I'm not really understanding what your question is - taking a diuretic like lasix doesn't call for an increase in fluid intake, in fact those with CGF often are asked to limit fluids. Can you tell us more?
He's retaining water, so they put him on the lasik(sp) and potassium. But they want him to drink water because the pills are hard on kidneys(that are not fully up to speed anymore) and liver. He thinks if he is retaining water, he shouldn't drink any at all. I've read where water intake should stay under 2 liters, lucky to get him to drink 2 glasses. Doesn't like taking the pills because they make him get up during the night to go. Trying to get him to take the drugs as early as possible. He thinks he should only take them every other day. It's not just water when the legs and feet swell, it's also blood that doesn't circulate very well because heart is pumping slower.
Yes I agree with willie. Lasik is getting rid of the extra water in his system because the heart isn't pumping effectively to get rid of it normally. I would ask if support hose would help in gettiing rid of the water.
My Mom is 95 and has the same situation her cardiologist said she can 64 ounces of water a day in her case the Lasix stopped working after several years and they switched her to another one that seems better I also got her a very nice edema pillow for her recliner to elevate her legs in addition she always wears her compression hose it can be a journey finding the right fit a drugstore that carries them or a medical supply but you may have to measure him in the morning before the swelling starts
I would notify his cardiologist and ask if he would write a prescription for the amount of water be should be drinking. Also, ask if he can take all of his dose in the morning.
How slight is slight? Has anyone put a number on your father's heart function?
This is such a fiddly, complicated tangle of a problem to unravel and I really feel for you.
Having to pee urgently is a serious drawback from your father's point of view because: it risks humiliation it is very uncomfortable he is very fatigued (think: the tiredest you've ever been in your life) and would rather sit still he may also, does he, have mobility problems?
So he avoids having to pee by trying not to drink too much and fannying about with his diuretic instead of taking it as prescribed. You can understand his thought process - but it is still wrong!
To control the systemic oedema caused by his heart failure, your father needs to take his diuretic as prescribed and also needs to take in enough water to maintain his normal balances and allow his kidneys to work as well as possible. It's a dynamic system, not a static one. It is not just a case of "less water in, less water out" in the simple way that he's thinking of it.
There may be adjustments to his px that can help. For example, if he is taking his Lasix twice a day, mornings and evenings, ask the prescribing doctor if he can take one at breakfast and one at lunchtime instead; or if a switch to a different, once a day diuretic might be appropriate. This should reduce the number of night-time bathroom visits.
Then, think about how he gets to the bathroom and back. Make the trip as quick and easy as possible. If it's a real struggle for him, consider alternatives such as portable urinals or commodes.
For peace of mind, perhaps discreet absorbent chair and bed pads would be an idea - not for regular use, you can reassure him, just for "in case."
Also, remind him that the real problem for him is not the volume of urine but the frequency of trips he has to make; and if he is having to go at all then he might at least have plenty to do when he gets there!
Plus, of course, he just may not feel thirsty. Is there anything that he positively enjoys drinking?
Everything has been mentioned except sodium. Is your dad being given a salt free diet? The less salt he eats, the less fluid his body will hold onto. And the less to get rid of.
For sure watch any canned products and read your labels. In fact, watch all your ingredients. I once bought a “low sodium” chicken broth to cook with and compared the sodium level to another brand and the “low sodium” one was off the charts. It freaked me out when I thought about how hard my mom worked to keep the fluid off. I almost always made my own broth before that but redoubled my efforts after that. You really have to watch chicken as it can be pumped full of sodium to keep it moist and holding fluid. Just an example of how hard it is to not accidentally set them up for failure.
So, no salt. Enough gets in the diet accidentally without adding any on purpose.
Elevated feet when sitting, the hose do help to keep the heart from having to work so hard to get the fluid back up the legs, my mom didnt wear them but my dad did. Pain to put on but they help.
And he needs enough water and the pills earlier in the day vs later.
We went to depends to keep my mom from rushing to the bathroom to avoid falls. She used a walker.
She had a bedside commode for during the night (up an average of 4 times) but during the day she would use the bathroom. She counted that as her exercise. She would go from her perch in her den through her kitchen down a hall to the bathroom and on the way back she would stop to drink water. She had her glasses lined up. Four to six glasses, about 10 Oz each with a straw in the one she was working on. She always wanted those glasses filled. She would stop at her kitchen counter and drink water and then back to her lift chair at command central. Her fingers were numb on the tips so to avoid holding the water glass she would stand at her counter and drink through a straw.
That was her life for a couple of years. TV and telephone. She also had therapy three times a week to keep strong. She used the bike pedals to help the valves in her legs keep the blood moving.
And yes, it was easy to see how tired she was. We were all tired.
I just remembered this part. She would go to bed early. Not to sleep but to help the fluid come off. She used a hospital bed.
