We've been through it with two different older cats. In one case it added an extra year to his life, and in the other case a year and a half.

We wrapped ours loosely in a bath towel while giving the fluids, in case they fought, and always followed the treatment with a food treat to build a positive association. We inserted the needle parallel to the body surface in an area where the skin was loose, varying the spot from time to time.

Our compounding pharmacy ordered the fluid bags and needles for us, which was a little cheaper than buying them from the vet.

You sound like a loving pet owner, and if Casey is over 20 you must have been taking excellent care of him. I hope all goes well.

Thank you, Petaloid. Are you talking about the fluids adding the extra time or a combo of other treatments? I don't think Casey will tolerate too much intervention; she's been too much the boss all her years--we've never been able to pick her up and love on her on OUR terms, so trying to do that and "worse" now is totally foreign and unacceptable to her. I've been trying to do it solo because hubby is leaving on a month-long trip in a week or so, so I thought I'd better try and get used to it. Maybe when he gets back, we can try at-home fluids again, together.

Thanks for the info on where to buy the fluids. Our vet is rather expensive. I did order my own needles today--I read about Terumo brand needles being sharper and having really thin walls so that you can use a smaller needle without compromising too much on the flow rate.

Tracey

Hi Tracey,

You are definitely not alone. I'm currently caring for my third CRF cat, and with each one I become more knowledgeable, more experienced, and more effective at dealing with the associated conditions and their management. It can be so overwhelming at first because CRF can affect so many different body systems. Dehydration, constipation, and inappetance are very common accompaniments to CRF, but all three can be successfully managed.

My first recommendation is for you to read and bookmark the following website:

Tanya's Feline CRF Info Centre

There is a large online community of CRF caretakers who consider Tanya's website to be the CRF bible. There just isn't much about this disease, its associated conditions, and their management that isn't covered on this site. Even after many years of CRF caretaking, I still find myself constantly referring back to the site for info.

Next, I strongly recommend joining the Feline-CRF-Support mailing list at Yahoo Groups. It is a very large and active list with members who are astoundingly knowledgeable about CRF. They can answer virtually any questions you may have and will lend support and guidance anytime you have concerns or problems with the management of Casey's disease.

Just a few quick notes before I head off to bed. If you want more info on any of this, please feel free to post again, email me privately, or refer to the resources I noted above.

SubQ fluid administration - This is the single most important and effective CRF management technique available to you, so it's well worth mastering. Always warm the fluids before administration. Less restraint is generally a more effective strategy than more restraint while administering fluids. A cat who feels forced will tend to fight.

Constipation - This is a frequent symptom of inadequate hydration and indicates the necessity for more frequent subQ administration. In addition to better hydration, Miralax can be extremely useful in controlling constipation and softening stool. It is essentially tasteless and can easily be mixed with food. I put it in a needleless syringe, add a little water, shake it up, and administer it orally to Billy twice a day to control his constipation. It's very effective.

Picky appetite - You will find many tips for dealing with difficult appetites on Tanya's site, along with a link to the assisted feeding mailing list, if you feel the need for additional info.

I'm too tired to continue now, but please post again if you have more questions or just need some more support. There are thousands of us CRF caretakers out here, and we have a wealth of information, tips, and tricks to share.

Laurie

Tracey, just a quick note to second what Laurie wrote (and she has helped me tremendously with my CRF/cancer cat. Constipation was one of the most heart-breaking thing to watch in my cat. So, please try MIRALAX. It is really easy to administer as it is a tasteless powder (so MUCH BETTER than lactulose which is really messy!!). Whatever your cat likes to eat (soft food, home-made chicken broth-no onions ..), she won't taste it, thus no fight, no syringe.... and it is an OC med you can get at any drugstore. Start with a 1/8 to 1/4 teaspoon.

My best to you and Casey, and keep us posted,
Anne-Marie

Tracy...nothing much to add to the excellent info so far. My Max was on a compounded med called Cisapride for digestive motility that helped with the constipation along with the Laculose, stool softeners, and SubQs. He was also on 2 blood pressure meds and an antacid. We both got to be real pros at giving and taking meds! Word of advice...get hold of a big bag of #3or4 gelcaps (there are resources on the Tanya site Laurie posted)...you can cram 3 different meds in one cap and they go down real smooth.

One word of encouragement about the fluids: Ive been there/done that with 2 cats...my first, Cecil, was so far gone that he only lasted 6 months from the diagnosis. But Max was on fluids for 2.5 years. They both got to the point where they seemed to acutally look forward to it. Max was a little difficult at the beginning, but soon was actually jumping up on the sofa where the set up was when he heard me preparing the bag. It got the point where after the needle was in, he just hung out without being held. That was good because I started using a finer needle. It takes a few seconds longer but Puss won't even feel it going in.

Just one important note...be careful not to overdo the amount of fluids: I think that is what did Cecil in.

Good luck

Lisa

Me again ...

Tracey, it would be helpful if you could provide us with more information about Casey. How much does she weigh? How well is she eating? Does she have any vomiting? Do you have copies of her latest blood test results that you could post? If not, I strongly recommend you request copies of all test results from your vet so that you can keep your own file on Casey at home. How much fluid is she receiving at the vet once a week, and how much were you instructed to administer at home? Which fluids are you using? Are you administering any other meds or supplements?

CRF can be quite a costly disease, but it can also be managed pretty economically if you know where to shop for supplies and if your vet is willing to write prescriptions so that you can price shop. For instance, some folks pay as much as $25/bag (or more) for fluids from their vets, but I pay about $27 for a CASE of 10, 1000 ml bags of LRS by getting them from Target with a prescription from my vet. If Casey needs any sort of prescription meds, you might also be able to save significant bucks by checking with Target, K-Mart, and Walmart to see if the meds are on any of their low-cost prescription program lists (each store has its own list of program meds, so you need to call each pharmacy to check). Tanya's site also provides a resource list of sites where different supplies and meds can be purchased inexpensively.

I know you must be feeling completely overwhelmed right now, and that's perfectly natural. Reading through Tanya's site will probably make your head spin, but just keep reading. I've reread those pages more times than I can count, and each time a little more sinks in and sticks. There's a steep learning curve with CRF, but you don't have to know everything immediately. Tackle the current problems first - dehydration and constipation. Once you get a handle on those, you can let all of the other info trickle in as time and need dictates.

How are you and Casey doing today? Ready for the challenges and rewards of a new year?

Laurie

Oh, thank you kind ladies! It's the most optimistic I've felt in the last couple of days. Her frequency of urination is wearing on us both, but then when you add the cries of constipation, it's just so sad.

