Competing Physiology
Renal perfusion, hydration, congestion risk, blood pressure, and cardiac output can pull treatment in different directions.
Cardiorenal Care Initiative • Miami
Heart and kidney disease should be managed as one connected problem.
The Happy Project is developing practical tools to improve medication reconciliation, monitoring, handoffs, and owner communication for pets living with both cardiac and kidney disease.
Starting with one high-risk clinical problem. Building the system before building the hospital.
♥ + ◌
One patient. Two organ systems. One coordinated plan.
Hydration, renal perfusion, respiratory status, blood pressure, and chronic heart medications all interact. The goal is to make those decisions explicit and visible.
Our Mission
Make cardiorenal care safer, clearer, and easier to coordinate.
We are focused initially on dogs and cats living with both heart disease and chronic kidney disease, especially during acute illness, hospitalization, medication changes, and discharge.
The goal is not to tell veterinarians how to practice medicine. It is to create practical systems that make important clinical decisions easier to document, communicate, and carry across shifts and between hospitals, specialists, primary veterinarians, and owners.
Why Cardiorenal Care
The hard part is the interaction.
A patient may need fluid support for the kidneys while also having heart disease that limits how aggressively fluids can be given. Chronic medications may remain essential—or may require reassessment during an acute crisis. The safest plan depends on seeing the entire clinical picture together.
Medication Complexity
Diuretics, ACE inhibitors, inotropes, and adjunctive cardiac drugs should be reconciled against the patient’s current status.
Handoff Risk
Clinical reasoning can disappear across referrals, overnight shifts, and discharge unless it is explicitly documented.
Cardiac Monitoring & Medications
The cardiac side of cardiorenal care.
Heart and kidney disease cannot be managed in isolation. Respiratory trends, blood pressure, hydration, renal values, and medication effects all belong in the same clinical picture. The tools below are designed to help owners monitor and ask better questions—not to change medications without veterinary direction.
Sleeping Respiratory Rate (SRR)
Home sleeping or resting respiratory-rate monitoring can be useful in dogs with heart disease, especially those with a history of congestive heart failure. Healthy and clinically controlled dogs often have sleeping rates below 30 breaths per minute, but each patient should have an individualized baseline and action plan from the veterinary team.
- Measure while the dog is quietly asleep—not panting, dreaming, or just after activity.
- Count chest rises for a full 60 seconds, or count for 30 seconds and multiply by two.
- Record the number and watch the trend rather than relying on one isolated reading.
- Call the veterinary team for a persistent rise above the dog's normal baseline, or immediately for increased breathing effort, distress, blue/gray gums, collapse, or other emergency signs.
Quick SRR Log
Blood Pressure
Systemic hypertension can worsen kidney and other target-organ injury, while hypotension can compromise perfusion. In CKD, IRIS recommends repeated systolic blood-pressure measurement and interpretation in context, including stress or "white-coat" effects.
<140Minimal target-organ-damage risk
140–159Low risk / prehypertensive range
160–179Moderate risk / hypertensive range
≥180High risk / severely hypertensive range
Ask your veterinarian: What was the systolic blood pressure? Was the reading repeated under standardized conditions? What is the patient's target, and when should it be rechecked?
Medication Guide
Know what each cardiac medication is trying to accomplish.
These summaries are educational. Whether a drug should be continued, held, reduced, restarted, or replaced depends on the individual patient and must be decided by the treating veterinarian.
Furosemide Salix / Lasix
Class: Loop diuretic
Role: Promotes urine production to relieve pathologic fluid accumulation, including pulmonary edema in CHF.
Cardiorenal question: Does the patient currently need diuresis, and how should the dose be balanced against hydration, renal function, electrolytes, respiratory status, and congestion?
Ask: "Given today's respiratory findings, hydration, renal values, and electrolytes, is the current furosemide plan still appropriate?"
Enalapril ACE inhibitor
Class: Renin-angiotensin-aldosterone system (RAAS) inhibitor
Role: Used in selected cardiac patients and in some renal patients for blood-pressure and proteinuria management.
