Doc put me on Lasix because I’m retaining water in my left leg. (“How long has this been going on?” “I dunno, a few years. You already know I don’t take care of myself. But it’s started to annoy me.”) Boy howdy, did I get the warnings! The right side of your heart is sensitive to low blood pressure (mine isn’t currently low but on the high end of normal it’s not nearly as high as you’d guess looking at me) so we have to be careful I don’t lose water too fast. Let’s start it on a weekend because I’ll become intimately familiar with the toilet. Blaw-blah-blah and NO mention of how 20mg of this stuff is supposed to help me see without glasses. rimshot It was like they were feeding me a sugar pill but trying to convince me it would work.
Har-umph! I swear that I’m peeing LESS! Maybe a couple extras early on but nothing impressive overall, especially surprising after a large McCoffee while shopping that should’ve left me scouting washroom locations. And there’s some extra muscle aches but I’m taking extra potassium to minimize that
“It’s not a race, Mr Zone. You have your whole life to get this worked out.” Yeah, that’s easy for my doctor to say. He’s not the one who has finally talked himself into caring about this condition and who wants results NOW. “We’ll start you with 20mg a day then work you up to 40mg every other day.” Feh! I’m a Baby Boomer so I want instantaneous gratification AND I’m not afraid to take drugs to get it. If 20mg is good and 40mg is better then 80mg daily should be just right. (Okay, that was just hyperbole. I like my doctor and do much of what he tells me to do.)
spingears,** dropzone** should be limiting his fluid intake, not trying to drink more!
Dropzone, the potassium is approved by your physician, right? Lasix tends to work a little oddly. Nothing at all at 20mg, but WAY too much at 40mg, so they start you low and work up as and when.
If they’re working out your dose usuing your age and BUN…they’ve been reading too much Samuel Shem.
What is wrong with Google today? Do I really have to use Yahoo search? Okay, BUN is apparently blood urea nitrogen which is one of the few things I haven’t been tested for yet. He’s planned an entertaining day of tests for me but that is not specifically on the list. I believe the initial dosage was arrived at because 20mg is the smallest pill furosemide comes in, since he’s distressingly prudent. They’re generic, too and look like some homemade White Cross I had once.
As my water retention is probably caused by a kinked hose and not heart failure (like I’ve said, I’m shockingly healthy, considering all the reasons why I shouldn’t be, but yes, I’ll be getting my ductwork ultrasounded) there is no need to limit my fluid intake. He also didn’t say anything about reducing my sodium intake but that might be because he knows I’m not stupid.
In re: my potassium source. I either forget completely that a conversation took place or else I remember it word for word.
“I need more potassium? I’ll eat an extra banana or two.”
“To get all of the potassium 20mg of furosemide removes you would need to eat a dozen oranges,” the doctor said, not realizing that his statement was a non sequitor because nobody eats oranges for their potassium.
“My wife has me on One-A-Day vitamins with minerals already.”
I disagree with irishgirl. 20 mg of furosemide (Lasix™) to a “Lasix virgin” with fairly normal kidneys should have very good response to the first few doses.
That doesn’t mean the swelling will in any way change for several days to weeks. The fluid in your leg isn’t accessible to the kidneys, as yet. The furosemide will take the load off your cardiovascular system, allowing room for the interstitial fluid to move into the vascular space.
What your doctor has discribed is congestive heart failure.
The heart is actually two pumps. The left side is the lung side pump and the right is the body. The pressure your doctor mentioned isn’t your blood pressure, exactly, its the central venous pressure from the right or body side of your heart.
In other words your heart isn’t working hard enough, so with each beat, a little blood is left behind so the central venous pressure rises. Since its a closed system, the fluid is squeezed out of the vascular space into the space between the cells. This is called the interstitial space, but it isn’t really a space, only a potential space. When fluid migrates into it, you see swelling. Because the venous system is passive and we live with gravity, the venous congestion is usually in the most dependant part of the body, feet, legs, scrotum.
Furosemide has a fairly short half-life so, you may not be aware of an increased output. One tends to pee a lot within the first hour or so after the dose and then taper off over the 2-3. Be aware of the color, it should be very pale. Most people can’t really tell if they’ve gone 300 ccs or 500 ccs but that is a significant difference.
Potassium doesn’t change the effect of furosemide, but if it isn’t monitored it can drop to dangerous levels. Potassium is vital to normal heart function. Tomatoes, oranges, bananas and milk all have potassium.
All that said, if indeed, you really feel your output has decreased, tell your doctor. Congestive heart failure can be a sign of failing kidneys.
I hope this helps explain why you aren’t better yet. As we age, instant gratification is less and less accessible.
Fair enough** picunurse**, I’ll take your word for it.
(the joke is in reference to Samuel Shem’s classic satirical novel “The House of God”, where one of the “rules” is that “AGE+BUN=LASIX DOSE”, which, considering that another “rule” is “the only good admission is a dead admission” should be taken with a large grain of salt.)
