OK, that's great that you're all set to start giving fluids. I'll try to find the pic I took of my setup to show you what works for me and why it works.

Phos is higher than you'd ideally want it to be, but it may come down once you get Peanut properly and consistently hydrated. K+ is right in target zone. Ideally, you want to keep the K+ between 4.0-5.5. Watch it in future bloodwork, because once he's receiving fluids regularly, he may lose potassium in all of that extra urine he'll be producing.

What about his HCT or PCV, and his WBC. Can you post those values, please?

Laurie

Do you have reference ranges for WBC and HCT? Based on other labs' reference ranges I've seen for those values, I assume Peanut's WBC is mid-range, but HCT is borderline anemic.

Laurie

Yes, I posted the WBC and HCT right above your reply.
It sounds like a lot of his values might be out of whack because of him being dehydrated? Hopefully, things will improve now that he'll get fluids regularly. Someone I know thinks we are nuts for doing this, their opinion is with an old animal you just put them to sleep if you suspect they are uncomfortable.

You posted Peanut's values for WBC and HCT, but not the reference ranges. Could you please also post the reference ranges for those values?

Yes, my assumption based on the values you posted is that a lot of them are related to his current state of dehydration. I would expect most of them to come down once he is consistently properly hydrated. Creat probably won't return to normal range, but I wouldn't be at all surprised if it moves from Stage 3 down to Stage 2.

Now, you know to completely ignore the person who thinks you're nuts, right?

Laurie

Yes, the person has been told off and will be ignored.

Sorry, I misunderstood re. the WBC and HCT. From what I can decipher, HCT ref. range is 24 - 45, and WBC is 5.5 - 19.5.

OK, Petra, I finally found the pic of my subQ setup at home.

I sit with my back facing the lefthand wall with my legs stretched forward across the fronts of the chairs. I position the cat between my legs and the backs of the chairs, allowing the cat some room to move forward and backwards across the chairs. Between the lefthand wall, the chair backs, and my legs, the cat's only easy escape route is forward off the righthand side of the chair closest to the window ... and I can easily prevent that escape with one hand held gently across the cat's chest, if necessary. If the cat tries to climb over my legs, a raised knee can discourage him/her.

This method of passive restraint helps to prevent the cat from feeling the need to fight active restraint and promotes a much more cooperative attitude and behavior. Administering fluids right by the window also helps keep the cat distracted.

The bag is attached with a double-ended clip to a hanger that hangs from the curtain rod.

If you have any questions about my setup, feel free to ask.

Laurie

Hi laurie, thanks for the setup pics, that looks pretty ingenious. Hubby hung the bag on the dining room lamp which works okay for now. Curtain rod would be easier and higher, but we don't have any in the house. We are all having a hard time with the fluids, it will take some getting used to. The 20 gauge seems to be easier on him but it's still difficult, he cries when the needle goes in. Hopefully it will get better, but if it doesn't might have to take him to the vet a few times a week instead.

Hi Petra,

Hang in there. It WILL get easier, I promise. It just takes practice for you to hone your technique AND for you to figure out how to keep Peanut happy and comfortable during admins. Every cat has his own little quirks. You just need to figure out Peanut's.

A few more tips ...

Peanut will be more compliant if you don't make a big deal out of it. Try to do the admins in a spot where he's comfy. Once you get more comfortable with your technique, you should be able to do it wherever Peanut is napping. Have your husband hold the bag up, while you slide in next to the napping Peanut and slip the needle in before he even realizes what's happening. Yes, it really can be that easy ... with practice and a very calm attitude.

Make sure you're using Terumo UTW 20 ga needles. They really are sharper and more comfortable going in than any other brand.

Rub, pet, and scratch Peanut before you slip in the needle. If he anticipates the needle stick, he may tighten his skin (some cats can turn their skin to concrete!), making it much more difficult and painful to insert the needle. But if you spend a minute rubbing and scratching the skin between his shoulder blades (and his cheeks and chin, since most cats LOVE those areas), he'll relax his skin so that you can insert the needle easily and pretty painlessly.

Once you get the needle in, lift the skin above it and rotate the needle gently to make sure its tip isn't embedded in tissue. You want to make sure it's in empty space between skin and muscle.

During admin, do whatever Peanut most enjoys. Some cats love brushing or petting. Some like to eat food or treats. Some like to be left entirely alone and just sit quietly until the admin's finished.

