Right-side Heart Failure and Ascites

Ginny big side(2) Fluid accumulation in the abdominal cavity (around the organs) is called "ascites".  The old-timey name for it was "dropsy".  Right-sided heart failure can certainly cause it.  There are other things that can cause it, as well. 

Cancerous growths in the abdomen can secrete fluid.   The first sign of my mother's ovarian cancer was the fluid build-up.  Starvation can cause it.  The plasma protein albumin is a big molecule that helps hold fluid inside the blood vessels.  They seep fluid without it, which is why those starving refugee kids (that you quickly skip past when channel-surfing) have such big bellies.  Without protein, they can't make albumin; that big belly doesn't mean they just got their CARE package.  If your liver is failing, it can't use the protein you have to make albumin, so that's another possible cause of ascites.

Hemorrhage from a ruptured spleen or urine from a ruptured bladder may fill the abdomen with fluid, but you'd have a lot of other things going wrong as well.

Since heartworms reside mostly in the pulmonary arteries (taking blood through the lungs to get oxygen), they are the most common cause of right-side heart failure in dogs.  The arteries filled with worms create too much work for the heart to pump against, and it wears out from constant overwork.  It becomes enlarged because the weakened muscle gets "flabby" and stretches out of shape.  Now it can no longer contract forcefully, and blood that should be getting pumped forward gets backed up in the great veins returning blood to the heart from the rest of the body.

Ginny big top (2) This back-pressure causes the veins to seep water like a canvas hose, and fluid accumulates in the abdominal cavity.  Ginny, here, does not have heartworms, but has (for unknown reasons) developed right-sided heart failure at a very young age.  She doesn't look too bad from the side view above, but she is carrying about three gallons of unwanted fluid on her abdomen.  From the top view you can get a better appreciation for the amount of abdominal enlargement she has. 

Medications can help the failing heart by decreasing its workload, such as diuretics (i.e. Lasix or furosemeide, spironolactone) to reduce fluid loading, and vasodilators (such as enalapril) to decrease the resistance in the blood vessels, and pushing the heart muscle a little harder (pimobendan, and the old standby digoxin).  Ginny is taking all of these, but it doesn't prevent the fluid build-up.  It's not too bad for a couple of weeks, but then she hits a "tipping point" and it balloons out of control.   We try to catch it before this point, but the big ice storm and two-week power-outage messed up our schedule. 

Ginny big bucket(2) Here's Ginny with the bucket (literally) full of fluid that we just drained out of her. 

Bucket (2) And here's a close-up.  The fluid looks clear when it is draining, but there are enough abdominal lining cells and blood cells present to make it look red when you have three gallons of it like this.

Ginny post-op (2) And here's Ginny, 24 pounds lighter, feeling good and looking a lot different.  Once that fluid is out, she feels pretty good.  She can't tolerate any strenuous exercise, but she has a good quality of life.  Pretty great for someone the cardiologist predicted would succumb by last October.  Her owner's devotion to getting all her meds on time, twice a day, every day has made the difference.  That and a few trips to the draining station.

162 thoughts on “Right-side Heart Failure and Ascites

    • Alex says:

      Has anyone has experience with their dog starting to shiver upon return of ascites?
      She has been managing well on medication for 2.5 months and the ascites returned a few days ago, took her to the vet and he gave her sq furosemide and added another oral dose to current regiment to try and get it off that way. This was unsuccessful, so hoping to get her in Monday for abdominocentesis. Worried about the shaking though. She is normally 65# and is 76# boxer rn with fluid.

  1. Melissa says:

    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

  2. Sarah Dzinbal says:

    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!

    • Angela says:

      Hi Sarah, I just came upon you reply to this post as I’m trying to search for information for my own (13 year old) Maltipoo. May I ask if you were supplementing your pup with anything other than the meds you mentioned? I’m currently awaiting a visit with our cardiologist in a few days but my vet has indicated that my pup has fluid in his abdomen and likely CHF now. Also, you mentioned your pup had been dealing with the disease for 2 years at the time you posted–is that 2 years with heart disease or 2 years with the diagnosis of heart failure? Trying to hold on to any hope I can while balancing being realistic.

      • Doc says:

        Hello, Angela,
        Let us know what the cardiologist says. Many dogs with congestive heart failure can live a long time with supportive medication.

    • Nancy says:

      How can i learn about at home taps my dog has right side congested heart failure , and feels great after draining abdomen but i have asthma and some heart difficulties and cant work ,and itsdifficult to pay 4 hundred to 900 each time. he has acities edema and heart enlarged they are taking him off enalapril . im getting him into a hollistic vet when i can hes on that furosemide 2 times and very small dose pimobenden once a day . Any help on doing this, and controlling abdomen fluids safe i would appreciated thanks Nancy

      • Doc says:

        Hello, Nancy,
        I had a bug in my comments, so just now seeing this. I understand your difficulty, but the procedure is difficult for an experienced professional. I don’t think that I could instruct you on doing it at home. Best wishes.

  3. mia c says:

    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 🙂

    • linda corbett says:

      at home tap?! please contact me I’ve had my dog’s ascites drained 4 times and can no longer afford it. i’m a disabled critical care nurse. and am looking for assistance on how to do it at home. other than the ascites her heart failure is managed! thank you

      • Doc says:

        Hello, Linda,
        I really can’t give you remote instructions on this. If I were working with you as my client, I would certainly let you observe the process so that you could get hands-on experience.

        • linda corbett says:

          thanks for your reply. my wonderful vet let me observe, also if I didn’t have my prior experience I would not even think of attempting this at home,or if there was any other symptoms my boston terrier was experiencing other than the ascites, I would rethink her care plan. this isn’t something I take lightly. She tolerated procedure extremely well by vet 4 times now, but I am NOT a vet, so if I have any doubt I can do safely then I will find the darn $ somehow. I have 2 BT’s in ❤️ failure so it’s been a challenge paying vet & medications, otherwise wouldn’t even consider this.(not advocating or advising this for anyone else, it’s my personal decision to make within next 7-14 days)
          thank you

          • Doc says:

            Hello, Linda,
            This is a very difficult situation, and I wish you luck. I’ve done it a bunch of times, and while it got easier as I developed more of a “feel”, it has always been a tedious process.