Cardiorenal question: RAAS inhibition can affect systemic and glomerular hemodynamics, so blood pressure, renal function, hydration, and proteinuria should be considered together—especially in unstable or azotemic patients.
Ask: "What is the indication for enalapril in this patient, and what blood-pressure and renal monitoring supports the current plan?"
Pimobendan Vetmedin
Class: Inodilator / positive inotrope
Role: Improves cardiac contractility and has vasodilatory effects; it is commonly used in appropriately staged canine heart disease.
Cardiorenal question: Pimobendan is not a diuretic, but whether it should be continued still depends on the patient's cardiac diagnosis, stage, blood pressure, rhythm, and overall clinical condition.
Ask: "What cardiac indication are we treating with pimobendan, and should that plan change during this acute illness?"
Spironolactone Aldosterone antagonist
Class: Potassium-sparing diuretic / mineralocorticoid-receptor antagonist
Role: Used as an adjunct in selected CHF patients; its diuretic effect is milder than furosemide.
Cardiorenal question: Kidney function, hydration, potassium, concurrent RAAS drugs, and the ongoing cardiac indication should be reviewed.
Ask: "What is today's potassium and renal status, and what benefit are we expecting from spironolactone right now?"
Cardiac Diagnostics
Different tests answer different questions.
Echocardiogram
Ultrasound of the heart. Assesses chamber size, valve structure and function, contractility, blood-flow patterns, and other structural/hemodynamic features.
ECG / EKG
Records the heart's electrical activity. Used primarily to assess rhythm and conduction; it is not the same test as an echocardiogram.
Thoracic Radiographs
Chest X-rays help assess heart size, pulmonary vessels, lung patterns, pulmonary edema, and pleural fluid. They are interpreted together with examination and clinical signs.
NT-proBNP & Cardiac Biomarkers
Can provide evidence of myocardial stretch or cardiac stress in selected situations. They complement—not replace—physical examination and imaging.
Blood Pressure
Especially important in kidney disease, suspected hypertension, and patients receiving therapies that affect cardiovascular or renal hemodynamics.
Respiratory Trend
Home SRR/RRR trends can be paired with examination and imaging to help recognize changing congestion risk earlier.
Evidence basis: This section is written to align with ACVIM consensus guidance for canine
myxomatous mitral valve disease, ACVIM/IRIS guidance on systemic hypertension, and published studies of
sleeping/resting respiratory-rate monitoring. It intentionally avoids universal medication hold/restart rules;
those decisions require veterinary assessment of the individual patient.
Navigating Veterinary Care
Know who is treating your pet—and what the facility can actually do.
“Veterinarian,” “specialist,” “clinic,” and “hospital” are not interchangeable terms. When a dog has both heart and kidney disease, knowing the training of the clinician and the capabilities of the facility can matter as much as knowing the diagnosis.
Who Is Who?
Understanding veterinary credentials.
DVM / VMD
Primary-Care Veterinarian
A veterinarian who has earned a professional veterinary medical degree. DVM and VMD are equivalent veterinary degrees.
Often the right starting point for: routine examinations, preventive care, stable chronic disease, basic diagnostics, blood-pressure checks, medication refills, and coordination of referrals.
Remember: DVM/VMD identifies the veterinary degree. It does not by itself mean the veterinarian is a board-certified specialist.
DACVIM (SAIM)
Board-Certified Veterinary Internist
A veterinarian who completed advanced specialty training and board certification in small-animal internal medicine through the American College of Veterinary Internal Medicine.
Especially useful for: complicated CKD, severe azotemia, anemia, electrolyte disorders, GI disease, endocrine disease, proteinuria, and difficult multisystem cases.
Cardiorenal role: often helps integrate the kidney and broader medical side of a complex patient.
DACVIM (Cardiology)
Board-Certified Veterinary Cardiologist
A veterinarian with advanced residency training and board certification in veterinary cardiology.
