Help for congestive heart failure?

Question

My father was diagnosed with CHF 2 years ago. Several months later he was diagnosed as diabetic. He takes lasix to get rid the fluid and glipizide which retains fluid. He has been "smothering" for the past few months, gets about an hour of sleep a night and the edema in his feet and legs getting worse and worse. He has been to the ER twice in the past few months and was sent home after a few hours each time, with nothing being done for him. Last time he was told that his condition was manageable at home and just to double his lasix dosage. This is obviously not working as he is getting worse every day. Why won't they drain the fluid at the hospital? Is there any way that his family doctor could order that he be admitted to have the fluid drained? I'm feeling at the end of my wits.

His doctor says it's nothing to worry about and the part I can't understand is why they won't give him the shots or the IV of lasix to get the fluid off quickly. I know he's drowning in it.

Answer 1

I'm sorry to hear of your father's troubles. Congestive Heart Failure is a serious disease with poor prognosis for many patients.

Removing the fluid with diuretics is only part of the treatment for your father. Giving him more lasix is a short-term treatment that won't have lasting effects.

Your father may need to be on a better diet with fluid restrictions (1 liter/day) and very low salt diet. How many milligrams of salt does he consume each day? Is he keeping track of the sodium. Is his blood sugar well controlled?

Medications are not a replacement for these hard tasks.

A cardiac rehab program may let him feel better, but may not alter his life expectancy.

Is your father on an ACE inhibitor? Does he have a cardiologist taking care of him?

Maybe you should go with him for a consultation with another doctor. Find someone with whom you and your father feel comfortable and who communicates with both of you.

Answer 2

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Answer 3

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Answer 4

CHF can be a little tricky to manage but it can be done successfully in most cases. Some cardiology offices have a dedicated congestive heart failure health professional assist patients in managing their condition once a regimen is established.

The first question is whether the source of your Dad's CHF is understood...and sometimes it is not always so obvious - so all things should be evaluated.

Is it due to prior heart attacks with existing scar tissue?
Is it because of ischemia (lack of blood supply to heart muscle)?
Is it due to high blood pressure or a malfunctioning valve? An arrhythmia?

If there is a definable and "fixable" source then of course the condition can be made better if something is fixed. Often CHF is multi-factorial and each of the contributing conditions should be ideally managed (bp at or below 130 at all times AND heart rate at 60 to 70 bpm AND blood sugar well controlled, for instance).

If your Dad is not being evaluated and treated through a cardiologist - I would strongly encourage you to consider this option. As I am considering your question there are layers of considerations that come to mind regarding this matter that would be very complicated to try to explain in this format.

In short, it is fair to say that your Dad's condition could be better controlled (almost in all cases - there are a few exceptions) than it is now. Seek the referral. In the mean time increase the Lasix as directed - be careful to limit the amount of oral water intake to 1.5 liters daily - including that from foods.

I doubt that Glipizide is contributing very much to your Dad's edema and fluid retention - its not normally a major limiting factor for this medication in patients with CHF.

Good luck.

Answer 5

You've gotten some excellent advice already, so I won't repeat the same recommendations. I just want to add a few additional comments. If sleep is a problem, he can try sleeping sitting up. A recliner chair is nice (my dad slept in one for years because of his CHF), but if that's not available, prop his head and chest up on a lot of pillows in bed.

As far as having the fluid drained, you can't drain it directly out of the legs, but if he has pleural effusions (fluid around the lungs), that fluid can sometimes be drained. However, that fluid should go away with medical treatment of the CHF, and if you drain it, it will just come back. So maybe that is what the doctors are thinking.

IV Lasix may be a little fast than oral Lasix, but other than that it has no great advantage. I hope it does work to increase his Lasix dosage.

I hope he feels better soon.

Answer 6

I am sorry that you're so frustrated with your father's healthcare and I'm sorry that he's been suffering so much. Lasix is a very common drug given to patient's with CHF and you're right it 'pulls' the fluid off of the extremities of patient's with CHF. Your father should speak with his MD about possibly changing his oral hypoglycemic agent (glipizide) since there is a chance that lasix can increase or decrease the affects of that drug. (Although I'm sure he/she has taken that into consideration.) Fluid would not be drained from a person's legs, typically the treatment is to increase the lasix dose or give it IV at the hospital for quick results. If your father's heart is not pumping effectively the fluid will always build up, so it's important to make sure that he is properly using his medication. If you're concerned with his status it's important to make an appointment with his MD and discuss your concerns. After all, his MD knows his condition best. BUT, if your father has trouble breathing or is unstable always go to the ER! I hope this is helpful and I'm sorry your situation is so frustrating right now.

Answer 7

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RE:
Help for congestive heart failure?
My father was diagnosed with CHF 2 years ago. Several months later he was diagnosed as diabetic. He takes lasix to get rid the fluid and glipizide which retains fluid. He has been "smothering" for the past few months, gets about an hour of sleep a night and the edema in his feet and legs...

Answer 8

If you are unhappy with the treatment your father is recieving from his doctor and you feel he is not providing maimum treatment available for him, go to a different doctor and get a second opinion.The new doctor will provide you with a new opinion of your father's condition and provide you some peace of mind.