        • Jen says:

          Hey doc. My dog has been tapped every 2 weeks for the past 2-3 months. Aside from cough and the filling up, her attitude is good. Same old. Less active. Always hungry. Bullying the cats. I wonder if she’s suffering. I am not very into euthanasia. Especially when she’s not obviously suffering – she’s a weird girl. When she’s feeling funky she shows it so she’s not necessarily hard to read..

          But yea – wondering if I’m keeping her alive w the tapping and meds and she’s really feeling bad. Im

          • Doc says:

            Hello, Jen,
            I think you know your dog better than I do. It sounds to me like she’s doing pretty well, considering that her heart is failing. I wouldn’t feel guilty about keeping her feeling pretty good.

    • Ala says:

      Hi Mia
      I came across your message just now it is 2023 now I know .. but my dog has also heart tumor, they diagnosed him 10days ago and we we are really devastated! he is on heart medication because his right side of heart is failing along with many issues the tumor causes to the heart, pulmonary hypertension and other things, he takes Sildenafil, Pimobendan; Furosemide, Spirolactone .
      I ordered for him holictic supplementation, turkey tail mushrooms, another mushroom blend, broccoli sprouts powder , red berrie powder, probiotics. He takes now Ubiquinol too and Cardio strength vitamin blend.
      I am hoping for a miracle and for the tumor to shrink , I am not ready to say goodbye yet.
      He is 11yrs old frenchton. They drained 3L of fluid from his abdomen when they did cardio examination, he was sedated so they used that time to drain it.
      The diuretics seems to work and other medication so far he is ok no fluid came back but maybe it ll fill up later I don’t know. Its really so hard to process it all what have happened over the last 10days.
      He just slowed down a bit and had bloated stomach so I took him to the vet to check it out I would never think he has heart tumor ????
      I would like to get in contact with you if its possible .

      • Doc says:

        Hello, Ala,
        This is a lot different than a failing heart muscle. Heart base tumors are really difficult to deal with. It’s not like you can amputate the dog’s heart.

        The medications help his heart to function by making it contract a little more forcefully, and reducing the load that it has to pump.

        I am not a cancer specialist. If you want to go further, then seeing a veterinary oncologist is what I would be doing next.

  4. BD and beezy girl says:

    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 –

  5. Bobbie says:

    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.

  6. Doc says:

    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).

  7. Bobbie says:

    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

  8. Doc says:

    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.

  9. Bobbie says:

    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.

  10. Bobbie says:

    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.

  11. Doc says:

    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.

  12. Bobbie says:

    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.

  13. Kathleen Haselden says:

    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.

  14. Doc says:

    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.

  15. Deb kluge says:

    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

  16. Doc says:

    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.

  17. Shannon says:

    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!

  18. Doc says:

    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.

  19. Catalpa Dotson says:

    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?

  20. Doc says:

    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.

  21. gaurav says:

    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

  22. Doc says:

    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.

  23. Chandrika says:

    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

  24. Doc says:

    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.

      • Doc says:

        Hello, Kim,
        Sorry I’m late in replying. These are difficult cases. Sometimes the corticosteroids like prednisone will open the inflamed pulmonary arteries, allowing the blood to flow more freely, giving less resistance to the failing heart. Unfortunately, the steroids also cause you to retain fluid, no would not be advisable here. We use diuretics to reduce the circulating fluid load that the heart has to pump, and these can also help pull fluid from the abdomen. We can also use heart-supportive medications like pimobendan.
        Using a needle or I.V. catheter to drain the excess fluid can be necessary in these dogs.

  25. Kevin says:

    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

  26. Doc says:

    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?

  27. Lokesh P says:

    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 ?

  28. Doc says:

    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.

  29. Shayna says:

    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?

  30. Doc says:

    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.

  31. Jacqueline says:

    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

  32. Dre says:

    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 . . .

  33. Doc says:

    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.

  34. Doc says:

    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.

  35. Dick B. says:

    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.

  36. Doc says:

    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.

  37. Jenny says:

    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?

  38. Doc says:

    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.

  39. Chandrika says:

    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.

  40. Doc says:

    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.

  41. Indiangie says:

    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.

    • Timmy says:

      Hi Doc, Im from Malaysia and have a 10 yr old female doggo we love & care dearly. Probably too much 🙂 She’s a local breed, most likely a Telomian. Around 15kg (without fluid) if she balloned up she will be ard 17-18kg.
      We bring her for draining abt once every week.
      Shes still doing quite well, just her appetite is worrying. She wants to eat but as if something is stopping her at the very last moment just as she is about to eat.
      Now we are having a hard time giving her medications as we cannot force feed her. She will snap even me. We used to stuffed the medications in her food. All was going will till she starts to be picky on her food. Her appetite now is like on off.
      Only advice out Vet gave us was no matter what must give medications.
      To tell you the truth we tried every trick we know.
      When her appetite was normal no problem. Shes is currently on vetmedin, lasix and multivit but only we can get her to consume them.
      We need some advice on how to give her, her meds. Any time she smell or taste med in her food she will stop eating tat food even those without meds.
      Cream cheese, hotdogs, chickens, etc not working even crushed em and add to chicken broth.
      Thanks in advance Doc

  42. Chandrika says:

    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?

  43. Doc says:

    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.

  44. Stephanie says:

    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!

  45. Doc says:

    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.

  46. Heather says:

    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!

  47. Doc says:

    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.

  48. Sonta says:

    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

  49. Doc says:

    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.

  50. Kevin says:

    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.

  51. Doc says:

    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.

  52. Jacqueline says:

    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.

  53. Doc says:

    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.

  54. Jacqueline says:

    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.

  55. Shelley says:

    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.

  56. jonathan says:

    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.

  57. Doc says:

    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.

