Following are selected posts to the Holisticat (TM) Mailing List on the subject of subcutaneous fluids/injections. There's a lot of information here, and the posts are arranged in ascending chronological order. If there is a particular word you're looking for, it's probably best to utilize the "Find in Page" function in your edit menu!

Happy hunting :)

<7/13/98 From Sandy A Re: Sub-qs>

Hey Sandy,

Good to see you on the list.  Sorry to hear about Puff  having kidney failure:(  What are Puff's BUN, Creat, and Phos values?

[snip unrelated]
Re sub-qs: When my oldest (9 yrs old) cat, Tasha was diagnosed w/ CRF, she had already lost over 95% of her kidney function.  She was in the emergency hospital for 8 days where they flushed her body w/ IV fluids.  Then we brought her home and started her on subqs 200 ml a day.  She was only 6 lbs by then.

At first it was really hard to do it but we got good at it after 2 days or so.  Our vet was very nice and showed us how to do it, like making a tent w/ the skin at the back of the neck and going in straight w/ the needle, warming the fluids, making sure the bag hangs right so the fluid flows thru etc.  Even a major needlephobe like me could do it so there is hope for everyone out there.  If ther is someone who can give Puff some treats (we gave Beechnut strained meat) so it distracts her.

There is only 1 thing I worry about w/ subqs, okay two.  One, too much subqs can dump water in areas where it is dangerous e.g heart and lungs.  Cats can die of congestive heart failure and pulmonary edema:(  So, I wouldn't go over 100 ml a day for a cat about 7-8 lbs.  I am no vet so this is just my gut feeling.

The other thing is I feel the cat (and human) body is not designed for either IV or subq.  I'd rather feed it the way mother nature intended - via the mouth, so the body can process it appropriately.  My cat does not get subqs but then I do give him 8 syringes (1 tsp each) of herbal liquid (not tinctures; I brew the loose herbs) each day plus he drinks water on his own.  I know Lactated Ringers are supposed to have the electrolytes added back but how they do know exactly what is being flushed out along w. the toxins?  Maybe they do know, maybe all cats lose the same good and bad stuff, I dunno.  Just seems odd to me esp when
one uses saline subqs.

Personally, I'm glad that when Boo was diagnosed, I was told subqs were out of the question due to his heart problems.  This gave me time to sort of sit back and think about it whereas if the vet had said go for subqs, I would have automatically given them.  I am pretty sure my opinion is the minority one on subqs; it's just that I don't accept anything w/o questioning or trying it so YMMV.  I would say the vocal people on the CRF list are almost 100% in favor of subqs.  Don't get me wrong, I really admire
the people who take care of CRF cats but I sure wish they used non-invasive means...that would be utopia, no utopia would be where no cat ever got sick or suffered in any way <sigh>

Sandy, off to look for a place to live <ugh>

Marty, you and I will just have to agree to disagree on subqs.  I think it is not w/o risk and will continue to say so.  When I joined the CRF list more than a yr ago, I can't tell u how many people wrote to me agreeing w/ me about giving too much subqs.  SO many people said their cats died from the excess fluids around their hearts.  Even Boo's vet told me when I took him in for his polyp problem that she feels emergency vets put kitties in kidney failure in more danger by in some case, literally drowning them in fluids:(Obviously, most of us would be careful about giving too much but I reiterate my concern for the good being flushed
out w/ the bad.

I think subqs are invasive b/c I don't fancy being stuck w/ a needle in my back for anywhere from 3-10 mins depending
on the size of the needle and amt given, and fluids forced into me a very "natural" approach.  As I said before, YMMV, and yours clearly does.  In the wild, I would expect a cat to seek out herbs and food that will help them but I don't expect them sitting around giving each other subqs anytime soon!

A vet who I am friendly w/ (alas she doesn't live in SoCal) just wrote back to my query on subqs that she (allo, btw) too feels subqs are a "very crude way to deal with CRF" but they don't have any other techniques in their arsenal besides that and lo-protein diets so I'm not sure where that leaves us.

In Boo's case, the specialists and regular allo vets said subqs are too dangerous given his heart problems so my  questions to them about subq are purely academic at this point.  Heaven forbid, I ever have to hear the dreaded acronym, CRF, again for any of my 3 precious daughter cats.

