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Cat Forum / Health and Behavior / February 2004Sub-Qs for Cory
Well, after almost 2 years of being diagnosed with CRF and hyper-t, my soon-to-be 18 year old Cory has to get sub-q fluids administered by me. I know you've all said it's no big deal after the first couple of times so I hope you are right. Tomorrow will be my first attempt. Cory has been acting very tired and not eating much for about 3 days so I called in sick today and took him to the vet. Unfortunately, the "real" vet is vacationing in the Bahamas and I got the relief vet. All he did was give him the fluids and do a UA and bloodwork, which is what I was planning on having done anyway. I won't get the bloodwork results until tomorrow but meanwhile, this vet said Cory should be on 250ml per day...daily. That seems really high to me since we don't even know his BUN and creatinine yet. I know it won't hurt to do it for a couple of days and he seems perkier already since getting 300ml at the vet but I'm surprised at this dosage...going from no sub-qs to that high of a volume. I thought most cats got 100ml every other day or such. I suppose it might just be a difference in the vet's philosophy and maybe when the blood work results are back and the "real" vet reviews them, he will cut it back. I kind of hope so. I hate to have to do it daily...for Cory's sake. Is there a standard for how high the BUN and creatinine should be before going sub-q and what the dose would be? It seems as though I read it once, at least the point the values should be at before deciding to go that route. I sure hope it works and that I will have my boy with me for a couple more years...He's lost 2 pounds since September. I'm thinking he might also need his tapazole adjusted. Who really knows what is causing his current problem; hopefully the blood tests will give some answers. I guess I better go reread Helen's website. Candace (take the litter out before replying by e-mail) See my cats: http://photos.yahoo.com/maccandace "One does not meet oneself until one catches the reflection from an eye other than human." (Loren Eisely) > Well, after almost 2 years of being diagnosed with CRF and hyper-t, my > soon-to-be 18 year old Cory has to get sub-q fluids administered by me. I know > you've all said it's no big deal after the first couple of times so I hope you > are right. Tomorrow will be my first attempt. I had maybe 6 lessons first, at the vets' - by both the vet & sometimes a tech, if she was really busy. Each of the first 6 times or so debbie needed fluids, I brought her to the vets' (only 4 min. form my house), & I'd get a lesson. My vet made me feel a whole lot better about the whole thing on my first try (which actually took 2 tries, to get a correct stick; I completely missed the first time!) by confessing that it took *her* 45 minutes just to get up the nerve to get the needle into the cat on her first try, in vet school. ;-) Hey, it only took me about 5 minutes of standing there, needle in hand, before taking the plunge. <g> I can't remember - have you ever read Peter Gethers' last book about Norton, & how he was absolutely petrified of the whole deal, & refused to do the fluids for the longest time, taking Norton to the vet all of the time instead? And then wound up sticking *himself* on an early try? <g> But even he eventually was able to do it. ;-) If your husband can help you (I'm pretty sure you're married, correct me if not), it will make it a real piece of cake. My earliest problem - when getting the lessons at the vets', was handling all of the stuff - the tubing, cock-stop, bag, needle & its cover, the cat, etc. all w/ just my 2 hands. Rather like a tangle of spaghetti, as my vet put it. But after a little while, even that was no prob - you hit a routine. After a few weeks of giving the sub-Qs w/ no problems, all of a sudden, I couldn't seem to get the needle in. I went back to the vet (w/ Debbie in tow), explaining that it sounded stupid, but it felt like I was hitting a wall, instead of mere skin. She said she's never exopereinced it herself, but that lots of poeple who give fluids at home have come back to her saying exactly the same thing. So, she gave me another lesson, & that was that - no more probs. > Cory has been acting very tired and not eating much for about 3 days so I > called in sick today and took him to the vet. Unfortunately, the "real" vet is > vacationing in the Bahamas and I got the relief vet. All he did was give him > the fluids and do a UA and bloodwork, which is what I was planning on having > done anyway. I won't get the bloodwork results until tomorrow but meanwhile, > this vet said Cory should be on 250ml per day...daily. That's a helluva lot of fluids, IMO! Esp. since he hasn't been on them, until now. I can maybe see 100 - 150mL/day, but even more likely - unless he's very dehydrated, 100 - 150mL 2 times/week to maybe every other day. > That seems really high > to me since we don't even know his BUN and creatinine yet. I know it won't > hurt to do it for a couple of days and he seems perkier already since getting > 300ml at the vet but I'm surprised at this dosage...going from no sub-qs to > that high of a volume. Same here. > I thought most cats got 100ml every other day or such. Yep. That was my experience, at any rate. IIRC, it was 100mL 2x/week, then gradually upped as time went by & her numbers became worse, till it was 150 mL each day - I think. At the very end, 2X/day, but that was for a relatively short time. > I suppose it might just be a difference in the vet's philosophy and maybe when > the blood work results are back and the "real" vet reviews them, he will cut it > back. I kind of hope so. I hate to have to do it daily...for Cory's sake. Is > there a standard for how high the BUN and creatinine should be before going > sub-q and what the dose would be? It seems as though I read it once, at least > the point the values should be at before deciding to go that route. I honestly don't know - would have to look it up. I