  58. JH says:

    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.

  59. Doc says:

    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.

  60. JH says:

    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.

  61. Samantha says:

    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.

  62. Emma says:

    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.

  63. Doc says:

    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.

  64. Emma says:

    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,

  65. sharon says:

    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.

  66. Doc says:

    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.

  67. JoAnn Halleran says:

    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.

  68. Doc says:

    Hello, JoAnn,

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

  69. Susie says:

    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.

  70. Donna Donna says:

    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 ?.

  71. Doc says:

    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.

  72. Monique says:

    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.

  73. Doc says:

    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.

  74. Natalie says:

    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.

  75. Doc says:

    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.

  76. Lisa says:

    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. 🙁

  77. Doc says:

    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.

    • Sandra Harrison says:

      12 year old Chihuahua diagnosed with Chf about three months ago. Not tested for heart worm. On analaprin and Lasix twice a day. Added prednisone but made fluid worse. Vet has it mentioned vetmedin. Vet mentioned not wanting to drain for fear of stroke. Tummy seems warm to touch. Problem? Viv is eating some and going outside to urinate in her own. Thing is that she has never coughed. Vet is perplexed about that. Any meaningful reason for no coughing? Shall I ask for vetmedin?
      Any other thoughts? Recent weight gain was about one pound – from 8 to 9 pounds.

      • Doc says:

        Hello, Sandra,
        Sometimes adding the diuretic spironolactone helps with this fluid accumulation, though some do require surgical drainage.
        Vetmedin is very safe and strengthens the heart muscle’s contractions.
        Right side heart failure fills the abdomen with fluid, but not the lungs, so often they do not cough.
        Prednisone can help open up pulmonary arteries if there are heartworms present, but it can cause fluid retention.
        Keep your veterinarian informed about how your dog is doing.

  78. Marie says:

    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.

  79. Doc says:

    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.

  80. Marie says:

    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.

  81. Molly Raymond says:

    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.

  82. Doc says:

    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.

  83. Phillip says:

    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.

  84. Doc says:

    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).

  85. Phillip says:

    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.

  86. Doc says:

    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.

  87. Britt M says:

    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.

  88. April's Parents says:

    Hello everyone. We have a 9.5 year old miniature schnauzer named April. She was diagnosed with CHF nearly two year ago. Our regular vet told us the majority of dogs diagnosed normally only survive for around 2 years. We were prescribed the normal meds to include Vetmedin, Lasix, Spironolactone and Enalapril. About two months ago (1.5 years after being diagnosed) we noticed some ascites – the fluid in her abdomen as well as scabbing on her skin and shortness of breath. Our normal vet stated there was nothing else he could do. At that point we had spoken with several people about holistic vets and started research. We found a holistic vet (closest was 2 hours away) and scheduled an appointment. Prior to arrival we had our regular vet send all of her records to the new place.

    Once we arrived for our appointment the people in her office we terrific. They did a full workup on April to include EKG, echocardiogram and some bloodwork. They already had the x-rays from our regular vet. After receiving the results about two days later we went back to speak with the vet. She told us April’s condition was fairly advanced, but they believed they could provide her with a comfort of life beyond what our regular vet diagnosed using not only the medication she was on, but also several holistic supplements, as well as some acupuncture (to assist with blood circulation) and vitalight treatment (to help strengthen the heart). On that day they gave her an accupuncture treatment and vitalight therapy and sent us home with two supplements and told us to continue her normal meds. She also told us if we would have come to them much earlier they could have provided her a much longer life span.

    On the two hour drive we noticed April was back to breathing mush better – her normal smooth, deep breathing. About a week later however, we noticed her belly getting even bigger form the ascites. We scheduled another appointment. When we arrived April not only received another round of accunpuncture and vitalight, but was also tapped. Her normal weight is around 23lbs and when we arrived she was 27lbs. Once they drained 1.5 liters form her she was back to her normal weight.

    We’ve had to go back weekly to have her tapped, as well as for her acupuncture and vitalight. To date she has been tapped 4 times for total fluid removal of 6 liters.

    On our last trip they also added additional supplements and increased her Vetmedin and Lasix – which seem to have helped tremendously. We are now scheduling about every 10 days to take her for her tapping, acupuncture and vitalight. She even likes going to this place – which never happened at our regular vet.

    This is a bit pricey, about $400 per trip, but once she is tapped and has her treatments she is like her old self. Our new vet states she is not in pain as of yet and there will come a time where they may not be able to tap her fluid as each time they do the proteins in the fluid build up strands – making it harder to get the needle in to tap.

    We will continue this with April as fortunately we can afford to. As with any person, treatments are necessary when sick. If you can afford to keep them comfortable to where they can live a comfortable, yet not as active as they once were, then do it. After all they are just like our children.

  89. Doc says:

    Thanks for sharing your experience. I hope that the alternative medicine treatments are making your dog more comfortable. It does sound like draining the fluid (the traditional medicine) is making the most difference.

  90. Joey says:

    Hey Doc, just read through this whole thing and by the time I got to the bottom, I was surprised to see your last reply was just a few weeks ago. So I thought I’d write here too.

    My dog is a 16-year-old Jack Russell, diagnosed with CHF a few years ago. He’s on furosemide and Cardalis every day, as well as tramadol for his arthritis. Has since outlived the initial outlook of our previous vet (by a ton), but is now not doing great.

    He started a round of Penicillin a few days ago, after the vet found he has an infection in his penis (a lot of puss and fluid there). He’s since not been eating very well at all, and has been getting weaker in his legs. Today, he ate a whole load of food, drank a lot, and did pretty well on his walk. However, I’ve just noticed he’s looking like he has ascites (at first I thought he was just bloated from eating so much). I’m getting him to the vets tomorrow.

    Do you think it could have anything to do with the penicillin course? It seems like odd timing. If we can get him treated, would it be beneficial to add anymore meds? I’ve read people here using “vetmedin” to great effect, and also “lasix” and “enalpril” – do you think these would be beneficial?

