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  #391  
Old June 27th, 2010, 01:51 AM
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Quote:
Originally Posted by driver8 View Post
What an interesting thread - good to know this is a common enough problem to make a sticky thread.
Hi driver8 Welcome to the forum & the CRF cat club.

Quite the opposite actually, it's heartbreaking that it is common enough for a sticky thread.

Quote:
Originally Posted by driver8 View Post
My Lucy is about to turn 14. For the past two yearly check-ups, she has lost weight each time, and this time she had lost enough to start doing investigations. She throws up a fair bit, but she's always had hairball problems so we assumed that's what it was, but maybe it was the renal failure symptoms. Her liver function was normal, but her creatininine was elevated, thyroid normal, no diabetes. The vet said it was "mild to moderate" chronic renal failure.
Is it hairballs she's bringing up or clear-yellow foamy liquid or food?

Find something to put under her food & water dishes to raise them between 2-6 inches off the ground, but make sure the dishes won't slip off. I used a phone book under my grrls water fountain dish & a planter stand on a block of wood under her food dish. This will make it easier on her neck to reach into the dishes as well as keeping her head higher than her stomach in order to keep any excess stomach acid in her stomach, reducing nausea.

Quote:
Originally Posted by driver8 View Post
She's always been a petite cat, and she is tiny but not emaciated. She has lots of energy still. Runs around the house, rolls on the carpet to get attention from guests, etc. Because she's had dry food most of her life, we're trying the dry food first - Renal LP from Royal Canin. She seems to like it so far, and hasn't thrown up at all since we started introducing it. She drinks tons of water on her own, so I'm not worried about dehydration so far.
How much does she weigh? How much has she lost in the last 2 years?

The reason she's drinking "tons" is dehydration in combination with the lack of water in her food.

Cats bodies are designed to retain as much water as possible by recycling it throughout their bodies. Unlike other species, their normally functioning kidneys concentrate their urine by removing as much water as possible, that water is then cleaned & filtered back to where it's needed. The concentrated waste that is removed as urine has very liitle water content in comparison to the other waste products. When the kidneys become compromised they can't filter efficiently and so they loose far more water than their bodies are designed to loose in flushing out the toxins as urine. Therefore they need to drink more to compensate.

If they aren't getting much moisture in their food and are instead drinking it straight, it flows through the body at a much faster raite - there is less to process during absorption.

Quote:
Originally Posted by driver8 View Post
For me, it's a quality of life thing and as long as she is happy and energetic and not in discomfort, I'm happy. But it's sad to know there is a tangible sign that she is becoming and older, more frail cat.
This is a good indicator of her overall health as well, her state of mind & how she's feeling is often a reflection of her health.

Quote:
Originally Posted by sugarcatmom View Post
I sent Natura an email for clarification on this, because I know this food is frequently recommended for CRF kitties on other sites. I'll let you know what they say.
Hopefully it's just an error on their site

Quote:
Originally Posted by driver8 View Post
But I read the labels on the canned foods, and they all have less protein content than the dry foods, and I wonder if that was why my cats were so hungry when we tried to transition.
If you were to remove all the moisture from the canned food & the dry food you would see that the canned actually has a higher protein content.

They likely were hungry from not eating enough if they were so stressed about the change in food. Some cats can be so picky about what they'll eat so often the transition needs to take a longer time.

Quote:
Originally Posted by driver8 View Post
I didn't ask the numbers of her lab values, I don't want to get too focused on numbers. (Treat the patient, not the numbers) She still has lots of energy, etc, so I'm not too worried yet. I know that with CRI, diet is only a small part of it, and that the disease will still progress anyway. I'm pretty confident that she has a lot of living left to do.
Treating the cat not the numbers is essential, basing treatments on how the cat is physically doing, but you still need a frame of reference for the things that may not be so obvious or that take a little longer to show their effects. For example in the urinalysis some cats may have minute amounts of blood in their urine which you will not see as red (unless there is something seriously wrong) but may indicate other issues that have the same symptoms as CRF.

Among other things the lab values will also guide you when it comes time to start subq fluids, as it is better to start before the cat becomes dehydrated to the point of being very obvious & in need of IV fluids.

Yes she has lots of life left in her, keep up the positive outlook & it will transmit itself to her as well.
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Last edited by growler~GateKeeper; June 28th, 2010 at 01:41 AM.
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  #392  
Old June 29th, 2010, 10:35 AM
OtisIsMyCat OtisIsMyCat is offline
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I heard back from Halo re: their guaranteed analysis of phosphorus. At that time I didn't know to ask for the more thorough breakdown to see what the dry matter would be.

Here is what they wrote:

Hi Andrea,

Thanks for visiting our website and caring for the ones we love naturally! If you have not already signed up to receive our Newsletter, please feel free to do so at Halopets.com, to receive the most current coupons and promotions we are offering.

The Phosphorous content for each of the varieties you've requested is below.

Chicken - 0.14%
Turkey - 0.18%
Lamb - 0.18%
Salmon - 0.20%

Please feel free to e-mail or call us at 800-426-4256 anytime with questions or to search for a store in your area. Wishing you and your pets GREAT health!

Halo, Purely for Pets
800.426.4256


Seems like Chicken, Turkey, and Lamb are all even lower than the Felidae I found (which I haven't opened yet). Seems okay to me, no? I tried doing the calculation you've included, Growler, but it's too confusing for me.


Quote:
Not necessarily. If they are allowed free roam outside & not just out supervised on a harness they could've been anywhere in your neighbourhood or the next. One may have wandered away from the other.

Lilies are especially nephrotoxic but popular & pretty lots of people putting in gardens. Someone working on their car spills antifreeze - it is very sweet tasting which is attractive to cats. Most people think antifreeze poisoning will only occur in winter but some people do change out antifreeze when they do regular maintance or have a leak. I have heard of some free standing basketball hoops recommending to fill the base with antifreeze so it won't freeze & also for ballist
Marsh and Otis do not roam outside. They've never been "outdoor" cats free to explore past the boundaries of my sight, or out of my immediate sight when we're out in my landlady's garden. When they're out there, I'm out there and most of the time they sit right beside me under the sun and hang. They've been indoor cats all their lives and don't seem to have the urge to escape and do the outdoor cat thing. For the most part they're pretty chill and in fact will go back inside my place before I do. ha. There are also no lilies in my landlady's garden, and I double checked with her last week. Also, I've been living here for three years, same plants bloom every summer...

That's why I'm so confused over the idea of it being toxicity from anything outside my place. There is not much out there that they seem to be interested in and if there is something, they'll munch down in unison and it's usually little sprouts of grass that have come through the cracks in the path coming from the gate. So if it was something Marshall ingested from the garden, Otis would have too and thus Otis should have also become sick. But he's perfectly fine.

If it was ARF then the only thing it could possibly be is the Nair I mentioned from my last post. But I don't want to think about it because it upsets me and I can't go back now. *big sigh*

We've got the follow-up appt tomorrow evening so I will ask for the analysis from the blood tests including urine weight and post them here.

This is our first follow up since the catastrophe and I am crossing my fingers that he is okay. After that, I can concentrate on getting this food issue organized.

As a side note, T/D contains "pork by-products" - I always thought pork was bad for cats?

Thanks again for all the info. I am SO HAPPY I found this forum.

Last edited by OtisIsMyCat; June 29th, 2010 at 07:19 PM.
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  #393  
Old June 30th, 2010, 07:17 AM
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Quote:
Originally Posted by OtisIsMyCat View Post
The Phosphorous content for each of the varieties you've requested is below.

Chicken - 0.14%
Turkey - 0.18%
Lamb - 0.18%
Salmon - 0.20%


Seems like Chicken, Turkey, and Lamb are all even lower than the Felidae I found (which I haven't opened yet). Seems okay to me, no? I tried doing the calculation you've included, Growler, but it's too confusing for me.
Ideally it is always better to use the actual value for water since it is essential to the formula but the actuals for water are generally not too far off the max. Any other ingredient you are using in the formula must be exact, no using mins & maxs - it will throw the calculation way off.

Wholesome Turkey has max 85% moisture as listed on their site


100-moisture = dry matter; phos/dry matter * 100 = dry matter phosphorus

Break it down in to smaller sections:

100 (represents total of protein, fat, carbohydrate {not listed}, fiber, ash, and water) - moisture (water) = dry matter (what's left of everything without water)

100-85 (moisture) = 15 (dry matter)


phos (or whichever ingredient you want to check) / dry matter (calculation from above)

0.18 (phos listed above) / 15 (dry matter calculation from above) = 0.012


* 100 (* by 100 in order to get the percentage value) = dry matter phosphorus (the amount of phosphorus without water)

0.012 * 100 = 1.2 dry matter phosphorus percent in this brand flavour of food


100-85 moisture = 15 dry matter; 0.18 phos/15 dry matter * 100 = 1.2% dry matter phosphorus

Halo WholsomeTurkey 1.2% dry matter phos is good less than what I consider should be the max 1.25%


Halo Wholsome Chicken is too high 1.4% phos

100-90 moisture = 10 dry matter; 0.14 phos/10 dry matter * 100 = 1.4% dry matter phosphorus


Halo Wholsome Lamb has good phos 1%

100-82 moisture = 18 dry matter; 0.18 phos/18 dry matter * 100 = 1% dry matter phosphorus


Halo Succulent Salmon is too high 1.66% phos

100-88 moisture = 12 dry matter; 0.2 phos/12 dry matter * 100 = 1.66% dry matter phosphorus


Of the 4 Halo cans only the Turkey & Lamb are low enough.