also have a feeling that there may be different schools of thought on the best regimen. > I sure hope it works and that I will have my boy with me for a couple more > years...He's lost 2 pounds since September. I'm thinking he might also need > his tapazole adjusted. Who really knows what is causing his current problem; > hopefully the blood tests will give some answers. If his Tapazole needs adjusting, it should show up on the thyroid bw, & give you direction. Good luck, w/ the whole scenario. > I guess I better go reread Helen's website. Just what I was thinking! ;-) Cathy -- "Staccato signals of constant information..." ("The Boy in the Bubble") Paul Simon << Just what I was thinking! ;-) Cathy >> Thanks for the info, Cathy. I was hoping you would write. Yes, I do have a husband and I'm sure he will help me...somewhat...but I would like to be able to do it alone, if necessary, since he goes out of town once in awhile and I would like him to be able to do it alone, too, since I'll be going out of town in April for a week. Years ago, I used to be a pharmacy tech in a hospital so I don't mind handling the bag or the needles or the tubing; it's just the sticking part I'm going to mind. One time, about 20 years ago, I attempted to give a poor stray kitty a vaccine, one of those OTC things, and the poor thing shrieked. I've never attempted to jab anyone since. I remember you writing that you took the bag to the cat instead of vice versa. What did you hang it on? I've been looking around and there aren't many (or any, really) places I can see to hang anything other than the shower rod and I don't really want to do it in the bathroom. I'd like to do it somewhere comfy for him. I wish I had an actual IV pole; I'm sure I could buy one if need be but that seems drastic. On Helen's website, it said sub-qs generally don't need to be started until the creatinine hits 3.5-4. Last time he had bloodwork, it was only about 2.8 but, like I said, he's lost 2 pounds. I'm pretty shocked about that because, although he did feel lighter to me, I really couldn't see that. It's odd, though, because he was his old chatty, happy self until Saturday. I guess I'll just have to wait and see what is reavealed. I just gave him 1/4 cyproheptadine to get him eating. He seems perkier but still not hungry. That usually works so hope it does. I sure didn't get the lessons you got, though. The vet tech just briely showed me, I didn't try it myself, and that was that. They said they'd show me again if I couldn't do it. Thanks again for the info and the encouragment. And, no, I never read the last Norton book. I read the first 2 but I just couldn't bring myself to read the last even though you said it wasn't totally depressing. Candace (take the litter out before replying by e-mail) See my cats: http://photos.yahoo.com/maccandace "One does not meet oneself until one catches the reflection from an eye other than human." (Loren Eisely) > Thanks for the info, Cathy. I was hoping you would write. Yes, I do have a > husband and I'm sure he will help me...somewhat...but I would like to be able > to do it alone, if necessary, since he goes out of town once in awhile and I > would like him to be able to do it alone, too, since I'll be going out of town > in April for a week. Yes, good idea then for each of you to be able to do it on your own. Also, I don't know if you hire a cat sitter for when you're both out of town, but I discovered that my pet sitter does sub-Qs & whatever other meds are necessary - that's also a helpful thing to have in the wings, if needed. Years ago, I used to be a pharmacy tech in a hospital so > I don't mind handling the bag or the needles or the tubing; it's just the > sticking part I'm going to mind. Well, then, keep my vet in mind, the first time she had to do it, hovering w/ the needle for 45 minutes... <g> One time, about 20 years ago, I attempted to > give a poor stray kitty a vaccine, one of those OTC things, and the poor thing > shrieked. I've never attempted to jab anyone since. Ahhhh... but that was 20 years ago. And may've been a pure fluke, right? > I remember you writing that you took the bag to the cat instead of vice versa. Yes, although this didn't dawn on me for a few months. (Jeez!) > What did you hang it on? I've been looking around and there aren't many (or > any, really) places I can see to hang anything other than the shower rod and I > don't really want to do it in the bathroom. I'd like to do it somewhere comfy > for him. I wish I had an actual IV pole; I'm sure I could buy one if need be > but that seems drastic. At first I had the whole set-up in the bathroom. Which was convenient for me, but after a while I could sense Debbie tensing up whenever I picked her up & carried her upstairs. So... one night I decided to bring the goods to her - where she was napping, & ta-da! Much easier on her, & wasn't difficult for me, either. If she was on the sofa, I hung the bag from a nearby curtain rod. If she was in the kitchen, from the top of an open cabinet door. If she was out on the porch, I hung the bag from a large staple sort of deal that used to be for hanging rattan porch shades, or from a cleat where the shades' cords were wrapped. > On Helen's website, it said sub-qs generally don't need to be started until the > creatinine hits 3.5-4. Last time he had bloodwork, it was only about 2.8 but, > like I said, he's lost 2 pounds. I'm pretty shocked about that because, > although he did feel lighter to me, I really couldn't see that. It's odd, > though, because he was his old chatty, happy self until Saturday. I guess I'll > just have to wait and see what is reavealed. I hope the bw will give you pointers, & that he feels better soon. > I just gave him 1/4 cyproheptadine to get him eating. He seems perkier but > still not hungry. That usually works so hope it does. Debbie usually responded to the cyproheptadine w/in 20 minutes - half an hour. I can't remember the dosage, though - a quarter tab, a half tab?? Good luck w/ that. > I sure didn't get the lessons you