    Just want to say it’s so awesome to see you reply to every post here and give them your time, I can tell you’re really helping people and their friends. Thanks Doc.

  91. Doc says:

    Hello, Joey,

    Sorry I didn’t see this right away.

    Cardalis has benazepril, which is the same class of drugs (A.C.E. inhibitor) as enalapril, and some think it is superior. So no enalapril for you.

    Cardalis also has spironolactone, which is a diuretic. Lasix is the trade name for furosemide, which is a different diuretic, which works in a slightly different way than spironolactone. I have had cardiologists recommend using both of them together in cases of ascites.

    Vetmedin is the trade name for pimobendan. This drug causes the heart to contract more forcefully, similar to digoxin (the digitalis type drugs), but is MUCH MUCH safer. It also helps dilate the blood vessels a little, which makes it easier for the heart to work (your benazepril is supposed to be doing this, but they can be used together). Vetmedin is a little pricey for a big dog, not so bad for a smaller dog. It is a very good drug, very safe, and could be added to what you are doing, if your veterinarian thinks it advisable.

    The worsening of the condition is unlikely to be due to the penicillin. CHF is a progressive disease. Sometimes additional meds or change of meds or change of dosage helps the weak heart to function more effectively, and improves and prolongs the dog’s quality of life. Ultimately, the weak heart keeps getting weaker, and one day nothing helps.

    It’s great that you are working so hard to keep your dog comfortable.

  92. Steven R. says:

    My 14 year old dog Blackie has had CHF for over 3 years. My vet has done a good job managing it with the typical medications mentioned in the above posts. He had 2 abdominal drains in the previous 2 months removing about one to one and a half liters of fluid in a 35 lb dog. He continued to have some fluid build-up even with fairly high Furosemide dose (120 mg daily).
    I thought the dogs condition wasn’t that bad. His coughing and breathing had improved greatly with the increased Furosemide dose, but his walking was just terrible. His eating and bowl movements were fine and he had the same bright eyes and affectionate behavior he always had.
    Problem is that when he was at the vet his breathing was considerably worse in the higher stress environment. For the past 6 months the vet has been trying to convince me to euthanize him saying that he will die of suffocation — I resisted strongly. It had reached the point where the vet said to me — I guess there is nothing I can say that will change your mind.
    He did another abdominal drain on Wednesday. I brought him home and he was leaking fluid.
    The next day his lower abdomen area turned very red and was impossible to touch. He collapsed completely. He was in a great deal of pain and I had to buy a muzzle as my right arm was full of dog bites from trying to handle him.
    When I brought him back to the vet I was told he had cellulitis and was full of internal infections and could only be treated if opened up. This was not an option and the dog was near death so I had him put down. Blackie had died an awful painful death, not directly from Congestive Heart Failure (right side), but from the abdominal tap.
    Prior Wednesday Blackie showed no signs of abdominal paid or infection.

    Has anyone heard of this kind of result from an abdominal drain or maybe the vet just forced my hand. Blackie was my beloved companion, gave me his life and I allowed him to die this way. I read on many sites that abdominal drains were fairly safe procedures and that some people were even doing them at home.
    I never would have agreed to the drain if I knew it had this kind of risk.

  93. Doc says:

    Hello, Steven,

    We always do a sterile prep on these, as for surgery. That being said, you always have fluid leakage and I feel like I’ve dodged a bullet every time they do okay. It would certainly be a great place for bacteria to grow.

    With his age and other illness, his immune system wouldn’t be great, so harder for him to fight off stuff that might not be problem otherwise.

    Whenever we have a bad outcome, we always look to see what we could have done differently. Sometimes it would have been better, sometimes just “different”.

    I know you are hurting, but I suspect that your veterinarian is also pretty upset by this. We always want to make things better, and it’s tough when they go south.

    I sincerely doubt that your doctor had any thought of hastening your dog’s demise.

    Sometimes we just come to the end of the trail.

    I am sorry for your loss.

  94. Kate J says:

    Have you ever heard or experienced a dog that could not be drained? My Pom buddy is in later stages of CHF and has started accumulating fluid in his abdomen. This is causing gastrointestinal distress in the form of many “soft serve” small poops,low appetite and lethargic trembling behaviors. The vet first did an X-ray to confirm fluid and then tried to remove the fluid. However, when she tried to drain nothing came out and he was too wiggly to try going in deeper.

  95. Doc says:

    I can tell you that it can be really difficult. The patient needs to be very relaxed, and we are always reluctant to sedate them in this condition. I have had the best luck with having the owner sit with them and pet them during the process, while a technician (or two) helps to restrain them on their side on the surgery table.

    I use a big-bore IV catheter (14 or 10 gauge), with the inner needle removed. I feel pretty safe maneuvering this back and forth and in and out. Lots of times it will get stopped up with a membrane called the omentum. I will have to squirt a little air, saline, or even the abdominal fluid back through to open it up.

    The patient has really got to be pretty still, as this usually takes me 20 minutes or longer to drain off all the fluid.

    I wish I could give you better advice, but these are tough cases.

  96. Brian Catalino says:

    Great site to find owners with similar experience! My 12.5y old Bulldog suddenly ballooned up around the belly one day. After a battery of tests and initially thinking it was a tumor in belly, a referral to cardio determined right sided heart failure. Cardiologist said meds would not help and all but said I should put my boy down. My vet said no harm in trying some meds and draining. So she drained a lot of fluid off him over 3 days, prescribed vetmedin, enalpril, lasix and another diuretic. My boy was like himself for over 3 months! My vet told me eventually the heart will get weaker and the meds won’t keep up with fluid build up. We are at point where he’s maxed out on meds and need drained weekly. As long as he’s happy, playing and eating I’ll keep this up. Those few extra months I got with him will be forever cherished.