Thanks for the info on Miralax....I'll go get some today. Surely she'll take that mixed w/ tuna juice much better than the Laxatone.

Thanks for the info on gel-caps, but I don't know about getting a pill down her. That will be my last resort. I'll try crushing pepcid and mixing with water in the syringe--I just ordered a box of oral syringes. Can the Pepcid and Miralax be given to her at the same time/dose? That would cut down on her stress of being manhandled.

Oh, and thanks for Tanya's website. I'd come across it before, but back before things got this advanced; I'll certainly get back there and read up.

Oh, what about "over-doing the fluids"? I asked the vet yesterday if too much could be given, and she said no. Of course, giving them to her myself, I don't think that'll be a problem since Casey isn't that patient with me.

Thank you again!!!
Tracey

It depends so much on the cat and the suitation. 21 is getting up there but some can live 30+ though this is rare. Diet helps, but after 21 years if on lower food ( purina,Iams, mew mix, friskies) the damage may have already been done.

I would switch carefully to Instincts, Innova Evo, ziwi peak, Orijen, with such an old cat it will be stressful, but for the better, one would hope. Grains have no place in the feline diet and often cause many of these health issues over time.

Sorta reminds me of my Uncle mike quitting smoking after 30+ years- with lung and brain cancer- doctors gave him less then a year to live though he thinks he can beat it....sigh

Hi Laurie:

I guess we posted at the same time.

I can't seem to locate Casey's last results of 2 months ago--I'll keep looking. Prior to those, in August (before we were giving her fluids), her BUN was 61 and her Creatinine was 3.2. She had gone up somewhat--I want to say her BUN was lastly at 70.

Casey weighs approx. 5.75 lbs. She was only 10.5 at her heaviest, though. She's on no other meds. She prefers Science Diet Senior dry kibble; vet said she'd rather see her stay with this than go to the "junk foods" just to get her eating canned. She will occasionally eat canned, but to her it's a "treat" and she easily tires of it. She only likes seafood flavors, and we've been through them all. I'm about ready to try Fancy Feast, though...

She eats fairly well, but is a grazer, although she has her off days. I'm wondering if those days are from upset stomach the day after a vomiting/bowel event (the 2 usually go hand-in-hand). She throws up about 1x a week. She's always done that, though.

To me, the biggest "annoyances" to her are the constant trips to the litter box and BM troubles because she lets me know about it....and that's at least 1-2x an hour to urinate (I'm home during the day). Thankfully, she doesn't "mention" her litter box trips during the night.

Oh, since mid-Sept., Casey has been getting 100-150 mls of Sub-Q once a week. Vet wants me to do it twice weekly now.

Thanks!
Tracey

Tracey,

Did your vet run a complete blood chemistry and CBC at Casey's last check? If not, you should have them done ASAP. Things can change very quickly with CRF cats, so you really need to keep current on the bloodwork. For instance, CRF cats can have problems with potassium and phosphorous levels (as well as others) that can have serious physical effects. It's quite common to have to supplement potassium and reduce phosphorous in these cats, but you mustn't do either without current bloodwork to identify the need. Anemia is another common accompaniment to CRF, as is hypertension. You just need to keep on top of things so that you can tweak her management plan as necessary. Like I said, it'll serve you well if you keep copies of ALL of her test results so that you can track the changes at home and get a good feel for how the disease is progressing.

Yes, it's possible to overhydrate a cat, but you are nowhere near that danger with Casey. This is one reason why it's a good idea to invest in a digital baby scale. If you weigh her immediately before and after administering subQ fluids, you'll know how much of the weight is attributable to the fluids, and you can wait until after her weight returns to pre-subQ level before administering more. You just want to make sure that she has processed the previously given fluids before giving more or you may run the risk of overhydration. Overhydration can result in internal drowning, esp. in cats with compromised heart function.

But as I said, it is extremely unlikely that you are anywhere even near adequate hydration, much less overhydration, with just two administrations a week. With creat above 3, I would think Casey would benefit from daily subQ fluids, or at least every other day. Even if you just gave her 100 ml every other day or perhaps 50 ml every day, it would improve her hydration status and probably help with the constipation AND her appetite. Many CRF cats get 100 ml daily, but again, you do have to make sure each administration is getting absorbed before the next subQs are given.

Laxatone is useless for resolving current constipation problems. All it's doing is irritating Casey when you try to make her take it. Use the Miralax, instead. If Casey likes tuna juice, just mix 1/8-1/4 tsp into a little tuna juice twice daily and let her lap it up. Miralax is very safe and effective for CRF cats and is a dose-to-effect drug. If 1/8 tsp doesn't do the trick, increase the dose little by little until her stool reaches a nice squishy-firm consistency. I've been giving Billy Miralax twice a day for about 6 mos now, and he has had no further problems with constipation since I started it. Miralax should be given to cats who are well hydrated because it pulls water into the bowel and holds it there to soften the stool. It's probably best to administer Miralax a couple of hours before or after Pepcid or any other antacid that reduces the acidity of the colon.

Empty #3 or #4 gelcaps and Pill Pockets can be real lifesavers for cats who are difficult to pill. Also a piller. Keep them on hand.

I disagree with your vet about feeding dry Science diet instead of any type of canned food. Canned is ALWAYS the better option for CRF cats. Kibble draws fluid out of the body during digestion, which is only making Casey's dehydration and constipation worse. Canned food, esp. when turned into "cat food soup" by mixing with hot water, adds fluid to the cat's system, aiding in hydration. The more canned food you can convince Casey to eat, the better. With a CRF cat, the rule is that junk food or even dry food is better than no food, so if Casey reaches the point where she will eat only junky dry food like Science Diet, then so be it. Try to convince her to eat canned (yes, even Fancy Feast), but if she won't, then feed her whatever she will eat.

Acid stomach is a problem with many CRF cats, but if Casey is only throwing up once a week and only when she's trying to pass constipated stool, then she may not be having much of a problem with stomach acid yet. Of course if you're giving her Pepcid regularly, that would be taking care of excess acid, anyway.

It isn't normal for a CRF cat (or any cat) to go to the litterbox once or twice an hour to urinate ... even if she was getting subQ fluids daily. I suspect that her frequent trips to the box are her attempts to pass constipated stool, and her straining just releases a little urine, instead. Once you get the constipation resolved, if she continues to urinate that often, I'd recommend you get her tested for a UTI again.

Time for me to hit the barn.