The Felidae chicken & rice you mentioned earlier is right in the middle of the two Halo cans @ 1/16% dm phos

From their site: Moisture actual 77.5; phos actual 0.26%

100-77.5 moisture = 22.5 dry matter; 0.26 phos/22.5 dry matter * 100 = 1.16% dry matter phosphorus



Quote:
Originally Posted by OtisIsMyCat View Post
This is our first follow up since the catastrophe and I am crossing my fingers that he is okay. After that, I can concentrate on getting this food issue organized.

As a side note, T/D contains "pork by-products" - I always thought pork was bad for cats?
for the appt

Pork is very high in fat which can lead to other issues including pancreatitis, I've read some that say pork is highly digestable but then when I asked at the raw food store here they said no it's not.
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Last edited by growler~GateKeeper; July 1st, 2010 at 01:30 AM. Reason: spelling
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  #394  
Old June 30th, 2010, 03:13 PM
OtisIsMyCat OtisIsMyCat is offline
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Oh my... is it possible that I've actually found a healthy and safe alternative to K/D that both my cats can enjoy??

I'm so happy!!

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  #395  
Old August 18th, 2010, 04:11 AM
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Thanks for all the information

Hi,
My 16 year old cat, Blur, was diagnosed this week with stage 2 kidney disease. I took him to the vet cause he was getting a bit thin.

I have found the information on this site to be a tremendous help and such great information.

Blur was also diagnosed with pancreatitis. The vet is focused on hydrating him and getting him to gain some weight back before doing anything else. She gave me pain pills for him for the pancreatitis, but I managed to get him to take 1 out of 4 over 2 days, so tomorrow I try a liquid! It is so hard to tell if he is even in any pain.

The vet suggested Sub-Q, 100ml daily for now. I said I would do it at home. He had one round at the vets office and one very successful one at home, but the last two days he has been like a leaky pincushion. I thought I had it figured out after talking to the vet today, but tonight same thing - ugh. I am going to take him to the vets tomorrow to go over it again.

Now to the food part -
I switched both my cats (I also have Spot who is 17) to Natural Balance dry and Merricks canned about a year ago, although Blur doesn't eat much dry food. I did this as a result of spending 4 1/2 years of trying to manage my Black Lab's seizures. After no help from the vet and bad reactions to prescriptions, I finally did the right research and realized I needed to change Naslund's food, and my cats too! On advise from the Natural pet store, I chose Natural Balance Limited Ingredient Diet food and his seizures went from every 4-6 weeks, to twice in the last year - both after he accidentally got into some food he shouldn't have!! End result - food allergies. Now he is almost weened off the harmful prescriptions that were actually causing liver damage and pacreatitis (that is a whole other story I am sure I should post elsewhere on this site).

Blur is a finicky eater at the best of times. Has never liked treats and as he has gotten older has been demanding canned more and eating less dry - maybe he is smarter than I thought!

The vet gave me some Royal Canin Recovery food to try to get Blur's weight up before the lab results came back, which he loved. Once the result came in she said a renal food like k/d would be better, but getting his weight up is important right now and he could stay on Recovery a little longer, so I have given a few cans of that. He has gained a bit of weight back (130 grams in the first 4 days).

I am not willing to put him on a steady vet food diet, so I dug through the cupboard for the Merricks (lower phos types), but he has been turning his nose up at it a bit, so today also bought some Wellness turkey, which he ate. I was thinking about RAW, but I don't want to change too much too fast, so I will go with this for now.

I will also lift his dishes up off the floor.

The vet suggested trying to feed him some Pepcid for nausea, but I think the pain pills are more important so I haven't even tried that. Has anyone else offered Pepcid to their cats for stomach upset and had good result?

Spot really likes her dry food, and currently has no health concerns, so I am hesitant to take it away from her and since Blur mostly isn't interest that is probably ok, but since he will eat it occasionally I would like to feed a lower phos dry food. Any suggestions? Yes I know I should try to get them off dry altogether, but for now it is baby steps
Thanks
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  #396  
Old August 18th, 2010, 06:52 AM
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So sorry to hear about your kitty.

Growler will be able to assist you when she logs on again, she is so very knowledgeable.

Just out of curiosity, what pain pills did the vet prescribe?
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  #397  
Old August 18th, 2010, 03:32 PM
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Thanks.

The pain pills are Tramadol HCL 25mg. The vet said to give him 1/4 - 1/2 a pill every 12 hours.

Since he won't take those she has given me a liquid to squirt into his mouth that is absorbed through the skin - Buprenorphine 1mg/ml. He is to get 0.05ml every 12 hours. Because she said to watch him afterward to make sure he isn't wobbly I haven't given it yet. I didn't want him to have it unless I was going to be home/awake for a few hours to keep an eye on him.

She said if he gets a bit wobbly, to give a bit lower dose the next time, like 0.04ml. For such a minute dosage, I may err on the side of caution and go with 0.04ml the first try.

I went to a different pet store today and found Wellness Healthy Indulgence turkey and duck and some chicken pure bites. So far he doesn't like the pure bites. But worth a try.
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  #398  
Old August 18th, 2010, 11:44 PM
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Hi Blur's Mom Welcome to the site & the CRF Cat Club

Quote:
Originally Posted by Blur's_Mom View Post
The vet suggested Sub-Q, 100ml daily for now. I said I would do it at home. He had one round at the vets office and one very successful one at home, but the last two days he has been like a leaky pincushion. I thought I had it figured out after talking to the vet today, but tonight same thing - ugh. I am going to take him to the vets tomorrow to go over it again.
When you are about to remove the needle, place your thumb over that poke hole, remove the needle & lift the skin up slightly away from the pocket of fluids you've just given. Hold for about a minute or three, this will allow the skin to start to heal & will draw a bit of air between the skin & the fluids, it helps slow the leakage.

You can also try massaging the fluids away from the needle entrance point while you are giving fluids, gravity will naturally bring it down under the chest & down the legs this just helps it along while at the same time prevents leaking.

Quote:
Originally Posted by Blur's_Mom View Post
I am not willing to put him on a steady vet food diet, so I dug through the cupboard for the Merricks (lower phos types), but he has been turning his nose up at it a bit, so today also bought some Wellness turkey, which he ate. I was thinking about RAW, but I don't want to change too much too fast, so I will go with this for now.
Some canned suggestions low in phos:

Wellness Turkey great dry matter phos number 1.05
Wellness Kitten good dry matter phos numbers 1.15
Wellness Beef & Salmon great dry matter phos numbers 1.06
Wellness Chicken good dry matter phos numbers 1.15
Wellness Chicken & Beef good dry matter phos numbers 1.17
Evo 95% Chicken & Turkey has great dry matter phos 0.88
Halo Wholsome Lamb has great dry matter phos 1.00
Halo Wholsome Turkey dry matter phos is good 1.2
Felidae Chicken & Rice dry matter phos is good at 1.16
Eagle Pack Holistic Select Turkey & Barley canned has good dry matter phos 1.05
Eagle Pack Holistic Select Chicken & Lamb has good dry matter phos 1.15

Quote:
Originally Posted by Blur's_Mom View Post
I will also lift his dishes up off the floor.

The vet suggested trying to feed him some Pepcid for nausea, but I think the pain pills are more important so I haven't even tried that. Has anyone else offered Pepcid to their cats for stomach upset and had good result?
I've never had to use pepcid, I found that just raising the dishes up between 4-6 inches and a late snack/small meal right before bed, kept any nausea issues away. My girl was given Zantac during a weekend stay in the ER with good results, though I think it also might have dropped her appetite down as well.

Quote:
Originally Posted by Blur's_Mom View Post
Spot really likes her dry food, and currently has no health concerns, so I am hesitant to take it away from her and since Blur mostly isn't interest that is probably ok, but since he will eat it occasionally I would like to feed a lower phos dry food. Any suggestions? Yes I know I should try to get them off dry altogether, but for now it is baby steps
Thanks
Yes definately both cats off the dry asap, but to tide you over until then here are some low phos dry foods:

Wellness Healthy Weight has great dry matter phos numbers 0.79
Wellness Indoor has great dry matter phos numbers 0.85
Wellness Complete Health Adult Salmon, Salmon Meal & Deboned Turkey has good dry matter phos numbers 1.01
Wellness Complete Health Adult Deboned Chicken, Chicken Meal & Rice has good dry matter phos numbers 1.12
Eagle Pack Holistic Select Dry Duck has good dry matter phos numbers 1.13
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  #399  
Old August 19th, 2010, 01:25 AM
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Growler
Thanks for all the info.