  97. Brad Riley says:

    My bulldog of 9 years has come down with right sided heart failure and Ascites. Looking back, it has been coming on for a period if time. We have her on furosemide, Enalapril, Pimobendan and digoxin. I noticed her heart rate became very fast so being a paramedic of 25 plus years I ran an ecg strip to find she was in a fib at 240-260 hence the digoxin. We have HR well under control at about 140 now. She originally responded very well with the Furosemide and Enalapril but I think that’s when she went into a fib. I’ve recently had her drained where she felt great for a few days but the severe Ascites came back in about a week. I have two questions if you will. Do you think spironolactone in conjunction with furosemide would be more affective than furosemide alone? I’d also appreciate your thoughts on self draining the Ascites. I feel confident in doing it. Will it always come back so quickly or can you get ahead if you do it regularly for a period of time? Thank you in advance.

  98. Doc says:

    Hello, Brad,

    The cardiologists have recommended the combination of spironolactone with the furosemide to me in the past on these cases. You should ask your regular veterinarian for dosing.

    My experience draining these is that there’s a lot of “developing a feel” for it. I use a 14 gauge, or 10 gauge large animal IV catheter about six inches long (removing the stylet, of course after entry). We do a surgical prep, and it usually takes one tech, plus the owner to keep the dog calm for the procedure. Depending on the amount of fluid, it often takes 20 to 30 minutes. I find that the omentum tends to plug the tubing, and one often has to manipulate it, and sometimes flush it before the fluid starts flowing again. One often has to reposition the catheter to find the fluid “pocket”.

    I used to aspirate them with a syringe, but find that letting it drain on its own works better, and is a lot less work for the operator. Big mess, though.

    I would have a hard time recommending this for a home operation.

    I don’t think you would really get ahead by draining more frequently, plus it’s a traumatic procedure, and you worry about introducing infection. The fluid may re-accumulate in a few days or a few weeks. It depends on the dog’s situation.

  99. TC says:

    I was relieved to find your information on draining fluid often, as most websites just focus on one off or occasional draining. So thanks.
    My 11 year old mutt has been diagnosed with mesothelioma. He became sick last October. He is now at the point where draining fluids is needed about every 4 days. And this does give him a few days of relative normality.
    The thing is, I live in Thailand where euthanasia is not an option, so we will have to see this through to the end.
    The cardiologist has laid out some options…chemo but the cancer has already spread. Also to place a a catheter to release the fluid. But the vet said this is liable to infections and blockages and will lessen his life quality.

    So for the moment we are just continuing with removing the fluid every time he begins to show severe discomfort -restlessness, unable to lie down.
    We really want him to die at home not at the vets… But at the same time we can not do nothing when he’s in clear distress.
    Is there anything else we could be doing?!

  100. Doc says:

    Hello, TC,

    I really do not have any experience with mesothelioma.

    I wish that I had something to offer you, but I do not.

    Best wishes.

  101. Linda L says:

    My 13 year-old Lab started coughing almost 2 weeks ago and her harness got tight. We went to the emergency vet, they did x-rays and an echo and diagnosed heart hemangiosarcoma (presumed due to a 2.2 inch mass on the right atrium). They said there was not enough fluid around the heart to drain, nor was there enough in her abdomen to drain (the abdominal fluid was diffusely scattered). It has now been a week. I use a tape measure on her abdomen and it stays pretty consistent at 32-33 inches. But she now seems to have pouches on each side of her belly rather than an overall enlarged tummy. She sometimes puffs out her breath, but she does not have pale gums or a bluish tongue. She walks like half a block, but only when she is willing. I think she would feel perkier, and breathe better, if drained. So my questions are:
    1. Do the pouches indicate pooling of the fluid so that drainage would work?
    2. How stressed do dogs get during this procedure? With all this CoVID stuff, clinics are not letting owners into the building (unless it is a death situation). I don’t really want her to have sedation again since she was lightly sedated last week.
    3. I live near a veterinary teaching hospital, complete with cardiologists. Would that be my best bet?
    4. Her problem is, I think, her left-sided enlargement. Though the mass is on the right side, the left side seems to have compensated. Would meds have a decent chance of getting rid of the fluid without doing a drain? If so, could you give me a general timeframe of how long it takes for the fluid to dissipate if only on meds?
    5. Does the fact that her belly has not increased in size perhaps mean that that there is no, or very little, new drainage?
    I am also consulting with an internal medicine specialist and am awaiting her reply … but I don’t know when that will be. I read about Ginny, and I liked your replies to other questions, so I thought I would ask. Thanks!

  102. Doc says:

    Hello, Linda,

    In regard to questions 1 and 5, I don’t think that we can tell that without a new ultrasound of the abdomen.

    #2. It depends on the dog. If the dog is not unhappy lying on its side, then it’s not bad. We have been fortunate to have pretty laid-back patients in the dogs we have had to drain.

    #3. Yes, that would be your best bet.

    #4. My experience with medications alone (heart meds and diuretics) has been inconsistent. Several dogs have been unresponsive to meds, but some have responded. They showed improvement within a few days.

    The cardiologist would have vastly more experience than I have.

    Best wishes

  103. Brent says:

    I rescued a Bentley, a Boston Terrier. His previous mom didn’t know how old he was, but estimated him to be 4 1/2 or 5. That was 5 years ago. As soon as I got him, he went straight to the vet and they found a severe heartworm infestation and said he needed treatment immediately. After a successful fast kill treatment, he did pretty well, but the vet said he had sustained substantial damage to the right side of his heart and that his vessels were likely the largest she had ever seen. He was not symptomatic until about 6 months ago, putting him at maybe 9 1/2 to 10 years old. He started getting ascites, and started having odd episodes(all while sleeping) where he would suddenly open his eyes widely and look lost while taking in a deep breath. On occasion, he would also arch his head and neck back, almost like stretching, but he was not stretching. I would talk to him and softly rustle his sides, and he would come out of it after a few seconds. I still do not know what this is. He is still with me, and these episodes still happen nearly daily(nightly). He started getting stomach taps to relieve the swelling, and the goal was to try to keep a 14 days cycle. Well, he quickly needed to be tapped every 7 days, and now, I am needing to take him every 6 days, and sometimes I think 5 would be better. He still eats like a hog if I offer him what he wants, and he still has concerns for where is stuffed ‘babies’ are and will carry them around. About 4 days after a tap, I can tell he’s getting uncomfortable, but I try to hold off due to the frequency of the procedure, for his sake. Even on really swollen days, he loves to ride in the car and watch for cows, horses or deer that frequent the fields near our home. He doesn’t run anymore, but he walks around the yard a good deal and will lie in the grass in the sun when the weather permits. Is it too much to have him tapped every 5 or 6 days? I know he’s not going to get better, but when the fluid is not excessive, he seems pretty good for an older guy with a bad heart. He’s on 4 different meds, and I give them faithfully, but since he has right side failure, I don’t really know if they help him. I would just appreciate your thoughts. I know what’s coming, but it’s so hard to know when it’s wrong to keep going.

