what type of fluid do use and why?

wasabipea

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Lactated ringers? Dextrose? Plain saline? Does it make a huge difference?
I'm confused, again. My vet kind of gave up customizing my cat's treatment (I'm seeing another vet on Monday, he seems nice) Hopefully he can give me some recs with explanations attached...
Thanks (again) -
 

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When I had a really sick cat (later found out he had a brain tumor) and wouldn't eat or drink, I was given Lactated Ringer's to give him.  I am sure someone else with more knowledge will give you more advice.  I hope your cat feels better soon.
 
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cocheezie

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I use the 0.9 saline solution because that is what I was initially given and the vet has never said otherwise. Lactated Ringers contains saline, potassium, and calcium. It depends, I'm assuming, on your cat's potassium levels. Is this new vet at the same place? If not, you should bring recent copies of any blood panels with you so the new vet can get an idea of what to advise.
 

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The fluids I use depend on what the cat is being treated for. For my CRF cats I use Lactated Ringers, since they can use the extra nutrition in it. For a cat that is sick and dehydrated I use NaCl because it has a faster uptake. Dextrose shouldn't be used subq as it can cause sloughing of the skin, but is great IV for a cat that needs nutrition. For a diabetic cat never use anything that has any sugar in it, it will raise BG, and that's a whole new set of problems! I wish you luck at the vet's and I hope you get the answer for the correct fluid to use. 
 

quiet

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Lactated Ringers unless directed otherwise.can use 0.9 saline provided sodium levels are ok. Can also use Norm.R. but the LRS is the standard. Never ever use any dextrose subq.Dextrose is a breeding ground for bacteria
 

that guy

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Mine has renal failure and IBD and I give him 150ml of Lactated Ringer every day to stop dehydration and help flush out toxins.
 
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wasabipea

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I have four blood panels to bring, the last one was at the end of July when they decided to write her off as dead. I think she should be getting LRS too, but God Forbid I question my vet. She told me the cat had stomach cancer (I think) early July. I lost a cat to stomach cancer and I've seen it. I could be in denial, but I think something else is going on.

Back to fluids, i don't see anything labeled high, except her white blood cells (various forms of WBCs, all high, steadily increasing even with AB treatment - and her creatinine and urea on the low end of high.

The new vet is an entirely different practice, not only am I bent at the attitude, Roni comes home sad and usually doesn't eat the next day - even just for a fluids visit (if she is being difficult and I can't get them in).

Anyway tomorrow I have 1 cat, 4 blood readings, all since May, and 1 X-ray visiting what seems to be a compassionate vet. She is on .9 sodium(?) now. I'm questioning that since the mild head tremor the other day and think I read that can be a sign of low calcium.

Guess we'll see what the (new) vet says. I hope she likes him - lol.
 
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wasabipea

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Well re: fluids. She was prescribed Normasol-R, which has some added nutrients to it over the regular saline. I read on Tanya's site that for some cats it stings, I think it might sting her because I get the needle in and as soon as the warmed fluids start flowing, she starts with the whimpering.

Does anyone else use this fluid and have this problem?
 

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I guess you would need to check why she needs this type of fluid especially if it hurts her. My cat has failing kidneys and IBD yet he eats like a horse and is nothing but skin and bones. He was given standard Lactate Ringers to keep him hydrated and we are worrying about nutrients orally. Check if there is no way to get her what is in the sub-q liquid into her in some other way. If it is failing kidneys then the important part is keeping her hydrated and reduce her stress. I have had some injections where it was really bothering him so I abort and move the needle and it is better again. I just finished the sub-q on my guy and he made a bit of noise when the needle was going in but for the most part he was comfy after that.

If she is making noise then at a guess I would say she does not like where the needle is paced because it is contacting something perhaps. She does not like the feel of the liquid going into her because it is too cold/hot. She makes noise because this fluid stings and it either hurts her or it is uncomfortable. I give my guy 150ml and it probably takes 8 - 10 minutes to do the procedure at a guess. Over the countless sub-q's given he has gotten used to it and is usually very relaxed. This is him getting a sub-q, he is lying on a folded up sheet that is on egg crate foam which is sitting on a dining room chair. He just jumps on up and then gets comfy and the procedure begins. He knows it is coming so I wait for him to come to me and then pet him and talk to him (with my head close to him, I think he is partially deaf still) and gently get some skin and go at it.


