If she were your cat...CRF question

bbairdAugust 5, 2010

Sorry if this is long...

As I've posted before, my cat has CRF and cancer.

11 months ago, 4 vets (including 1 very well respected oncologist) gave her only a couple of months.

She's pretty happy most of the time except when I give her fluids and meds each day.

She started out (11 months ago) with 50ml fluids very third day. Pretty soon she was up to 50ml every other day, then 75ml every other day, then 100ml every other day, the past 3 months -- 75ml every day.

This week, the vet asked me to give her 50ml twice a day. Because she hates getting fluids (even though she's very good about it), I asked if I could giver her 100ml once a day. He said okay.

So, here's my problem/question--what would you do if she were your cat?

That much fluid at once is very uncomfortable for her. I can see it. But, I hate to split it into 2 times a day because she dreads getting it.

Would you just keep it at the 75ml a day and let her live her days in relative comfort (even if that meant less days) or give her the higher amount (either in 1 or 2 doses per day) and cause her some discomfort?

She's been pretty quiet since we got back from the vet on Monday--not at all herself. I don't know if it's the fluids, the vet visit or the rabies shot (that I gave her because of the scary story someone else posted recently).

All my options stink.


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Personally I would put my cat to sleep but thats just me. It's sticks what your going through,if you feel your cat is suffering then theres only one thing to do and I know its heartbreaking. I went through the same thing with my rottie when she got cancer and I put her to sleep because I didnt want her to suffer any longer since there was no hope. My heart goes out to you.

    Bookmark   August 5, 2010 at 9:17AM
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Most cats can handle 100 ml at a time without discomfort. I have found that if I exceed 125 ml in one spot, my CRF cats have gotten uncomfortable with that amount. So I'm wondering if perhaps there isn't something you can do to make fluids in general more comfortable for your girl. A few things come to mind:

1) What type and size needles are you using? I strongly recommend 20 gauge UTW Terumo needles. Monoject needles often cause more discomfort than necessary because they aren't as sharp as Terumo needles, and larger gauge needles (18 or lower) make a larger hole and are more painful going in.

2) Are you warming the fluids before administration? Fluid temp can make all the difference in terms of cat comfort during admin. Most cats prefer fluids warmed to about the temp one would feed baby formula to a human baby. Some cats, however, prefer fluids slightly cooler or warmer than that. Experiment with fluid temp to see if you can find a temp your girl finds relaxing.

3) Are you always administering fluids in the same spot? If so, try moving the needle a bit. Scar tissue can build up around a frequently used injection site, making it uncomfortable for the cat, so varying the site can make a bit difference. Also, you can partially pull out the needle after the first 50 ml and reposition it for the final 50 ml so that the fluid disperses over a wider area and doesn't pool up in one large pocket.

If you are doing all of these things and your girl is still uncomfortable with 100 ml, then doing 50 ml twice daily or sticking with 75 ml once daily are better options than 100 ml once daily. No reason to make fluid admin even more uncomfortable for her than it already apparently is.

The fact that your girl is still with you 11 mos after such a grim prognosis is a true testament both to the quality of care and love that you provide, and to your girl's determination to live. You're both obviously handling the situation admirably well.


    Bookmark   August 5, 2010 at 10:00AM
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I am very sorry for your cat. I certainly would go for 100 ml once a day and see how she takes it. You will know!
This said, I am surprised your vet went along with the rabies shot (especially if she is an indoor only cat that was regularly vaccinated). Giving a rabies shot to a kidney AND cancer patient is like throwing oil on a fire (and YES, I, too, got scared by that sad story posted earlier--as I stopped rabies shot for my older girl). A bad response to vaccines is more likely to happen than a bat entering your home--depending on your area, of course. Anyway, it is very likely that your little one is lethargic due to the shot and, just give her a little quiet time with lots of affection...
Sending you my very best,

    Bookmark   August 5, 2010 at 10:01AM
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Hoping this is just a temporary set back and your cat rebounds. Only time will tell.

Besides what Laurie said, you can give 50ml in one spot and the other 50 in a second spot at the same time. Prevents the camelback effect which may be painful.

I'd opt for comfort, having certainly done so in the past and will again in the future. What's the point of living if it is just in dread of treatment? It ruins your relationship with your kitty and denies her the dignity of a gentle passing.

I believe you are in tune with your cat well enough to know if she is enjoying life enough to bear the SQ treatment every day. Just be honest with yourself. Sending all my good thoughts to you and your kitty.

    Bookmark   August 5, 2010 at 10:43PM
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I want to thank all of you for your responses. Yeah, my little cat has a great big spirit.

I'm not putting her to sleep -- it's not her time.

I didn't think about repositioning the needle halfway through the treatment. I'll try that. It seems to be carrying around that load of fluid that makes her uncomfortable.

I live in NYC where it's been in the 90s and 100s most of the summer, so, I know the fluids are warm enough. Even when I turn the air on, periodically, it's not in the kitchen where the fluids hang. It's very warm in there.

It's not a bat that I'm worried about:) She's bitten me very badly twice in the past 3 weeks as I tried to shove meds down her mouth and she tried to close her mouth (not intending to bite, just trying to close her mouth to refuse the meds). Her jaws are like a pitbull. If, for any reason, an accident like this were to occur with anyone else, I wouldn't be able to quarantine her for 6 weeks (NY law). We'd both die.

