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Patty, my vet also suggested the subcu fluids (once or twice weekly). So
far, I have done them once (at the vet office with the technician coaching
me). I haven't attempted it at home yet. This seems to be what many vets
recommend, although when Phil responded to the same question regarding my
cat, it seemed that he was kind of against the idea because he said it may
put a strain on the cat's heart. My vet agreed that we should limit them to
only once or twice a week and not more than 100 cc at a time. She also said
that it wasn't worth doing if it was going to be a huge struggle with my cat
such that it was ruining my relationship with him. I think it's worth noting
that my cat has a preexisting heart problem. So, this can make a difference.

Phil emphasized to me that the cat should have potassium supplementation
because even though Alex's numbers for the blood potassium were within
normal range (as are your kitty's), potassium is being lost from the
tissues. He also recommended Omega-3 supplementation (from a fish source not
vegetable source). My vet was ambivalent about the potassium
supplementation, stating that it was really unnecessary at this point (the
second opinion vet agreed with the first one), but nevertheless, they both
agreed that as long as the cat is urinating copiously (which mine is), it
can't hurt. The risk would be if the cat weren't urinating too much, then
you could be dealing with hyperkalemia (too much potassium which would be
bad for the heart). I took Phil's advice on this one because any human for
whom a doctor prescribes a diuretic (increases urination to eliminate fluid
retention) is immediately told "make sure you eat a banana every day" (full
of potassium) or is given potassium supplementation outright. Well, Alex
isn't going to eat a banana, so I'm supplementing him with a veterinary
potassium/vitamin B compound prescribed by the veterinarian and available
only at the veterinary office ($27 per tube).

I also have omega-3 capsules, which can be opened up and squirted on his
food (they are a fishy-tasting liquid inside). This is also from the
veterinarian (around $6 or $7 for a bottle of 30 capsules).

The other thing you need to watch is the phosphorous. If the cat's
phosphorous goes above normal, you will need a phosphorous binder. Maalox is
a phosphorous binder, and I think it is used for cats, but I'm not sure how
much. I haven't crossed this bridge yet, and you kitty's phoshorous seems to
be within normal limits as well.

I also give Alex a 5 mg dose of Pepcid every day. It's the human version
that I buy over the counter at the drugstore. I chop up a 20-mg pill into
four parts. I am told it also comes in 10 mg size (I just happened to
already have some of the 20 mg pills in my house), which would probably be
easier to chop. The purpose ofthe Pepcid is to increase the cat's appetite.
Sometimes, they are nauseous from being uremic (due to the kidney
dysfunction). The Pepcid helps with this. The cat can have 2.5 mg to 5 mg
per day but should never have more than 5 mg in a given day. Again, ask your
vet.

Ask your vet about all of these things. And I just want to say that Phil was
a tremendous help, and I learned a lot from him, and because of him, I knew
what questions to ask the veterinarian. I am very greatful for all his help,
but I know he is busy with his colonies, so I am passing along Phil's advice
to you (not as good as if Phil answered, but hopefully accurate)
Best regards,
---Cindy S.

Hi Patty,

My cat Molly was diagnosed with chronic renal failure last summer; we
started giving her sub-q fluids right away but she was dehydrated and her
lab values were more abnormal than Rusty's.  She really wasn't feeling well.
The fluids seemed to help her a lot but  it sounds like she was sicker than
Rusty is now.  As far as giving fluids, she was a dream to work with.  She
was always a very mellow cat and the whole procedure took maybe three or
four minutes.  I'd hang the bag of fluids on a nail above the door and just
let gravity work.  She would just sit there and a lot of the time would purr
during the whole process.

I am currently giving sub-q fluids to another cat, Tortle, who is much more
resistant to the process!  It's a two person job and we try to do it as fast
as possible.  My vet showed us how to draw up the fluids in a couple of
large syringes and we're pushing the fluids in as fast as we can.  As much
as
Tortle hates it she is tolerating it much better than she did originally.
We're hoping we can discontinue them as soon as possible.  When we first
brought her home from the hospital we were giving her 100ml daily to keep
the kidneys flushed (she had/has kidney stones and had a blocked ureter) and
now are giving them every three days.

Not all cats will tolerate getting fluids and I really agree that quality of
life is the most important thing.  If giving them fluids (or any other
treatment) is making them that unhappy it's probably not worth it.  Molly
was so easy and Tortle is hopefully on them only for a little longer.

I wish you and Rusty the best.

Bonnie

PS I'm not sure that giving fish oil is the same as giving omega-3.  I would
check with your vet first.  I was giving Welactin (a vet supplied Omega-3
liquid) to Molly and it isn't the same as the fish oil I take.

Another PS:  You might want to ask your vet about Azodyl.  It's a probiotic
that helps with azotemia and seems to be effective in lowering the BUN and
Creatinine levels.  The main draw back is that it's most effective in
capsule form and it's a huge capsule!  It seems to have really helped with
Tortle.  I asked Phil about Azodyl and he said that it could also be
sprinkled on the food but isn't as effective that way.