I think it is most likely the type of fluid as you have mentioned it does hurt in some cats and yours is probably one. Check with your vet and see if there is another type of fluid you can use such as Lactated Ringer which is painless.
 
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wasabipea

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I did leave a message via email with the vet, he's not in the office today. He said he rarely prescribes LRS - told me why and I forgot. He sent her home with the Normasol-R (no dextrose) since it was infused with electrolytes. turns out her potassium, calcium and phosphorus are all in the normal range, I was concerned about giving her too much potassuim which has a host of other problems, but he said that fluid therapy will flush out electrolytes, so he doesn't see her getting too much potassium. Does LRS include electrolytes? I just want to get this down and get into a routine... first it was the needles - now I got the Terumo (which take longer than I was hoping for to administer), and now it's the fluid. At this rate, she's going to go into a total boycott.

Last night we went thru seven needles, because as soon as the fluid hit (and I primed the line down to the warm part) she would move and the needle would come out and land on some unsavory spot and I'm sure was contaminated. Before we tried this new solution, once the needle gets in, she will settle into cat-loaf position and generaly wait it out. Last night it was definitely when the fluid hit her, and she is very used to that sensation - I think she even likes the warmth. Last night I had to hold her by the scruff of the neck just to get 100 into her, and who wants to do that?

I just want us to be able to get to that point that you are at, where she accepts it, doesn't fight it and can be relaxed for it. It has happened, I know it can again.

What size Terumo is that in your pic? I got 20G UTW, but thinking of going to 19G TW to get it over with faster, she gets fidgety. Those 18G monojects are just not good for either of us, even tho they get the job done quick.

BTW, I recall you telling me your kitty was 19. When my new vet gave roni her exam, he asked about he hearing. I told him it had diminished, but she could still hear, he said most cats are totally deaf by 18. That surprised me. You are lucky your kitty can still hear you a little.

And regarding nutrients, she loves her Nutrical - so I supplement her with that daily - it's loaded with vitamins. Has your vet ever mentioned vitamin D to you? Mine brought that up at some point (I was overwhelmed) - he suspects she may have IBD as well, not the stomach cancer the other vet was pointing at. I'm not sure if the Vit D was in reference to CKD or IBD.

He actually sent me a copy of his notes via email, very handy. I'll have to go over them again.
 
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quiet

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Hi;

Sorry didn't have time to read all the replies. Just got a new computer because my old one broke and I am not used to the key board yet so also excuse any typos. I hate change!!

See if the vet will give you LRS lactated ringers solution. I wouldn't see why she wouldn't. It is you basic fluids. I have never had it sting a cat. Are you using the same spot every time you do the fluids? Also I don't know how much they want you giving but lets pretend it is 100mls. You don't have to give the entire 100mls all at once. You can give 50mls. and if she gets anxious then stop and give the other 50 mls. later on. The total amount is usually with in a 24 hour period of time. So you can even do 25mls. 4 times a day. Some cats find having allot of fluids in one spot to be uncomfortable especially when it is a smaller cat. You are using the smaller size needle right? The 20 gage.? I hate this computer. Anyway, make sure that you hang the fluid bag as high as you can from the cat so that the line goes in a straight line down to the cat without any dips or curves. Also, and do all this before you get the cat involved, open up the.....

Well, the above was the a start of a huge reply I wrote you last night before my new computer decided that it hates this site. GRRRRRRR It keeps saying that the catsite is not responding. Well I tell you what I am about to respond to this new computer by throwing it out the window.

I need to write a bit to you and I have to go now as a storm is coming in and my horse is still partially blue. So I will try to ....

open the roller clamp thing and check the line to make sure it isn't flattened from use if it is you can try to unsquish it with your fingers but you may need to get a new line.

When you insert the needle it goes bevel up and in horizontally, in the shoulder scruff area that you are holding up in a triangle to be able to insert the needle but not go through the skin. You go in the direction away from the head with the needle pointing towards the tail. Then you turn the dial and run your fluids. After about
 

quiet

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I hate this computer

anyway. You don't have to give all the fluids at one time. Don't ever fight with her about it because what happens is what happens with my horse and baths and why she is blue. They develop a very real fear associated with the bad experience. End always on a good note. How do you do that? by stopping before it becomes bad. It seems to me to take 100 good times to counter act one bad time with horses and I don't know if you can undo a bad time with a cat but I would figure they are a bit more forgiving. Cats are predator/prey. That means they have a huge instinctive fear of being caught or held down or captured. That is why I compare them to horses allot because I have found some of the same types of reactions in cats that are in horses. Only thing is the horse is missing the predator part.