Especially useful for: echocardiography, complex CHF, valve disease, cardiomyopathy, arrhythmias, cardiac staging, and difficult cardiac-medication decisions.
Cardiorenal role: helps determine how much cardiac therapy is needed while the team protects renal perfusion and kidney function.
DACVECC
Board-Certified Criticalist
A veterinarian board certified in emergency and critical care after advanced specialty training.
Especially useful for: unstable hospitalized patients, respiratory distress, shock, severe metabolic disturbances, intensive monitoring, and complex ICU decisions.
Ask: Is a criticalist involved in this case, or is the patient being managed by an emergency veterinarian?
DACVIM (Nutrition)
Board-Certified Veterinary Nutritionist
A veterinary specialist with advanced training and board certification in nutrition.
Especially useful for: creating nutritionally complete homemade diets for patients whose kidney, cardiac, GI, pancreatic, or other medical needs make ordinary feeding plans difficult.
Connects to: our renal food calculator, which is a planning tool—not a substitute for complete diet formulation.
Where Are You?
Clinic, hospital, specialty center, or tertiary center?
The word “hospital” alone does not tell you which specialists, ICU capabilities, advanced procedures, or overnight medical coverage are available. Ask about capabilities directly.
Primary Veterinary Clinic / General Practice
Best suited to routine and stable care: examinations, vaccinations, basic imaging and laboratory testing, chronic-disease monitoring, blood-pressure checks, and medication management within the practice's capabilities.
Escalate when: the disease becomes unstable, diagnosis is unclear, advanced imaging/procedures are needed, or multiple organ systems require specialist coordination.
↓
Emergency / 24-Hour Hospital
Designed to evaluate emergencies and often provide hospitalization, IV therapy, oxygen, repeated laboratory testing, imaging, and continuous nursing support.
Important: 24-hour emergency care does not automatically mean that an internist, cardiologist, or criticalist is physically present around the clock.
↓
Specialty & Referral Hospital
May combine emergency care with board-certified specialists such as internal medicine, cardiology, surgery, neurology, oncology, and critical care, plus advanced diagnostics and procedures.
Ask: Which specialists are physically available today? Who will manage the patient overnight? Which advanced services are actually offered at this location?
↓
Tertiary / Academic Referral Center
A high-level referral center—often a veterinary teaching hospital or major specialty institution—capable of coordinating multiple specialty services and, at some centers, advanced renal replacement therapy, complex ICU support, interventional procedures, and uncommon diagnostics.
Think tertiary early when: the patient has severe multisystem disease, requires technology the current hospital does not possess, or is failing to respond despite appropriate specialty-level treatment.
Find the Right Level of Care
Start with what your dog needs.
Routine CKD / stable chronic diseasePrimary DVM/VMD, with referral when complexity increases
Progressive or complicated kidney diseaseInternal medicine / DACVIM (SAIM)
Complex heart disease or CHFVeterinary cardiologist / DACVIM (Cardiology)
Unstable cardiorenal crisisEmergency/ICU care with appropriate specialist involvement
Shock, respiratory failure, complex ICU needsEmergency & critical care; consider DACVECC involvement
Dialysis or unusually complex multisystem failureCenter with the required renal-replacement/tertiary capabilities
Long-term homemade medical dietVeterinary team + board-certified veterinary nutritionist
When Your Dog Is Hospitalized
Ask for the whole clinical picture every day.
Who is responsible today?
Get the attending veterinarian's name. Ask who takes over at shift change and who is responsible overnight.
What changed?
Ask for current laboratory results and trends, hydration/volume assessment, respiratory findings, blood pressure when relevant, appetite, urine output, weight, and important events.
What medications changed—and why?
Ask which medications were continued, held, reduced, added, or restarted and the clinical reasoning for each change.
What is the next 24-hour plan?
Know what the team is trying to accomplish, which parameters will be rechecked, and what findings would cause the plan to change.
What would trigger escalation?
Ask what deterioration would require a specialist, ICU transfer, dialysis-capable center, or another higher level of care.