Sandy

HI Sandy

<<So I don't know, for right now I prefer the lab assistances doing it. But I can see that at some point I will need to do it at home.  Can you tell me about you experience with it.  Any tips & tricks?>>

I had to do the sub-q's for several years (first weekly then later, daily) for my Old Lady Cat Bonnie.  My vet was WONDERFUL!  She showed me the in's and out's of doing sub-q's.  I had a someone hold Bonnie at first, as she would try to head for the hills when I poked her with the needle.  I used a LARGE syringe with an IV tube attachment.  I would take the fluids from the "belly button" of the bag with an 18 g needle.  I would attach the IV tube to the syringe and switch to a smaller g needle (usually a 22 g) so as not to leave a gaping hole in Bonnie's back. (The vet's always recommended using the 18 g HUGE needle for the sub-q's into
the cat.  I tried it, but found the smaller one worked just as well and was much more "comfortable" for Bonnie)  We'd sit in a quiet area with the TV on, while I "pumped her up" with the fluids (Lactated Ringers)

Recently, since I've had my Himalayan, Maggie the Muffinhead, come down with cystitis, I've had to start the sub-qs again.  This vet (a different one) didn't give me a syringe and said to just take the IV line directly from the bag to the cat.  "It's easier" they said.  HUH!  It takes FOREVER!  And when you have a "happy " cat to begin with, you need it done NOW!

My opinion, which may not count for a hill of cat litter, is that syringe sub-qs are infinately easier than "bag iv lines", for speed and accurate dosing.

Good luck.
Release...., Kristy

Kaylen,

prayers are being sent to you and Baranof. Don't worry about giving sub q fluids at home; only us humans are terrified of it. I'm terrified of needles and have passed out on several occasions from the sight of them, but I put that aside and did what I had to do for Wiley.

<<I have to take him in every day for fluids.  I can manage this for about a week and a half and then I'm going to have to do it myself for financial reasons.>>

if you warm the bag in hot tap water up to about cat body temp, it actually feels good going in. hang the bag high enough so gravity helps you out. Have the vet or vet tech show you how to do it. a smaller needle will take a little longer, but be more comfortable for him. A bigger needle is better if you want to get it over with more quickly, or if he's squirmy and won't sir still. They barely feel it if you inject them in the scruff. I had a special pillow set up under a lamp so it was a safe comfort zone for him. He even napped there when fluids were not scheduled. But he knew that when I put him up there, it was fluids time.

You must not be scared. Baranof will pick up on that. What you are doing here is providing him with the best care available; have that confidence when you administer the fluids. He loves you, and will forgive you being nervous, but calm yourself down, and remember, vets and techs do this all the time. So can you. He's your baby, and who else but you could administer them with the love and tenderness that you can? So make it a therapeutic experience for both of you. Repeat to yourself over and over that this is helping him get healthy and strong. Make it a prayer. Thank God for the strength that he is giving you to be able to care for Baranof in this way. Praise B. for being so brave. In my case, wiley was brave for both of us. It does get easier after you've done it for a while. Oh, and welcome to the list!!

Sue

Here are some links that may help

• CRF support: http://www.best.com/%7Elynxpt/recep2.htm
• sub Q info: http://members.aol.com/aquila111/subq/  (most helpful for me)
• http://www.best.com/~lynxpt/managb.htm
• http://pricemd.com/felinediabetes/inject.htm

Kaylen,

Before you inject the needle, you can let the bubbles run out.  Tiny bubbles won't hurt your kitty- I was scared about that at first too.  I was confused thinking it would cause an embolism, etc, but it won't.  I think someone on one of the other postings said it will help your comfort and confidence to visualize how much better your kitty will feel and to visualize yourself doing it with confidence and compassion.  that approach helped me too.  I was very nervous at first, too--my hands shook, but it does really get easier.  You can do it--hang in there!

Linda M

Hi all,

[snip unrelated]

As for subqs, here's my $0.02 based on our experiences w/ it in Tasha's case (could not give 'em to Booey b/c of his  cardiomyopathy):

• 1. Get your vet to write a prescription for subqs, and order them from Valley Vet or KV Vet supply - http://www.kvvet.com    (that's 2 vs)  W/ a $40+ order, S&H is free.  They also have needles and the rest of the set-up.  My vet is not money-grubbing, so she cut me a deal on it, and i never dealt w/ KV and gang but if T had lived longer, I might have due to the cost.
• 2. Have your vet show u how to do the subqs.  My vet was very nice in this regard and John and I had no trouble doing it on our own thanks to her demonstration.  Here's how we did it:
• John knelt over T holding her between his legs w/ her back to him
• Meanwhile I had heated the fluid bag in a sink of hot water.  I always put in a new needle each time (no point taking chances w/ infection)
• I ran the fluid so if there was any cold fluid, it would make its way out of the line.  I ran it over my hand to ensure it was warm (cats have higher body temps so the fluid has to be warm or it is very uncomfortable for them)
• John then made a tent of sorts by folding the skin on the back of her neck area
• He put the needle thru this tent at an angle from top (move to a slightly diff spot each time so as not to develop scar tissue)
• Make sure the fluid is going in, and when u reach the desired amount e.g 100ml or whatever, take the needle out, and hold the area where the needle went in gently or else fluid can squirt back out sometimes.