Laurie

Tracy
I should mention that I had to take Max to the vet for a few ennemas when things got really bad...I don't want to discourage you, but that was one of the options that we dealt with. I also got into the habit of keeping a 'poop diary' so I could tell the vet exactly how he was responding to treatment and how long it was between BMs.

AFA food...he was OK on SD/KD (wet and dry) for about a year...when he became inappetant, I just started feeding him anything he would eat dry or wet: Meow Mix, Fancy Feast...anything. I would sprinkle a friskies treat over his food and that helped until the end. I know its junk food, but my vet assured me that it is more important that the cat eat something.

Also, AFA pilling: There is a piller syringe called the "Bullseye" that is much more effective than the more common piller with the rubber tip. If Casey will eat them, Pill Pockets Treats also work very well...especially with the gel caps.

LF

Science diet and Francy feast is crap... Look on the bag and you'll see by products grains and all sorts of weird chemicals... one of which starts with e was used once and treated as a pesticide.. vets are not nurtionalist its not their field... animal health and diseases are.

here are good websites

www.Naturapet.com

www.felinefuture.com

www.rawfedcats.com

www.innova EVO.com

look at at this way, if a cat had perfect teeth and heath as they do on raw diets they wouldn't be marketable to vets.... only spaying/neutering and the bare minum of vac/and if outdoor flea tick, would be required. Provided no injuries happen.

runsnwalken, your information on feline nutrition is of value to healthy cats, but Tracey is dealing with a very elderly cat in renal failure who is immunocompromised. Raw meat is not advisable for an immunocompromised cat because the cat will not be able to effectively fight off bacteria in raw meat that an otherwise healthy animal could handle with ease. The commercial foods you advocate, though very good quality, are also high protein foods, and that is contraindicated for cats in renal failure who do best on a low protein diet that takes stress off of the kidneys.

CRF cats often have minimal appetites to begin with, and many are skin and bones before they die because they simply don't feel like eating. The bottom line for CRF cats is that they MUST eat, and that often means that we end up feeding them whatever they're willing to eat, junk or otherwise. Just because a food is high quality doesn't mean that a CRF cat will eat it. In fact, in my experience, the higher quality the food, the more likely my CRF cats have been to reject it.

Laurie

Hi everyone and many thanks!

Yes, she had complete blood workup each time. We don't want to draw blood too often because of the stress and how hard it is to find a vein on her. K and Phos haven't been an issue yet, but I do understand the concern. She's due for another blood test in the next week or two....

By over-hydration--do you mean giving her fluids on top of fluids not yet absorbed, OR giving too much to her at one time? It takes a couple of days to stop noticing her fluid "pouch" after getting 150 mls.

Right now, I simply can't imagine daily fluids on this Tasmanian Devil (which is what she turned into yesterday when I was trying....it's amazing how strong a 5.75 lb kitty can be!).

I'm about to head for a store in order to get some Miralax--hope someplace is open today. I'll also get a piller and some gel-caps to have on hand for "just in case." How little water can I mix the Miralax with?

I understand the concern about the proper diet for animals. In hindsight, I wish I knew then what I know now, but I can't go back and do it over again. She's been a Science Diet dry kibble kitty for all of her 20+ years, and she's been perfectly healthy until this (so it can't be all that bad). Maybe this wouldn't have occurred if she'd been on the ultimate, proper diet, but it's useless to beat myself up about it now. And, she's a stubborn, ill-feeling cat--she's not going to change her diet willingly--we've tried!!! Right now, it's just imperative she eats and that it isn't a battle. I'd rather have her happy for 2 more weeks/months/yrs eating whatever she wants than for 5 more years of forcing her into something else and being very unhappy about it. She's mad enough at me as it is. I HAVE thought about trying raw on her, but I really don't see that happening. Just like the Cat Sure she devoured when we first discovered it 2 days ago--now she could care less. She might like something up front, but she ends up refusing it and returning to her kibble. We've tried whatever premium brands we could find locally, some I can't remember the names to, but none were well received. I have a stockpile of all Science Diet, Iams, Pro-Plan, and a few others (Wellness? and ?) that are in seafood flavors to rotate on her to see which one she might like on a particular day. It's hit and miss with her. Oh, and Casey has excellent oral health and all her teeth.

I know that sometimes her frequent trips to the litter box are for trying to force BMs, but otherwise, she doesn't complain about painful urination like she did that time she did have a certifiable UTI. I hate to let the stress Casey out by inserting a needle into her bladder for a sample. Any thoughts? Even after her course of ABX and her pain being relieved, her trips to the litter box remained unchanged. If there's anything more serious going on (bladder cancer, etc.), I'm pretty sure we would not try treating it at this late stage of her life--after all, when all is said and done, she'd still be an ancient cat with CRF. I think I will re-visit that with the vet though......I can't find anyone else complaining about constant trips to urinate, but 2 vets both said that sometimes the kidneys just get so overwhelmed with toxins that they just need to keep dumping it. So, no one with a CRF kitty in dire straits ever had such frequent urination???

LOL....poop diaries. Just like regular old folks talking about their BMs (or lack thereof).

Anyway, you all have been a wealth of information and have made me feel so much better and less alone. Thank you for your time!!! I hope all your kitties and pups are doing well.
Happy New Year.
Tracey

Tracey, I have a CRF cat who we've been giving fluids to at home for almost 3 years now. She fought like crazy until I started using a restraining bag. She is so calm and cooperative when she is in a bag. I made my own out of canvas- but you can buy them as well.

There is a non RX diet for kidney disease cats named Hi-Tor. It's canned and when we've bought it, it had to be mail order, but it is still cheaper by the can than K/D RX and the cat liked it much better. We also feed Royal Canin Mature, which can be bought at many big pet stores, but is comparable to K/D RX dry in regard to nutritional breakdown (protein particularly). The cat also likes that food much, much better.

If your kitty likes running water, the trickling water bowls are a good thing to try. I just bought one recently and was surprised at how inexpensively they can be had for. My CRF cat is not real interested in running water, so it's turning out to not be such a good purchase, but if you have one of those cats who does, it can encourage them to drink more water. I also just started growing wheat grass (seeds from the health food store). I understand that is what the cat grass at the pet store is, and I think it might help my kitties bowels stay a little more regular.

Just a few odd thoughts that might help you. Below is a link for a restraining bag. I've never ordered from this place, so can't recommend it, it's just an example of what is available.

Here is a link that might be useful: Cat restraint bag

Blood draws are generally much easier on elderly cats if they are taken from the jugular vein in the neck. Those leg veins are smaller and can be much more difficult to find, requiring more needle sticks and a slower draw.