Can I have the records now?
Request current labs, treatment plans, medication information, imaging reports, and other available records needed to understand the case or seek another opinion.
Before leaving your pet at any hospital, ask:
- Is a veterinarian physically present in the hospital 24 hours a day?
- Who will be the attending veterinarian, and who covers overnight?
- Is a board-certified internist available today?
- Is a cardiologist available if the cardiac plan becomes complicated?
- Is a criticalist available or on call?
- How are medication changes handed off between shifts?
- How often will I receive clinical updates and laboratory results?
- What can this hospital not do?
- If my pet needs a higher level of care, where would you transfer them?
Important: Credentials and services vary by clinician and facility. Verify current board
certification and the services physically available at the specific hospital. The appropriate level of care
depends on the patient's condition; an emergency should not be delayed while searching for a particular specialist.
Hospital → Home
Going home should be a clinical handoff, not just a checkout.
Discharge is a high-risk transition. Before leaving, the owner and veterinary team should be looking at the same medication list, the same monitoring plan, and the same follow-up schedule.
Reconcile every medication
For every drug: continue, stop, hold, change, or restart? Confirm the dose, timing, purpose, and what would trigger another change.
Get the current clinical picture
Review important lab trends, hydration/volume status, respiratory findings, blood pressure when relevant, appetite, urine output, and unresolved problems.
Learn the home monitoring plan
Know what to measure at home—such as sleeping respiratory rate, weight, appetite, water/food intake, urine changes, and prescribed medication observations.
Know the red flags
Get written instructions for what requires a routine call, a same-day assessment, or emergency evaluation.
Book the recheck before leaving
Know when CBC/chemistry, blood pressure, weight, imaging, or specialist follow-up should occur and who owns that follow-up.
Leave with the records
Request the available discharge summary, medication list, current laboratory results, imaging reports, and other records needed for continuity or a second opinion.
Safety Net
Know what should trigger a call—and what is an emergency.
Your dog's veterinary team should give you individualized thresholds. These general warning signs are reasons to seek veterinary guidance promptly; respiratory distress, blue/gray gums, collapse, or severe neurologic signs require emergency evaluation.
Breathing changesPersistent rise above the dog's established sleeping/resting respiratory baseline, especially with increased effort, abdominal breathing, inability to settle, or coughing.
Blue, gray, or very pale gumsMay indicate inadequate oxygenation, poor perfusion, or significant anemia. Treat marked color change as urgent.
Collapse or profound weaknessRequires prompt assessment, particularly in a cardiac, renal, or anemic patient.
Sudden blindness or neurologic changeCan accompany severe hypertension or other emergencies and warrants urgent evaluation.
Repeated vomiting / cannot keep water downCan rapidly worsen hydration and interfere with medications and nutrition.
Major appetite declineContact the veterinary team for persistent or complete food refusal, especially in a CKD patient; do not wait for a fixed time threshold if the dog is otherwise unwell.
Major urine changeMarked reduction/no urine, straining, or a dramatic unexplained increase should be reported promptly.
Rapid weight or fluid-status changeUnexpected gain or loss can matter in patients balancing CHF and kidney disease.
Understand the Disease
Stages, complications, and what treatment may look like.
A stage is a framework—not a prognosis by itself. Kidney stage, cardiac stage, blood pressure, proteinuria, anemia, hydration, appetite, respiratory status, and the patient's response to treatment all matter.
IRIS Chronic Kidney Disease Stages — Dogs
Staging is performed in a stable, hydrated patient after CKD has been diagnosed. Creatinine and SDMA are interpreted together; IRIS also substages by proteinuria and blood pressure.
Stage 1Creatinine <1.4 mg/dL
Kidney abnormality is present, but creatinine may still be within the conventional reference range.
Stage 2Creatinine 1.4–2.8 mg/dL
Mild renal azotemia. Clinical signs may be absent or mild.
