Martin, you are asking a very good question. I'm not a medical professional and I don't have a definitive answer for you, but let me tell you what I went through to arrive at the point where I did have a baseline number. I have CHF as a result of a bad heart attack. I was 61 at the time (am now 66) and I was at the low end of BMI-defined obesity. I'm 5'9" and weighed 235 at the time of my heart attack. I was traveling in another state on business when it happened so the cardiologists who saved me did not become my permanent care team. I was in the ICU for a week and when I left the hospital to fly home, my EF was 25%-30%. I had almost died and the heart attack scared the living hell out of me, so as soon as I got home, I started following the Ornish diet to the letter, and my weight started dropping almost immediately. I was losing 8-10 lbs. per month steadily. Now, during this time, I was also putting together my cardiac team in Raleigh, NC, where I live. My focus was on the heart attack and the stent, and I wasn't really focused on the fact that I also now had heart failure, and the heart failure aspect of my condition wasn't really being addressed yet. My new cardiology team in Raleigh at this point consisted of an interventional cardiologist and an electrophysiologist. I was told that I had heart failure, but the focus was really on getting the meds right for my post-heart attack needs. I was effortlessly losing weight, and this was documented in each of my several visits to the cardiologist in the first couple of months post-heart attack. I also charted my weight every day, and I still do to this day. So, because I was losing weight, the fluid retention aspect of CHF was not a concern at this point, and therefore, I was not put on a diuretic. 3 months after my heart attack.....and at this point, I had lost around 25 lbs, I woke up one morning and was feeling a tightness in my chest and shortness of breath, and I went to the ER to be on the safe side. They quickly determined that I was not having another heart attack, but rather, I had a pleural effusion.....fluid buildup surrounding my lungs. The pleura is a sack that surrounds your lungs, and the space within that sack was approximately half-filled with fluid. The fluid was pressing on my lungs, preventing them from fully expanding, thereby causing my shortness of breath. This was an acute heart failure episode, and I was in the hospital for 3 days as they used intravenous Lasix to remove this fluid. I lost about 10 lbs of fluid during this hospital stay. I was immediately prescribed a lasix pill that I was now to take daily as part of my heart-meds regimen. The weight I was at when I was discharged from the hospital was my new baseline weight. At this point, my interventional cardiologist felt I needed to have more care focussed on my heart failure and I was referred to the heart failure clinic at my hospital. So now, I have my interventional cardiologist, my electrophysiologist, and my CHF specialist. I continued to lose weight, and finally reached 180 lbs, which was a 55-pound weight loss from the time when I had my heart attack. I've bounced up and down between 180 and 190 for the past 5 years. I weigh myself twice a day and log it in my daily heart log. I take my oxygen saturation and heart rate twice a day, my BP twice a day, and weigh myself twice a day. I weigh myself in the evening because it is indicative of what I will weigh the next morning. Once I got the heart failure specialist, I was told to call them if my weight increased 3lbs or more overnight or 5 lbs or more in a 5 day period. They would instruct me on taking additional Lasix pills, usually for a period of a few days, to bleed off that extra fluid. Once my weight returned to the point it was before the sudden weight increase, I'd go back to my regular dose. This sudden weight gain would happen every few months. After going through this routine of talking to the heart failure clinic, I was told that I could now self-medicate if I had a sudden weight gain and that I should call the clinic if I was not able to bleed off the fluid. After about 3 years, Lasix started losing its consistent efficacy for me and I was changed to Torsemide, with has worked well consistently,
I'm very careful about my sodium intake with my diet. I religiously adhere to the <1500 mg sodium consumption limit recommended for CHF patients, and I am closer to 1000 mg than 1500 mg on a daily basis. If I go out to a restaurant (all restaurant food is LOADED with sodium), I make the best choices I can to reduce my salt intake and I may take a Torsemide pill when I get home if I can tell that I consumed too much salt. This is very important. If you are not paying attention to your sodium intake, you really need to. It makes a big difference. I'm a lousy cook, but I've had to learn, and I make all my food from scratch now. I look at all labels for sodium content (bread, for example....go with Ezekiel no-sodium bread).
So, in your question, you say " I take Lasix and Metolazone when needed. It drives my weight down to 204-206". The fact that you say "when needed" indicates to me that you only take diuretics when needed and you are not taking a diuretic on a daily basis. So, please clarify, are you taking a diuretic on a daily basis? If you are not, you should definitely ask your cardiologist about that. Again, I am not a doctor, but what I have been told by my heart failure clinic is that the core, standard daily medications for CHF patients are a beta-blocker, an ACE inhibitor, and a loop diuretic. Lasix is a loop diuretic. Torsemide is a loop diuretic. Metolazone is a thiazide diuretic and I believe it is given to supplement the loop diuretic if the loop diuretic is not as effective as it should be. If you are not being treated by a heart failure clinic, I would definitely ask your cardiology team to refer you to one. I see you live in Spartanburg, and there will definitely be heart failure clinics in Spartanburg. My heart failure clinic is now my first point of contact. My cardiovascular disease that caused my heart attack is well under control. My ongoing biggest issue is my heart failure, so my heart failure clinic is now really my primary cardiologist.
As far as your baseline weight, if when you take your diuretic, your weight is driven down to "204-206", I would use 205 as your baseline number. Unless you are taking an excessive amount to drive off fluid, you should not be dehydrated at that weight. I'd use that as your baseline.
When you take your diuretics, how much Lasix do you take? How do you determine how much to take? Have you been given instructions by your cardiologist? It just seems to me that you should be taking a loop diuretic on a daily basis. That's pretty much standard operating procedure for CHF patients, and if your cardiologist who treats your heart failure has not prescribed Lasix on a daily basis, you need to ask them why not?