Stay calm. It helps if you visualize placing Peanut's parched body under a warm, gentle waterfall. The warm water soothes his dryness and relaxes every inch of him. Keep that visual in your mind during admins, because that's in essence what you're doing for him. You're soothing and rehydrating his dehydrated body. He'll figure that out as soon as you relax enough to allow him to relax, as well.

Don't give up, Petra. You can do this. I know it's nerve-wracking right now, but like any other new skill, it just takes practice.

Laurie

Yes, we'll keep trying. Giving insulin to the diabetic guy is a picnic compared to the fluids. But I know it will get easier, and I will order the Terumo needles if they might be easier on him. These needles don't seem to bother Peanut at the vet's office, but at home they do. He is probably so distracted there that he does not feel the needle.

Peanut's almost certainly responding to your own tension. After you get more comfortable with the procedure and the larger needles, and you're able to maintain a relaxed, matter-of-fact attitude, Peanut will respond to that calming effect, as well.

BTW, you can buy portable, adjustable IV stands on eBay or Amazon or through any store that sells medical supplies. That would allow you to admin fluids wherever Peanut happens to be, and you could easily adjust the height of the bag.

Laurie

How's it going, Petra? Any better?

Laurie

Hope things are going well, Petra. I hadn't had a chance to catch up with this thread.

Our set up was to just hang the bag from a towel rod in the bathroom with a clip (I think they are called lanyard clips- like what mountain climbers use, but they are used now by everybody), and then have a nice rug on the floor where we would sit. We had to keep our bag set up in a plastic shoe box after we got our young cat, because he thought it was really neat to chew through the tubing. Storing it in a non-hanging position led to problems for us with the port on the side, though earlier we had some problems with those side ports leaking even when left hanging. We ended up finding IV lines that did not have that other port, and it worked much better for us.

When I had to give fluids to CRF cat's brother, he liked to sit in the bottom half of his carrier while we did it. He was the type of cooperative Laurie describes, and that you see on websites. I hope you can get Peanut to that point too, but I will contend that my Muddy kitty preferred to be restrained in a bag, which I don't think is a bad thing at all. I think of what we did with Muddy as being more like swaddling a baby so they can feel secure, rather than binding a cat to control it. She was definitely much happier and more relaxed in the security of her bag. I hope the smiley in my first post didn't come across as sadistic, I smile at the thought of Muddy because she was 7 lbs of spit and vinegar, and that cussedness is what kept her going for 6 years, and I love her for every ounce of grief she gave me in addition to the joy.

One more thing. You mentioned Azodyl. Instead of azodyl, we opted to buy a human probiotic complex from a health food store, that contained the same strains as are in azodyl (found this info online). We were able to reduce our costs from $30/month to $14 every 4 months. They key, if you decide to do that, is to make sure you buy a reputable brand so you can feel comfortable that you are getting a quality product.

I hope you and Peanut are doing great.

Laurie and Quasi, thanks for asking. Things are going much better!! Hubby decided to try inserting the needle, and he is much more capable than I am. So, he will be the designated needle nurse. We are both looking forward to the Terumo needles, hopefully they'll be easier to use than the vet needles.

The "hanging the bag on the lamp" is working quite well. Doing both sides only takes around 8 mins or less.

Quasi, too funny about your tube chewing cat. Peanut loves to pinch flower stems so the flowers topple over. He would probably sabotage his own tubes if they weren't out of reach. :o) What brand probiotics did you buy, if you don't mind my asking?

I can't possibly tell you guys how much I appreciate all the replies and suggestions and tips and photos and help and encouragement you've given, it made this so much easier. Thank you from me and hubby and, most of all, Peanut. Here he is on his 18th birthday party, not too happy about the hat. I had to put it on him really quickly, and it was off about 2 seconds after hubby took the pic. :o)

I'm so glad things are going better with the fluids. One little heads-up regarding Terumo needles. Since they are sharper than other brands, and they don't have that painful barb on the tip that some other brands sometimes have, they tend to slip out easily during admin. So have hubby keep a hand on the needle or line to keep it in place so that it can't slip out during admin.

Laurie

P.S. If it'd make Peanut feel any better about his birthday humiliation, I could post pics of several of my cats wearing birthday hats on a similar occasion. They weren't any happier about it than Peanut was.