Stage 3Creatinine 2.9–5.0 mg/dL
Moderate renal azotemia. Clinical signs and complications become increasingly common.
Stage 4Creatinine >5.0 mg/dL
Severe renal azotemia with greater risk of systemic complications and uremic signs.
Do not stage from creatinine alone during dehydration or an acute crisis. Stabilization and repeat assessment can materially change the interpretation.
ACVIM Heart Disease Stages — Canine MMVD
These A–D stages apply to myxomatous mitral valve disease (MMVD). They are different from the audible murmur grade.
Stage AAt risk
Predisposed dog with no identifiable structural heart disease.
Stage B1Heart disease, no CHF
Structural disease/murmur is present, but enlargement does not meet B2 treatment criteria.
Stage B2Remodeling, no CHF yet
Significant cardiac enlargement meeting defined criteria; pimobendan is commonly indicated for qualifying MMVD patients.
Stage CCurrent or previous CHF
The dog has experienced clinical congestive heart failure. A dog remains Stage C even when congestion is controlled.
Stage DRefractory CHF
End-stage disease with heart-failure signs refractory to standard therapy, requiring advanced strategies.
Murmur grade is not heart-failure stage
A veterinarian may grade an audible murmur from I/VI to VI/VI: I is very faint; II is soft but readily heard; III is moderately loud; IV is loud; V is very loud with a palpable precordial thrill; VI is very loud with a thrill and can be heard with the stethoscope slightly off the chest. A louder murmur does not by itself tell you whether a dog is in CHF. Imaging and the clinical picture determine cardiac stage.
CKD Complications
Anemia deserves its own monitoring plan.
Why CKD causes anemia
Diseased kidneys may produce inadequate erythropoietin, the hormone that signals bone marrow to make red blood cells. Iron deficiency, inflammation, shortened red-cell lifespan, bleeding, nutrition, medications, and repeated blood sampling can contribute.
What to monitor
CBC trends including hematocrit/PCV, hemoglobin, red-cell indices and reticulocytes; the veterinarian may also investigate iron status, bleeding, inflammation and other causes. Pale gums, weakness, poor appetite, lethargy or reduced exercise tolerance warrant attention.
2026 IRIS treatment trigger — dogs
IRIS now recommends treating CKD-associated anemia in dogs at HCT <30%, or persistent anemia at 30–35%, in clinical context. The number is not a stand-alone transfusion threshold.
Iron therapy
Iron can be important when absolute or functional iron deficiency contributes to anemia, and is often considered alongside erythropoiesis-stimulating therapy. Iron should not simply be added because hematocrit is low; the cause and iron status matter.
Blood transfusion
Packed red cells or whole blood may be used for severe, clinically symptomatic anemia or acute blood loss. Transfusion can improve oxygen-carrying capacity quickly, but carries risks including reactions, volume overload, and other complications. The decision is based on the patient—not one HCT number alone.
Darbepoetin / ESA therapy
Darbepoetin is an erythropoiesis-stimulating agent used by veterinarians for CKD-associated anemia. It acts like erythropoietin and can stimulate red-cell production over time. It requires monitoring, including blood pressure and hematologic response, and is not an emergency substitute for transfusion when immediate correction is required.
Dialysis / renal replacement therapy
Hemodialysis does not “cure” CKD. It removes uremic toxins and manages fluid/electrolyte problems when the kidneys cannot do so adequately. It may be considered for life-threatening uremia, refractory kidney failure, dangerous overhydration, selected toxin exposures, or other severe indications at centers equipped to provide it.
These therapies solve different problems
IronProvides substrate when iron availability is inadequate.
Darbepoetin / ESASignals the marrow to make more red blood cells; response takes time.
Blood transfusionProvides red blood cells immediately when anemia is severe/symptomatic.
DialysisSupports blood purification/fluid-electrolyte control; it does not directly replace red blood cells.
Questions to ask when anemia appears
- What are today's HCT/PCV and hemoglobin, and what is the trend?
- Is the anemia regenerative or non-regenerative?