Bear in mind that some blood values, like potassium and phosphorous, aren't necessarily optimal for a CRF cat even when within normal range on the blood test. You want potassium to be squarely in mid-range. If it is below 4.4 on a CRF cat, it is generally advisable to start supplementing potassium. Phosphorous, OTOH, becomes problematic when it gets too high. It is generally recommended to start using phosphorous binders when the phos level reaches 6.0.

Overhydration can result in fluids accumulating to a level that impairs cardiovascular function. That can occur if a huge dose of fluids is administered at one time or, more likely, if additional fluids are given before the previous dose has been absorbed and eliminated. The only time I have witnessed overhydration was in one of my own cats after his initial diagnosis. He was badly dehydrated, so my vet instructed me to give him 300 ml of fluids daily for 5 days (he weighed around 12 lbs at the time). Shortly after receiving his 4th administration, he went into respiratory distress (open mouth breathing, unwilling or unable to move around), and I rushed him to a different vet. He was drowning in excess fluids because I was unaware of the dangers (or even the possibility) of overhydration at that time and didn't know what to watch for. We pulled him through that crisis, but I had to be extra careful with fluid administrations after that.

There are a lot of tips and tricks to giving subQ fluids. The most important is the fluid temp. Are you warming the fluids before administration? If so, how are you warming them, and how are you testing the fluid temp before beginning administration? What size and brand needles are you currently using? Where (household location) are you administering the fluids, and how are you keeping Casey in place during administration? Have you tried feeding her during administration? Or grooming her if she enjoys brushing? Setting a calm mood with quiet background music? Providing a warm towel for her to sit or lie on during administration? Have you tried the clothespin technique described on Tanya's site?

Miralax - I think I mix Billy's dose with 1-2 cc of water in a needleless syringe. It doesn't take much to dissolve the Miralax.

Feeding CRF cats is usually a hit-or-miss proposition. Just remember that what totally repulses them today might be their favorite food next week, so keep a little of everything on hand (including the beef, chicken, turkey, and liver canned foods that Casey currently hates). You just never know what might appeal to a CRF cat on any given day. If Casey is really stuck on SD dry, you might try soaking some in hot water until it turns to mush and see if she'll eat it that way. At least then it'd be adding more fluid to her system than it's drawing out.

It's possible that Casey is harboring a low grade UTI that never was completely resolved with the antibiotics she was given before. Sometimes those UTIs can go into hiding when an antibiotic knocks it back but doesn't completely eliminate it. Try collecting a urine sample at home and taking it to your vet to be cultured. As often as she's going to the litterbox, it might be possible to just slip a little saucer under her and capture some urine that way. Or your vet should have some non-absorbent beads that you can use in your litterbox instead of regular litter to make it easy to pour off the urine when she uses the box.

There are ways around most of the problems you're having with Casey right now. A lot of this is trial and error until you discover the tricks that work for your own cat.

Keep at it. You'll find your way around her defenses eventually.

Laurie

Wellness canned is better then Science diet. You could try grain free.

I really hope everything goes well. it looks like the end is near though.

Remember the loving years she gave you, you wouldn't want her to suffer would you? useally they let you know when its time. I hope its not going to be for awhile yet but do be fair.

Thanks for the info on the restraining bag, Quasifish; I might have to try that. I do have a nice leather carrier that has 3 entrances, one of which is from the top, and that's what I'm using now. It's worked out great at the vet since you could never drag her out of a traditional carrier. With this one, you just unzip the top and pick her up. However, when I take her for hydration, I have them leave her in to keep her stress level down.

We tried one of those watering fountains a few years ago to try and get her to drink more water, but she wouldn't go near it. She's never been one for running water; actually, she was never introduced to it since she wasn't a bathroom kind of kitty. I did find out she likes hot water, though. Strange.

Laurie--do you mix the Miralax before you draw it up into the oral syringe or pour some in from the backside and add water, then put the plunger back in?

As for my attempts at Sub-Q, I place her in her carrier (mentioned above) with towels rolled up on either side to keep her from being able to turn around, and I unzip the top and come at her that way. Treating her while doing it wouldn't work--that's just not her thing--nor petting. She could care less about any kind of lovin' when under restraint. No music either--she's pretty much deaf.

Thanks to you all, I do think I will have the vet test her for UTI again.

Yes, I know the end is near, and no, I don't want her to suffer. I was about ready to let the vet put her down when she was crying from her UTI (it was at the beginning of having to be hydrated, etc., and I was overwhelmed with all of it), but my husband wouldn't even talk about it. The vet said we should give it 24 hours to see if the ABX worked, which it did. So, I almost lost the last 3 months with her by being over-reactive. We've always put this cat's feelings first....which is why I think she's hard to manage--because we never made her do anything she didn't want to do. The vet gave me a "quality of living" handout as a way of judging when it might be time to put her to sleep. I had to chuckle at one of them, regarding human interaction/loving, etc.....Casey would never have scored very high on that at any point in her life :-)

Thanks,
Tracey

With the Miralax, I pull the plunger out of the end of a 5cc syringe, then hold the syringe, tip down and pressed against the base of my pinkie finger (to plug the tip so that the Miralax doesn't run out the tip). Then, using a 1/8 tsp mini measuring spoon, I spoon the Miralax dose into the open end of the syringe and replace the plunger. I carefully turn the syringe over, tip side up, and tap the tip to shake the Miralax down into the syringe. Then I place the syringe tip under a running faucet and suck a little water into the syringe with the plunger. Put my fingertip over the syringe tip and shake until the Miralax is dissolved, then squirt it slowly into the side of Billy's mouth. Honestly, though, if Casey will reliably lap up tuna juice or a tiny bit of canned food, it's easier to just mix the Miralax into that. I just can't rely on Billy to finish anything I put in front of his mouth, so it's easier for me to give it to him via oral syringe.

Casey sounds like Billy in some respects. Billy has a very short temper, so I have to be very careful how I handle giving him both his subQs and his meds. With Billy, as with many other cats, the less restraint I use, the more compliant he is. If he's feeling forced, he'll fight back HARD, so I keep everything very low key and as quick as possible. While administering subQs, he's less likely to complain if I keep still and just sit there quietly with him until the administration is complete. If I have to tweak the needle position to achieve adequate flow, Billy can get very impatient, so I have to make any such adjustments as unobtrusively as possible.