I KNOW seeing those pics would make Peanut feel a lot better! :o)
Thanks for the Terumo tip, I will let him know. We had some slippage the first time, so he has been keeping his hand on the needle. I sure hope the Terumo will be easier to insert.

Ok, Peanut, these are for you ...
BooBoo

Clearly, several of them imbibed in waaaaay too much "nip" during the festivities.

Haha, Peanut feels better! But he wants to know why he wasn't invited to that party, especially if their was lots of nip. :o)
Too funny one of your pretties is called BooBoo. That's our 120 pound lab's name.

Oh, I'm so sorry, Peanut, but that party was years ago. I do keep nip in the cabinet, though, so feel free to stop by for a good roll any ole time.

120 lbs??? That's a LOT of BooBoo (not to mention a LOT of lab)!

Yes, he is a huge guy. Years ago, someone in the neighborhood moved and abandoned him. He was a stray for a couple of months before he wandered up our driveway (we found all of that out from the neighbors behind us after they noticed we took him in). We ended up keeping him because all the animal rescues in the area were full and animal control would have killed him after 48 hours.

A very smart and very lucky boy to have walked up your driveway. How do they always seem to know where to go?

Well, it did take him a while to figure it out. Or rather, to notice the huge "sucker" sign on our door. :o)

Yeah, I know all about that sign. What I want to know is who's teaching all of these animals to read???

Things are going well as far as administering fluids, we've switched to 100 ml once daily rather than 200 every couple days. Peanut is doing much better, he is much perkier and happier and more interactive. Yesterday, I picked up another bag of ringers from the vet and realized they charge $30 for ONE BAG!! I asked if there was a price break for a case, and was told, no, its a set price. I did find a mail order place and called the vet clinic to ask if the mail order place could call them to verify the prescription, but was told the vet does not deal with prescription verifications by phone. So I will have to shop locally and pick up a prescription when I find a place.

$30.00/bag of LRS is obscene. I pay about $2.00/bag when I buy them by the case from my local Target Pharmacy. Just call around and price them at all of your local pharmacies. The prices in my area vary WIDELY, so price shopping is essential. Also, you may find that no pharmacy carries LRS in stock, but they can all order it for you if you request it.

Laurie

Yes, I am going to start calling around tomorrow. I am really disturbed at that price, I know vets mark stuff up, but WOW!!

Yeah, I think that may be the highest price I've ever heard charged for a single bag of LRS. I've heard of other CRF caretakers being charged $20/bag by their vet ... maybe even $25/bag. But I can't remember anyone being charged $30/bag before. I think my local pharmacies have quoted me CASE prices ranging from $23-45. When you do your price checking, make sure you ask how many bags are in a case (some brands are 10; others are 12) AND make sure they're pricing 1000ml bags (LRS also comes in 500ml bags).

Remember that when you purchase fluids with a prescription, you are buying ONLY the fluids. You will still need to purchase the needles and IV sets separately. I provided you with a link to Thriving Pets earlier in this thread. That's where I buy my needles and IV sets. If you purchase from Thriving Pets, use the discount coupon code "Tanya" at checkout for a discount on your order. You also get free shipping if your order totals at least $55.

I'm so glad that Peanut is doing better and that fluid admins are going well. It's truly amazing the wonderful effects fluids have on a CRF cat. Many CRF cats are dehydrated for so long before they start receiving regular fluids that they get used to feeling sick all the time. Once they're properly hydrated again, these cats quickly make the connection between fluid admins and feeling better. That's why even the most combative feline patients often learn to enjoy fluid admins. They just like to feel good.

Laurie

Many thanks, Laurie. I will use that code. Do you know if the IV sets fit both Hospira and Braun lactated ringer bags? I checked on the website, but it doesn't say, unless I overlooked it.
Yes, Peanut is perking up so much. He was eating okay before, but is eating even more now. He climbs on the table every evening around fluid time, I think you are right and he associates feeling better with the fluid treatment. The 100 every day seems to be helping more than 200 every couple of days. Probably because it keeps him consistently hydrated.
I know, I am still flabbergasted by $30 a bag, that would cost us almost $100 per month. I wonder why they charge so much? I read vet clinics have had large declines in income because of economic conditions, but it seems to me raising prices to that extent is short-sighted because it's going to discourage even more people from using them.