Up very often during the night and then first thing after the morning pee, she would weigh herself and record her weight and check to see if her weight had gone up or down. To see if she had it in balance more or less. The right amount of Lasix and water to keep it all working.
But it can be tricky. Loss of weight can be real and not fluid. Over time she had lost weight and was holding more fluid than she realized. But she weighed each morning without fail. She followed the rules, weighed and recorded.
Then off she would go down that hall to her oatmeal.
That was how my mom managed her CHF. I really wonder sometimes at what point it stopped being worth it. All that hard struggle. Just looking back it’s difficult to know. I wish I had read the book “Being Mortal, Medicine and what matters in the end” by Atul Gawande earlier. I also wish I had pushed for palliative care earlier and harder.
I would ask if support hose would help in gettiing rid of the water.
Can't hurt to ask.
For night time perhaps a portable urinal will help.
This is such a fiddly, complicated tangle of a problem to unravel and I really feel for you.
Having to pee urgently is a serious drawback from your father's point of view because:
it risks humiliation
it is very uncomfortable
he is very fatigued (think: the tiredest you've ever been in your life) and would rather sit still
he may also, does he, have mobility problems?
So he avoids having to pee by trying not to drink too much and fannying about with his diuretic instead of taking it as prescribed. You can understand his thought process - but it is still wrong!
To control the systemic oedema caused by his heart failure, your father needs to take his diuretic as prescribed and also needs to take in enough water to maintain his normal balances and allow his kidneys to work as well as possible. It's a dynamic system, not a static one. It is not just a case of "less water in, less water out" in the simple way that he's thinking of it.
There may be adjustments to his px that can help. For example, if he is taking his Lasix twice a day, mornings and evenings, ask the prescribing doctor if he can take one at breakfast and one at lunchtime instead; or if a switch to a different, once a day diuretic might be appropriate. This should reduce the number of night-time bathroom visits.
Then, think about how he gets to the bathroom and back. Make the trip as quick and easy as possible. If it's a real struggle for him, consider alternatives such as portable urinals or commodes.
For peace of mind, perhaps discreet absorbent chair and bed pads would be an idea - not for regular use, you can reassure him, just for "in case."
Also, remind him that the real problem for him is not the volume of urine but the frequency of trips he has to make; and if he is having to go at all then he might at least have plenty to do when he gets there!
Plus, of course, he just may not feel thirsty. Is there anything that he positively enjoys drinking?
Is your dad being given a salt free diet?
The less salt he eats, the less fluid his body will hold onto. And the less to get rid of.
For sure watch any canned products and read your labels. In fact, watch all your ingredients. I once bought a “low sodium” chicken broth to cook with and compared the sodium level to another brand and the “low sodium” one was off the charts. It freaked me out when I thought about how hard my mom worked to keep the fluid off.
I almost always made my own broth before that but redoubled my efforts after that. You really have to watch chicken as it can be pumped full of sodium to keep it moist and holding fluid. Just an example of how hard it is to not accidentally set them up for failure.
So, no salt. Enough gets in the diet accidentally without adding any on purpose.
Elevated feet when sitting, the hose do help to keep the heart from having to work so hard to get the fluid back up the legs, my mom didnt wear them but my dad did. Pain to put on but they help.
And he needs enough water and the pills earlier in the day vs later.
We went to depends to keep my mom from rushing to the bathroom to avoid falls. She used a walker.
She had a bedside commode for during the night (up an average of 4 times) but during the day she would use the bathroom. She counted that as her exercise. She would go from her perch in her den through her kitchen down a hall to the bathroom and on the way back she would stop to drink water. She had her glasses lined up. Four to six glasses, about 10 Oz each with a straw in the one she was working on. She always wanted those glasses filled. She would stop at her kitchen counter and drink water and then back to her lift chair at command central. Her fingers were numb on the tips so to avoid holding the water glass she would stand at her counter and drink through a straw.
That was her life for a couple of years. TV and telephone. She also had therapy three times a week to keep strong. She used the bike pedals to help the valves in her legs keep the blood moving.
And yes, it was easy to see how tired she was. We were all tired.
I just remembered this part. She would go to bed early. Not to sleep but to help the fluid come off. She used a hospital bed.
Up very often during the night and then first thing after the morning pee, she would weigh herself and record her weight and check to see if her weight had gone up or down. To see if she had it in balance more or less. The right amount of Lasix and water to keep it all working.
But it can be tricky. Loss of weight can be real and not fluid. Over time she had lost weight and was holding more fluid than she realized. But she weighed each morning without fail. She followed the rules, weighed and recorded.
Then off she would go down that hall to her oatmeal.
That was how my mom managed her CHF.
I really wonder sometimes at what point it stopped being worth it.
All that hard struggle.
Just looking back it’s difficult to know.
I wish I had read the book “Being Mortal, Medicine and what matters in the end” by Atul Gawande earlier.
I also wish I had pushed for palliative care earlier and harder.