I administer fluids in my diningroom where I have three chairs lined up next to each other with their backs along a wall and against a corner of the room. I place Billy on the center chair and then I sit sideways across the edges of all three chairs and use my body as a barrier to keep Billy on the chair. He's free to move forwards or backwards a few steps across the chairs, but I prevent him from crossing over me to jump off the chairs. I can limit his movement that way without making him feel unduly restrained or held. It's a compromise that generally keeps him satisfied until the administration is complete. I expect if I tried to put him in a restraint bag, I'd have a mighty nasty fight on my hands. Less is more when dealing with an impatient patient.

Actually, my first CRF cat, Pea, was even more like Casey. Pea was a world class complainer all of her life with a vocabulary that would make a sailor blush. She HATED being held or loved on, though she did occasionally deign to lie on my lap as long as I did NOT touch her. When she developed renal failure, I couldn't imagine how I would ever be able to give her any meds, much less subQ fluids. As it turned out, subQs were the easiest part of her management. I think she figured out pretty quickly that the subQs were making her feel much better, so she barely objected to them at all, much to my amazement. With her, I administered fluids sitting in the bathtub with Pea between my legs. She was about Casey's age and was far too feeble to be able to jump out of the tub, so it was an easy place to be able to restrict her movements without actually restraining her.

Managing chronic illness in felines requires a bit of imagination and creativity, and a whole lot of tenacity and patience Get creative with Casey, and you'll figure out how to get things done with as little stress and argument from her as possible.

Oh, about the UTI testing - ask for a urine culture so that the specific infective organism can be identified (assuming there is one). Unless a culture is performed, your vet is just going to be shooting in the dark with an antibiotic, hoping it'll be effective against whatever organism is causing the problem.

Laurie

About Miralax: As Casey is not the best patient, I would simply sprinkle the 1/8 to 1/4 teaspoon directly on wet food, chicken broth, tuna juice or whatever she likes. My cat loves olive oil and chicken broth, so that's what I use. It doesn't take much to dissolve, and even if it is not totally dissolved, she still licks her little plate clean! Also, the more liquid Casey drinks, the better. So you can judge what she can absorb. It is a (pretty much) tasteless powder.
And yes a BM diary is very useful!
Best of luck, Anne-Marie

Tracy... one more thought about the constipation issue: In addition to the dehydration issue,Casey might have a touch of mega colin...that is where the colin stretches out, looses elasticity, and too much hardened stool accumulates there...combined with the elderly patient's weakened ability to squeeze. For a long time, the Cisapride RX was very helpful in this regard but even with that, Max had to have (in the beginning) periodic ennemas. It started out that he would be OK for months after an ennema, but then he needed the procedure more frequently...not fun for the poor old guy!

Also, if you want to tempt Casey with broth, you might have to go the home made route because any kind of onion or garlic extract can be lethal to cats.

Lisa

Hi Laurie: I guess I'd better get a bigger syringe (or a small funnel to pour the Miralax into my 3cc ones). However, last night I mixed it with tuna juice, which she drank. No BM overnight, though. I gave her more this morning (this time a rounded 1/8 tsp). My dilemma right now is that we need to go away the next 2 nights. My MIL is dying of cancer, and I haven't seen her since she was Dx'd last summer (because of Casey). The last time my husband was able to get off down there (out of state), Casey was in the middle of ABX for that UTI, so I couldn't go. I have wonderful neighbors who are both in the health-care field (although of the human variety). They will check on her 2-3x / day and have been through an elderly cat's problems before (and I helped with their old one when they had to be gone). I feel guilty, BUT, I have to weigh that guilt with how I'd feel if MIL dies without me having seen her again. Casey is "normal" right now, so I don't anticipate any change. I just wish I'd be here to monitor how the Miralax is working. We'll leave as late today as we can and return as soon as we can on Sunday. Neighbors have a long list of instructions (I'm anal) and phone numbers and directions to the Emergency Clinic, etc. I don't know what else I can do....

LOL....I loved your description of Pea. Sounds like she's Casey's twin. We joke about the next cat needing to have a "lovability test" AND a "meow test".....no more loud-mouths for us! It's amazing how loud a small cat can be (and louder as they go deaf). My sister has a monster cat with the teeniest mew.

Thanks, Anne-Marie....I'll have to try Olive oil with Casey. I've tried offering chicken broth, but she's strictly a tuna juice gal (but if she gets it too often, she loses her fondness for it). Maybe I could find some fish bones somewhere and make my own broth.

I've wondered about megacolon, Lisa, because of the SIZE of some of the hard marbles that come out of her. But gosh, I hope we don't have to go the enema route--I'm afraid that would require sedation. Poor kitty!

You really don't know (or maybe you do) how much help you've been. Mostly the support--it felt so lonely being a cat's caregiver. No one I know has gone through CRF management. My neighbor's old cranky cat had thyroid issues--I pilled him 2x /day when they would leave on trips, not to mention cleaning up after the messiest cat ever--he was big and thought that if his head was in the litter box, the whole of him was.....so he usually missed, especially with his runny, 2-3x/DAY BMs. And talk about mean! Every other meow was a hiss. He was something else. He went to the Bridge last year, and they're just now going to get a new kitty.

Anyway, thanks so much for the support and suggestions, etc. I truly appreciate your time and thoughtfulness. "See" you when I get back.

Tracey

Oh, here's a recent pic of Casey:

Well, of COURSE Casey is a multicolored beauty! The cat who raised me, Tempest, was a tortie, and Pea was a dilute tortie. I have a thing for these beautiful girls in their colorful party dresses. Tell Casey I think she's GORGEOUS!

Miralax can take a day or two to get through the digestive tract and work its magic, so be patient. If Casey is really impacted, though, she may need a manual extraction or enema by your vet to get her cleaned out initially. Hopefully that won't be necessary, and she'll be able to expel the remaining constipated stool on her own. Once the Miralax takes effect, you may need to tweak the dose to get the stool consistency you want. Too much Miralax will give her the runs. Too little will leave the stool too hard. Let your neighbors know that they should reduce the Miralax dose a little if they see runny stool. Also, tell them not to be alarmed if they see HUGE stools in the litterbox. Once the constipation has been resolved, you'll be amazed at the size of the tootsie rolls coming out of your girl.

If Casey tires of tuna juice, try mixing the Miralax into a tiny bit of warmed baby food meat. Lots of cats LOVE baby food meat (just make sure the food has no onion or garlic in it).

