14-yo Cat NEW to Sub-Q, kidney/constipation - advice?

[u2girlcj]

Hi everyone,
Wow. what an awful lot I've already learned going through some of these discussions.

My guy Macphisto (Mac) fell off the bed Thanksgiving week and didn't seem to be walking well. Since he's 14, I assumed some kind of vision problem and got a vet appointment for the day after Thanksgiving. My husband had been out of town and said it looked like Mac had lost a bunch of weight. The night before the appt, I was petting Mac and could feel a large lump in his rear side. All of a sudden I expected the worst.

His "twin" brother went first in the check up and sailed through with flying colors. As in, the vet said he didn't even look or sound as old as 14.

Then I brought Macphisto out and as she worked her way back, I knew something was bad. She too, thought he had a tumor at the very first, but as she worked her hand around it, found that it could move - he was severely constipated.

That day he was put under and the vet was able to work out what had built up to a small fist-size stool. He also had a full blood and urine analysis and his kidney levels were off, he was dehydrated, and he was down nearly 5 pounds from a couple years ago. He stayed on an IV fluids drip all day and we were able to bring him home that evening.

Ugh.

We spent a week waiting for him to have a stool in the litter box, with an enema thrown in there, meds to increase his appetite (cyproheptadine) and soften the stool (lactulose), and another vet visit where a different vet said it didn't look good for him and to be ready for letting him go soon. A great vet tech taught me how to do the sub-q fluids at home, which we started over the weekend.

We spent an entire Sunday getting ready (as if you can) to come to terms with probably having to put him down, since he hadn't pooped in 3 days and seemed very shaky - we were reading that as pain.

Monday AM at the vet, he perked up, wandered the office, opened one of the drawers, and the vet must have thought we were crazy for coming in all doom-and-gloom. He said Mac had showed low potassium levels, which can result in shaking...as long as he was still walking around and showing us some attention, he wasn't in that much pain. So now Mac is taking a (really large!) Renakare potassium pill 2 times a day. His weight was up half a pound, and he does seem to be enjoying life a bit more and REALLY appreciates a good massage.

I've become a litter-box-watching hawk. He has had at least one or two stools since Monday and I'm taking him in this afternoon for a weight check and to pick up more fluids.

What I would love advice on is in regards to Sub-Q fluids - if anyone has done this for a long period of time.
I am doing it once a day and got a little scab on him - how much area can I really use his back, because I worry about how quickly it heals and when it bleeds, it freaks me out. The needle is rather large and I don't want to be pricking the same spot too often, but it doesn't feel like I have a lot of space back there.
I will also ask the vet today, but he did vomit afer fluids the last two nights. Normal?
It feels like sometimes the fluids go in really fast - at a steady flow instead of a drip. Do I need to slow them down?

We figured out a good spot for him to sit - on the sofa in front of the space heater and I hang the fluids from a china hutch nearby. He does it with minimal squirming. I think we could do this daily if needed. I just worry about him getting constipated again - becasue the enema was NOT his favorite. And of course there's my GUILT over letting him get so stopped up in the first place

If anyone has a good video link or techniques for feeling where the stool/colon/whatever is, I would love to see or hear. I know the vet has given him a bit of a massage to get things moving, and if I can do that at home, I'd love to help him out Coming so close to the edge with this guy and then seeing him perk up has been so scary, but so beautiful - especially seeing his otherwise alpha-cat brother treat him so, so well. Hoping we have lots of time left together

Thanks so much!
CC

[cricketsmom]

Welcome! and Kudos to you for working so hard to help your buddy. I'm glad he's been having some successful bowel movements now. His tract is probably going to be irritated for a while and he could develop mega colon from the stretching so I agree massage is a good thing to do. I have to do that a bit with my cat. A tail injury caused her to be urinary incontinent and her bowel tract is slow. Since she can't push the poops out, they just fall out or I help them fall out. When I express her I often check to see how much is in her tract, and if they feel large or long, I gently squeeze them to break them up and push them toward her tail a bit. For her that's all she needs to keep things moving. Have your vet or someone else there show you exactly where to feel for the colon.
About subq fluids, I haven't had to do it long term on anyone, but I have had to do it many times in my job. If the rate of flow is full drip, that's ok. Since it's just going under the skin it won't hurt him. That's also why the needle is large. Technically, you can use any area where you can pick up a tent of skin and not hit a blood vessel, but the farther back from the neck you go the more sensitive their skin is. I would tend to stay around the back of the neck and the shoulder area, and you can also go behind the elbow. I wouldn't worry too much about the scab right now. Just wipe the area off with a warm wet cloth if it bleeds. The vomiting probably wouldn't be related to the fluids... More likely it's from food or medication upsetting his stomach.
Good luck and hope his appointment went well yesterday!