Blur's Sub-Q went very smoothly today. So I am feeling much better about it again. I decided I knew I could do it and gave it a try without going back to the vets. Tomorrow's challenge will be doing it on my own.

Thanks for the information on dry food phos. I just went to do a search of the Natural Balance dry Spot currently eats and I see that the dry and cat food tables listing Phos (and other things) are all updated for the US & UK, just since earlier today - including the date of the information.

Here is the link: http://www.felinecrf.org/canned_food_usa.htm

In the US table it says the Merrick foods I had been using are as follows:
Merrick Cowboy Cookout 0.84
Merrick Thanksgiving Day Dinner 0.86
Merrick California Roll 0.88
Merrick Before Grain 96% Turkey 0.95
Merrick Surf N Turf 0.95
Merrick Turducken 0.97
Merrick Grammy's Pot Pie 0.97

These numbers seem really good, but Wellness, EVO, Eagle Pack and other foods, seem to be recommended more often. Is there some reason why Merrick may not be as good a choice?

I have Blur's food raised up, and my husband is going to build a special platform for his dishes.

Thanks again

Last edited by Blur's_Mom; August 19th, 2010 at 01:32 AM.
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  #400  
Old August 19th, 2010, 01:40 AM
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The fluids get easier as you go along, becoming more comfortable with them will boost your confidence.

Those are all great numbers for Merrick

The Wellness canned & Evo are also grain free so that is a big part of the recommendation there, cats being carnivores have little - no need for grains in their diets.

My girl never liked any of the Merrick flavours, possibly too much extra veggies & stuff for her tastes So I couldn't give a "personal" go ahead without the actual numbers.

Most of the recommendations you will see are ones that have worked for others or because the nutrient analysis is known for the foods. The list has just recently been updated where the previous one I believe was 3 years ago, so one can't recommend with outdated numbers, unless one has contacted the company directly.

Good for your dh making a feeding station
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  #401  
Old August 20th, 2010, 12:31 PM
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Can someone tell me why it is better to stay away from seafood catfood for CRF cats? I know I have read that you should, but I can't find the thread that say why.

Blur just love the Wellness Healthy Indulgence Turkey and Duck, in fact now he turns his nose up at the Wellness Turkey. The only other varieties of Healthy Indulgence that have lower phos all have seafood in them.

Last night when I did his Sub-Q on my own, I warmed the liquid first, until yesterday it has been very hot and I hadn't tried this yet. Blur sat completely still, I didn't even need to hold him and he purred the whole time once the needle was in, then wouldn't move once the needle was out. I guess he has now realized it makes him feel better.

Thanks again for all the help
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  #402  
Old August 20th, 2010, 12:49 PM
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When my old cat was in the final stages of kidney failure, she would only lick at the juices of her wet food. She ate very little. I kept her on sub Q right up until the end. Her end came peacefully in my arms.

take care
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  #403  
Old September 2nd, 2010, 04:23 AM
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Quote:
Originally Posted by Blur's_Mom View Post
Can someone tell me why it is better to stay away from seafood catfood for CRF cats? I know I have read that you should, but I can't find the thread that say why.

Blur just love the Wellness Healthy Indulgence Turkey and Duck, in fact now he turns his nose up at the Wellness Turkey. The only other varieties of Healthy Indulgence that have lower phos all have seafood in them.
The main issue with seafood based catfood is often times a CRF cat will refuse to eat/become picky, and if they do & are given seafood alot of times they then won't eat anything else . Non-crf cats are the same.

Some info here on some reasons to avoid fish foods as a regular diet for all cats: http://www.felinecrf.org/which_foods.htm#fish

I, personally, would be okay with feeding a seafood based food once every 2 weeks or so as a treat just so he doesn't get too used to having it. I'd also be okay with seafood as a 3rd protein source for a CRF cat, for non-crf cat as a 2nd protein source is good but I'd prefer not to have it as the main protein in any food. Just my

Quote:
Originally Posted by Blur's_Mom View Post
Last night when I did his Sub-Q on my own, I warmed the liquid first, until yesterday it has been very hot and I hadn't tried this yet. Blur sat completely still, I didn't even need to hold him and he purred the whole time once the needle was in, then wouldn't move once the needle was out. I guess he has now realized it makes him feel better.
Warming the fluids always helps as it's quite an unpleasant shock to have cold water appear under the skin Animals w/CRF definately do come to quickly realize that the additional fluids makes them feel a whole lot better & will tolerate the process very well.
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  #404  
Old September 3rd, 2010, 11:49 PM
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Hi everyone, I thought I'd post here since this seems to be a general "CRF cat" thread, I hope that's ok. My cat Smokey was diagnosed with CRF back in mid-July. He's doing fairly well right now with the treatment, but I want to make sure I do everything possible for him and so I wanted to see what other people's experiences are like, etc. I'm just starting to educate myself about these issues, but I will try to contribute and be helpful as much as I can.

Basically back in July Smokey "crashed". Over the course of a week or so he gradually lost his appetite until he refused to eat at all and spent all the time hiding under the bed, not relaxing like he sometimes does, but refusing to come out at all. He was taken to the vet and diagnosed with CRF after urine tests, bloodwork, ultrasound, etc.

On July 17th his BUN was 40.5 and his Creatinine was 783, with slightly elevated phosphorus. He was put on IV fluids for a few days, and then started a regime of:

-150 ml of subQ fluids every other day,
-Fortekor once a day
-antacid once a day
-Azodyl twice a day
-Rubenal and Renal Essentials twice a day each (these are vitamin/supplements)

He was also given renal prescription dry food and wet food. He quite liked the dry food but wouldn't touch the wet food, so we resorted to Fancy Feast, which I know isn't very good but the main thing was getting him to eat that point, and that was all that he was interested in.

On July 22, he was tested again, and this time his results showed a BUN of 13.5, Creatinine of 200, and normal Phosphorus levels (1.54, normal range 1.10-2.74 according to this lab). Still not quite right, but a significant improvement.

After this, the vet changed his regimen to 150 ml SubQ's twice a week, with everything else the same, except that we stopped the antacid. Giving him the pills every day was ridiculously difficult at first but we are much, much better at it now, although he still tries to outsmart us from time to time. We have been doing the SubQ at the vet but are psyching ourselves up to do it at home, and after having gotten a couple of "lessons", will be doing the procedure next week at the vet myself before trying to do it all at home.

He was tested again on August 13th. His BUN was 12.9, Creatinine 204, and Phosphorus 1.44. Our vet was quite pleased with the results, saying that he seemed to be stable, and that we should continue giving the SubQ's twice a week and the pills, with the exception that we could try reducing the Azodyl to once a day. Her reasoning is that we should try to find the most conservative therapy that can keep him stable, which makes sense to me.

About 3 weeks have passed since then, and I am trying to evaluate his current state and make sure I am doing everything I can. There are a few things I'm wondering about.

1) Being quite pleased with his Aug 13 results, the vet thinks we should do the next testing in 4 months. Now, I've read up on this a bit, and it seems to be a roughly standard amount of time, but I confess to being a bit paranoid about waiting that long to monitor how he's doing. On the other hand, I have read that testing too often could be counterproductive and obviously stressful for the cat. I don't want to give the impression that I don't trust my vet either, since as far as I can tell, she has saved my cat's life. But I also don't want to be passive or complacent. Does waiting that long seem like a reasonable idea, and I should just relax?

2) I am wondering if you guys had any ideas about what it means that his numbers were so high, and then suddenly went down so low again, to where they are *almost* brushing up against normal. One reason I wonder about this is that I've heard that cats with low values shouldn't be put on SubQ's prematurely, but then, it's a bit different for him since he *started out* with much higher results.

3) The dosage for Azodyl is 1 pill for cats 5 pounds and less, and two for cats that are over 5. My cat is just over 5 at the moment, as he is regaining weight he lost when he wasn't eating. His normal weight is around 5.5 or so. So would it be a good idea to give him one Azodyl a day instead of 2, as the vet recommended? As far as I can tell, there's no pressing reason to reduce the dose of a probiotic, as opposed to a "drug" that can have side effects. However, it would certainly be easier to pill him only once a day (and he'd be happier as well I expect).

4) Since I've been lurking this forum for a while, I'm much more educated about cat food than I was before. Unfortunately the result is that I'm kind of appalled by the pseudoscientific and dishonest practices of the pet food industry and the collusion of many vets with these practices. It's really disappointing. Silly me to trust a prescription product sold by medical doctors! That being said, I'm considering moving Smokey off dry food completely, and off the prescription food as well, wet or dry. Does this seem like a good idea, and do you have any advice for making the transition? For example, would it be a good idea to mix some new, better wet food in with his Fancy Feast at first in order to get him to try it, and then gradually change the ratios? Or will this upset his stomach?

