# *GULP* CRF and SubQ fluids for Shasta



## Heidi n Q (Nov 22, 2006)

Shasta was starting to decline, refusing food and vomitting yellow bile. I stopped at the vet yesterday to ask for a refill of her Rx (_appetite stimulant_) and make an appointment for today. They have written an OTC product down for me to find at a pharmacy, it appears to be a liquid or paste antacid? I'll have to use some of my smaller syringes to dose her. The vet said this will help cut down on her stomach acid and keep her feeling better about eating and able to keep it down. They re-checked her and showed me how to give her SubQ fluids. 

I give myself weekly injections, and have been doing so for 10 weeks. I am confident giving them to myself. The vet kept asking me if I thought I would be okay with it. I told her in all honesty: I will certainly be concerned the first few times I do it, but I know I can do what I have to do to help my cat. They have recommended I give her 150ml of fluids twice/week. I have chosen to do them about 3-4 days apart. They also said I could just keep an eye on her, and as long as she is doing good...good. If she starts to show signs of declining, give her fluids. So, until I can get a handle on how she is coping, I will be watching her closely and making my adjustments according to what I see her needs are. 

I brought her right home after the appointment and called my husband, who was returning from out-of-state training and they (_co-worker, and the co-worker drove_) were less than an hour out from the co-worker's home, so I headed right out to pick him up. We returned home within a few hours (_ate and did some quick shopping_) and Shasta was doing FABULOUS! Tail in the air, meowing and talking to us, I offered her some of her special cat food and she ate it...she is doing very well. I am amazed at the quick bounce-back after the fluids. 

It looks like my supplies for her will cost a bit, but they are affordable. I can get her food shipped to me for about $30, until/unless I can find a local provider. Her supplies for the sub-Q (ringers solution, drip line and needles) will last me about a month to a month and a half, and cost $27 to replace each time. They didn't charge me an office visit today.

Wish us luck and I'll keep everyone posted!
h

More info for those who wish it:
http://www.felinecrf.com/managb.htm


----------



## katlover13 (Apr 15, 2008)

I'm glad Shasta is feeling better. I know what you are going through, my RB kitty Bleu had only one kidney and we had to do the sub-Q fluids with her. She was such a sweet laid back cat, though, that it wasn't very hard. At the time I was taking her to an old-time vet who was an expert on cats. (retired now, unfortunately for all local cat lovers). He had me giving Bleu an antacid called Amphogel (sp?) that I had to ask for at the pharmacy because they kept it behind the counter. It was not a prescription medicine, though. 
Good luck with all you are doing with Shasta. She seems like such a wonderful cat, I wish you both the best.


----------



## Heidi n Q (Nov 22, 2006)

Thanks, I just checked the paperwork and it is "alternagel" that she wants me to get, but I think I'll also keep "amphogel" in mind if I can't find the first one.
h


----------



## marie73 (Jul 12, 2006)

I'm so glad she's doing better. That *was* a quick bounce-back!


----------



## laurief (Jun 22, 2008)

I'm sorry that Shasta is having to deal with CRF, but I'm glad that you are getting the experience. Some vets speculate that virtually all cats will develop renal failure if they live long enough, so knowing how to deal with the disease is a critical skill set for cat owners. Administering subQ fluids, in particular, is a very useful skill. I can't tell you how many times I have administered subQs, not only to my CRF cats, but also to my non-CRF cats in the cases of fever, inappetance, and constipation. The ability to administer subQ fluids is as vital to cat caretaking as being able to give oral meds.

I'm not at all surprised that Shasta is doing much better after receiving fluids. It is the single most important management tool we CRF caretakers have in helping our cats feel better. Dehydration does all sorts of nasty things to their bodies and can make them feel really sickly. Of course those first few administrations will be nerve wracking for you. It takes a while to get comfortable with the procedure, but once you get the technique down, it's really no big deal. 

Once you are comfortable with it, I strongly recommend that you administer fluids at least every other day. I assume that your vet prescribed a larger amount of fluids less frequently to make things easier for you, but that's not necessarily what's best for Shasta. A twice weekly schedule just means that she'll have 3-4 days in which to dehydrate between subQs. The goal is to achieve a consistent level of adequate hydration, and that is accomplished by providing fluids more frequently. If your vet prescribed 150 ml twice weekly, you will probably see better results with Shasta if you split that into 75-100 ml every other day instead. As her disease progresses, you'll most likely have to start administering fluids daily. I give my boy, Billy, 75-100 ml daily, and his kidney values are still reasonably low. I can tell, though, that he is more comfortable now that his hydration level is more steady.

You should be able to cut the cost of at-home subQ fluid administration waaaaaay down if you purchase your fluids by the case through a pharmacy (you'll need a prescription from your vet) and your needles and IV sets online. I think I pay about $25/case for 10, 1000 ml bags of LRS at Target Pharmacy, and $6.50/100 Terumo 20 ga UTW needles and $2.85 each for IV sets online.

The website you linked in your post is very useful, but the following site is the one many of us CRF caretakers consider to be the "CRF Bible". I strongly recommend that you read through its pages. There just isn't much of anything about CRF and its associated conditions and treatments that isn't covered in this site. If you're like many of the rest of us dealing with this disease, you'll find yourself bookmarking and referring back to the site countless times. It's an invaluable resource:

http://www.felinecrf.org/

If you find yourself having any sort of difficulty getting the hang of subQs or convincing Shasta to cooperate kindly, feel free to PM me. There are lots of tips and tricks that can make it easier. The two most important are to warm the fluids to cat body temp, and to use the right brand and size of needle.

Welcome to a whole new level of cat caretaking.