It's funny that you should mention your sister's soft-spoken lunker of a cat. I have one of those, too - my Lion King, Noddy. At his heaviest, Noddy weighed in at 26.45 lbs. Now I have him down to a svelt 16.25 lbs. He has a tiny eek of a mew ... unless he's in the car where he turns into a panic-striken Pavarotti. When Noddy was an adolescent and Pea was still alive, he would occasionally make the mistake of getting too close to her. She would hiss right in his face, and he would jump back and squint like he'd just received a venom strike in the eyes. It was quite a sight to see Noddy, in all of his youthful massiveness, put firmly in his place by the ancient, frail, and undisputed Queen of the Domain.

You have my sympathy for your MIL's illness. Try not to worry too much about Casey while you're gone. It sounds like you have responsible folks looking after her and a good veterinary support system in your area in case of emergencies.

"See you" when you get back.

Laurie

Her coats looking a little ragged, I really hope every things okay, people get older, cats do too.... they don't live forever. The oldest recorded cat in the world was over 30.

A "clumpy" coat is indicative of dehydration which is a common problem in CRF cats. I expect that Tracey notices a significant difference in the smoothness and silkiness of Casey's coat after her subQ fluid administrations. The effects of hydration on the coat (and the rest of a CRF cat's body systems) are really quite remarkable.

Laurie

Tracey, I know you've probably already left to go out of town, but I meant to write this the other night and forgot because it was late and I was too tired to be coherent. So I'm going to make this observation now while I'm thinking about it and hope that you see it when you get back.

I've been thinking about the problems you're having administering subQ fluids to Casey, and something struck me as I was rereading your descriptions. If I understand correctly, you're attempting to administer fluids to Casey by putting her into the same carrier in which you take her to the vet. Is this right? I'd bet money therein lies your biggest problem.

You've already stated that vet trips are very stressful for Casey. She undoubtedly associates the carrier with being taken to the vet, therefore each time you put her into the carrier, she is automatically stressed and fearful of what's going to happen to her. No wonder she's fighting the subQs. That carrier is NOT an environment conducive to the relaxed administration of subQ fluids. You need to choose a different, less confined spot to give subQs - some place that holds absolutely NO association with the vet or any other unpleasant experience for her - some place that she associates with relaxation and safety. A favorite napping spot, perhaps.

It also helps to give subQs at a time when she is feeling particularly satisfied, like right after she's eaten and is feeling groggy.

Location, location, location and timing, timing, timing. You've been inadvertently setting her up to get stressed out about subQs. You can turn this around with some simple adjustments.

Laurie

Tracey, your Casey is indeed a beautiful cat, I hope she is doing well.

I haven't had to deal with this illness, but a dear friend of mine has lost a furbaby to CRF and she's set up a website to honor Luckie.

Here is a link that might be useful: Luckie Kitty's tail

Oh, she is a pretty girl. I hope she does well while you are away- sometimes I swear our cats do better when we are gone- it's like they *know* they will get a chance to relax!

I'm sorry to hear about your MIL too. Sounds like you have an awful lot to deal with right now.

My CRF girl is a tortie- those 3 color cats... She makes the loudest, most obnoxious noises imaginable. We also think she has gone a bit deaf, making matters worse. We call her talking "meyowling".

Her brother (the one just diagnosed with cancer) is a great big orange tabby with a teeny tiny, musical voice.

Positive thoughts for a good weekend and safe return.

BINGO, Laurie! I think you have it....the carrier is stressful for her! I'm going to order one of those cat restraint bags (with her, I just know I need restraint when doing it alone) and give home fluids another go. Thanks for pointing that out to me!!!

I know, her coat hasn't been "nice" for about a year now. I attibuted it as much to her lack of grooming now as anything, but it makes sense that it's a hydration issue. She has arthritis, too, so she only licks what she can easily and comfortably reach. I guess her skin is more sensitive these days, too, as she's not as fond of brushing as she once was. As for the arthritis, she gets Adequan injections, which seems to be helping--doesn't take her nearly as long to lay down anymore (but she can always jump right up and move about....she even uses the stairs, although I've closed the upstairs off to her to discourage it).

Anyway, Casey obviously did quite well and had BMs while we were gone (yea!)....so the Miralax is working (thanks so much for THAT tip, for sure!).

I'm letting the vet hydrate her in the morning, and I might try it again myself later in the week if the Terumo needles come in (and I get a cat bag). Same neighbor that helped out while we were gone this weekend is the daughter of a vet who isn't squeamish about stuff (she's a Physician Assistant, too), so I might even have her do it for me--since she volunteered....at least to get Casey used to having it done at home.

Quasi--I love the "meyowling" word--now I know how to describe it :-) Do you have a "caterwauler"? All her life, Casey has carried on in this gutteral, truly pathetic "caterwaul" (don't know what else to call it). She was given a "woobie" as a kitten (a terry cloth belt from an old robe) that she'd pull around in her mouth and carry on with that pathetic crying. She only makes the sound when "pulling the woobie" (as we call it)....well, except for once when she did it with a blue (same color as the belt) fake-feather duster. It's usually at night (when we're in bed) and/or when she's alone (or thinks she's alone in the house). The woobie was never a play-thing. She just has this weird attachment to it, and I've always hesitated throwing it away. I have put it away from time-to-time, but if it's in her "reach", she always finds it. Strange kitty. I'm just curious if anyone has one like this???

Thanks for the good thoughts, hints, and such!
Tracey

What runswalken meant to say was,

"What a beautiful, beautiful, well-cared for and well- loved cat!"

Has anyone mentioned the "clothes pin trick" yet? It is on the Tanya website if you are interested. The theory is that you apply clothespins to specific pressure points and it relaxes them before and during the sub-qs- check it out if you get a chance.

I also wanted to say that we had a terrible time with sub-qs the first few times. Persistence pays off and you will get the hang of it. The first time, Muddy escaped from DH, the needle came out as she ran off, and fluid was shooting all over the place. I think the first 5 or so times ended with me in tears. It can be rough at first, but it does get better.

Muddy has a strange personality, but that seems to be typical of those 3 colored cats. She's always been a talker. That's cute that Casey has such an attachment to her woobie.

Thank you, Elly. That's what I see when I look at her too. :)

Oh, Runsnwalken--there was a kitty named Baby who died last year at the age of 38. He was featured in Cat Fancy the year (?) before, winning the oldest cat contest. I found a news video online about him a couple of years ago. I read that he was fed table scraps (the owner said "some of whatever we had to eat") and regular cat food.