She purrs, she jumps up on the bed, she eats well -- she's just very very quiet since we went to the vet.

I hope it's temporary.

Thanks again. I appreciate the info and good thoughts.

    Bookmark   August 6, 2010 at 12:00AM
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Oh, I forgot to say that I use the pink Terumo needles.

I know they're extremely sharp because I've accidently given myself fluids more than once:(

The process goes pretty quickly, so, I guess the pink might be 18 guage rather than 20.

    Bookmark   August 6, 2010 at 12:04AM
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The packaging will tell you what size Terumos you're using. If you're using 18's, I strongly recommend switching to 20's, and make sure you buy the UTW (ultra thin wall) type, because they will give you an 18 ga flow from a 20 ga needle.

As far as warming the fluids is concerned, unless the ambient air temp in your kitchen is consistently 101-102, the fluids are below your girl's body temp and probably chilling her during administration. That can make a cat extremely uncomfortable and may very well be responsible for your girl's discomfort. You may find things go MUCH more smoothly for her if you warm her fluids before admin.

I warm fluids by putting the bag and most of the line into a sink of hot water for a few minutes, being VERY careful NOT to submerge the connections between line and bag, and line and needle. I keep the bag in the water until the water has cooled enough so that it feels comfortably warm when I dip my wrist into it. I then run a little fluid from the bag over my wrist (like you'd do to test the temp of baby formula) to make sure the fluid in the bag is also comfortably warm.

DO NOT warm a fluid bag in a microwave, because the fluids can easily become too hot and the heat may be unevenly distributed in the bag.


    Bookmark   August 6, 2010 at 10:41AM
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Laurie has a point about ambient temp vs puss's body temp. Since you live in NYC and probably have a gas oven, try this: Put the fluid bag (tubing and all)on a long serving platter and then into an UNHEATED oven for 1/2 hour or so...that should warm it up to about 100F. If you have any doubts, make sure about the oven temp with a thermometer. I administered fluids to my late Max for over two years and this worked out fine (the fact that I don't do a lot of cooking and seldom turned on the oven made this method very conveninet). Also, as the bag emptys, it takes less time to achieve oven temp.

    Bookmark   August 6, 2010 at 4:03PM
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I admire all you are doing for your cat. I know the love you have is strong. I just hope if I ever have this problem occur with any of my cats, I am as good a kitty mom as you. Best of luck to you and kitty.

    Bookmark   August 6, 2010 at 4:56PM
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Thnak you.

    Bookmark   August 7, 2010 at 1:23PM
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spedigrees z4VT

I have given fluids over the years to 3 cats including my 18 yr old girl who is still with me. 100 or 110 ml has been the prescribed dose per day all at one time (although my kitties only required fluids once or twice weekly.) I think this is pretty much standard dose for a cat. Every cat is different but most seem to handle this amount of fluids without discomfort. Mine all just lay on my lap and purr(ed).

Are you sure that your cat feels discomfort from the fluids? The reason I wonder is that you say she is good about getting the fluid treatment. Most cats do not hesitate to show their objection to a treatment they dislike. One thing you could do to reduce discomfort is to request size 20 gage needles rather than the 18 gage that vets for some reason like to dispense. The 20 g is smaller and less painful to insert.

Relief from the discomfort of dehydration is very rapid after fluids are administered and it is my belief that pets can connect the dots and realize that the fluids make them feel better. Certainly the nausea, headache and loss of appetite and coordination evaporate very quickly after an intake of sub-q fluids. And I can attest from experience that dehydration is extremely uncomfortable.

If it were me I'd try the 100 ml. It is a standard dose and could be the 75 ml is not enough to help your cat at this point.

    Bookmark   August 8, 2010 at 6:34PM
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I'm so sorry your cat is going through this.

I cannot add to the medical advice from the extremely knowledgeable pet lovers here.

I've been through excruciating illnesses & excruciating treatments with pets in the past, as has my friend Janie.

One day when Janie had just lost one of her beloved old cats, we were commiserating on the "when" question, & Janie told me that she had made the decision to have Radar put to sleep when he began to dodge her because "he knew I was going to do something painful to him".

It sounded like a good milepost to me then, & it still does today.

I wish you & your beloved cat the best.

    Bookmark   August 9, 2010 at 2:34PM
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I think your kitty is very lucky to have such a concerned 'cat parent'. I went through that same scenario with my 18 year old kitty. I can tell you that you will know when it is time to make that decision.
Until then, every day together is a blessing and a gift of time you get to spend with your wonderful companion.

I do recommend warming the bag of fluid to the proper cat body temp. It makes a BIG, BIG difference in kitty's willingness to receive fluids. I would heat up a bowl of water to the right temp, test the bag temp with a thermometer and my cat would even purr once the warm fluid started.

Have you tried getting medications compounded for your cat? They can flavor the meds to tuna or chicken in either a liquid or a pet 'treat'. It can help both you and kitty to have another option.

Good luck with your kitty. It's a tough situation and sometimes friends and family are not as supportive as they should be.

    Bookmark   August 9, 2010 at 11:33PM
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