Good Evening - My elderly mother, 94 yrs. old, is on hospice for end stage CHF. She takes 40 mgs. a day of Lasix, and 20 mgs. (?) of metazolone a day for severe edema in her lower legs and also congestion for her lungs. when she's on the water pills for a few weeks, they greatly help her edema and congestion, but her b/p goes dangerously low and the nurse/doctor gradually reduces her water pills until she is off them all together. But then her edema builds up again and she gradually goes back on her water pills. This has been going on for about 6 months now. She is currently getting low b/p again, so this will be repeated once again. She gets very light-headed when her b/p goes down - sometimes as low as 70/52. They don't let it go much lower than that before they take her off the water pills again. I know they don't want her to become a fall risk. I guess I am wondering how long she can go through this and not have it take a toll on her?
My impression from her cardiologist is, while low BP is a concern, the real danger to long term diuretics is loss of kidney function. But I think this "dance" our moms are doing can last quite some time. The last time we saw her cardiologist (before the quarantine) he had mentioned if she started to retain fluid, he was going to discuss some sort of device permanently placed to reduce the fluid build up around her lungs (which is where she first starts to collect fluid). He said it would greatly increase her quality of life - but the downside it there's a risk it might shorten the time she has left (my impression is there is a tube that is permanently placed in the sac around her lungs to drain - kind of like a catheter, maybe? - and it's a pathway to possible infection).
You might want to ask her doctors/hospice about switching to Bumex; my mom can take a lower dose, and it seems to control the edema a bit better. She is additionally on Spirolactone (sp?), with the Metolazone "as needed" 2-3 times a week.
Be very careful about the diuretics. When my mom first made the switch, she was so badly swollen that her legs developed ulcerations from the pressure. The Bumex dried her out so efficiently she ended up in the hospital for dehydration. So they were giving her IV fluids for rehydration and Lasix to keep her from retaining fluid. It seemed counter-productive to me at the time, but they were able to get her back on an even keel, so to speak.
Prayers for you and your mom at this time!
Ask her hospice nurse’s advise and discuss the above plan with her as everyone is different.
End Stage CHF can linger indefinitely which may be one of the conditions she is already on hospice for. Her routine of gaining fluid weight and then given water pills to take off the fluid places a great effort on her heart.
Try to limit her sodium intake if she is still eating. Sodium is the worse enemy of CHF and many cardiac conditions but especially CHF.
No one has a crystal ball of course, regarding how long this can go on but from my experience an indefinite time unless something acute occurs that changes everything.
Also, since she is on hospice, wondering which way keeps her more comfortable. Getting rid of the fluid or keeping her BP up? I really think they can strike a better balance.
Good luck.
I hope they will be able to help her and make her more comfortable. Best wishes to you both.