Laurie


----------



## Heidi n Q (Nov 22, 2006)

laurief said:


> Welcome to a whole new level of cat caretaking.


Amen! 8O While I don't like the idea of the frequency (every other day) I certainly see the benefit. I am sure I can get more needles from my pharmacist (I have to have needles anyway for me and I don't see a problem with him giving '_me_' *wink-wink* extras) and I can do it every other day. 
Are there more sites I can do the subQ besides just at the 'tent' of her scruff/shoulders? ...so I don't wear out one area with sticking it over and over.


----------



## OsnobunnieO (Jun 28, 2004)

you can give the fluids anywhere there is skin, but between the shoulders is best because there is just soooo much more skin there than anywhere else. Plus, they tend to react much less to needles there - I've noticed SQ injections really seem to cause more pain, twitching, etc when given toward the lower back or legs.

You can vary the areas you give the fluids though. Towards the left one day, middle the next day, right the following and so forth. Farther forward and farther back. You get the point.

I also second getting your supplies elsewhere, possibly online if possible. The markup at the vets is outrageous. Our cost of a bag of fluids is I think around $2-3 and we would charge people closer to $10-15. Needles are pennies apiece and we'd charge at least $0.25. I know there's markup on everything but to me it seems excessive to way overcharge something that few people will be purchasing.


----------



## laurief (Jun 22, 2008)

There are additional benefits to administering less fluids more frequently. When cats become impatient during fluid administration, one common reason is because the administration just takes too long. Giving 75 ml every other day rather than 150 ml every 4th day means that each administration takes half the time. The quicker you're finished with the admin, the more cooperative Shasta is likely to be. Also, 150 ml is a lot of fluid to put into a single location at one time and can create an uncomfortably large fluid pocket for the cat. I find that once I get over 100 ml in one spot, the cat will often start objecting and becoming increasingly squirmy or aggressive in trying to get away. If you're going to give 150 all at once, you may find it necessary to stick Shasta a second time in a different location halfway through the admin.

I was giving Billy about 125 ml of fluids every other day until just recently, which he tolerated with just a bit of growling when we got over 100 ml. But over time, he became increasingly impatient with the procedure, so I switched him to about 75 ml every day. Now he is MUCH more cooperative because we get done quicker and the fluid pocket is smaller and more comfortable for him.

CRF caretakers generally recommend using Terumo needles over Monoject. Terumos are sharper and cause less discomfort to the cat. Monoject are not as well made and sometimes have spurs on the end, earning them the moniker, "kitty harpoons". Terumo makes their needles in regular wall, thin wall, and ultra thin wall styles. The ultra thin wall needles provide a faster fluid flow rate with a smaller needle size, allowing shorter admin times and thinner needles that are more comfortable for the cats. I use the 1", 20 ga UTW Terumo needles for Billy. I buy them from http://www. thrivingpets.com for $6.50/100 needles.

BTW, the larger gauge a needle you use, the larger the hole it will make in the cat and the more scar tissue will develop around the admin sites. Some people use 18 ga needles because the larger the needle, the faster the fluid flow rate. I dislike 18's, though, because of the larger hole they create in the cat and because the fluids tend to leak out of that hole a lot more readily than with a smaller needle size.

Theoretically, the best areas in which to administer fluids are in the "saddle" area - the area covered by a saddle if your cat were a horse. However, I have found that the least sensitive area is between the shoulder blades, and if I try to go behind them with a needle, I'm in for BIG TROUBLE with the cat. Some cats are likely to be more or less sensitive than others, however, so you really just need to see where Shasta is most comfortable receiving her fluids.

Laurie


----------



## Leazie (Apr 14, 2007)

I'm glad that you are able to help Shasta feel better, the poor thing. You are a good Momma.


----------



## Heidi n Q (Nov 22, 2006)

Thank you, I will certainly be checking out other purchasing sources.
h


----------



## Kobster (Feb 1, 2007)

Heidi, Helen who runs the felinecrf.com site, also has a yahoogroup that is just fabulous. I joined when Kobie was diagnosed. 

You can get everything cheaper online except for fluids. Shipping costs on fluids is ridiculous. Get an RX from your vet and get your fluids from walmart pharmacy. a case of 24 for about 22 bucks. It takes about 24 hours from the time you order it to get it in. For your needles, supplements etc try www.entirelypets.com. Order 20gage terumo needles. The monoject ones are duller and hurt more. (just ask Kobie, he'll tell you.)

Those are all my words of wisdom for now. Welcome to the club. I'm glad Shasta has responded well to treatment. 

Did the vet recommend a special diet? Which one are you using?


----------



## Heidi n Q (Nov 22, 2006)

I am trying to get her to enjoy a canned food diet, but the switch is slow. She hates it. I bought two bags of dry food, Royal Canin and ...I can't remember it, just that she didn't like it... so I'm feeding her the Royal Canin. I keep a small glass container with air-tight lid near me and offer her some every time I see her. The rest of the cats LOVE her special CRF food and want to "help" all the time. After the fosters leave I will have better luck with her diet because I can let her go in the Master bedroom and have plenty of time (and company from me) to eat comfortably. I tried using the other bedroom and the bathroom, but she was very nervous about "what-was up?" and she wouldn't settle and eat. She finally got an appetite after the fluids yesterday and she was a little more enthusiastic about the canned food yesterday PM and today AM, so I am a little more hopeful about being able to make her switch.


----------



## Auntie Crazy (Dec 10, 2006)

Wow, Heidi, you sure are going through a lot. God bless you for all you do for these kitties!


----------



## Kobster (Feb 1, 2007)

oops, the link I meant to give you was for www.thrivingpets.com for your subQ supplies and supplements.


----------