  104. Doc says:

    Hello, Brent,

    It sounds like you are doing an amazing job caring for this guy, and so is your doctor.

    You ask if it’s “too much” to drain him more often. If he is tolerant of it, and it makes him feel better, I don’t see a problem. The alternative is feeling miserable until he dies. So I’d say “go for it” as long as it’s making him feel okay.

    This is a progressive disease and there’s not much we can do about that. It will get worse, but if you are finding a way to keep him comfortable, I think that’s okay.

    The first patient I ever had with this finally got such a huge liver that we just couldn’t deal with things. She looked like the ascites, but it was all liver. The other patients have all finally succumbed to the heart disease.

    If you and Bentley and your doctor can stay with it, I don’t see a reason to hold back. You’ll know when it’s not working anymore and Bentley just has all bad days.

  105. Renau Bozarth says:

    I have a 8 year old Cavalier. Had abdominocentisis yesterday. He has cushings and heart issues. He is still leaking quite a bit. The vet said this was normal, but not sure how much is normal? He soaked through a blanket and onto a chair as I did not expect the volume. I have continued to change spots with towels, etc. Can you tell me how much normal is?, and how long the leaking may continue? He weighs about 25 lbs, and the took on liter of fluid. Thanks.

  106. Doc says:

    Hello, Renau,

    I cannot really answer your question in a meaningful way. I think the continuing leakage would depend both on the amount of undrained fluid (the hydrostatic pressure) and the size of the catheter used to drain. I have used mostly 14 gauge catheters, and just put a band-aid on the hole.

    If there were more fluid present (and it can be very difficult to empty all of it), then one might need a bandage to help the hole seal.

    You should absolutely keep giving your doctor feedback on what is happening, as he/she is the best person to advise you.

  107. Dana says:

    I have a dog that was diagnosed with DCM in 2018. At first medications kept the condition under control. All of a sudden in the summer of 2018 she started developing ascites. I had to see a cardiologist who told me to have her drained. It isn’t always easy finding a veterinarian that is willing to do this. I have found it once a week it’s about as long as she can go. They usually drain anywhere from 2400 ml the 3500 ml. Normally around the 2400 mark. Recently they have said the fluid is harder to get off I don’t know what this means. I don’t have a good explanation. She has done excellent over a two-year period of the draining and no problems whatsoever and has made her feel so much better. Is there a point where the fluid cannot be drained? Does the fluid become too thick as the heart begins to fail further? It’s hard to believe that just two weeks ago she was drained completely and now there seems to be trouble draining her. Have you run into this? Right now I have two and a half days to go until her draining and she’s miserable. When full of fluid her cough is at its worst and even breathing seems labored. My main worry is when I take her back this week will they be able to get the fluid off. Opinion please!

  108. Doc says:

    Hello, Dana,

    I can only speak in general terms, since I have not actually seen your dog.

    Sometimes you have difficulty because the membranes (mesenteries, greater omentum) will clog your catheter. I frequently have to push a little fluid back in, re-position the catheter, etc.

    Over time, you could also develop adhesions where things stick together a little from being previously traumatized. This can make it difficult to find your way into all the fluid pockets. It can be a little “subdivided” instead of one big pocket of fluid.

    I have had one patient whose heart disease caused such enlargement of the liver that it was filling the abdomen, rather than it being full of fluid.

    An ultrasound could be helpful in this situation.

    My own experience has been that it takes patience and time (usually around 30 minutes) to drain these patients.

    I don’t think that the fluid would be getting any thicker.

  109. Erik says:

    Just found this message board as I was researching fluid in the abdomen of dogs.

    I have a 13.5yo English Bulldog named MEATBALL. About a month ago he developed weakness in his back legs and was having trouble jumping up on the couch. As he is such a senior dog (officially the oldest English Bulldog EVER in his vet office), we know his time is limited but it wasn’t until one days suddenly he just wouldn’t walk that we brought him in.

    The vet diagnosed arthritis and noted fluid in the abdomen + a growth in there somewhere that they could not determine what it was without further expensive procedures. They said that the fluid accumulation would affect his systems and that he possibly only had a week to live. They prescribed Gabapentin and Prednisone to help with pain and the fluid.

    The medications have really helped as I thought that he would pass that night but the next day he started walking around, eating heartily, it took a couple days but he was back to going to the bathroom as normal.

    It is now 2-3 weeks later and his abdomen is still large. I plan to weigh him today to see what the weight difference is and if the medication has helped with the fluid retention. My vet has re-upped his prescriptions and advised us to cut his prednisone dosage to 1/2.

    They did not advise tapping his abdomen but I have noted he at times has rapid breathing, but he is a generally lazy old dog so any physical activity leads to this.

    Any recommendations on how we should proceed?? We of course want him to be as comfortable as possible and despite the numerous times we thought he was at the end he just keeps on chugging along as his lazy happy self. The current coronavirus situation has made the whole euthanasia option much more difficult to navigate when it should become necessary.

  110. Doc says:

    Hello, Erik,

    There are tumors that actively secrete fluid, and I would be concerned about that.

    The gabapentin can help with pain, and the prednisone is anti-inflammatory, and can promote appetite. It would make his arthritis feel better, too.