got, though. The vet tech just briely showed > me, I didn't try it myself, and that was that. They said they'd show me again > if I couldn't do it. Whoa - in that case, I'd feel pretty nervous, to tell you the truth. I think I got more lessons than most people get, but I felt I needed them, in order to feel confident enough to do the job. Otoh, after learning to do sub-Qs, I found that giving Debbie Procrit injections later on, when she became anemic, was *really* a piece of cake. > Thanks again for the info and the encouragment. You're welcome; hope it helped, at least to a degree. > And, no, I never read the last > Norton book. I read the first 2 but I just couldn't bring myself to read the > last even though you said it wasn't totally depressing. Right; it really wasn't. Of course parts were sad, but overall, it was written in the same light-hearted, fun vein that the previous two were, I thought. And IIRC, he stated that at the beginning - that he wasn't out to depress people w/ the book. ;-) Cathy -- "Staccato signals of constant information..." ("The Boy in the Bubble") Paul Simon circa Mon, 16 Feb 2004 21:23:09 -0500, in rec.pets.cats.health+behav, Cathy Friedmann (clfr@adelphia.net) said, > At first I had the whole set-up in the bathroom. Which was convenient for > me, but after a while I could sense Debbie tensing up whenever I picked her [quoted text clipped - 5 lines] > staple sort of deal that used to be for hanging rattan porch shades, or from > a cleat where the shades' cords were wrapped. Interestingly, Jacob really doesn't like it if I do that. I brought his fluids into my bedroom tonight because he was napping and I thought it would be easier. He really wasn't enthused with the whole thing. I think he really prefers having his fluids at his regular "juice bar". The only times I've ever had difficulty with him were the times when I brought the fluids to him. I think it spoils his "routine" as far as the fluids are concerned. Laura  SignatureI am Dyslexia of Borg, Your a.s will be laminated. circa 17 Feb 2004 00:46:21 GMT, in rec.pets.cats.health+behav, MacCandace (maccandace@aol.comlitter) said, > I remember you writing that you took the bag to the cat instead of vice versa. > What did you hang it on? I've been looking around and there aren't many (or > any, really) places I can see to hang anything other than the shower rod and I > don't really want to do it in the bathroom. I'd like to do it somewhere comfy > for him. I wish I had an actual IV pole; I'm sure I could buy one if need be > but that seems drastic. Get one of those over-the-door hooks that people use to hang clothes on, and close it in the top of a window or hang it on a door when you administer the fluids. Works like a charm for me. Laura SignatureI am Dyslexia of Borg, Your a.s will be laminated. Unfortunately this is not a reply or any advice because I've never been in that boat yet. But I wish you good luck with your precious kitty! What is Helen's website? Thanks Hailey I guess I better go reread Helen's website. > Just what I was thinking! ;-) > [quoted text clipped - 3 lines] > "Staccato signals of constant information..." > ("The Boy in the Bubble") Paul Simon > Unfortunately this is not a reply or any advice because I've never been in > that boat yet. But I wish you good luck with your precious kitty! > > What is Helen's website? > Thanks > Hailey http://www.felinecrf.org/index.htm Cathy -- "Staccato signals of constant information..." ("The Boy in the Bubble") Paul Simon 16 Feb 2004: > Well, after almost 2 years of being diagnosed with CRF and hyper-t, my > soon-to-be 18 year old Cory has to get sub-q fluids administered by > me. I know you've all said it's no big deal after the first couple of > times so I hope you are right. Tomorrow will be my first attempt. <snip> Good luck Candace and many purrs that you both get used to doing this. And many purrs for Cory to be healthy and helped by the fluids. SignatureCheryl Trapped like rats. In a chia-pet. MIB II << Good luck Candace and many purrs that you both get used to doing this. And many purrs for Cory to be healthy and helped by the fluids. SignatureCheryl >> Thank you very much, Cheryl. Candace (take the litter out before replying by e-mail) See my cats: http://photos.yahoo.com/maccandace "One does not meet oneself until one catches the reflection from an eye other than human." (Loren Eisely) > Well, after almost 2 years of being diagnosed with CRF and hyper-t, my > soon-to-be 18 year old Cory has to get sub-q fluids administered by me. ... > Candace Best wishes for an uneventful sub-q administration and that Cory will be doing fine and with you at least a couple of years more. Annie << Best wishes for an uneventful sub-q administration and that Cory will be doing fine and with you at least a couple of years more. Annie >> I hope so, Annie. Thank you. Candace (take the litter out before replying by e-mail) See my cats: http://photos.yahoo.com/maccandace "One does not meet oneself until one catches the reflection from an eye other than human." (Loren Eisely) circa 16 Feb 2004 23:56:16 GMT, in rec.pets.cats.health+behav, MacCandace (maccandace@aol.comlitter) said, > Well, after almost 2 years of being diagnosed with CRF and hyper-t, my > soon-to-be 18 year old Cory has to get sub-q fluids administered by me. I know > you've all said it's no big deal after the first couple of times so I hope you > are right. Tomorrow will be my first attempt. Don't worry, you'll do fine. Remember, the key is just to be relaxed about it. It sounds hard to do, but it really does make it easier. Set everything up beforehand including having kibble or treats nearby, a towel ready for spills, the bag already hanging, the drip line already run and the needle already on the line. Then get Cory and have at it. Lots of petting during seems to help, especially as it will help keep Cory from "wandering" off- Jacob is wont to do that occasionally. > Cory has been acting very tired and not eating much for about 3 days so I > called in sick today and