- Could iron deficiency, bleeding, inflammation, or another disease be contributing?
- Should iron status be assessed?
- At what point would you consider darbepoetin?
- What clinical findings—not just a number—would trigger transfusion?
- Is kidney failure severe enough to warrant consultation with a dialysis-capable center?
- When will the CBC and blood pressure be rechecked?
Safety note: This is an owner-education map, not a dosing protocol. Anemia treatment, transfusion, erythropoiesis-stimulating drugs, iron, and dialysis require veterinary assessment and monitoring. Cardiac disease can make fluid balance during transfusion or dialysis especially important.
Cardiorenal Safety Toolkit
The whole picture, every time.
Version 1.0 is designed as a set of simple, one-page tools that can be reviewed with licensed veterinarians, piloted in existing practices, and refined based on real-world use.
Cardiorenal Medication Review
Document whether each chronic medication is continued, held, modified, or restarted—and why.
- Hydration / volume status
- Respiratory / lung findings
- Blood pressure, when clinically indicated
- Renal trend
- Clinical rationale
- Reassessment / restart criteria
Held Medication Handoff
Carry the reasoning forward between clinicians and shifts.
- Medication held
- Reason for hold
- Who made the decision
- What must be checked before restart
- Next responsible clinician
Daily Owner Clinical Summary
Give owners the decision-relevant picture, not just raw numbers.
- Key labs + trends
- Hydration and respiratory findings
- Medication changes
- Major events
- Next 24-hour plan
Discharge & Follow-Up Checklist
Make the transition home explicit and measurable.
- Medication reconciliation
- Owner monitoring instructions
- Defined warning signs
- Scheduled recheck
- Responsible follow-up veterinarian
Renal Nutrition Planning
Turn a homemade meal plan into something measurable.
Homemade renal diets can look simple while still being nutritionally complex. This planning tool helps owners organize calories, protein targets, water, and meal portions so they can have a more precise conversation with their veterinarian or veterinary nutritionist.
Homemade Food Planning Calculator
Planning aid only — not a complete renal-diet formulation.
Daily → Per Meal
Enter your veterinarian-approved daily targets to calculate simple per-meal amounts.
Important: Calories, protein, and water are only part of a complete diet.
Calcium, phosphorus, potassium, sodium, essential fatty acids, vitamins, minerals, amino acids,
and the pet's medical conditions also matter. Have a veterinarian or board-certified veterinary
nutritionist review any long-term homemade diet.
1. Get the targetsAsk the veterinary team for the patient's daily calorie and nutrition goals.
2. Measure the recipeWeigh ingredients rather than relying on visual estimates or household portions.
3. Track intakeRecord how much food and water is actually consumed—not simply how much was offered.
4. ReassessAdjust the plan with the veterinary team as weight, labs, appetite, or disease status changes.
Renal Support Options
Know what category a product belongs to—and what questions to ask.
This section is designed as an educational comparison framework, not a prescription. Product formulations can change, and the appropriate choice depends on the individual patient, diet, laboratory results, concurrent medications, and veterinary assessment.
Phosphorus Binders
Phosphorus binders are generally used with food to reduce intestinal absorption of dietary phosphorus. Selection and amount should be individualized using the patient's diet and serial phosphorus measurements.
Epakitin
A veterinary renal-support product commonly used as a meal-associated phosphorus-binding supplement.
Naraquin
A veterinary renal-support supplement that includes ingredients intended to support phosphorus management.
Other binder strategies
Veterinarians may use other calcium-based or non-calcium binder approaches depending on the patient. Ask which active ingredient is being used and why.
Ask your veterinarian: What is our phosphorus target? Should this product be given with every meal? When should phosphorus and calcium be rechecked?
Probiotics & Renal Supplements
Products marketed for kidney patients are not interchangeable. Some are probiotics, some are broader renal-support supplements, and their ingredients, storage requirements, intended roles, and evidence differ.
Visbiome Vet
A veterinary probiotic option. Discuss its intended gastrointestinal role and whether it fits the individual patient's care plan.
