (2014) she was coming up to her tenth birthday and the vet mentioned that her heart condition was becoming more pronounced.  They have a scale from 1 to 6, and she was now around 3 on the scale.

My vet raised the topic of heart medications for the first time.

I asked a few questions about what tablets were needed and how much it was going to cost.  At the time, I thought a pound a day seemed a bit expensive, and I wasn’t immediately convinced that my dog needed them.  She seemed outwardly the same happy dog as always.

A couple of months passed and I went on holiday, leaving the dog with my brother.  While I was away, he texted me asking about some heavy breathing she was doing in the evenings.  He was obviously concerned enough to ask the question.

When I returned home, it was noticeable that her breathing in the evenings was very heavy, deep and even laboured.

I took her to the vet the next day and we started the heart medications.

She started on Vetmedin (1 x 1.25mg tablet twice daily), active ingredient pimobendan, and another called Benazecare (half of a 5mg tablet once daily), active ingredient benazepril hydrochloride.  The hope was that these would make her leaking heart more efficient at pumping the blood around the body.

Within a few days I noticed her breathing seemed much easier, so I was happy to continue her on the tablets.

It was around the same time that I noticed she wasn’t as keen on walking anymore.  In fact, as soon as the lead would go on and we would start to walk, she would slow to a snail’s pace and really put the brakes on.  The vet had warned that she might want to walk or exercise less and not to push her.

After a couple of months, she was groomed to remove a lot of heavy hair and I noticed with all the hair removed that her stomach was very large, almost bulging.

Another trip to the vet and they decided that it was fluid that was building up in her abdomen.  Apparently this can happen as a consequence of Congestive Heart Failure in dogs, a term I strongly suggest you Google for more information.

Basically, with the heart not working at proper capacity, other organs in the body can start to suffer as well.  The inefficiently pumping heart leads to some backwards pressure in the circulatory system causing fluid to leak into the abdominal cavity from more permeable veins around the stomach (or at least that’s how my vet explained it to me).  From there it has nowhere to go, building up into a swollen bloated belly.

The vet gave me an additional diuretic tablet to add into the daily mix.  This one was called Tempora (quarter of a 50mg tablet once daily), active ingredient spironolactone.  The diuretic should cause her to need to pee more often, removing fluid faster from the body, and hopefully slow the build up of fluid in the abdomen.

Another month passed and her bloated stomach seemed to be getting bigger, especially when viewed from behind.  I would describe it as very pear-shaped.  Also she was struggling with steps or trying to jump on to or off the sofa.

I had read on the internet about people getting this fluid drained from their dogs and I asked my vet about this.  What I had read suggested that the diuretics were good at preventing fluid build up but were very limited at removing fluid from the abdomen that was already there.  My hope was that by draining this fluid, we could both make her more comfortable and give the tablets a chance to work from an easier base level.

We’ll see what happens……..

Ultimately I know we are in the final few laps of the race.  She is still a happy dog but this congestive heart failure is taking its course and there will only be one outcome.  And I can’t tell you how sad that makes me feel.

Update January 2015

I wrote this article back in July 2014 and to be honest I did not expect her to still be here, but she is. It has not been without bumps in the road though.

To pick up the story where I left off, the vet was not overly keen to drain the fluid, preferring to see if we could manage it with medication.

To do this we increased the Vetmedin to 1 x 2.5mg tablet twice a day and a full Benazecare 5mg tablet daily. This was the maximum safe dosage they recommended. To help get rid of the fluid we changed the diuretic to 1 x 40mg Frusemide three times a day.

I have to say this made a big difference. Within a week her belly was much reduced and she was feeling a lot better generally.  However with this level of diuretic she needs to drink frequently and needs to pee a lot too.

She was even able to go for little walks occasionally which was fantastic.

Her weight stabilised at an acceptable level until December when it started to increase quickly. She gained a kilo and a half of fluid in around two weeks. Her breathing became shallower and I thought I was going to lose her. At this point the vet agreed to drain the fluid. In total they removed over 3 litres of fluid from her abdomen, which for a little dog is a massive amount. It was nearly a third of her body weight!

This was two days before Christmas and I can’t tell you how much of a difference it made. She was a tiny dog again and she felt SO much better, running around, playing with toys as she always did, a really happy and much more comfortable wee dog.

The vet did say this would be temporary and fluid would fill the abdomen again, and even ten days later I can tell there’s some fluid there again. But it meant so much to have her being happy and comfortable over the Christmas break.




Update October 2015

Well, unfortunately the inevitable course of this progressive heart condition has taken its final turn.  My little dog had to be put to sleep on 9th September.

Continuing the story from January, the fluid drain performed just before Christmas lasted for quite a while.  But after 6 weeks she had filled up again, the weight had returned to her maximum and she was like a little barrel again.

The fluid draining procedure only requires the dog to stay in the vets for a few hours. It is best if they can be awake and standing to allow for easy draining, although some dogs have to be sedated.

The vet performed the drain again and we went around in slowly decreasing circles of draining the fluid and gradual refilling.  I used a set of bathroom scales to keep an eye on her weight and made an appointment when it was getting excessive.

The next few times it was 4 weeks between abdominal drains, but then as the rate of fluid build up increased, the time between drains decreased to 3 weeks and eventually 2 weeks.

This stomach fluid contains quite a lot of protein so it is important to supplement your dog’s diet with protein-rich foods to help to replace vital nutrients.  Chicken, beef, the occasional egg, scraps of fish like tuna or salmon will all go down well and help to supplement the dog’s protein intake.

However, as much as you may try, you will start to notice a gradual wasting of muscle and fat from your dog. Their weight (after the drain is performed) will slowly reduce each time.  They will become a bit more bony, especially noticeable with their backbone being more visible, and they won’t have the strength to be able to jump up on things the way they used to.  My little dog always jumped up on the sofa or the bed, but after a while she needed a boost, and eventually needed lifted up.  But it gave her comfort to be up on her familiar, cosy places.

By the time it was around 2 to 3 weeks between drains, additional symptoms like diarrhoea started to come to the fore.

What’s happening is that as the heart condition worsens, your dog’s systems will try to keep the best bloodflow pumping to the core, essential organs, brain, lungs, heart, etc.  But there is just not enough good, high pressure bloodflow to fully supply all the organs.  Their paws will feel cooler than normal to the touch. Their tongue may be cooler and appear paler than normal.  Reduced bloodflow to the stomach and intestines leads to these organs slowly beginning to break down.  Food cannot be digested and processed properly, resulting in less nutrients being absorbed into the system and waste products being looser.  Intestinal mucus may also start to pass out through the system.

You could tell she was getting weaker and slower a couple of weeks before the end.  Her appetite changed and it was difficult finding food that she would eat (Pedigree meaty pouches went down well when all else failed).  In the last few days, when going out to the garden she would stop after a dozen steps and wait, before eventually walking a little further.  She wasn’t out of breath, she just didn’t have the energy or power.

Ultimately, I knew the end was at hand when I came home from work to find that she hadn’t been able to get up under her own power that day, she could barely lift her head.  This all seemed to happen quite quickly.  Her mind was still good, but she was tired.  She could give me a lick on the nose, but her wee body was just done.

I called the vet in the morning and arranged to take her in.

My little friend lasted much longer than I dared to hope.  Around 17 months of heart medications and 9 months with fluid drains.  The vets used to call her their wee miracle dog, it seems they often do not last as long, or cope as well, as she did.

She had been with me through thick and thin, always with a waggy, flicky tail and a licky tongue.  And she made me smile every single day.  I will miss her very much.

Thank you little one, sleep well.  9/9/2015 Aged 11.

 

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