5) Finally, is there anything I should watch out for that I haven't mentioned? If we keep going with this regimen, and don't get him tested again for a few months, are there any signs or warnings I should be looking for, beyond the obvious? I realize I sound like a paranoid lunatic, but I want to do right by Smokey because he's a good cat and an excellent companion, and cats can be so frustratingly stealthy about their health. Again I apologize for asking so many questions, any advice, big or small, you could give at all would be greatly appreciated. I'll try my best to return the favour.
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  #405  
Old September 5th, 2010, 01:16 AM
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growler~GateKeeper growler~GateKeeper is offline
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Hi everyone, I thought I'd post here since this seems to be a general "CRF cat" thread, I hope that's ok.
Hi nemesis welcome to the forum & the CRF cat club . It is absolutely ok that you post here, this was my hope when I started this thread - that we could all gather our experiences & ideas in one place to help ourselves & others.

Quote:
Originally Posted by nemesis View Post
He was also given renal prescription dry food and wet food. He quite liked the dry food but wouldn't touch the wet food, so we resorted to Fancy Feast, which I know isn't very good but the main thing was getting him to eat that point, and that was all that he was interested in.
At this point the more important thing is getting him to eat, not really what he's eating, especially considering his previous refusal to eat. Fancy Feast does have a number of varieties that have good phos numbers, the most recently updated food table listing by dry matter phos shows quite a few flavours under 1.20% dry matter phos . You want to stay below 1.25% max and try to stay away from fish varieties as much as possible.

Quote:
Originally Posted by nemesis View Post
On July 22, he was tested again, and this time his results showed a BUN of 13.5, Creatinine of 200, and normal Phosphorus levels (1.54, normal range 1.10-2.74 according to this lab). Still not quite right, but a significant improvement.
When posting blood/urine values please put the reference range for the lab that did the tests (like you did for the phos ) depending on the equipment the numbers can vary quite a bit.

That is a very good drop from the previous numbers

Quote:
Originally Posted by nemesis View Post
After this, the vet changed his regimen to 150 ml SubQ's twice a week, with everything else the same, except that we stopped the antacid. Giving him the pills every day was ridiculously difficult at first but we are much, much better at it now, although he still tries to outsmart us from time to time. We have been doing the SubQ at the vet but are psyching ourselves up to do it at home, and after having gotten a couple of "lessons", will be doing the procedure next week at the vet myself before trying to do it all at home.
Cats realize pretty quickly when something is making them feel better & will adapt relatively easily to the changes. My crf girl Duffy went from being a pill spitter to a cat who would willingly sit & wait for her twice daily supplement regiment.

Giving fluids for the 1st time yourself at home can be a scary thing, but if you go into it with confidence you'll do fine. It definately gets easier with practise to the point it just becomes routine.

Here's a step by step instruction guide you can refer to: http://www.weirdstuffwemake.com/weir.../catjuice.html

I would recommend getting a price comparison of the fluids, lines & needles from the vet, a human pharmacy and/or a medical supply company if there is one in your area. I found a local medical supply company to be the cheapest, fastest & easiest to get supplies from.

Most vets will use a Monoject 18g needle for giving fluids to cats, ask your vet for a Monoject 20g instead, the needles are smaller & therefore the "poke" not so noticable. The fluids will run slightly slower through a smaller gauge needle, but in & out it's more comfortable for the cat. If your vet carries Teurmo Ultra Thin Wall needles that's even better , get those in a 20g. The Teurmo 20g UTW needles are super sharp, have a bevelled edged & the shaft is much thinner so the poke is hardly noticable at all - even compared to a Monoject 22g (even smaller needle). Given the thinner walls the fluid flow rate is about the same as a Monoject 18g.

Quote:
Originally Posted by nemesis View Post
1) Being quite pleased with his Aug 13 results, the vet thinks we should do the next testing in 4 months. Now, I've read up on this a bit, and it seems to be a roughly standard amount of time, but I confess to being a bit paranoid about waiting that long to monitor how he's doing. On the other hand, I have read that testing too often could be counterproductive and obviously stressful for the cat. I don't want to give the impression that I don't trust my vet either, since as far as I can tell, she has saved my cat's life. But I also don't want to be passive or complacent. Does waiting that long seem like a reasonable idea, and I should just relax?
Every 3 months is standard time between appointments, unless you notice something "off" ~ eating less, lethargic, change in behaviour/litter box habits or Smokey looks like he's slipping towards a crash.

You should always keep in mind that you can call the vet at any time to ask a question or give an update, if they think something is not right they'll have you bring Smokey in.

One thing I found very helpful is a cat journal - each day write down how Smokey is feeling (content/grouchy/playful), what his attitude is like (social/unusual hiding), how much he ate (more/less/same/doesn't like this flavour or that brand), litter box habits (more/less/same), what he did that day (slept all day/watched the birds/played w/toys/terrorized the dog). This will make it easy to spot any subtle changes before they become an issue.

A journal will also give a good reference point in relation to when he gets fluids - ie: the day before his fluids he feels really grouchy etc as compared to the rest of the week. A couple of months down the road maybe you notice the amount of time he feels better after fluids is getting shorter, so you can talk to your vet about changing the schedule or volume of fluids.

Quote:
Originally Posted by nemesis View Post
2) I am wondering if you guys had any ideas about what it means that his numbers were so high, and then suddenly went down so low again, to where they are *almost* brushing up against normal. One reason I wonder about this is that I've heard that cats with low values shouldn't be put on SubQ's prematurely, but then, it's a bit different for him since he *started out* with much higher results.
Most of that drop is due to the IV fluids, fluids directly in the bloodstream flush out far more of the toxins that cause the rise in values. However it also flushes out many essential minerals, nutrients etc that the body needs, which is why IV fluids is not done for an extended period of time.

Since Smokey was brought in with high numbers, it is best to keep him on Subq fluids for now until there is a stable value shown over the course of a couple of tests. Your vet has already adjusted the schedule to less frequent treatment to compensate for the better numbers.

Quote:
Originally Posted by nemesis View Post
3) The dosage for Azodyl is 1 pill for cats 5 pounds and less, and two for cats that are over 5. My cat is just over 5 at the moment, as he is regaining weight he lost when he wasn't eating. His normal weight is around 5.5 or so. So would it be a good idea to give him one Azodyl a day instead of 2, as the vet recommended? As far as I can tell, there's no pressing reason to reduce the dose of a probiotic, as opposed to a "drug" that can have side effects. However, it would certainly be easier to pill him only once a day (and he'd be happier as well I expect).
Personally I would keep him on 2/day. According to the IRIS Staging Guide Smokey is in Stage 2 of kidney disease, Azodyl is ideally suited for stages 2-4. The Azodyl will not have a negative effect, but instead continue to help reduce the toxin levels making him feel better which in turn may increase his appetite.

Quote:
Originally Posted by nemesis View Post
4).....I'm considering moving Smokey off dry food completely, and off the prescription food as well, wet or dry. Does this seem like a good idea, and do you have any advice for making the transition? For example, would it be a good idea to mix some new, better wet food in with his Fancy Feast at first in order to get him to try it, and then gradually change the ratios? Or will this upset his stomach?
If Smokey is still at a fragile/unstable point weight wise I would keep him on both right now, until he gains more ground in that respect. At 5lbs that's just tiny w/no room to lose, once he gets a bit more weight on him you can try some of the tips here: Transitioning Dry Food Addicts to Canned Food

As for the canned food, that depends on Smokey, some cats will jump right in & try something different whereas others need it mixed so the change is less noticable. Slowly adding a tiny bit of new canned to the FF is a good way to "trick" him into eating a better food without turning him off right away. Some cats take better to change than others but slowly changing shouldn't be anymore upsetting to his stomach than if you did a straight switch, unless he's intolerant to a specific ingredient.

Quote:
Originally Posted by nemesis View Post
5) Finally, is there anything I should watch out for that I haven't mentioned? If we keep going with this regimen, and don't get him tested again for a few months, are there any signs or warnings I should be looking for, beyond the obvious? I realize I sound like a paranoid lunatic, but I want to do right by Smokey because he's a good cat and an excellent companion, and cats can be so frustratingly stealthy about their health.
Things to watch for: any changes in drinking/eating/litter box habits/mood/time spent sleeping, any new symptom you hadn't seen before like lip licking, vomiting, unusually bad breath, drooling.

Are you familiar with the skin pinch test for dehydration? Have your vet show you what to look for - grasp the skin between the shoulder blades between your thumb & first finger, gently pull it up so it's taut & let go. If it "tents" or takes longer than 2-3 seconds to go back to normal, your cat is showing clear signs of dehydration - if it tents & stays up go to the vet asap.