A caution about the needles - we tried #18 - #22 all of 'em at one time or another to see which was better for Tashie.  The larger the #, the finer the needle, hence less uncomfortable.  But then it takes longer to administer the fluids.  So u'll have to see for yourself which is the better option for you and your cat.  Let's face it - subqs are invasive as defined by allo medicine; the skin is pierced after all.  So I can see why someone dedicated to non-invasive procedures would have probs w/ this.  I struggled w/ this issue too.

BTW, subqs, force feedings, and other such types of care are not for everyone.  And the wonderful vet on the CRF list has checked in on this issue from time to time saying that while subqs might mean lower #s for BUN and Creat on the blood tests (do the math - more liquid in the body) they *may* stress the kidneys to where the net effect may not be all on the + side of the column.  If someone can't give subqs for whatever reason, pls don't beat yourself up over it.  subqs didn't help my first cat, and I don't think they would have my 2nd cat even if I could have given 'em so I'm not 100% convinced yet about them.  It is one of many tools we have in the arsenal so use it if it works for your cat, is what I'm trying to say here.

[snip unrelated]

Sandy, owned and operated by the mountain cats - Hunny Bunny, Missy, Pigpen, plus Booey and Tasha (in spirit)

<<The vet wanted to have Baranof in the hospital for 3 days doing fluids with "no guarantee" .  Do you think it is worthwhile?>>

Depends.  Usually when a cat is first diagnosed w/ kidney failure, vets give IV (as opposed to subcutaneous) fluids to flush out the toxins.  This is rough on the cat but I suppose it sorta works b/c it gets them out of crisis mode.  My vet (allo) is very opposed to IV fluids and not a big fan of subqs either.  I asked her many times about giving them to Boo and in his case, I could definitely understand why she was so against it.

Anyway, after the IV fluids initially, some vets will suggest giving subqs at home.  At the emergency hospital where I took Tashie, the vets were divided - 1/2 were real proponents of subqs whereas the other 1/2 didn't rely on subqs at all (in their regular practice) so looks like there are 2 schools of thought on this.  Be that as it may, there are never any "guarantees" anyhow, are there?:(

<<Wish me luck as I have to do his first at-home fluids today in a couple of hours. I'm going to heat up the bathroom with the
space heater. >>

Good idea.  Make it as pleasant as possible an event as u can w/ placing him on a warm towel, treats, lots of soft cooing etc.

One other thing I just thought of - hang the bag of subqs from a hanger on a hook above kitty level so the fluid flows more easily. Forgot to include that yesterday.

<<Do you think wrapping the bag in a heating pad would work to heat up the fluid? >>

I doubt it would warm it enough.  Yesterday I was in a lot of pain and put my heating pad on hi, and it barely felt warm against my skin.  I'd just fill up the sink w/ hot water, and soak it for a few mins.

Hope the first subq went/goes well.  Not to worry tho; first time is really tough but it does get easier.  Some cats actually like the subqs so u never know, your kitty may be one of them:)

As someone whose been there, do what I tried hard to do too - stay focused, positive, and in the moment.

All our best.
Sandy and the mountain cats

Dawn,

Here's one more thing:  http://members.aol.com/aquila111/subq/  this page is really informative!

sue

<<It's rather remote that Baranoff would be allergic to Ringers.  >>

Hi Kidz,

Maybe not an allergic reaction, but some type of reaction!  My Sammy gets LR's too, and normally I would warm them up so not to give him a system shock.  For the longest time I couldn't figure out why after each and every sub-q treatment Sammy would throw up during the nite.  Then I read in the newspaper that EPA found that there was a chemical called DEHP that was leaching into the fluids from the plastic.  I phoned the pharmaceutical company and was told that warming the fluids was not
recommended.  She didn't say this, but I think warming the bag makes the chemical leach out faster or more.  Since then I have not warmed the fluids, but Sammy is fidgety now, whereas he wasn't before -- but he isn't throwing up in the nite any longer.  Next time I'm gonna try to warm the tubing, keeping it in a heating pad while administering the fluids.