took him to the vet. Unfortunately, the "real" vet is [quoted text clipped - 3 lines] > this vet said Cory should be on 250ml per day...daily. That seems really high > to me since we don't even know his BUN and creatinine yet. I know that Jacob's new vet said she has lots of patients who get that much daily, and I suspect Jacob's fluid dosage is going to go up a bit after his next visit(I've already bumped him from 100ml daily to 125ml daily). However, that does seem kind of high for a cat who is just starting fluids. > I know it won't > hurt to do it for a couple of days and he seems perkier already since getting > 300ml at the vet but I'm surprised at this dosage...going from no sub-qs to > that high of a volume. I thought most cats got 100ml every other day or such. Actually, 100ml is a pretty low dosage, AIUI. When I expressed surprise at the vet recommending 100ml daily for Jacob, she told me that it was a fairly low dose, anyway. I think a lot of it depends on the size of the cat, as well. Is Cory large? Jacob is quite small. > I suppose it might just be a difference in the vet's philosophy and maybe when > the blood work results are back and the "real" vet reviews them, he will cut it > back. I kind of hope so. I hate to have to do it daily...for Cory's sake. Actually, as I've mentioned, Jacob's new vet is a proponent of daily fluids, and I have to say, it has definitely been good for Jacob. He doesn't get dehydrated with a daily dose, and he really seems to feel better. > Is > there a standard for how high the BUN and creatinine should be before going > sub-q and what the dose would be? It seems as though I read it once, at least > the point the values should be at before deciding to go that route. According to Helen's site, it's when creatinine hits about 3.5-4, but I don't know if it's that clear-cut or not. Purrs, Laura SignatureI am Dyslexia of Borg, Your a.s will be laminated. I wish you the best of luck. I don't have much knowledge about the BUN levels and all, but this newsgroup has been WONDERFUL with all the advice re: subq's. We are on our third week of giving Newman fluids. We were told to give him 150 ml twice a week. But in reading the replies and website mentioned, we decided to give him 100 ml Mon-Weds-Friday (ok'd by vet). We want everyone to get used to it, and don't want him to get too dehydrated in between administrations. I wonder if you can start with smaller amounts? It took us 10+ minutes to get the first 150 ml in, because I wasn't sure of the rate I should have it at, and my husband and I weren't talking enough to each other and Newman to keep him calm and still. But geez, after just two weeks, Newman is a different cat. He had gone 3 days without eating, and now eats his two full meals a day. Plus, his eyes look great and his fur is very clean and fluffy. And he is even playing with his brothers! It's terrible to think how bad he must have been feeling before. It does get easier giving them the fluids, so don't get too upset the first couple of times. This past time, I stuck the needle in too close to his head and I swear I thought I punctured his brain!! But I just got another needle and did it right. Someone also suggested keeping the needles in the freezer - I think they can only stay there a couple of days. I put mine in after dinner so it is ready around 9pm for the adminstration. And DON'T reuse the needle, even if it is in the same session. I did this once and could really tell it was duller. We hang the bag from the top of the kitchen cabinet using one of those door-hanger things. Then I bent up a hanger to use to hold the bag. I had to work to get the contraption set up good so that the bag stayed level and we could make sure we were doing it right. I like administrating it on the kitchen counter, where we are at waist level. I didn't want to do it where he slept. He doesn't seem to association the counter with his medicine yet. Also, I get the needles and Lactated Ringers from www.drsfostersmith.com. My vet was charging $.85 per needle, the web site charges $.14/each for a box of 100. Plus the lactated ringers were only $4.99 when I bought four of them (my vet charges $13.99). My vet has reasonable office and procedure prices, but sky-high prescription prices for some reason! I do think this website is the best www.felinecrf.org. SO much information. Again, thanks everyone for the information, and for pointing me to this newsgroup. > Well, after almost 2 years of being diagnosed with CRF and hyper-t, my > soon-to-be 18 year old Cory has to get sub-q fluids administered by me. I know [quoted text clipped - 32 lines] > "One does not meet oneself until one catches the reflection from an eye other > than human." (Loren Eisely) (re: sub-Q fluids administration, w/ lots of snipping) > But geez, after just two > weeks, Newman is a different cat. He had gone 3 days without eating, and now > eats his two full meals a day. Plus, his eyes look great and his fur is very > clean and fluffy. And he is even playing with his brothers! That's great that's he's feeling so very much better! :-) It's terrible > to think how bad he must have been feeling before. > It does get easier giving them the fluids, so don't get too upset the first > couple of times. This past time, I stuck the needle in too close to his > head and I swear I thought I punctured his brain!! But I just got another > needle and did it right. I was giving my cat her fluids out on the porch one summer night. She was lying on the floor, flush up against the screening, & I was thinking how incredibly fast & easily the fluids were running that night... when I finally happened to notice that they were running out the screening on the other side of her, watering whatever plants were down there! I'd put the needle in one side of her skin & right out the other - no *wonder* the fluids were running so easily. ;-) > I do think this website is the best www.felinecrf.org. SO much information. Yes, I completely agree. Tons of info, well organized, & written for the lay person. IOW - *useful*. Cathy -- "Staccato signals of constant information..." ("The Boy in the Bubble") Paul Simon > Well, after almost 2 years of being diagnosed with CRF and hyper-t, my > soon-to-be 18 year old Cory has to get sub-q fluids administered by me. I know [quoted text clipped - 7 lines] > done anyway. I won't get the bloodwork results until tomorrow but meanwhile, > this vet said Cory should be on 250ml per day...daily. That's the daily water maintenance requirement for an 8 lb. cat (60 ml/kg/day - 1 oz/lb/day) that isn't drinking or eating anything at all - The cat's actual total daily fluid requirement is based on the replacement needs to correct for dehydration + contemporary losses from diarrhea/vomiting + maintenance - water obtained from the diet and free drinking. 