Poor quality writing here.

So if you have to give 100cc. You give 50 and she is doing great with you just stop and finish the other 50 later on. Don't have any sessions with her like I did with my horse last night covered in blue shampoo with several people {trainers} trying to help me get her into a wash rack and ending up with them saying "wow she has a really bad temper...don't get hurt. " So, I only say this so you know I can relate, there I was with a really reactive crazy horse that is now bright blue with her eyes about to pop out of her head and she is rearing and I am pissed off and embarrassed and in a hurry and all the other human things that animals just don't understand. So, I dropped the whip ( I don't beat her it is to keep her from running me over) and we went for a walk. We had some food. She had some quiet time alone in her corral. We visited one of her horse friends. Then about two horse later she stood there like a perfect horse and let me hose her down. Of course by then it was almost dark and she is going to be blue until she grows out I think. But the point is you just cannot fight with them. None of them. Dogs maybe a bit but they are predators. And by fight I mean talk them into doing things your way. Cats will never say "Oh, yes good idea lets do it your way" .

I do have to run now and hopefully this will help alittle. Glad you have the new vet and Norm R has different electrolyte balance than LRS both are fine. None of the fluids have any sort of nutrician to them other than the electrolytes. No nutriants.
 
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wasabipea

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No worries, quiet - I gotcha. I hate typing on my tablet because sometimes the browser just shuts down and then I try to fix typos and I can't get the cursor in the right spot and it auto corrects half the time and then I go to edit and it crashes. Speaking of cat site problems, I was having network error problems earlier - right after I answed a PM with a relatively lengthy answer. Luckily the Back button retrieved my message but I didn't want to type it all over again.

Your poor blue horse, you think the shampoo has a dye in it that just dyed her fur? Well, she'll be a jaunty little thing for the next few months! Talk of the town! Sorry you had such a hard time getting her cleaned up, shampooing a horse can't be easy, especially an unhappy one.

I know what you mean about not making it a bad experience for her, and we're in the start of it all... so now getting it right is crucial. she was really good for a couple of times, perfect actually, then one day she acted up very badly and and I was in a terrible mood to begin with. It got ugly and I should have had the self control to control my patience, but, alas... she not no fluids that night and the next night I took her to the vet to avoid a repeat (plus she needed the fluids). This was the previous vet, I don't know what's going on there but she used to be fine with going to that office but lately something changed. The day after she is very depressed and doesn't eat that much, so I'm really trying to avoid taking her there anymore.

I know what you mean about giving her 50 ml once and another 50 ml later, but I'm really trying to establish a routine so every time I approach her she doesn't think a needle is going to get poked in her, just so she had some kind of idea when to expect it.

Yes, I'm using 20 G Terumo Ultra thin walls, I was led to believe that they deliver almost as fast as a monoject 18G, but when I look at the chart on Tanya's site, 200 mls is almost a minute longer. Also having a hard time keeping that long line straight with no kinks and "up and down" placement. It's sooooo long.

She wasn't being horrible last night, she just kept on twitching or jumping a little and the needle would fall out, and me being one person... and a newbie, it was tough. I was trying not to give in because then she will learn that all she has to do is act up and I'll stop, she knows I'm a softie... It's a fine line getting this established. When I had her by the scruff and the 100 was dripping into her, I was scratching her behind the ears and giving her "good girl"s and trying to be soothing, but she still wasn't happy (she has drama queen tendencies, no doubt). Afterwards I gave her some of her favorite food and petted and gave her lots of loving.

I'm going to use the plain saline tonight until I can talk to the vet about my concerns about the Norm-R. Maybe, hopefully it will go better.

I don't know what happened, she was doing so well for a few days. I saw something on Tanya's site about them being realy good in the beginning and then revolting after a few days and that is common. I'll have to go back and she if there is any more info regarding that.