Azodyl
A kidney-focused supplement containing probiotic organisms. Ask the veterinarian about evidence, handling, and how response will be assessed.
Nephrodyl
A renal-support product that should be evaluated by its specific ingredients and intended purpose rather than treated as interchangeable with a probiotic.
Ask your veterinarian: What problem are we trying to solve with this product? What evidence supports it? How should it be stored and given? How will we know whether it is helping?
Coming next: evidence-based comparison tables
The Happy Project can expand these pages into veterinarian-reviewed tables comparing active ingredients, intended use, administration, storage, important cautions, and strength of published evidence—without turning the website into an online prescribing service.
Why This Exists
Inspired by Happy. Built for the next patient.
The initiative grew out of caring for two elderly dogs with both heart and kidney disease and seeing firsthand how difficult treatment becomes when medication decisions, hydration, renal function, respiratory status, and owner communication are not considered together. Its founder is a pet owner who lost one of those dogs after a hospitalization that raised serious questions about cardiorenal medication management, clinical communication, and care transitions—and began building these tools so future owners can ask better questions earlier.
The purpose is forward-looking: help veterinary teams and owners see the same clinical picture, understand the same plan, and carry that reasoning safely from one decision point to the next.
Know Your Numbers
Trend the patient, not just the latest result.
One value is a snapshot. A series shows direction. This browser-based tracker lets an owner record major cardiorenal variables together so renal function, anemia, blood pressure, body weight, and respiratory trends can be discussed as one picture.
Add a reading
Entries stay in this browser only. They are not uploaded anywhere.
Trend table
| Date | Cr | BUN | Phos | SDMA | HCT | Hgb | UPC | BP | Wt | SRR | Notes |
|---|
Demonstration Case
Happy & Dopey: why context matters
Happy and Dopey were elderly littermates living with kidney and cardiac disease. Their records illustrate why trends can be more informative than isolated numbers. The examples below are selected owner-recorded/medical-record values and are not a controlled comparison and do not prove that one treatment caused either outcome.
Happy — acute hospitalizationCreatinine 5.3 → 3.6 mg/dL during initial IV-fluid treatment; phosphorus >15 → 9.4 mg/dL; BUN remained >140; HCT 25.7% → 20.7%.
Dopey — subsequent outpatient trendCreatinine 2.8 → 1.7 mg/dL; BUN 67 → 46 mg/dL; phosphorus 6.8 → 6.0 mg/dL while her care plan and monitoring were being actively reassessed.
Different patients—even littermates—can be in very different physiologic states. These cases are included to demonstrate longitudinal recordkeeping, not to establish causation or predict another dog's outcome.
Continuity of Care
Chronic disease means chronic reassessment.
A chronic medication list is a starting point, not a permanent treatment plan. When kidney function, weight, blood pressure, hydration, respiratory status, appetite, or clinical condition changes, ask whether the heart–kidney balance and each medication still make sense for the dog today.
When a medication changes
Ask what changed, why it changed, what to monitor, when it will be reassessed, and whether you can have the plan in writing.
Patterns worth questioning
Medication changes without explanation, important trends without follow-up, or an old medication list carried forward despite major physiologic change are reasons to ask for clarification.
Book the next before you leave
Never leave chronic-care follow-up undefined. Know when you are rechecking, what will be reassessed, what to monitor, and what would make you return sooner.
Printable Tools
Use the forms directly on the website.
Seven forms are built directly into this page. Fill them in on screen, then print or save them as PDFs from your browser. Fill it in on screen, then use the Print button to print or save it as a PDF from your browser.
The Happy ProjectHeld Medication Handoff Form
Cardiorenal medication safety and shift-handoff tool. Clinical decisions remain the responsibility of the treating veterinarian.
Medication Decision
Relevant Findings at Decision Point
The Happy ProjectDaily Owner Clinical Summary
One-page daily synthesis for a hospitalized cardiorenal patient.