[Jean]

Hi CC,
Glad your fellow Mac is better !!! It is amazing the difference that is seen with subQ fluids. I gave my kitty Greyling fluids 2x a day for the last 7 years of his life. We would snuggle on the couch in the evenings and watch Seinfeld while the warm fluids hydrated my boy. I gave the fluids in his shoulder area and the back of the neck where the skin is loose.
Greyling also had constipation issues and he received Lactulose and plain canned pumpkin.
Like Cricket's mom suggested I would have your Vet or tech show you how to ease stool through Mac's colon. With a normal kitty they might squirm a little but I do this 2x daily with my paralyzed cats and dogs and my kitties with Manx syndrome.
Greyling was also on meds for nausea occassionally but I can't remember what specific drug was used.
Good luck with Mac. He will appreciate all you do to make him comfortable and your bond with him will deepen as you care for him. /Jean
PS: I use a 20 gauge needle that is 3/4 " long for fluids.
Is Mac on a low protein kidney diet?
With my paralyzed kitties I give subQ fluids below the point of paralysis so that they can't feel the needle prick. Jaime and Caramel Apple my paralyzed kitties are biters. But, with Mac who is normal neurologically stick to the neck and shoulder area.

[CarolC]

Here is a great website for the way you are doing it. If your kitty is comfortable doing it the way you are doing it, you probably want to stick with that.

http://weirdstuffwemake.com/weird/stuff ... juice.html

I gave fluids to my Himalayan 2x a day for 3 years, and we did it differently. I will describe it, just so you know the option. I learned this watching an emergency hospital vet tech do it. I gave fluids using large syringes, rather than by drip. In other words, I squirted them under her skin with large hypodermic syringes. I would put the bag of fluids in warm water. It was propped up on a stainless steel cheese grater because that kept the bag from slipping down into the water--see attached. When the bag was warm, I would hang it up on the cupboard door and swab the rubber port with sterile gauze and iodine, then get 3 big empty syringes. (I had 60 ml and 35 ml syringes--see attached--and would combine them to get the right amount of fluids, depending on how much we were giving.) I would put a large 18g needle on one syringe, poke it in the rubber port and draw out fluids till the syringe was full, then remove it from the port. I would take the needle off that syringe and put it on another one. (the full syringe does not dribble even if you lay it on its side). I would then poke syringe number two into the rubber port, fill it, and repeat with syringe number 3 if needed. Now I had 3 big syringes full of warm fluids. Discard the first needle. I would get a smaller needle, size 21g, and put it onto one of the syringes, and carry them to where my cat was resting. I would lay the 2 extra syringes down next to her, and pull up the tent of skin and poke the needle in and squeeze the fluids of the first syringe under her skin, then hold the needle in place in her skin, pull only the barrel of the syringe off the needle, take the next syringe, attach it to the needle and squeeze it empty, remove it while keeping the needle still in her skin, put the third barrel on, and empty that. When the last one was empty, I would remove the needle from her skin. So she was only poked once. Doing it this way had some advantages. Even though it was a smaller needle, it went fast because you squeezed the fluids in, you did not wait for them to drip in. I had to do this on my lunch hour so being quick was important to me. Also, you could take the fluids to the kitty, rather than having to disturb the cat by bringing the cat to the fluids. The small needle meant we never had scabs or sore spots, even doing it twice a day for 3 years. About the only disadvantage was you used twice as many needles--see attached--but it was worth it.

The vomiting you describe is not normal. I don't know what it is, I would ask the vet about that. My cat felt better after her fluids, she liked them, she would rub her chin on me while I was administering the fluids.

Here are links to examples of massaging the colon. A couple of the videos may seem a little rough but hopefully they will help.

http://www.youtube.com/watch?v=HVdJI-qsOus
http://www.youtube.com/watch?v=KIFTKuR9-uc
http://v.youku.com/v_show/id_XMTczNjAzOTk2.html
http://www.youtube.com/watch?v=LbVxdFyGKjs

You know, you still have other options besides giving up if he gets constipated again. There is a medication that increases the action of the colon, called cisapride. From what I've heard, it isn't something you would want to use long term, ask the vet. Also, they can do surgery to remove the part of the colon that is stretched, if the problem keeps coming back.

[critters]

With my monsters, I've almost always shot it in as fast as possible because they're usually the uncooperative sort.

[CarolC]

Just remembered this thread, where someone said Miralax is better than lactulose, and there is a yahoogroup dedicated to this condition. I haven't tried Miralax, I've used lactulose for both cats and dogs and like it.

http://handicappedpet.net/helppets/view ... 358#p82063