    The downside of prednisone is that it can make you retain fluid (which is probably why they have suggested that the dose be decreased).

    You might ask them about adding a diuretic drug like furosemide (Lasix) to see if that would help with the fluid. Since he is eating and feeling better, he would be better able to tolerate that than he was before.

    I really cannot make specific recommendations for a patient I have not seen.

    Stay in touch with your doctors and give them the feed back they need to try to answer your questions.

  111. tom hayes says:

    hi took my dog to vet yesterday and she said she has tumor on liver and spleen she is 12 +she said to old to operate or do anything has anyone else had dog same problem did vet treat them plus looked on site and vet says dont assume its cancer it could be benign what should i do

  112. Doc says:

    Hello, Tom,

    To investigate further, you would need to get a biopsy.

    Many veterinarians are not skilled enough to be comfortable with an ultra-sound guided needle biopsy.

    This procedure can usually be done with no sedation (or very minimal sedation).

    A needle biopsy is not as good as a surgical biopsy with an exploratory, but can give very good information. Then you would have a better idea what you are dealing with.

    This would be a great deal less expensive than a C-T scan. However, if you were contemplating surgery after the biopsy, a C-T would give a better idea of the true extent of the tumor, and whether it is operable.

  113. Anon says:

    Hi Doc,

    I bred a litter of puppies and one little boy has a heart murmur, and now what I believe to be ascites. I have an appointment with our vets to discuss treatment moving forward but I want to prepare myself for the prognosis. He sleeps a lot, has labored breathing and has a very swollen abdomen, at ten weeks old I worry that he will go downhill very quickly. All of the above messages seem to refer to much older dogs, is it possible my puppy could manage his condition more easily or will it be worse give his size (1.4kg) and age (10 weeks)? I’ve been advised that euthanasia may be the kindest course given how quickly his condition has worsened but this is not a route I want to go down unless there is no other choice.

    Thanks in advance.

    • Doc says:

      Hello, Anon,

      If your baby has a congenital heart defect, there may not be much that can be done. There are pediatric heart surgeons for human babies with such problems. With the small size of a puppy, I don’t know whether you’d have something correctable or not. A veterinary cardiologist doing an ultrasound would give you the best information.

      From what you describe, it’s hard to be optimistic.

  114. Kristina says:

    Hi Doc,
    I can’t tell you what an immense relief it is to find this page. I have felt very alone going through CHF and treatment with my little girl, and it is such a comfort to read about experiences others are having, with the same issues and questions I have, which are then answered with frankness and compassion. Thank you so much for doing this.

    So, my concern. . . my chihuahua mix Nutmeg has had left-sided CHF since September. We went through some hard months, but her coughing is now pretty much non-existent on vetmedin, furosemide, and enalapril. Recently we noticed her belly was distended and thought it was connected to GI issues, as she had been having diarrhea. I suppose that was just an unfortunate coincidence, as it turns out it’s ascites because she has right-sided CHF as well now. She underwent abdominocentesis on Sunday, and then by Tuesday it looked like she was becoming distended again, which is such a scary quick turnaround. On Wednesday our vet recommended we go to the ER, and she had abdominocentesis again. The ER vet cautioned that the end is near and that we should talk about euthanasia. This is not surprising, as both sides of her heart are failing now, and I have been trying to prepare myself for this since September.

    My issue is that I was expecting the end to look a certain way. I thought she would have zero energy and not want to get up and go anywhere or do anything and just seem overall miserable. Right now, especially after the most recent abdominocentesis but even when she was distended, she seems happy and follows us around and greets us with joy and is excited to go on walks and even manages to jump up on the couch. Of course she is not the same dog as it has been a slow decline, and now her eating preferences are so far beyond pickiness, but it seems impossible to consider euthanasia while she is behaving this way. I know abdominocentesis is not sustainable long term, and perhaps the end really is very near, but I am of course struggling with this decision. Obviously going to the vet is very stressful for her, especially if it continues at a rate of every few days, but she just doesn’t seem ready to go. And I don’t want to give up on her if she isn’t ready. BUT I am concerned for her quality of life and want to protect her from suffering. I know there is no black and white answer for this kind of question, but I imagine you see this situation often? Do you have any advice for this? I would appreciate any insight, thank you.

    • Doc says:

      Hello, Kristina,

      I have had a couple of patients where we did repeated abdominocentesis for several months, but it wasn’t needed more often than every two to four weeks.

      Sometimes adding a different diuretic slows this down. Spironolactone helps some dogs.

      I understand about how difficult it is to make this decision while the pet is acting like he feels good (after the centesis).

  115. Dana says:

    Hello, I had asked a question about a year and a half ago about my dog that has been drained weekly of ascites fluid. Currently it has been for 3 years and i has given her quality life.
    I asked before, when the vet ran into a problem, why he could not seem to drain her. He eventually did xrays, there was no reason she wasn’t draining the issue resolved.
    But now, it is happening again and xrays show a moderately enlarged liver. I took her to an ER Vet she said she needed pleural effusion fluid removed. My vet agreed. It was removed and what a terrible procedure that was! I had no idea! She looked dead afterwards, but again rebounded!
    No one seems to be hearing me, she has had pleural effusion since day one, BUT if the ascites isn’t drained that fluid in my experience will build around the lungs. She has no cough until the ascites builds too much, after ascites draining, she is great again.
    Also, they found a “moderately enlarged liver”. The ER vet would not remove ascites the same day as pleural effusion. She told me to wait several days. I returned to my primary vet and he says he cannot get the ascites fluid and it makes zero sense. The ER Md said she could, so we are going back in the next day or so and paying 5x’s the amount to get it removed.
    My dog has not had ascites drained in 3 weeks, she has NEVER gone this long and we are panicked! She is eating small amounts, but remains resting most of the time, I suspect due to the weight of the fluid, I can see the weight loss and how horrible she is feeling with ascites not drained for so long.
    My primary is ill equipped with no ultra sound in his office.
    One day they were able to get 800 mls off of her, that is far below the normal weekly 1500 -3K.
    Do you believe ascites fluid can move upward when not drained into the pleural area?
    I know DCM (right and left) heart failure can create enlarged liver, but, overnight? Her last good drain 6/24 went great then a week later, they could get no fluid, 2nd week and so on.
    Am I hoping against hope? I worry about Leptospirosis (we do have wildlife crossing our yard) or another possibility for the liver enlargement. My main worry now is getting the ab fluid off! I cannot find another vet (other than super costly ER vets) that has ultrasound able to take her as a patient as it seem Corona has packed veterinary offices and most are not taking new patients. I am at a loss.
    Vets don’t know with certainty why the moderately enlarged liver and my question is, can ascites still be drained? ER vet said to tell my vet to stay in the the “coddles” to be safe since he has no ultra sound and still he got zero fluid last week. While all this is going on she is miserable and I don’t want her to suffer. Have you heard of anything taking a turn so quickly? Is there hope for a normal return to fluid draining weekly as before, or is she simply progressing to the point of no return? I think what astounds me most is how she was draining great ….then it just stopped with no warning. Honestly I need someone to tell me if it’s time to give up. She is a fighter like I have never seen in my life and I know if the ascites is drained she will rebound. Problem is…my primary is “flying blind” and can’t get the fluid!
    Any advice, much appreciated.