250 ml/day seems very high - as if the vet is trying to use fluid therapy like dialysis -- if this is done chronically, it could actually promote the progression of CRF because it makes the kidneys work harder. Here's a chart to help you calculate fluid requirements: http://maxshouse.com/Calculation_of_24-Hour_Fluid_Requirement_at_Different_Level s_of_Dehydration.htm The most accutate method for calculating daily fluid needs is by weight because the daily fluid needs aren't the same every day. If I were you, I'd by the best pediatric scale your finances can handle. I have the Tanita BLB-12 and 1583 Baby/Nusery Scale. The BLB is graduated in .1 g but the 1583 is more than sufficient and $400 cheaper: http://maxshouse.com/tanita_baby.htm or http://tanitascale.com/pro_scales/1583.html That seems really high > to me since we don't even know his BUN and creatinine yet. I know it won't > hurt to do it for a couple of days and he seems perkier already since getting > 300ml at the vet Sure, intense fluid therapy will make a cat feel much better because it promotes diuresis and lowers the concentration of uremic toxins in the blood. Uremic toxins make the cat feel sick and queezy. Intense fluid therapy should be used only in a uremic crisis or during acute decompensation. Otherwise, daily (or chronic) fluid therapy should be used *only* to prevent or correct dehydration. but I'm surprised at this dosage...going from no sub-qs to > that high of a volume. I thought most cats got 100ml every other day or such. Each cat has a different fluid requirement - but 100 ml/day or e.o.d. is much closer to the average. > I suppose it might just be a difference in the vet's philosophy and maybe when > the blood work results are back and the "real" vet reviews them, he will cut it > back. I kind of hope so. I think he will, also - at least I hope he does! If he doesn't, its time for a second opinion. I hate to have to do it daily...for Cory's sake. Is > there a standard for how high the BUN and creatinine should be before going > sub-q and what the dose would be? It seems as though I read it once, at least > the point the values should be at before deciding to go that route. There's really no set number. Other than a uremic crisis, chronic fluid therapy should be initiated only in cats that are at risk of dehydration but not before or as a simple form of dialysis. > I sure hope it works and that I will have my boy with me for a couple more > years...He's lost 2 pounds since September. I'm thinking he might also need > his tapazole adjusted. His hyperthyroidism may have a lot to do with this. If his thyroid function changes - slows a bit - his BUN/Cr. will go up. You may need to do a juggling act and strike a delicate balance between an "acceptable" level of hyperthyroidism and an "acceptable" level of azotemia. Can be done - That's the most important advantage of antithyroid drugs over radioiodine - CRF is a dynamic disease that's always changing - With antithyroid drugs, you can adjust thyroid function as CRF changes. Keep the faith! Phil. << Sure, intense fluid therapy will make a cat feel much better because it promotes diuresis and lowers the concentration of uremic toxins in the blood. Uremic toxins make the cat feel sick and queezy. Intense fluid therapy should be used only in a uremic crisis or during acute decompensation. Otherwise, daily (or chronic) fluid therapy should be used *only* to prevent or correct dehydration. Each cat has a different fluid requirement - but 100 ml/day or e.o.d. is much closer to the average. >> Thank you, Phil, Laura, Cathy, everyone for your advice and well wishes. This is my update today. Fortunately, the "real" vet's partner, who was not there yesterday either called me instead of the bonehead relief vet. All of Cory's bloodwork is normal or only slightly elevated. His BUN is only 39 (down from 45 5 months ago and his creatinine is 2.3 down from 2.8). His USG was low, as to be expected. Everything else was normal altho his amylase was slightly elevated but that can be attributed to his kidney disease, she said. So...meanwhile, last night, Cory had 3 coughing episodes lasting about 3-5 minutes. He never coughs. I looked it up on Helen's site and coughing can be a sign of overhydration. I mentioned this to the vet's partner today and she concurred that he was probably overhydrated. She also reiterated that he has a heart murmur (grade 1 out of 6) even tho the relief vet said he could not hear it when I asked him and one especially does not want to overhydrate a cat with a heart condition. His coughing seems to have subsided now, 28 hours later, so I'm sure that was the cause. She said she also concurs that 250ml every day is too high; she suggested 200 ml every other day but, in looking at these levels, I'm thinking he may not need them at all or maybe 100 ml 3X a week at most. Today he is eating pretty well and seems better but I'll have to see how he's doing tomorrow. If he seems to be not drinking enuf, I will go ahead and give him 100ml or so but I don't want to tax his heart. Additionally the bonehead relief vet did not order the bloodwork to test Cory's hyroid. How dumb is that? Here we have a cat who has lost 1.5 pounds in 5 months, who is on tapazole, and the vet