Petra,

IV sets and fluid bags are all standard the way they fit together, though the exact designs can vary a bit. Any set should work just fine with any bag. I would recommend, however, that you buy sets with an injection port, in case you need to add something during admins, like vit. B12. Here's a link to the sets I buy:

http://www.thrivingpets.com/index.php/iv-admin-set-dehp-free-hospira-12672-28.html

Who knows why some vets mark up prices so astronomically high. I suppose they think distraught pet owners are easy prey for price gouging ... and they're probably right about that.

Hey, have you noticed how incredibly soft Peanut's coat has become now that he's properly hydrated? That's the first thing most folks notice after starting fluid admins.

Laurie

Thanks, that's good to know! I was afraid of buying a set that doesn't fit the bags.
I hate to think that of the vet, but I guess it makes sense.
His coat doesn't feel any softer, but it looks shinier and the dandruff is gone! I've also noticed his eyes look different, they almost looked sunken before.

Success!! Thanks so very much for the Walgreen's tip. The first 2 pharmacies quoted $60 per case of 12, and Walgreens did as well. I then asked about the drug discount program and they told me $23 a case if I enroll Peanut in that. I ordered 2 cases, so we are going to be set for a while.

$23 from Walgreen's vs $360 from your vet. I'd say you were very successful! I need to check with my local Walgreen's. They might even be a little cheaper than Target, though my Target will price match the lowest price I can find in town.

Should be the same price at your Walgreens, hopefully. I was very surprised it went from $60 down to $23 with the enrollment. Well worth the $20 enrollment fee. The next closest Target, CostCo, Sam's, etc. are about an hours drive from us, so we are stuck with either Walgreens, CVS, or independent Drugstores. And the independent ones I checked with did not give a discount, though $60 for 12 is still a lot better than $30 for one.

Actually, the cheapest price for LRS in my area is at an independent drug store (isn't even a discount program). But since Target Pharmacy will price match, and since the pharmacist as Target has been willing to order any med I needed for my animals in the past, I like to give him my business.

Glad to read through the updates and see that you and Peanut are doing better.

My vet charged $28/bag and I like them very much otherwise, but that always seemed like highway robbery to me. Fortunately they were great about outside RX any way I needed it- made me wonder if they charged so much because they didn't want to provide the actual RX? (Somehow I doubt it though).

I found a local independent pharmacist who would get us the Braun ringers by the case. He had to special order everything and was unfamiliar with needles and tube sets, but he was so helpful. Later he became the go-to guy for our vet for fluid supplies. He sells bags, needles, and tube sets individually. He sells the bags individually for like $4. I thought that was great that he got into doing that, and that our vet was very supportive of having a local pharmacist who would manage that end of things. I miss having more small businesses like that this day and age.

Sorry to get so long winded, and so glad that you found a supplier and can keep this affordable.

Quasi, your pharmacist sounds great. Even $4 per bag is so much better than $30. In our case, $72 per year vs. almost $1100, that makes a huge difference when you have several aging pets with illnesses. I would have liked to stick with an independent pharmacy, but with Walgreens charging so much less, had to go with them.
Laurie, I tried to use TANYA, but did not get a discount. Still lots cheaper than the vet prices, even without a discount. Amazing how things evolve, I would have never thought sticking needles and IV's into the critters would become routine.

I just went and checked on the "tanya" discount. I had forgotten that there was a minimum order of $55 before the 10% "tanya" discount would apply. Sorry about that. But if you want to get that discount, you could try calling them and increasing your order to meet the $55 minimum, then requesting the "tanya" discount.

Yep, "routine" takes on a whole new parameter when dealing with chronically ill animals.

Laurie

It's okay, the shipping was around $10, so not too bad considering the low price for the needles and IV sets.

You should be all set for a while. Glad to hear things are going well!!!! Just wanted to mention-oral B12 is just fine as long as you get the right formulation. I can't seem to find the paper I have on it, but I will keep looking if someone is interested.. It has to be the superior form of B12 which is Methylcobalamin. The recommended Vitacost one is linked on Tanya's site. BTW I usually find the best price of Pet Tinic on amazon. Luckily Kitty likes the taste-its a liquid with a syringe. I can even squirt it in his mouth as he walks by LOL! Oh-one more thing-don't give another thought to the 200 unit dose of fluids Peanut received. My old vet had me giving Trevor 300 a day for Years-I had no idea that is abnormal!! Just had to get rid of that vet for that and other reasons! Now with new vet he gets 100 per day.