Quasifish--I had to see a new vet last week when I had to quickly get Casey in for her fluids (before NY's day). When I mentioned Casey's contrariness, she took one look at her and said-- "oh, she's a calico; that explains it." LOL....I told hubby, no more torties/calicos for us! Of course, I'll always be partial to them. They are gorgeous, aren't they? I'd never seen one before when we met her with her litter mates--it was her unique-ness that made us choose her.

My kitty had a nice, nice poop earlier, and we're both so happy :) Doing the happy poop dance....
Tracey

The Terumo needles are very helpful...you can administer fluids as quickly with a much slimmer needle than the regular ones.

And yes, you know that you are really into CRF care when a mega-poop is a cause for major celebration. Once I was on the phone with the vet's office scheduling an enema for Max (I think it had been 8 days). He must have heard what I was up to because I smelled something...uh wonderful??? in the box...lo and behold a major, doggie sized tootsie roll!

LOL, lfnyc.....my husband thought I'd gone crazy when I got so excited about Casey's loooong tootsie roll, then he really rolled his eyes when I asked him if he wanted to come see it.

I did order a smaller size of the ultra thin walled Terumos (vet gave me 18 gauge to use, so I ordered a 20 gauge) based on what I'd read online. They haven't arrived yet.

Oh, and quasifish, yes I saw the clothespin trick. Sounds strange, but I do understand the theory behind it. I might end up trying that out of desperation.

I am soooo relieved that the Miralax is working for Casey (and I'm sure she is, too)! I feel the same way every time I see one of Billy's nice long tootsies. Constipation can make them feel so miserable and sick. You have vastly improved Casey's quality of life with Miralax.

I definitely think you should take your neighbor up on her offer to administer subQs for you at home. I know you're having a hard time believing that Casey will be more cooperative with less restraint, but hopefully your neighbor will be able to demonstrate the validity of that for you.

I do understand your misgivings, though. Billy is extremely short-tempered and does NOT like to be messed with, so when he was diagnosed with both CRF and hyperT, I was dreading having to medicate him, much less having to eventually administer subQs to my potentially violent old man. To make matters worse, my housemate moved out right before Billy started needing subQs, so I was faced with having to administer them without any assistance. I had nightmares of lying on the floor bleeding to death with Billy firmly attached to my jugular vein.

But what choice did I have? Billy needed subQs, and I was the only one here to administer them. I knew my only chance of surviving the procedure was to keep it all as low key as possible. Billy had chosen a diningroom chair as his favorite sleeping spot, so I rigged a way to hang the fluid bag from the curtain rod next to the chair. While he was napping, I quietly hung the bag, sat down next to him (which instantly woke him and caused him to stand up), and slipped in the needle as quickly as possible. To my utter amazement, Billy didn't object at all. He stood there while I silently stroked his face until the administration was finished. I was stunned at how easily it all went.

Things have changed a bit since then. It didn't take Billy long to figure out that the diningroom chair was where he got his fluids, so he abandoned the chair and started napping elsewhere. Now I have to find him and carry him to the chair for fluids, but as long as I do so quietly and carry him carefully, he usually doesn't do more than grumble softly. Sometimes if I don't get the needle exactly where he wants it, he'll start growling in mid-administration. I have to be VERY careful at that point NOT to touch him (other than to hold the needle in place), or he'll attack me. So I just hold my hand an inch or two in front of his chest so that he knows I won't allow him to leave, and he stays put and growls until I'm finished. If I get the needle in a comfortable spot, however, he'll generally sit or stand without objection until we're done. I can absolutely guarantee you, though, that if I did anything other than use my body position to restrict his movement, he'd fight like a demon during subQs.

There is absolutely NO WAY that a restraint bag would do anything other than increase Billy's fight instinct, and I suspect the same will be true for Casey. You need to reduce the stress response, not increase it, in order to be successful with subQs. A restraint bag is likely to feel a lot like a carrier to Casey, so she may very well have the same stress response to the bag that she has to her carrier.

Casey's also likely to be in a considerably happier (and hopefully more cooperative) mood now that she's not dealing with chronic constipation anymore.

Don't worry. All of this will work out, one day and one procedure at a time.

Laurie

So exciting to read Casey's good progress! Wished I had known of Miralax when my poor CRF/cancer friend needed it so badly!! Lactulose was always such a messy process!

Anyway, I am really happy that things are under control with your Calico lady. "oh, she's a calico; that explains it." LOL..... Our 'old' lady is also a calico, and very difficult at the vet's. So we hope we'll never have to give her fluids..

We recently adopted a new cat (15 months at our local shelter, and I got pity on him..), and he also is a 'vocal' cat with such a variety of meows... Could not put them into words, but it might be that "caterwaul" Casey does.. He chases a little ball, and does that sound when he brings it back in his mouth... and he keeps doing that.. yes, of course when we are trying to sleep!!

Well, Casey is really a beautiful, lucky lady, and I hope she keeps you delighted with regular 'presents', and that she likes those Terumo needles!!

Thank you for all the updates,
Anne-Marie

Tracy, for geriatric cats, it is always good to set up extra litter boxes near (not close to) their favorite places to sleep.

Tracey, DH and I always say no more torties too! It's a one of a kind personality and can wear a little thin at times. We actually went to get Gus as a kitten and thought Muddy had such a great personality we wanted her too.

I hope the restraint bag is a positive and not a negative for Casey, like Laurie suggested. There's only one way to find out though. I'm not sure why Muddy responds so well to being in the bag- she's not one to figure something is futile and not fight. I've wondered if there's some comfort for her in being bundled in the bag, sort of the way newborn babies like to be swaddled. I surely hope it works for you.

Thanks so much for everything ladies!!!

I guess I got too pleased with Miralax, though.....for Casey has decided that she doesn't love tuna juice as much as she once did (I guess because she's getting it offered too ofen?). I'll have to figure out another way of consistently getting the Miralax in her. Maybe mix some with melted ice cream (which she loves) and alternate it with the tuna juice.

Laurie--me thinks you might be right about restraining Casey, period. Heck, she doesn't even like the feel of 2 hands on her at the same time! I'll come up with something--no other choice!

Hey, is there a thread on here where you all have posted pics of your fur-babies? I love seeing everyone's pets.

Have a great day,
Tracey

Tracey, you may just have to mix up a couple cc's of water with Miralax in a syringe and give it to her orally like I do with Billy. That's the only way I can make sure that Billy gets full doses. Or you could try baby food meat and see if that appeals to Casey.

You can see pics of just about all of my 4-leggeds on my website. The link is on my member page.