You can also, if he'll allow, rub your finger along Smokey's gumline - if it's wet & slick he's fine, but if it's dry, sticky/tacky - he's showing clear signs of dehydration & you should contact a vet asap.

I've found this site http://www.felinecrf.org/index.htm to be a invaluable resource written by a woman whose been throught it all before.

Paranoid lunatic? no Good pet parent? yes
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  #406  
Old September 9th, 2010, 03:02 PM
nemesis nemesis is offline
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Quote:
Originally Posted by growler View Post
Hi nemesis welcome to the forum & the CRF cat club . It is absolutely ok that you post here, this was my hope when I started this thread - that we could all gather our experiences & ideas in one place to help ourselves & others.



At this point the more important thing is getting him to eat, not really what he's eating, especially considering his previous refusal to eat. Fancy Feast does have a number of varieties that have good phos numbers, the most recently updated food table listing by dry matter phos shows quite a few flavours under 1.20% dry matter phos . You want to stay below 1.25% max and try to stay away from fish varieties as much as possible.



When posting blood/urine values please put the reference range for the lab that did the tests (like you did for the phos ) depending on the equipment the numbers can vary quite a bit.

That is a very good drop from the previous numbers



Cats realize pretty quickly when something is making them feel better & will adapt relatively easily to the changes. My crf girl Duffy went from being a pill spitter to a cat who would willingly sit & wait for her twice daily supplement regiment.

Giving fluids for the 1st time yourself at home can be a scary thing, but if you go into it with confidence you'll do fine. It definately gets easier with practise to the point it just becomes routine.

Here's a step by step instruction guide you can refer to: http://www.weirdstuffwemake.com/weir.../catjuice.html

I would recommend getting a price comparison of the fluids, lines & needles from the vet, a human pharmacy and/or a medical supply company if there is one in your area. I found a local medical supply company to be the cheapest, fastest & easiest to get supplies from.

Most vets will use a Monoject 18g needle for giving fluids to cats, ask your vet for a Monoject 20g instead, the needles are smaller & therefore the "poke" not so noticable. The fluids will run slightly slower through a smaller gauge needle, but in & out it's more comfortable for the cat. If your vet carries Teurmo Ultra Thin Wall needles that's even better , get those in a 20g. The Teurmo 20g UTW needles are super sharp, have a bevelled edged & the shaft is much thinner so the poke is hardly noticable at all - even compared to a Monoject 22g (even smaller needle). Given the thinner walls the fluid flow rate is about the same as a Monoject 18g.



Every 3 months is standard time between appointments, unless you notice something "off" ~ eating less, lethargic, change in behaviour/litter box habits or Smokey looks like he's slipping towards a crash.

You should always keep in mind that you can call the vet at any time to ask a question or give an update, if they think something is not right they'll have you bring Smokey in.

One thing I found very helpful is a cat journal - each day write down how Smokey is feeling (content/grouchy/playful), what his attitude is like (social/unusual hiding), how much he ate (more/less/same/doesn't like this flavour or that brand), litter box habits (more/less/same), what he did that day (slept all day/watched the birds/played w/toys/terrorized the dog). This will make it easy to spot any subtle changes before they become an issue.

A journal will also give a good reference point in relation to when he gets fluids - ie: the day before his fluids he feels really grouchy etc as compared to the rest of the week. A couple of months down the road maybe you notice the amount of time he feels better after fluids is getting shorter, so you can talk to your vet about changing the schedule or volume of fluids.



Most of that drop is due to the IV fluids, fluids directly in the bloodstream flush out far more of the toxins that cause the rise in values. However it also flushes out many essential minerals, nutrients etc that the body needs, which is why IV fluids is not done for an extended period of time.

Since Smokey was brought in with high numbers, it is best to keep him on Subq fluids for now until there is a stable value shown over the course of a couple of tests. Your vet has already adjusted the schedule to less frequent treatment to compensate for the better numbers.



Personally I would keep him on 2/day. According to the IRIS Staging Guide Smokey is in Stage 2 of kidney disease, Azodyl is ideally suited for stages 2-4. The Azodyl will not have a negative effect, but instead continue to help reduce the toxin levels making him feel better which in turn may increase his appetite.



If Smokey is still at a fragile/unstable point weight wise I would keep him on both right now, until he gains more ground in that respect. At 5lbs that's just tiny w/no room to lose, once he gets a bit more weight on him you can try some of the tips here: Transitioning Dry Food Addicts to Canned Food

As for the canned food, that depends on Smokey, some cats will jump right in & try something different whereas others need it mixed so the change is less noticable. Slowly adding a tiny bit of new canned to the FF is a good way to "trick" him into eating a better food without turning him off right away. Some cats take better to change than others but slowly changing shouldn't be anymore upsetting to his stomach than if you did a straight switch, unless he's intolerant to a specific ingredient.



Things to watch for: any changes in drinking/eating/litter box habits/mood/time spent sleeping, any new symptom you hadn't seen before like lip licking, vomiting, unusually bad breath, drooling.

Are you familiar with the skin pinch test for dehydration? Have your vet show you what to look for - grasp the skin between the shoulder blades between your thumb & first finger, gently pull it up so it's taut & let go. If it "tents" or takes longer than 2-3 seconds to go back to normal, your cat is showing clear signs of dehydration - if it tents & stays up go to the vet asap.

You can also, if he'll allow, rub your finger along Smokey's gumline - if it's wet & slick he's fine, but if it's dry, sticky/tacky - he's showing clear signs of dehydration & you should contact a vet asap.

I've found this site http://www.felinecrf.org/index.htm to be a invaluable resource written by a woman whose been throught it all before.

Paranoid lunatic? no Good pet parent? yes
Thank you so much! All that is extremely helpful. One thing I should point out is that I made a very silly mistake. His weight is 11 pounds, or 5 Kilograms, NOT 5 pounds.

Things are still going well, so cross your fingers. I have another question, this time about pilling. He doesn't squirm too much, he doesn't try as hard to spit the pill out, but he vomits right afterward! Could he be doing it on purpose (is that even possible), or is something about the pills making him throw up? I can't imagine what it would be because he didn't used to throw up after getting his pills. And I'm quite sure it's connected to the pills and nothing else, because he rarely throws up otherwise, and in the last few days without fail a couple of hours after he gets his pill I find some vomit with the half-digested treats in it that he gets after his pills. Any ideas?
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  #407  
Old September 9th, 2010, 05:20 PM
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sugarcatmom sugarcatmom is offline
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I have another question, this time about pilling. He doesn't squirm too much, he doesn't try as hard to spit the pill out, but he vomits right afterward! Could he be doing it on purpose (is that even possible), or is something about the pills making him throw up?
After you administer the pills, do you chase them with a few cc's of water or tuna-juice in a syringe? If not, it could be that they're getting stuck in his throat and that's causing the vomitting. Coating the pills with butter might also help, but do try the liquid chaser as well just to be sure. Here's more info: http://www.catinfo.org/?link=pillingcats
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  #408  
Old September 11th, 2010, 03:01 AM
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His weight is 11 pounds, or 5 Kilograms, NOT 5 pounds.
Ah that's much better then

Quote:
Originally Posted by nemesis View Post
Things are still going well, so cross your fingers. I have another question, this time about pilling. He doesn't squirm too much, he doesn't try as hard to spit the pill out, but he vomits right afterward! Could he be doing it on purpose (is that even possible), or is something about the pills making him throw up? I can't imagine what it would be because he didn't used to throw up after getting his pills. And I'm quite sure it's connected to the pills and nothing else, because he rarely throws up otherwise, and in the last few days without fail a couple of hours after he gets his pill I find some vomit with the half-digested treats in it that he gets after his pills. Any ideas?
Could be the the dry pill getting a bit stuck, if it's the Azodyl that he's vomiting it may be the size & the fact it's a capsule - they get sticky/start to dissolve when wet.

The easiest way I've found to pill a cat:
Sit the cat on the floor in the kitchen facing the cupboards, pills at the ready on the counter above, crouch behind him w/your legs on either side to block escape. One hand holding the head still, pill between the thumb & forefinger of the other hand, use your ring or middle finger, of the pill hand, to pry open the mouth. With forefinger on the pill place it on the roof of the mouth & slide it all the way down the back of the throat. This way there is no chance for them to spit it out, and it's over much faster. Treat afterwards.
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  #409  
Old September 14th, 2010, 11:59 PM
nemesis nemesis is offline
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Thanks guys, I took your advice and he's not throwing up the pills anymore!

In other news, we gave Smokey his first at home sub-q treatment. I would put in the "success" column simply because the needle was inserted with a minimum of fuss, and the fluid went where it needed to go. On the downside, he squirmed a lot more than he does when getting the sub-q at the vet, and I'm guessing this is because at the vet's he's uncomfortable and somewhat afraid. He just sits in his carrier and doesn't move much until we leave, whereas at home, his "domain", he feels perfectly entitled to just get up and leave whenever he feels like it. We'll try again in a few days and try to make him more comfortable.