His guess is that pressure on a lymph duct in my waist caused by my, um, excess belly has caused the duct to kink, which they don’t recover from all that quickly. But what does he know? He’s an osteopath.* I suspect it’s lower, like around my knee, and I’m meaning to call to get him to add an ultrasound down there as long as they’re spreading the silicone jelly around. Thanks, though, for the explanation that the main response to furosemide is in the first hour. I thought those first urinations were just because of suggestion and it couldn’t possibly work that fast and my disappointment was that it had stopped working after only an hour or so when the implication in all of the warnings was that I’d be up all night if I took the stuff too late in the day.
I’m not really expecting visible results immediately. I was just thinking that things would work a little closer to the doctor and pharmacist’s descriptions. Instead, it’s working precisely as picunurse says it would.
I’ve mentioned before that I always thought osteopaths were chiropractors with prescription pads. I have been corrected and told that no, they are REAL doctors often enough that I’ve given up and kept my “If he’s a real doctor why ain’t he an MD?” comments to myself. Anyway, I like him and he trusts my judgement of how treatment is working. And, looking at what the NIH says about them, maybe he knows a little more about the flow of my humours than I give him credit for. It also explains his “you’ve got another fifty years to get all this straightened out” attitude, which I have NEVER seen in MDs.
Now I just have to get him to prescribe a Hepatitis B test to verify or not that the result I got from the blood donation service was actually the false positive I think it was. My dental assistant spent my whole visit ragging on me for not getting that done (a continuation of last April’s lecture).
I have no problem with DOs. They do seem to take a more laid back, wait and see attitude, which, IMHO, is a good thing. I’ve worked with a few, and found that if they know what the don’t know, they’re pretty good.
As long as he is able to hand off to a specialist any problem he can’t solve, you should be fine with him.
If indeed, your excess weigh is occluding your main lymphatic duct, you won’t see much improvement until you get rid of the weight.
If you stand on the hose, does turning up the water work better than stepping off the hose? You’re standing on the hose that’s responsible for carrying off excess fluid. The furosemide is turning up the flow. So, you need to get off the hose.
If you’re non-compliant, and he’s still willing to try to work with you, he must be very patient, and you’re very lucky. In this age of no one being responsible for their own actions, some doctors will ask non-compliant patients to find another source for their healthcare. Its less frustrating and the risk of being sued goes down, when one only cares for patients that follow instructions.
Of course, if we were all pro-active in maintaining our own health, we’d see doctors looking for work. I’m not trying to beat up on you. I know how hard losing weigh can be. I also know the lure of immediate gratification. As we age, gratification gets delayed more and more. I know you didn’t mean to get old, but it was in the fine print and we have to live with it… think of the alternative.
Good luck, take your meds correctly, eat right exercise and don’t expect a pill to fix a problem you created by not taking care of yourself.
irishgirl Your only misstep was that the rule was refering to GOMERs in their case, its absolutely true. As are most of his “rules”. You had the right formula, but the wrong patient. I wonder where my last copy of that book went… I think I’ve bought at least 10 copies… it just goes away…
Actually, I’m as compliant as hell and take my meds like clockwork and monitor precisely how they are working or are not working. I’m just slow to complain about new problems so they are pretty old by the time I say anything and I’m fat and he figures, like with the water retention, that I have fifty years to get that gnawed down. I can’t bear to tell Dr Patience that the Death Psychic said I’ll die at 92 so I really only have forty-two years left. But he has prioritized my depression first THEN my weight. Sadly, my depression has been doing pretty well lately so I probably will need to start dieting soon. Drat!
“Right heart” and “left heart” are essentially independent names, not directional designations. They are completely different in most ways.
I’m sure that picunurse would never have made that mistake on the wards. It’d have had the nursing students giglling – though perhaps not in her presence. I don’t think one iota less of her for that slip. That’s also why I try to toss a disclaimer on any mediocal posts I make
We all make those little slips when we’re not in “professional mode”. I was known to make such dopey remarks at home that my ex was convinced that I was a medical moron. Meanwhile, the pediatricians she idolized often sent their kids and other family members to me, despite the oversupply of docs hereabouts.
(Which is as it should be. caring for you own is a risky, but tempting, business. My dad was a doc (albeit not licensed to practice in our state) and I grew up with the sloppiest medical care imaginable. I’ve always meant to write a humorous story about what passed for medicine in our house – the few “professional courtesy” exams I got by by other doctors as a child were nothing short of malpractice.)
Eeeek! That sounds scary, KP. My wife is “medical,” though not the MD she should’ve been, intelligence and temperamentwise, so I know how useless they can be sometimes, though she doesn’t play as fast and loose with the kids’ health as she does with her own.
Me, many times: “You are over 40/45/50 and should have a baseline mammogram.”
Her, an equal number of times: “Shut up.” (See? I told you she has the temperament of a doctor. Maybe a surgeon, even.)
This conversation has recently been modified.
Me: “Your little sister just had a lumpectomy. You really, REALLY should have a baseline mammogram.”
Her: “Shut up.”
The most recent modification was this:
Me: “Okay, I did what you wanted and am getting the water retention looked into and treated. It’s your turn. Are you going to make the appointment for your baseline mammogram or would you like me to call them for you?”
I wonder where my last copy of that book went… I think I’ve bought at least 10 copies… it just goes away…