commented on that, and he still doesn't order thyroid levels in the bloodwork? The woman vet I talked to seemed to find that rather shocking, too, although she didn't quite come out and lambast him. I'm sure, like regular doctors, they have that code where they protect each other...esp. since this is the guy they hired for relief. He looked to be about 22, a big, strapping blond frat jock looking type that seemed full of himself. I'm pissed. My poor cat could have had a heart attack or something. The woman vet is going to call the lab and see if they still have some of Cory's blood to test but I certainly assume this will be a free test for me. The guy must be an idiot to not order a thyroid test on a hyper-t cat. So, I realize what Phil said in that pure numbers don't determine the necessity for fluids but, for instance, on Helen's site, she said fluids don't generally need to be given until creatinine hits 3.5-4, which is a long way from where Cory is. Prior to a couple of days ago, he didn't appear dehydrated. I just hope he doesn't have yet another condition going on...it seems CRF, hyper-t, heart murmur, is enough. His urine is being cultured to see if he's developed a resistance to the low level clavamox he takes to prevent chronic UTIs. For today, he seems much improved, is eating, although he may still be feeling the effects of 1/4 tab of cyproheptadine I gave him about 28 hours ago. That always makes him hungry...yet hyper. He still doesn't seem his normal self, however. I will check out the chart you suggested, Phil, and thank you all. Maybe my kitty is still going to be with me for quite awhile. Candace (take the litter out before replying by e-mail) See my cats: http://photos.yahoo.com/maccandace "One does not meet oneself until one catches the reflection from an eye other than human." (Loren Eisely) > Thank you, Phil, Laura, Cathy, everyone for your advice and well wishes. This > is my update today. > > Fortunately, the "real" vet's partner, who was not there yesterday either > called me instead of the bonehead relief vet. All of Cory's bloodwork is > normal or only slightly elevated. Great! :-) <snipped> > Additionally the bonehead relief vet did not order the bloodwork to test Cory's > hyroid. How dumb is that? IMO, dumb!!!! Here we have a cat who has lost 1.5 pounds in 5 > months, who is on tapazole, and the vet commented on that, and he still doesn't > order thyroid levels in the bloodwork? Dumb, dumb, dumb. <snipped> > I will check out the chart you suggested, Phil, and thank you all. Maybe my > kitty is still going to be with me for quite awhile. I hope so! Cathy -- "Staccato signals of constant information..." ("The Boy in the Bubble") Paul Simon > << Sure, intense fluid therapy will make a cat feel much better because it > promotes diuresis and lowers the concentration of uremic toxins in the [quoted text clipped - 13 lines] > normal or only slightly elevated. His BUN is only 39 (down from 45 5 months > ago and his creatinine is 2.3 down from 2.8). What are the lab's reference ranges? Those values aren't very high at all. Unless Cory was severly dehydrated, I think 300 ml was *way* too much fluid. His USG was low, as to be > expected. If the urine sample was obtained after fluid therapy begun, what the hell did he expect? Fluid therapy can bring down even a normal cat's USG. The influence of the fluids on urinary values can be very misleading and very, very difficult to sort out. Urine, blood and body weight should be obtained before *any* treatment begins. Once the samples have been obtained, fluid can be admisintered while you're waiting for the results. The hydration status shouldn't be based on BUN/Cr. or on USG alone. Serum protein levels and PCV (Hct) coupled with USG provides a much more accurate assessment of renal function than either test alone. The skin pinch test is very unreliable for assessing the hydration status especially on older cats because many older normal cats that aren't dehydrated have reduced skin turgor. You said Cory lost weight -- Cats that have lost weight often have delayed skin-pinch return without dehydration because of reduced elastin and adipose. OTOH, the skin pinch return is usually normal in obese case that *are* dehydrated because the extra fat enhances the skin return. So, the skin pinch test can underestimate dehydraton in obsese cats and overestimate dehydraton in older cats or cats that have lost weight and and emaciated cats. Serum protein/PCV coupled with USG provides the most accurate assessement of hydration status. Everything else was normal altho his amylase was slightly elevated > but that can be attributed to his kidney disease, she said. > > So...meanwhile, last night, Cory had 3 coughing episodes lasting about 3-5 > minutes. He never coughs. I looked it up on Helen's site and coughing can be > a sign of overhydration. I mentioned this to the vet's partner today and she > concurred that he was probably overhydrated. I'm *sure* he was. He's lucky he didn't develop cardiac overload. Thoracic ausculation for signs of respiratory distress should be routine procedure while administering fluids - especially when the volume is more than the cat's total daily water requirement! She also reiterated that he has a > heart murmur (grade 1 out of 6) Might be secondary to hyperthyroidism and not from primary heart disease. even tho the relief vet said he could not hear > it when I asked him and one especially does not want to overhydrate a cat with > a heart condition. His coughing seems to have subsided now, 28 hours later, so > I'm sure that was the cause. She said she also concurs that 250ml every day is > too high; she suggested 200 ml every other day but, in looking at these levels, > I'm thinking he may not need them at all or maybe 100 ml 3X a week at most. I think you may be right. I'd really like to see his total protein, PCV (Hct) and USG values. > Today he is eating pretty well and seems better but I'll have to see how he's > doing tomorrow. If he seems to be not drinking enuf, I will go ahead