  116. Sarah Ramirez says:

    Hi there,
    10 y/o German shepherd with perialcardial effusion & ascites and DM. we have drained over the years, once a year , now twice a year and now looking at a third time. my vet has never recommended medicine. Is this because he is also on clopidogrel ? it’s hard to know if we are doing everything for the fluid build up and the draining is really hard on my boy.

    • Doc says:

      Hello, Sarah,
      Many times there is no alternative to surgical drainage. Medications just won’t take the fluid off. You are describing a case with complexities that are beyond my expertise. I would be referring that dog to a specialist if I ahd to deal with it. I am sorry that I don’t have any help to offer you.

  117. Anita Raghavan says:

    Hello, My 9.5 year golden retriever is suffering from cancer (chest) and has severe hind leg weakness, a severe pressure sore and ascites. He is on gabapentin and dexamethasone. His breathing is not that labored and I was wondering would it then make sense to have his belly fluid aspirated? Are there any risks to his life ? Also will diuretic or enacard help?
    Thanks for your time.

    • Doc says:

      Hello, Anita,
      Sorry I’ve gotten behind again. I had an injury and it has slowed me down some. If you cannot see enlargement of the abdomen (which you are sure is fluid) then there is little to be gained by draining it. If there is fluid, and the dog is having trouble breathing, then I would consider it. Since he already has cancer in his chest, I wouldn’t be as worried about the chance of spreading it by moving a catheter around in the abdomen. We do this without anesthesia, so no risk from that. I have read that suddenly draining a large amount of fluid can cause the dog difficulty, but I have never encountered any. When we are doing this, the dog has really no alternative, so we take what little risk there is. If the ascites were due to congestive heart failure, then enacard may help. Diuretics are usually not very successful in removing large amounts of ascites from right side heart failure. I can’t say how much they would help if the fluid is being produced by tumor growth. It wouldn’t hurt to try.

  118. Maria Foster says:

    Thank you for sharing all this information it gives me hope for my eight year old mini schnauzer with the CHF over a year, and now ascites for a several months as a complication. I spent few thousands of dollars on her diagnosis and visits to the doctor and the right now I’m not going to visit anyone because the last suggestion was to Euthanize my dog. She’s on the VETMEDIN , furosemide, Spirolactone and Fortikor. I try to feed her all kinds of vegetables and she loves it. I am also thinking about trying Q10 after eating your posts.
    Do you have any thoughts about sildenafil?
    Thank you, M

    • Doc says:

      Hello, Maria,
      Sildenafil is prescribed for primary pulmonary hypertension. These patients have unexplained constriction of their pulmonary arteries, and sildenafil relaxes this. It is not customarily prescribed for heart failure patients (though my only patient with pulmonary hypertension has developed right side heart failure later in the course of the disease). I don’t have the expertise to use the drug. It was prescribed for my patient by a cardiologist.

  119. Michael says:

    My almost 14 year old Boston terrier American bulldog mix has right side CHF. He takes furosemide, cardalis, vetmedin and gabapentin. He is now getting bloated from abdominal fluids…ascites? And having abdominocentisis about every 2 weeks now. If I wait longer in between is that hard on him or painful? He is definitely hungry for food and active. Usually get about 3-4L when he is drained. Keep draining him or is he in end stage of life?

    • Doc says:

      Hello, Michael,
      Many dogs with right sided heart failure do require periodic draining of the fluid, as medication alone will not always control the buildup.

      These dogs do experience discomfort when the abdomen is so full of fluid, and seem to feel much better after being drained.

      I have had patients who were able to be comfortable for months as long as we kept the fluid drained periodically.

  120. Bree says:

    I have a micro bully we just got diagnosed with stenosis of the heart and heart failure. The breeder never got him checked as a baby and now he is 8 months old. He has ascites and we are at the vet every week draining the fluid. We were told to see the cardiologist again after paying 3000. The cardiologist wanted to charge 700 just to redo test but we already know what is wrong. We just need a new medication. He is currently on lasix three times a day which we are to ween off along with a stronger diuretic once a day. After one day of getting drained the pharmacy wasn’t able to make the medication until a day later. He bloated up so fast within a day. After 4 days of having all the medication he is himself but the bloating is still there. We can’t afford to take him every week to the vet to get drained. Not sure what routine is best for the medications. We have heard different instructions. I’d hate to put him down when he still is happy and unbothered. Not sure where to go from here

    • Doc says:

      Hello, Bree,
      I can certainly understand your reluctance to let this guy go, but with this kind of a birth defect, he is living on borrowed time. If the cardiologist cannot suggest a helpful medication, I am sure that I can’t, either.
      I wish that I could give you some help and guidance, but this type of problem is just pretty tough.

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