Today's Clinical Picture
Key Lab Trends
| Marker | Prior | Today | Trend / interpretation |
|---|---|---|---|
| Creatinine | |||
| BUN | |||
| Phosphorus | |||
| Potassium | |||
| HCT / PCV | |||
| Hemoglobin |
Medication Changes
| Medication | Continue / Hold / Change | Why |
|---|---|---|
The Happy ProjectCardiorenal Discharge Checklist
Hospital-to-home transition safety tool.
Medication Reconciliation
| Medication | Dose / timing | Action | Purpose / monitoring |
|---|---|---|---|
Before Leaving
The Happy ProjectSleeping Respiratory Rate Log
Measure while your dog is quietly asleep and not panting. Use individualized thresholds from your veterinary team.
| Date | Time | Breaths/min | Breathing effort / cough? | Notes |
|---|---|---|---|---|
The Happy ProjectNext Visit Card
The Happy ProjectOwner Checklist for Cardiorenal Vet Visits
Current medications
| Medication | Dose | Why prescribed? | Change? |
|---|---|---|---|
The Happy ProjectCardiorenal Longitudinal Care Plan
One living summary that connects visits over time.
Current treatment plan
| Medication / therapy | Dose | Current indication | Last change + reason | Next reassessment |
|---|---|---|---|---|
For Veterinarians
Owner education should reduce friction—not create it.
The Happy Project is owner-led. Its clinical tools are intended to be reviewed, corrected, and piloted with licensed veterinary professionals before broad adoption.
The forms do not dictate treatment. They are intended to make medication reasoning, shift handoffs, daily clinical synthesis, and discharge planning easier to document and easier for owners to understand.
Pilot concept: test the forms in a small number of cardiorenal cases, identify what adds value versus unnecessary workload, revise with veterinary input, and measure whether continuity and communication improve.
Long-Term Vision
Start focused. Expand only after the model works.
The first phase is the cardiorenal initiative: build the toolkit, recruit veterinary reviewers, and pilot the workflows in existing practices.
If the model proves useful, the broader vision is a nonprofit veterinary-care network in Miami offering high-quality, financially accessible care, followed eventually by a dedicated facility and mobile outreach program.
What This Looks Like at Home
Good chronic care happens between appointments.
For many families, cardiorenal care becomes a daily routine: a gram scale on the kitchen counter, measured meals in containers, water mixed into food, medication times, respiratory-rate logs, weight checks, and a calendar full of rechecks.
The goal of The Happy Project is not to tell every owner to provide the same intensity of care. It is to make the plan understandable enough that an owner who wants to participate can do so safely, consistently, and in partnership with the veterinary team.
Future versions of the project can include owner stories showing different realistic levels of home care—from simple medication and SRR tracking to complex renal nutrition and multispecialty follow-up.
About Happy
The dog behind the project.
Happy was a 15-year-old Shih Tzu—bright, demanding, sighted, still interested in food and family, and still capable of making her opinions very clear.
In July 2026, Happy entered the hospital with advanced kidney disease, dehydration, anemia, and a history of heart disease. Her renal values initially improved during hospitalization, but she ultimately deteriorated and died. Reviewing her records afterward raised serious questions for her owner about medication reconciliation, cardiorenal decision-making, communication, access to clinical information, and the transition between shifts and discharge planning.
Her littermate Dopey then became the reason to turn those questions into systems: measured nutrition, respiratory monitoring, blood-pressure tracking, deliberate medication review, scheduled follow-up, and clearer owner participation.
The Happy Project is her legacy: a practical effort to help the next family understand the whole clinical picture earlier and to make safer conversations between owners and veterinary teams easier.
Founded by Peter Leung, a pet owner. The project is owner-led and is intended to develop its clinical materials with veterinary review. It does not replace a veterinarian or specialist.
Founding Network
Help us build Version 1.0.
We are looking for veterinarians, veterinary technicians, cardiology and internal-medicine professionals, nonprofit advisors, rescue groups, donors, and pet owners to review and test the model.