Hi Lisa, you're lucky your kitty is easy to squirt. :o) It takes 2 of us to syringe Peanut, and he acts as though terrible harm is being done to him.

Wow, 300 a day, and presumably this caused no problems for him? The 100 a day is working quite well, I can't believe how much Peanut has perked up.

Re. the Terumo needles, they don't seem to be different from the 20 gauge Vet needles as far as comfort is concerned. For the next order, we are going to try 22 gauge.

Petra, I'm so please that Peanut is doing well with the fluids. The difference in the 20 ga needles isn't huge, but the comfort is there by virtue of the fact that Terumos are manufactured with better quality control that avoids the painful "barbs" that are sometimes present on the tips of other brands. I've never used 22's myself, but I would expect them to have a substantially slower flow rate than 20's. If Peanut is very patient while receiving fluids, that may not be an issue, but if he gets impatient toward the end of the admin, you'd be best to stick with the 20's.

Laurie

Hi Laurie, I guess we'll have to stick with the 20's then. He gets almost violent toward the end of the fluid admin, takes 2 of us to keep him from shedding the needle and running off. Have tried warming the fluids, that hasn't changed his mind.

Petra-make sure you insert the needle with the hole in it facing upwards-the fluid will flow faster. You could tr a few 18's to see if Peanut prefers at faster flow. My cat does. After doing this for 3 years, I started wondering if I could train Trevor to come for fluids instead of me fetching him or bringing the fluids to him and hanging them on a window blind?? I started giving him 2 treats after each session (up till then he very rarely ever strayed from the rx diet). By the third day he came to me as soon as he heard me applying a clean needle, getting his B12 capsule out of the bottle, and getting the Pet Tinic!! He comes to me every day when I am getting ready eager to get things going!! I don't even have to call him LOL.

Lisa, thanks for the needle tip, I told hubby and he will make sure the needle faces upwards tonight. Also thanks for reminding me of the treats, Peanut is a treat hog and I know Laurie mentioned up thread trying to distract him with food or treats during admin. I will definitely try that as I am the designated distractor and he is hard to keep in line toward the end of the fluid session. :o)

Just wanted to update, we lost our Peanut on Tuesday, at the age of 20 years and 2 months. He was doing really well on the fluids, but he came down with what appeared to be an eye infection in December. It improved a little with triple antibio cream and lysine, but never fully cleared up.

Over the last few weeks, he lost a lot of weight though he was eating very, very well. Last week, his eye swelled up tremendously and did not respond to any treatment.

The vet felt a tumor behind his eye and said nothing could be done at his age and in his condition. We miss him so much, I can't look at his favorite chair because I expect to see him in it. Hubby is the one who gave him fluids every night and he is having a really hard time too. He was doing so well on the fluids, if it had not been for the tumor we probably would have had him for quite a while longer.

Oh, Petra, I am so very, very sorry for your loss of Peanut. Cancer is such a horribly unfair disease. It comes on without warning and takes our beloveds in such insidious ways.

I am glad, however, that you had almost two good years with Peanut after his CKD diagnosis. Once they develop chronic illness, every day together takes on another level of importance and devotion. Peanut was so fortunate to have spent his life with you, and vice versa.

I wish you a peaceful grief.

Laurie

Thank you Laurie. It's going to be hard to get used to Peanut's absence. He was with us through moves and job changes and thick and thin. I wish he'd stayed with us another 20 years. Here's a pic of him from just last year, on the back deck, enjoying the sun. He was doing really well.

Peanut looks so much like my Mew in that picture. What a handsome boy! They sure do leave a big hole when they depart. Must be because they take sure large chunks of our hearts with them.

Don't worry. Peanut will stick around as long as you need him to. You'll catch sight of him out of the corner of your eye from time to time. They're sneaky little buggers that way.

Laurie

Yes, they sure do.I guess it's good we outlive them though, that way we can make sure they are well taken care of all their lives. And hope you are right about the sightings, I would love that.

I'm so sorry to read about your loss, Petra. It sounds like Peanut had a very long and happy life thanks to your excellent care. RIP Peanut kitty, you were a handsome cat!

Thank you spedi. He had such a huge personality that the house seems empty, even with our also much loved other furries around. After almost 20 years of Peanut, it will take a long time to get used to his absence.