Torsemide lasix conversionsx

My wife (age 69) was recently diagnosed with HFpEF, and has been hospitalized about 5 times in so many months. Local doctors seem to disagree on things and are passing the buck back and forth, so I'm wondering if a trip to Mayo Clinic or a similar world-class clinic is worth it. Has anyone had success doing that?
More details: she is on a literal boatload of pills, but the oral diuretics (Lasix at first, now on max dose of Torsemide) seem to have stopped working, so her weight keeps creeping up despite an extremely low-salt diet. She also has a significant number of comorbidities in addition to HF, like poorly controlled type 2 diabetes, chronic kidney disease stage 3, diabetic neuropathy, sleep apnea (is now on CPAP), hypercapnea (retaining too much CO2). The heart failure clinic now says it's not a heart issue, it's a kidney issue. Her kidney doc thinks her kidneys are ok, at her longtime baseline of 30-35 EGFR without extra diuretics, and didn't want to see her until two months from now. But she needs diuretics to keep the fluid off or she'll land in the hospital again. Not getting the sense that anybody is looking at the whole picture, so wondering if a trip to the Mayo Clinic is in order.
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One of our dogs (11.5 years) has advanced mitral valve disease, and has been in the excellent care of a Board Certified Cardiologist for several years. (USA)
In December, our dog had a crisis of Congestive Heart Failure. We spoke to our cardiologist who considered this routine, expected, and not a big deal in their long-term care. They advised a few days of IV Lasix therapy and went to their recommended ER. The criticalist kept suggesting and advocating euthanasia during intake, noting the cost and prognosis. We kept replying our dog's condition has been managed long-term by a board certified cardiologist, we have insurance, and we have been prepared they may have several ER trips in their final years. The criticalist replied we should consider euthanasia for cost, because they will not accept insurance and require a large deposit. We insisted on treatment. An hour later we are introduced to their head of cardiology, who looked over the case and expected a speedy and routine recovery. 36 hours later, our dog is home on a new regimen of medicine and is thriving. After a bit of analysis and adjusting the dose, our cardiologist realized there was evidence of a furosemide tolerance developing for several months, and we switched to torsemide.
In February, the same dog spiraled into dehydration and acute kidney failure after a bout of diarrhea (two bowel movements within 8 hours) after a positive cardio recheck that day. Our normal vet and cardiologist coordinated treatment plans to balance the concerns for hydration/kidneys with cardiac therapy a few days later after we had some concerns. Unfortunately they did not work and our dog needed to be hospitalized (at a different ER in a different state). Our cardiologist and normal vet strongly believed this was a survivable crisis, but the ER disagreed and kept recommending euthanasia as there was no hope. We kept our dog hospitalized for IV fluid therapy for two nights, hoping to stabilize our dog to have some positive last moments at home before our vet would make a housecall for end-of-life services. We did not want them to pass in the hospital if at all possible. The ER vets kept stressing the hopelessness of the situation and imminent death due to the renal values not declining fast enough for them. Our vet and cardiologist both still had faith, noting the IV therapy was conservative due to cardiac concerns.
We brought our dog home and coordinated end of life plans with our vet. This included two blood tests, in case they somehow survived, to see if they stabilized at all. We all (vets and owners) wanted to see some accurate third party labs done, as we did not want to make an end-of-life decision based on faulty readings or margins of error. [The renal values exceeded the machine's readability, so were computed with a dilution factor.] I requested to leave the ER with a kit to administer subcutaneous fluids, so our dog would not dehydrate. After coming home, our dog was much less stressed and interested in eating and drinking again. I administered subcutaneous shots as directed, and coordinated with our normal vet to increase/decrease as needed as the situation improved.
Our dog survived to both blood tests, which both showed continued renal improvement. Despite the declines being moderate overall, our cardio and normal vet expected them to drop significantly slower and are incredibly pleased and expect the numbers to continue to drop over the next few weeks. They both think our dog is somewhere between stages 2-3 of Chronic Kidney Disease and not end-of-life. Neither understand the rush of the ER to euthanize. We've slightly adjusted heart medication and have begun kidney treatment.
Our dog won't live forever and we know their time is limited. Through careful management of his disease by board certified specialists, he has no symptoms and should remain that way for 9-12 months when he will begin to have symptoms and we will make the quality-of-life decision.
In both ER trips, the criticalists stressed hopelessness and recommended euthanasia. Both times, days after bringing our dog home, they are running around the house, racing up stairs, and playing with other dogs in a park or on the beach. With medicine, our dog's quality of life is excellent and they are no way near euthanasia on any of the scales used in this sub.
I am still trying to wrap my head around this, and figure out how/when I can trust ER vets and when I should be second guessing them. Is this a cultural thing? Is this based on education or clinical experience? There was a tangible rush and pressure to euthanize a dog who is in a survivable crisis with a condition that can be successfully managed with long term care.
For the vets that want to know about numbers:
The normal baseline of Creat/Bun is 2.1/75 +- 15% over the past 2 years.The cardiologist measured 2.3/86 - the day of diarrhea.Five days later, the normal vet measured 6.9/140.Three days after that, the ER projected 12.8/170.Two days later the ER discharged with 7.6/180 (bun was projected, creat was readable).Two days later, our vet measured 5.4/128.Two days later, our vet measured 4.9/114.We have a renal recheck in 2 weeks.
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I am so freaked out about diuretics, I don't know why it's that of all things. I started out at 20mg of Lasix in November and now I'm on 60mg of Torsemide daily but honestly am currently at 120mg because I've been retaining again.
I feel so frustrated and sad and ashamed like I've failed. I'm afraid for my kidneys and for what it means to keep having to up my dose. I'm afraid to be hospitalized and I'm afraid to get a transplant. It's bad enough to have a fucked up heart but I hate the Idea of ruining all my other organs too. I'm also on amioderone and I hate that too. I feel like I'm lighting fire to my body but it doesn't even matter because it's already a pile of trash.
I've been too tired recently to cook or grocery shop so instead I've been eating out or eating prepared foods and I know I'm just making it worse. I could ask for help with people to drop off food but I just feel really ashamed. I'm 30 and I love cooking and I feel like a shell of myself.
This just sucks. It's a bad day. It will get better at some point but not today. Thank you for listening to me vent.
PS: I'm so thirsty and I miss drinking water and having people be impressed by how well hydrated I am. I miss guiltless water so much 😭