One question I had was, is there any harm to the fluids flowing pretty fast? Usually at the vet it takes him about 10 minutes to get 150ml of fluid, whereas today it took about 5-6 mins. Our setup at home has the bag hanging higher than they have at the vet's, so the fluid was flowing faster. Is there anything bad that can happen because of this? If so I'll make sure to adjust the rate of flow next time.
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  #410  
Old September 15th, 2010, 12:46 AM
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Thanks guys, I took your advice and he's not throwing up the pills anymore!
Awesome

Quote:
Originally Posted by nemesis View Post
In other news, we gave Smokey his first at home sub-q treatment. I would put in the "success" column simply because the needle was inserted with a minimum of fuss, and the fluid went where it needed to go.
Excellent!

Quote:
Originally Posted by nemesis View Post
On the downside, he squirmed a lot more than he does when getting the sub-q at the vet, and I'm guessing this is because at the vet's he's uncomfortable and somewhat afraid. He just sits in his carrier and doesn't move much until we leave, whereas at home, his "domain", he feels perfectly entitled to just get up and leave whenever he feels like it. We'll try again in a few days and try to make him more comfortable.
This is definately from being more comfortable at home as opposed to at the vets. Smokey can also sense your nervousness & he's trying to take advantage of it

Be sure to have a hand on him at all times, if he likes his ear/face/nose/belly scratched you can try doing that while the drip is going, it distracts them & makes it seem like they're not "waiting" for something - in this case ~ to leave

For both cats & dogs whether it's fluids/nail clipping/bath/brushing/whatever I always use a phrase to let them know they're done ie: "That's it, you're done", gives them a cue that there is an end to it, they just have to wait for it. I'll also often say "You're not done yet" if they get fidgety during whatever it is I'm doing.

You might also try a couple of different spots for Smokey to be sitting/laying while getting the fluids, he may have a preference ie your lap, back of the couch, top of the dresser, counter in the bathroom etc as long as he's relaxed & comfy.

Quote:
Originally Posted by nemesis View Post
One question I had was, is there any harm to the fluids flowing pretty fast? Usually at the vet it takes him about 10 minutes to get 150ml of fluid, whereas today it took about 5-6 mins. Our setup at home has the bag hanging higher than they have at the vet's, so the fluid was flowing faster. Is there anything bad that can happen because of this? If so I'll make sure to adjust the rate of flow next time.
Nope, no problem there, just aslong as you can see the mL marker on the bag & know when to stop.

I would suggest starting to warm the fluids prior to administration, if you aren't already, with the weather getting colder even room temperature fluids will feel cold (bit of a shock ) when injected under the skin of a cat, who normally have higher body temperatures than us.

There's one way of doing it shown here http://www.weirdstuffwemake.com/weir.../catjuice.html, I used an extra large ziplock bag to put the fluid bag & line in, then placed it in the bathroom sink full of hot water for a few minutes - be sure to test the liquid so it's not too hot!

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  #411  
Old October 8th, 2010, 10:19 PM
nemesis nemesis is offline
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Hi everyone, I'm just popping back into the thread with an update and some more questions, if that's ok. So we've been giving Smokey his fluids at home for a while now, and it's going pretty well. He's also been eating well and generally looking good so I've got my fingers crossed, while trying not to be *too* optimistic.

I had a question about the fluids. He's been getting less squirmy during the fluid adiministration as time goes by, but the last couple of times, I've noticed he flinches more when the needle goes in, and has been squirming more than before while waiting for it to finish. I don't think I'm doing anything different, but it's possible that my technique is slipping a bit without me noticing. The last time he had his fluids, there were a couple of drops of blood that trickled out after the needle went in, which I'm told is normal if it happens occasionally. I just want to make sure I'm not seriously harming him. Could it be that I've been inserting the needle incorrectly the last couple of times? I'm not jabbing downwards or anything so I'm not going into his spine, but could I be poking into a muscle or something? How would he react if I had? Basically, how badly could I theoretically screw it up, and does it sound like I've been doing so? And, does anybody have any tips to help me get it right consistently? Thank you!! We've already got things so much more calm and comfortable than I expected at the beginning of this process, thanks in large part to the help I got here.
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  #412  
Old October 9th, 2010, 02:08 AM
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Hi nemesis, happy to hear Smokey is eating well & looking/feeling good

Are you warming the fluids before giving them? Some tips in above post.

What size needle are you using?

You can also warm the needle up a bit before using by holding it (capped of course) under your arm or between your hands for a few minutes or place it capped inside the ziplock bag & warm at the same time as the fluids.

When inserting the needle do you have a nice clear "tent"? As shown here from http://www.weirdstuffwemake.com/weir.../catjuice.html
Name:  Sophia skin_tent.jpg
Views: 306
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Tenting the skin will ensure you cannot hit anything while inserting the needle, just don't poke through the other side. It is not necessary to hold the skin up during the entire fluid administration.

The needle should also have the open edge facing up as shown here, also from the same above mentioned site, ensuring the edge is facing up also helps reduce slicing the skin/muscle on the way in as the skin is tented up away from the end.
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Are you poking in the same spot each time? If you pick a different spot it will reduce the chances for tenderness and or scarring in that area. This picture, also from above mentioned site, shows the area you can safely use to insert the needle for fluids, anywhere the saddle covers is okay, it is always safer to place the needle parallel with the spine.
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A bit of blood usually means you've nicked a small vein, not generally something to worry about, lightly pinching the skin together for a minute or two is good to stop the bleeding. Sometimes it may happen if the needle doesn't go in smoothly or straight & the edge cuts a bit more of the skin on the poke.

Slightly skin flinching when inserting the needle can be caused by
- needle size is too big
- the needle going in on an angle
- the needle being too cold
- nicking a small vein
- a tender spot on the skin
- hitting muscle

If you had hit muscle you would likely see a fair sized flinch after the needle is inserted through the skin & possibly a meow if you've got a vocal one, sometimes they will turn their head around to see what that was/tell you off. Over time when you're more used to the process you can feel if the needle is entering something too dense to be just skin, if this happens slowly withdraw the needle, talk calmly to Smokey & try again in a slightly different spot.

Squirming while the drip is going could be from
- the fluid temp either too cold or too warm
- the flow rate is not fast enough
- some cats don't like to be restrained for the few minutes it takes - some can be distracted with a chin/cheek rub or a dab of food
- some cats also can feel when they've physically gotten enough fluids - but don't change the overall volume of fluids per week until directed by your vet

Smokey's still on 150mL twice a week right? Over the next couple of fluids days if Smokey continues to be squirmy during the last 50mL, you can change to 100mL three times a week - still the same overall weekly volume just slightly smaller amounts each time given more frequently. If you do alter the fluid volume/rate schedule be sure to mention this to your vet so they know what is going on.

You may also get a bit of fluid leakage after you are done, again lightly pinching the skin together in that spot & holding for 1-3 minutes will help the close the hole. I would also, while holding the spot in a light pinch, lift the skin up a bit & give a tiny shake as that will put a small air pocket between the fluid & the skin, reducing leakage. Massaging the fluids away from the injection site helps to spread the fluid pocket out a bit.

Doesn't sound like you are screwing up at all, sounds like everything is going pretty well just need a little refinement. Patience, practise & routine (same place giving fluids, same time of day, etc) will help things become smoother.
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  #413  
Old October 22nd, 2010, 09:41 PM
nemesis nemesis is offline
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Hi everyone, as usual your suggestions have helped a lot, especially you Growler

Unfortunately Smokey suddenly started feeling off today. Things had been going pretty well, no signs of anything wrong that I could notice. Then this morning, a few hours after his breakfast, he vomited. This in itself isn't necessarily a big deal, it happens sometimes due to a hairball or eating too fast. What worried me was that after vomiting his appetite seemed to be drastically reduced. Granted, he doesn't eat as much during the the middle of the day as he does in the morning and at night (in fact he often sleeps through the middle of the day), but it's unusual for him to be that uninterested in treats and wet/dry food even when he's not really hungry.

I eventually managed to get him to eat, by coaxing him with treats and some warmed up wet food, but I was definitely worried. In addition to this, he was licking/smacking his lips a lot, which as I understand is a sign of nausea. I didn't notice drinking more than usual, although he did seem to be "camping" in front of the water bowl for about 10 mins after having a drink.

He kept doing this for a while without getting better, so I took him to the vet. I could have waited until tomorrow but given that he has CRF, I don't want to take any chances anytime his appetite seems to be significantly reduced.

The vet gave him a physical exam, which showed nothing unusual. He did have a temperature slightly above normal, just on the borderline. They gave him an anti-nausea shot, and took some blood. We'll get the results of the blood test tomorrow. The funny thing is, when we got home from the vet, the first thing Smokey did is go to his food bowl. He didn't eat as much in one sitting as he usually might, but it was somewhat encouraging. He certainly ate more than he had the rest of the day, and seemed less "wary" of the food. I wonder if the anti-nausea meds could work that fast.