Laurie

Wow, Laurie.......WOW! That's about all I can come up with after reading everything you've written about your feline brood. Wow. First of all, you are a magnificent writer, as I've no doubt you've been told before. I hope you're composing all this into a book someday! You're the Joy Adamson ("Born Free") of the domesticated felines. Hey, how about a feline reality show of your household?!? You should start pitching that to Animal Planet network :-) I'd watch! It'd sure beat most of the other, people-based, ones.
Anyway, I came to the computer right before bed last night and saw your post, so I checked out your web page. If I'd only known how engrossed I'd get in your story, I'd have saved it for the morning. As it was, it was a "book I couldn't put down"....well, until I saw how late it had gotten and decided to save the last chapter or two of the Integration story for later (which I just now finished). I'll get back later and read about the doggies and irises.
I loved reading about Pea, the "chronically dissatisfied feline" That's my Casey. Actually, I looked at Billy first since that's the cat you're currently dealing with. Then I looked at Pea's page since you mentioned her, too, and her "calico-ness" temperament.
I guess life at your house is anything but boring! I can't imagine it, yet it sounds wonderful at the same time. I've always said I wanted to win the lottery so I could open a "cat house" and take in all the unwanted animals. I guess you don't get a vacation very often?

Well, the Internet has swallowed up yet another block of time..... Thanks for sharing.
Tracey

Hi Tracey,

I'm glad you enjoyed my website. I should have warned you not to start your visit at night. Sorry for the sleepless night. ;-)

Pea was my first CRF cat. She's the one to whom I administered subQs while sitting in the bathtub with her between my legs. It worked quite well since she didn't have the strength to jump out of the tub. It worked as a little corral so that I didn't have to try to restrain her. She was remarkably cooperative once she realized that escape was futile and that the fluids were actually making her feel MUCH better.

Billy has been a major concern for me lately. He was doing quite well in terms of managing his CRF and hyperT, but then be developed a tooth infection in his lower right fang. The tooth really needed to come out, but I just couldn't risk putting him under general anesthesia again, so I tried to keep the infection knocked back wtih antibiotics. Unfortunately, that only worked with the first round of antibiotics, but the infection flared up again within a week or two of stopping the antibiotics, so we had to put him back on them again. The antibiotics weren't nearly as effective the second time around.

After weighing the substantial risks of general anesthesia in a cat his age (approx. 19) with his health issues against the risks of chronic mouth pain, long term antibiotic use, and the potential for the tooth infection getting into his bloodstream and affecting other body systems, I finally decided to have the extraction done this last Thursday. As it turned out, he had to have FOUR teeth extracted. He came through the procedure fine, but his mouth is still very sore and swollen.

I'm giving him Tramadol for pain, and unfortunately I also have to give him a number of other meds for his other conditions, so I am having to force things into his painful mouth several times a day. I hate knowing that I'm causing him pain, but I know that he'll feel MUCH better once his mouth heals. I just have to keep my eye on the ultimate goal, for Billy's sake.

Boring? No, not boring. I'd love some boring. Know where I can find some?

Vacation? Wait, let me grab my dictionary and look that up. Hmm, interesting concept. Nope, none of them around here, either.

Truth be told, I wouldn't have my life any other way. The animals and I take care of each other, and we love doing it.

How are you and Casey getting along? Has your neighbor been helping you with subQs?

Laurie

Hi Laurie:

Oh gosh, I'm sorry about Billy's woes. Poor kitty and mamma, indeed! I hope his mouth is better soon, and that he's not too mad at you.

I believe you when you say you wouldn't have your life any other way....your love for the animals comes through loud and clear in your writings. After Casey, though, we'll probably have a nice vacation or two before getting on with more fur-babies (yes, plural this time!) in our lives.

No, neighbor isn't helping yet; I took Casey to the vet for her hydration yesterday, and she wasn't very cooperative there either. I hope she'll soon correlate getting fluids with feeling better! The Miralax is definitely helping her be less complaining....thank goodness.

We have a new BIG issue to deal with. My husband just accepted a new position in his company, and we'll have to move from central IL to NC! Oh Lordy, how to do this with a cat who has to pee every hour??? And that's just the traveling part of it..... I've already been brain-storming about it. Maybe renting an RV to drive there with her is the best option. That way we could stop every hour and "hang out", waiting for her to walk around and do her thing. Gosh....if you have any ideas, let me know!

Good luck with Billy and all your fur-kids.
Tracey

Hi Tracey,

Thank you for your well wishes for Billy. He is on the mend. The first few days post-extractions were not easy for him, but he's doing a lot better now. His mouth is still pretty swollen, but it's not nearly as painful as it was. He eating on his own again and acting pretty normal, so I'm very relieved.

I can understand wanting a break between animals, but that's not likely to ever happen in my household. It's quite a production here to even be able to slip into town to shop for a few hours. But my lack of vacations is more than compensated by all of the love these animals give me every day.

I wish I was close to you so that I could try and help you with Casey and her subQs. I know it has to be stressful for both of you to keep having to go to the vet for fluid administrations. If your neighbor could help get Casey more compliant with home subQs, you might be able to administer them more frequently and keep her better hydrated. You should be taking advantage of your neighbor's offer right now BEFORE you move so that she can help you and Casey get comfortable with the procedure.

Ugh. Moving. What a hassle. I think the safest option for you and Casey is to rent a vehicle large enough to accommodate a large dog crate. Then buy or borrow a large dog crate and put Casey, a litterbox, and food and water bowls in the crate and leave them there for the duration of the trip. The idea of taking Casey out of the crate during the trip terrifies me. It would be so easy for her to get loose and lost. You might be amazed how quickly a 20 yr old, sickly cat can move when she's scared and disoriented. Keep her safely confined until you reach your destination. Except ...

If this trip will take more than a day, I recommend you contact a vet in each location where you anticipate being in mid-late afternoon and make arrangements for Casey to receive daily subQ fluids during the trip and again on the day you reach your destination. It is likely that she won't eat or drink well during the trip, and in her condition you can't risk her becoming dehydrated. You need to make sure her body gets the fluids it needs during the trip.

Don't forget to get copies of all of Casey's medical records and test results. You may also need an interstate health certificate for her from your vet. Also, stock your travel vehicle with everything Casey may need on the trip - subQ fluids, IV sets, and needles (in case you can't find a vet along the route), Miralax, any other meds or supplements she's taking, food, water from home (she'll be more likely to drink water with a familiar taste), litter, scooper, baggies, clean blankets and towels (including a large blanket to cover the crate in case she's scared of traffic), a hot water bottle in case she gets chilled, etc.

Good luck with your move. I don't envy you that trip.

Laurie