and give > him 100ml or so but I don't want to tax his heart. > > Additionally the bonehead relief vet did not order the bloodwork to test Cory's > hyroid. How dumb is that? Very... bordering on incompetence. Here we have a cat who has lost 1.5 pounds in 5 > months, who is on tapazole, and the vet commented on that, and he still doesn't > order thyroid levels in the bloodwork? Thyroid function has a *direct* impact on kidney function in cats with underlying renal disease. The fact Cory is on Tapazole should have instantly alerted the vet to the possibility of a change in Cory's thyroid function. Hyperthyroidism is also a dynamic disease that changes. Cory's tapazole dose may simply need to be adjusted. The woman vet I talked to seemed to > find that rather shocking, too, although she didn't quite come out and lambast > him. I'm sure, like regular doctors, they have that code where they protect > each other...esp. since this is the guy they hired for relief. Vets are slow to criticize other vets. They call it "professional courtesy"... I call it fear of a law suit. He looked to be > about 22, a big, strapping blond frat jock looking type that seemed full of > himself. I'm pissed. My poor cat could have had a heart attack or something. > The woman vet is going to call the lab and see if they still have some of > Cory's blood to test but I certainly assume this will be a free test for me. I'd order a complete work up (CBC/chem screen/urinalysis) using *fresh* samples. Never rerun tests with the same samples as the first test. > The guy must be an idiot to not order a thyroid test on a hyper-t cat. Vets like that make me want to add a tip to my vet's bill. > So, I realize what Phil said in that pure numbers don't determine the necessity > for fluids but, for instance, on Helen's site, she said fluids don't generally [quoted text clipped - 3 lines] > heart murmur, is enough. His urine is being cultured to see if he's developed > a resistance to the low level clavamox he takes to prevent chronic UTIs. Make sure the urine sample is obtained by cystocentesis to avoid contamination with bacteria that normally inhabit the distal urinary tract. Many cats diagnosed with UTIs don't really have a UTI. True bacterial UTIs are actually uncommon in cats. However, older cats may be at increased risk of developing bacterial UTIs, because of diminished urinary tract defenses secondary to aging - or secondary to disorders that are more common in geriatric cats. Renal failure, diabetes, and hyperthyroidism, all impair the normal defense mechanisms of older cats. > For today, he seems much improved, is eating, although he may still be feeling > the effects of 1/4 tab of cyproheptadine I gave him about 28 hours ago. That [quoted text clipped - 3 lines] > I will check out the chart you suggested, Phil, and thank you all. Maybe my > kitty is still going to be with me for quite awhile. Based on the BUN/Cr. numbers you posted, I agree 100%! Cats are amazingly resilient creatures. Keep the faith, Candace! Good luck. Phil Thanks, Phil. I'm printing out your reply and giving it to the real vet when he gets back. Cory's thyroid was normal although I don't know the exact number. I was in there today and requested a copy of his lab results but that one isn't on there...because it was done later, I guess. At least they didn't try to charge me for it...yet. Anyway, here are the abnormal values: BUN 39 (14-36) HIGH Creatinine 2.3 (0.6-2.4) not abnormal Amylase 1432 (100-1200) HIGH CPK 575 (56-529) HIGH Lymphocytes 504 (1200-1800) LOW Urinalysis: Ph 5.0 (5.5-7.0) LOW Occult Blood 3+ (neg is ref. range) HIGH RBC/HPF 3-10 (0-3) HIGH Casts/LPF Fine Gran 0-1 (Hyaline 0-3) HIGH USG is 1.023 (1.015-1.060) So, his kidney values aren't esp. high and his USG isn't really abnormal either. He always has blood in his urine and always has ever since he started having UAs when he was about 5. I'm confused about the CPK and amylase. To clarify, the fluid therapy was done the day I was at the vet..after they took the blood and urine samples... and the lab results were not obtained until the next day. I guess the relief vet felt he was dehydrated based on the pinch test. He did appear dehydrated, tho, and had not eaten well for a few days so I think he was, however the real vet generally only gives about 100-150ml when hydrating him. This was the most he ever got. So...he seems better, he's eating and drinking, does not appear dehydrated so I'm not going to give him sub-qs at this time. But he does not appear totally his normal self either. He's not as chatty as usual. He's not particularly lethargic or hiding or anything but he isn't interacting quite as much, not quite as much eye contact. It's subtle but he's different. I don't know...maybe he just went senile all of a sudden. but why's he losing weight? Are any of these values indicative of cancer or anything? He urinates, defecates normally and has not vomited since being hydrated. His cough is gone. His eyes are clear, fur soft. << I think you may be right. I'd really like to see his total protein, PCV (Hct) and USG values. >> Total Protein 7.7 (5.2-8.8) What's PCV? Is there something else it could be called? I don't see that on his results. He's been on low-dose clavamox for several months because he was routinely developing a UTI. The vet didn't want to do it but I inisisted. They did a urine culture, preliminary results are that nothing is growing. Thank you. Candace (take the litter out before replying by e-mail) See my cats: http://photos.yahoo.com/maccandace "One does not meet oneself until one catches the reflection from an eye other than human." (Loren Eisely) > Thanks, Phil. I'm printing out your reply and giving it to the real vet when > he gets back. Cory's thyroid was normal although I don't know the exact [quoted text clipped - 5 lines] > > BUN 39 (14-36) HIGH The BUN can be affected by nonrenal causes that's why creatinine is a better indicator of renal function. That slight elevation could have been caused by a meal or even from muscle (protein) catabolism from not eating > Creatinine 2.3 (0.6-2.4) not abnormal That's the important indicator of renal function. Although its still within normal, its high-normal. Could be an indication of very early renal disease. I'd monitor Cr. closely. You don't have to order a full blood workup every time. You can order specific tests for monitoring indivudual analytes. Saves a fortune! > Amylase 1432 (100-1200) HIGH Not nearly high enough to even suggest pancreatitis or even pancreatic infammation. Could be due to a slight decrease in renal excretion. > CPK 575 (56-529) HIGH Nothing to worry about. CPK indicates muscle injury or damage.The slight elevation could be caused by muscle catabolism if Corey didn't eat recently or from an injection. > Lymphocytes 504 (1200-1800) LOW Doesn't say which - T or B lymphocytes. Without seeing the rest of the hemogram, I won't even guess. > Urinalysis: Are these values from before or after Corey received fluid therapy? If after, its`very difficult to determine the effect the fluid had on the actual values. > Ph 5.0 (5.5-7.0) LOW What food are you feeding him? > Occult Blood 3+ (neg is ref. range) HIGH > RBC/HPF 3-10 (0-3) HIGH How was the urine sample obtained? Catheterization or cystocentesis can produce hematuria. > Casts/LPF Fine Gran 0-1 >(Hyaline 0-3) HIGH A few hyaline or granular casts (~1 to 2) can be found even in normal urine. Cory's are just slightly above normal. Hyaline casts are a sign of very mild renal irritation -- but the number of casts in a single sample is no way a reliable indicator of the stage of CRF. > USG is 1.023 (1.015-1.060) If this value is the USG *after* Corey received fluid therapy, then his normal value is probably close to or even normal. The usual "normal" range for cats is beyween 1.035-1.060. > So, his kidney values aren't esp. high and his USG isn't really abnormal > either. He always has blood in his urine and always has ever since he started > having UAs when he was about 5. Again, how are the urine samples obtained? Catheterization or cystocentesis (obtained via needle directly from the bladder) can produce hematuria. > I'm confused about the CPK and amylase. CPK is Creatine phosphokinase - is an enzyme that's found in the brain heart and muscles. Its an enzyme that's usually associated with muscle damage or injury. Just for a frame of reference, simple IM injections can raise CPK 2-3 times. Cats that haven't eaten can also usually have high CPK values from muscle catabolism. I don't think I'd be alarmed by the *slight* increase. > To clarify, the fluid therapy was done the day I was at the vet..after they > took the blood and urine samples... Ahhh, ok, that makes a big difference! In that case, Corey's USG is only slighly delute but the bloodwork (PCV/Hct & T Protein) shows *no* evidence of dehydration. and the lab results were not obtained until > the next day. I guess the relief vet felt he was dehydrated based on the pinch > test. The pinch test is too highly subjectve to be reliable. As you can see, the bloodwork and the USG don't indicate dehydraton. TP, PCV (Hct) and USG are much more accurate. He did appear dehydrated, tho, and had not eaten well for a few days so > I think he was, however the real vet generally only gives about 100-150ml when > hydrating him. This was the most he ever got. > > So...he seems better, he's eating and drinking, does not appear dehydrated so > I'm not going to give him sub-qs at this time. I think you made a wise decision. But he does not appear totally > his normal self either. He's not as chatty as usual. He's not particularly > lethargic or hiding or anything but he isn't interacting quite as much, not > quite as much eye contact. It's subtle but he's different. I don't > know...maybe he just went senile all of a sudden. but why's he losing weight? You might want to have his thyroid function tested again with another T4 followed by a Free T4 by Equilibrium Dialysis (fT4ED). fT4 is more sensitive in assessing thyroid function in sick cats and cats with concurrent or undiagnosed diseases that could alter routine T4 tests. > Are any of these values indicative of cancer or anything? Hell no!!! He urinates, > defecates normally and has not vomited since being hydrated. His cough is > gone. That's a relief. I was a little worried about cardic overload from all that fluid. His eyes are clear, fur soft. > << I think you may be right. I'd really like to see his total protein, PCV > (Hct) and USG values. >> > > Total Protein 7.7 (5.2-8.8) > What's PCV? Is there something else it could be called? Hct - Hematocrit. Hct and PCV are almost identical. PCV is the total percentage of cells in a sample of centrifuged blood anf HCT refers to the RBC (red blood cells) only. WBC's (white blood cells) and platelets usually make up less than 1% of the blood volume, so the difference between PCV and Hct is moot - for most clinical purposes. I don't see that on > his results. > > He's been on low-dose clavamox for several months because he was routinely > developing a UTI. The vet didn't want to do it but I inisisted. They did a > urine culture, preliminary results are that nothing is growing. Then how did your vet diagnose UTIs? > Thank you. I hope this helps a lttle. Good luck. Phil << I hope this helps a lttle. Good luck. Phil >> It does, thank you! Candace (take the litter out before replying by e-mail) See my cats: http://photos.yahoo.com/maccandace "One does not meet oneself until one catches the reflection from an eye other than human." (Loren Eisely) << I think you may be right. I'd really like to see his total protein, PCV (Hct) and USG values. >> Okay, never mind. I figured it out. PCV (packed cell volume) or HCT (hematocrit) was 40 (29-48). Total protein 7.7 (5.2-8.8) and USG 1.023 (1.015-1.060). Candace (take the litter out before replying by e-mail) See my cats: http://photos.yahoo.com/maccandace "One does not meet oneself until one catches the reflection from an eye other than human." (Loren Eisely)
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