So basically I'm trying to remain calm and not freak out, but it's hard. His kidneys could be getting worse. If he is crashing again, I hope he can be stabilized again and we can continue on from there. Or even better, I hope it's something more mundane than that (could he just have stomach acid/nausea without necessarily meaning that he's crashing? I know that cats with CRF sometimes just feel nauseous...). But I don't want to get my hopes up too much either.

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  #414  
Old October 23rd, 2010, 12:00 AM
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Hi nemesis just glad to be able to share my little bit of knowledge from experience

How often are you meal feeding Smokey? When is his last meal of the night? I found my girl did better in the mornings if she was fed a small meal around 11pm-midnight. Less time between meals means there is less time with nothing but stomach acid in the stomach.

Yes the lip smacking/licking is most likely caused by stomach acid nausea - do you have Smokey's food dish elevated? What about his water dish - raise that one up between 2-6 inches as well. Place a phone book, low plant table or an upsidedown 24-can-flat box (like the ones the canned cat food or pop cans sometimes come in) under the dishes - just be sure to make it so the dish can't slide off (like a rubber/cloth mat to put under the dish) & scare him while he's eating.

Tanya's CRF site has more info on a new page all about Stomach Acid http://www.felinecrf.org/stomach_acid.htm


I think you did the right thing by taking Smokey in today & not waiting until tomorrow, just because once a sick cat especially a CRF cat goes off their food it can be more difficult to get them eating enough on their own again without associating it with nausea/feeling poorly/vomiting etc. You can also keep up the enticements w/treats etc see if that will stimulate his appetite throughout the day.

The anti-nausea meds usually do start to work pretty quick.

Yes it could just be an excess of stomach acid that doesn't mean he's crashing. remember to breathe

How is Smokey doing otherwise? Feeling like his normal self or has he been hiding again? How's the fluid administrations going?

You mentioned he doesn't seem to be drinking any more than usual, is Smokey your only pet? If so it's easier to try placing a measured amount of water in the dish & leave it for the day - at the end re-measure what is left & write down the difference (how much he drank), try it again a couple more times to see if it's a normal amount for him - this makes it easy to see how much he's actually drinking. If you have more pets this won't work cuz you won't know who drank it

When you get the results/next speak to the vet ask if they think his fluids should be adjusted and if they think you should start giving antacids again at home. Sometimes the lip licking/hovering over the water dish indicates dehydration, to which you would need an adjustment in his volume or frequency, what usually happens during CRF progression is they absorb the subq amount faster & it doesn't hold them as long as it did so you increase either.

for good test results
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  #415  
Old October 23rd, 2010, 11:56 PM
nemesis nemesis is offline
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Update: So it turns out we didn't get the blood work results today, as the "lab was running behind". Argh. It's more frustrating because when we called earlier in the day they made it sound like we would be hearing back very soon. Ah well, nothing to be done. I did get to talk with the vet, and she said that she didn't necessarily think he was crashing and he might just be going through a phase of nausea/bad appetite which we can handle by altering the treatments in some way. Unfortunately we won't know exactly what the situation is until tomorrow, but the vet thought it was ok to keep him at home until tomorrow, when we get the results. In the meantime, she recommended trying to get him to eat as much as possible, and she also recommended moving up his scheduled fluid dose from Tuesday to tomorrow, so we'll be giving him that in the morning.

On the bright side, Smokey seems to be feeling a bit better. He takes a nibble of food now and then and I'm throwing a bunch of stuff at him to see what'll stick, so hopefully in total it'll add up to a decent amount. He's also not hiding, which is a good sign. He seemed reluctant to move around earlier, but now he's walking around, using the litter box, and hanging out in his usual spots. I'm keeping a close eye on him though. He's still obviously not his usual self, tired, not interested in playing, etc.



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Originally Posted by growler View Post
knowledge
Thanks for all the tips! I will definitely try elevating his food and water bowls, and making sure he has enough food before going to bed at night. I have been measuring his water drinking as you recommended, and there's no major change as far as I can tell. I usually check every day to see how much water he's been drinking.

I picked up some baby food and canned tuna (for the tuna water) since they've been recommended as useful in getting sick cats to eat. I couldn't find the brand of baby food everybody seems to recommend, the best I could get were chicken and beef flavours, with no onions or garlic listed on the ingredients, but the ingredients list does have a generic "spices" ingredient so I'm not sure what that means exactly and whether or not it's safe for Smokey to eat. I also got some chicken broth but I couldn't find any with no sodium.

I also got cans and pouches of stinky wet food to try, and hopefully like I said out of all that he'll get some food into him.
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  #416  
Old October 24th, 2010, 01:28 AM
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Being a bit more tired, not playful etc is to be expected with the nausea and/or possible dehydration, also if his numbers have risen that will reflect in how he is feeling. Keep in mind though the numbers may rise & fall slightly a number of times over the course of a year so it's not necessarily progression of the disease if the numbers have gone up a bit this time.

How are his poops? Good consistency? Any constipation or dryness?

To be on the safe side I would return the baby food with the generic "spices" as that could include garlic or onion powder.

Earth's Organic or Heinz Organics should be available in most North American grocery stores or some drug stores (Shoppers/London Drugs in Canada) or if you have a health foods type grocery (like Whole Foods/Choices in Canada). There may also be other organic brands that have no spices.

Not all cats will like the meat based baby food, Duffy wouldn't really eat it, she licked up a bit the first time offered & refused it after

For the chicken broth you could also make your own, just boil a raw chicken breast/or smaller pieces in a pot of water, no salt or spices, until tender & cooked, remove chicken for your meals or see if Smokey wants to try cooked chicken either as a treat or topped on his food. Save the water, allow to cool & use that as the broth.

Have you tried Evo 95% Chicken & Turkey canned food? It is a good meat based grain-free low phos food.

Keep us updated on how Smokey does with the food & the test results
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  #417  
Old October 24th, 2010, 04:51 PM
nemesis nemesis is offline
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The test results came in this morning, his numbers have indeed risen. His Creatinine is at 414 and his BUN is 21 (I don't have the ranges yet since I haven't seen the physical report). For reference, in August his Creatinine was 204 (range 27-186), and his BUN was 12.9 (range 3.6-10.7). So his values have doubled, roughly speaking. This was worrying, but the vet didn't seem to think it was an emergency. She said that we could put him on an IV at the hospital for a few days, and then increase the amount of subQ's at home, as well as resume giving antacids, and that this had a good chance of bringing his numbers back down or stabilizing him at levels that were somewhat higher than before, but lower than this new result.

So I opted to have him hospitalized with the IV fluids, hopefully I did the right thing and he won't be too stressed out there.

I'm a little perplexed because Smokey seemed to be gradually getting better on his own, despite us not doing that much. He just sort of fell into a funk on Friday, and then starting Saturday mid-day gradually started getting better, until late last night, when he voluntarily returned to his regular food bowl looking for food, and began soliciting pets and strokes again. If his blood work numbers are actually up, I would expect him to continue acting unwell until we had a more aggressive intervention. All we did was give him his regularly scheduled dose of fluids on Friday, try to make him comfortable and insist that he eat despite having no appetite.

Also, we just got a call from the vet, saying that originally they were planning on keeping him for 3 days or so, but that he was doing well (not sure what criteria they were using to evaluate this but I presume they mean what I was just saying, that he's not acting terribly sick) and so they thought they would only need him for 1-2 days.



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How are his poops? Good consistency? Any constipation or dryness?
He generally has good poops, although he does have the occasional soft stool, which sometimes verges on just plain diarrhea. No constipation that I can detect.

Anyway, I'm a bit confused about what to expect, and how his test results relate to how he's behaving, but hey, at least he's feeling better than he was on Friday
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  #418  
Old October 24th, 2010, 07:45 PM
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Quote:
Originally Posted by nemesis View Post
The test results came in this morning, his numbers have indeed risen. His Creatinine is at 414 and his BUN is 21 (I don't have the ranges yet since I haven't seen the physical report). For reference, in August his Creatinine was 204 (range 27-186), and his BUN was 12.9 (range 3.6-10.7). So his values have doubled, roughly speaking. This was worrying, but the vet didn't seem to think it was an emergency.
If the lab is the same as the last time & their machines haven't been recently updated the reference ranges would still be the same.

Given that Smokey generally (with the exception of this weekend) has been feeling good overall, the rise in numbers while not good, had he been feeling/acting worse it would be even more of a concern.

There is a saying in the CRF world - treat the cat not the numbers - you base treatment on how the cat is doing physically/emotionally while keeping an eye on the numbers and treat accordingly when there are changes but there are many cats that do great with numbers in the higher ranges.

Two different cats with the exact same numbers may not be feeling the same physically/emotionally, even with the same numbers they may have different symptoms so you treat them differently.

Quote:
Originally Posted by nemesis View Post
She said that we could put him on an IV at the hospital for a few days, and then increase the amount of subQ's at home, as well as resume giving antacids, and that this had a good chance of bringing his numbers back down or stabilizing him at levels that were somewhat higher than before, but lower than this new result.

So I opted to have him hospitalized with the IV fluids, hopefully I did the right thing and he won't be too stressed out there.
Given the symptoms he was displaying at home (not eating/nauseous/hovering over the water bowl) combined with his history of very high numbers (at the start) I think you made the right desicion to have Smokey in for IV treatments, most cats do fine at the clinic for a couple of days even in a busy environment.

As mentioned in the previous post, and given the increase in numbers Smokey would do well with a fluid adjustment, as it seems he's absorbing/using what he's given faster now. Adding the antacids back in will help with the nausea and should start to get his appetite back fairly soon, the vet will find the one that works best for Smokey while he's in hospital - overtime you may be able to reduce or stop giving them depending on how he does with the fluid adjustment etc. Remember to discuss all adjustments with your vet first though

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I'm a little perplexed because Smokey seemed to be gradually getting better on his own, despite us not doing that much. He just sort of fell into a funk on Friday, and then starting Saturday mid-day gradually started getting better, until late last night, when he voluntarily returned to his regular food bowl looking for food, and began soliciting pets and strokes again. If his blood work numbers are actually up, I would expect him to continue acting unwell until we had a more aggressive intervention. All we did was give him his regularly scheduled dose of fluids on Friday, try to make him comfortable and insist that he eat despite having no appetite.
He was likely slowly adjusting to the rise in toxin levels, but it caught up with him this weekend or there was a bigger jump in the numbers this weekend. Cats are also notorious for hiding discomfort/pain and sometimes it seems to come on suddenly but it's just reached a point he couldn't handle/hide it anymore. It's times like these you wish you could just ask them to tell you how they feel

Kidney failure isn't physically painful so Smokey is not in pain, the symptoms just make him uncomfortable, often you will notice a difference in him about 5-10 mins into or after a fluid injection where they feel more relaxed/mellower cuz they are feeling more comfortable with a return to better fluid levels.

Quote:
Originally Posted by nemesis View Post
Also, we just got a call from the vet, saying that originally they were planning on keeping him for 3 days or so, but that he was doing well (not sure what criteria they were using to evaluate this but I presume they mean what I was just saying, that he's not acting terribly sick) and so they thought they would only need him for 1-2 days.
Ask if they are running a Mini Chem Screen blood test either an in-house or lab run, before discharging him, it doesn't need as much blood drawn because it tests less values but the Cre & BUN are tested in there. This can be run at the end of the 1st day on fluids and again during the 2nd day to mark the changes.

He's probably perked up & showing that he feels good, likely he's eaten something after a day on fluids.

Personally from what you've described & the increase in numbers, I would have him there for 2 days of IV fluids. See how he's feeling by middle of the 2nd day, talk to the vet & discharge him at the end of the day.

If they run the blood test while on IV fluids you will see a dramatic drop in the numbers, which will come back up high out of normal once his body readjusts off the IV fluids but it will likely be in the same area or a bit higher than it was before this latest spike.

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Originally Posted by nemesis View Post
He generally has good poops, although he does have the occasional soft stool, which sometimes verges on just plain diarrhea. No constipation that I can detect.
No constipation or dry poop is very good Softer stool/diarreah could be the meds/food but as long as it stays occasional & he's not having issues with it, it's fine.

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Originally Posted by nemesis View Post
Anyway, I'm a bit confused about what to expect, and how his test results relate to how he's behaving, but hey, at least he's feeling better than he was on Friday
When the toxin levels (amount of creatinine & BUN) in the blood rise it makes them feel uncomfortable, irritable, tired, nauseaous, overall crappy so they tend to stop eating, hide, not want to be brushed/pet/picked up, whatever. You can see a change in behaviour because he's reacting to how the rise in blood level make him feel physically.

If you've ever skipped a meal or two & gone about your daily stuff, there usually is a point in the day where your blood sugar dips too low and as a result you get lightheaded, your energy tanks, you feel a bit nauseous, tired, muscle cramps, maybe even a bit of vertigo. At that point you feel cranky, don't want to talk to people etc, and when you do go get something to eat you sometimes feel a bit more nauseous until you've eaten enough to spike your blood sugar back up to normal, after that you feel better. The rise of blood toxins in a CRF cat is sorta the same thing but on a very basic level of comparison.

Once you are more in-tune/experienced with the symptoms of CRF you start to be able to tell when the blood levels are rising just by how the cat is acting/behaving in subtle ways.

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  #419  
Old October 25th, 2010, 09:03 PM
nemesis nemesis is offline
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Smokey is back from the vet this evening, the end of his second day there receiving IV fluids. We spoke to the vet earlier today and she said Smokey could come home and was doing better. In addition to the IV fluids, they had started giving him antacids again.

We spoke with the vet when we picked up Smokey and she said that we should go to subq's every other day. She also said that if we wanted to, we could even try every day, and see how that goes. So for now, I think we'll do every day, at least until Saturday, which is when the vet wants to do a blood test again (they didn't do a mini panel during his stay at the vet). We're also going to continue giving him the antacids at home.

The vet said that she hoped Smokey had mostly had a bout of gastritis, but his numbers are up, so it makes sense to increase his subq intake. We'll see how he does on Saturday on his test results.

The first thing Smokey did when he got home was go for his food bowl, which was encouraging. Then he wandered around, sort of like he was inspecting everything to make sure it was in order He drank some water, used the litterbox, etc. I brushed him and he quite liked it, purring and stretching out like he usually does.

I'm watching him like a hawk right now, to see if he goes back to hovering over his water bowl, or displays any other signs similar to how he was acting on Friday. Unfortunately after hanging out for a while, he's gone to sit under the couch, which is where he stayed for most of the day Friday and Saturday when he felt sick.

He's definitely got his appetite back, is less sluggish, and more himself than he was on Friday and Saturday, but the fact that he's back under the couch is worrying. I guess I'll just watch him really closely to see how he behaves over the next few days.
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  #420  
Old October 26th, 2010, 12:47 AM
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Quote:
Originally Posted by nemesis View Post
Smokey is back from the vet this evening, the end of his second day there receiving IV fluids. We spoke to the vet earlier today and she said Smokey could come home and was doing better. In addition to the IV fluids, they had started giving him antacids again.
Glad to hear Smokey's home & doing better

Quote:
Originally Posted by nemesis View Post
We spoke with the vet when we picked up Smokey and she said that we should go to subq's every other day. She also said that if we wanted to, we could even try every day, and see how that goes. So for now, I think we'll do every day, at least until Saturday, which is when the vet wants to do a blood test again (they didn't do a mini panel during his stay at the vet). We're also going to continue giving him the antacids at home.
How much fluid are you giving now?

When you give fluids everyday, you need to ensure the fluids from the previous session are compleletly absorbed before giving fluids again. You know the fluid pouch he gets under the skin & the "squishy" feeling of the skin in the back (where the needle goes in) and the chest/front leg area (depending on where the fluids settle before complete absorption) make sure that is gone & totally absorbed before giving fluids again. Smokey should have no problem absorbing the fluids everyday before the next session (unless giving higher amounts ie 250+) but it's always good to be sure. Should there be any residual fluid left just wait a few more hours until it's absorbed then give fluids.

Quote:
Originally Posted by nemesis View Post
The vet said that she hoped Smokey had mostly had a bout of gastritis, but his numbers are up, so it makes sense to increase his subq intake. We'll see how he does on Saturday on his test results.
for the test on Sat Let us know what the results are.

The vet likely didn't do a mini panel as they already had in mind to run the tests on Sat & often vets don't want take blood so soon after a previous test - depletes the cats reserves & can be stressing.

Quote:
Originally Posted by nemesis View Post
The first thing Smokey did when he got home was go for his food bowl, which was encouraging. Then he wandered around, sort of like he was inspecting everything to make sure it was in order He drank some water, used the litterbox, etc. I brushed him and he quite liked it, purring and stretching out like he usually does.
Good boy Smokey

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Originally Posted by nemesis View Post
I'm watching him like a hawk right now, to see if he goes back to hovering over his water bowl, or displays any other signs similar to how he was acting on Friday. Unfortunately after hanging out for a while, he's gone to sit under the couch, which is where he stayed for most of the day Friday and Saturday when he felt sick.

He's definitely got his appetite back, is less sluggish, and more himself than he was on Friday and Saturday, but the fact that he's back under the couch is worrying. I guess I'll just watch him really closely to see how he behaves over the next few days.
I would say right now he's probably hanging under the couch just to catch a little alone down time, he's had a lot of excitement lately. Lots of cats do like a "hidey" place even when there is nothing wrong, and some prefer to be up high like a bookshelf - it's just a safe napping spot.

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