Hope all is going better with your horse and everyone is calmed down (and clean!).
 

that guy

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Scratchy turned 19 on May 25th and it is always hard to say with cats and hearing, either they have a hard time hearing you or they don't really care. He had infections in each ear late last year and he was deaf then but part of his hearing seems to have come back but I don't know what range he can hear or not. He does cry at times when he is looking for someone which is common when they are hard of hearing. I have littered my house with night lights so he can easily see in the dark which seems to have helped with this.

I am currently using 21 gauge UTW needles and it is slower than both the 20 gauge UTW and 18 gauge UTW but it is easier for him. I don't rush the sub-q and as long as the needle is in a good place he is usually good and doesn't try to move. I took the pic above and I was able to remove the camera from the bag and turn it on and take the pic and he did not move. Most of the time he tries to capture a hand or arm then puts his head on it and crashes. I use the lines on the bag as a rough measurement and then using a small hanging digital scale to ensure I get the correct weight of fluid in him. To warm the bag I use a reptile heating pad made for aquariums and then plug this into an Arduino controller with a temp probe and this brings it to exactly 92 degrees.

For easy use I do not wrap the hose up and keep it as straight as possible and when I heat the bad I stretch the end out flat and put it under the bag which helps take the kink out of it. If she is an IBD cat then typically her stools will be very wet and or she may also throw up a bit or a lot and it is typically a lot of water with food. I don't have a carpet in the house where he has access that does not have stains on it from him throwing up. Last night it was a 03:45 wake up call with him throwing up, this time it was in his litter box but thankfully he didn't get too much on himself so the clean up was rather easy. He did pretty good, he made it just over 4 days without throwing up which is fairly good for this guy.

I would look at the solution you are putting into her and see if you can't change this, if it is stinging her then it better be used for a good reason because this makes it hard on both of you. I will usually do the injection and then pull his hair back around the needle so I can see where it went into the skin. I start the drip at a very slow rate with one hand and i hold the needle in place with the other so it doesn't move. If it is not in right then it will push out so I see this right off or feel it and typically liquid will start backing out as well. I have had a few where I had to hold the needle in place most of the time or it want to back out but he felt nothing so I let it go. If the needle sticks and does not want to come out then I just check it every 30 seconds or a minute to make sure it is good. If the flow is good and nothing is backing out then I turn up the flow about 4 times in increments until it is going full blast. If the flow is slow I will also pull the needle out just a bit and this will help at times to increase the flow. I also make sure the needle is going in with the cut away part facing away from his body. This is what I use on Scratchy and this is what the label says...

Braun Lactated Ringer's Injection UPS (Ref - 7500):

Sodium Chloride

Sodium Latate

Potassium Chloride

Calcium Chloride

Water

Calc.Osmolarity

Electrolites

Ca++ 3

All things considered you are doing exceptionally well and in time it will get better and better until it is like giving her food or treats. But, and there always is a but, if the fluid or procedure hurts her it will get harder and harder to give this to her which is why it is important to use the correct fluid. Keep in mind that sick kitties don't always want to get fluid either. If she is not eating or feeling well then you may have to let it go until later or even the next day. My guy is good and will come for his sub-q but if he is not feeling well then I just let it be even though I know he needs this fluid every day because there has to be a balance. If I turn it into a fight then it will just get harder and harder and this is not good for him. Thankfully he is good for a sub-q most of the time and it is not often that he misses one. I used to always have at least one person here to help all of the time and then I was abandoned for a few weeks and it was just myself. I found that I sucked at it and I am lucky if I can do it with just one needle a lot of the time but he is much happier this way so I have kept it up. I used to keep him calm and someone else did the injection but now I do it all and it works out well and he usually purrs right through the whole thing.

Check your fluids and keep at it because you are really helping her out. I don't buy any of this keeping her/him past their time as long as they are mostly happy which it sounds like it is the case with you so keep it up. If you think she may have IBD then check into it because it can be managed just like renal failure and they can have a mostly happy retirement. Keep in she is around 90 years old in our age so she is doing pretty well all things considered.
 
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wasabipea

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Thanks for your info packed reply
.

The fluids went much better last night when I went back to the saline. Only went thru one poke and one needle, she sat there in catloaf position and purred the whole time. I had to take my hand off her a couple of times to check the bag, this one is very hard to read because there is very little air in there, so the fluid line isn't very visible. Towards the end, she took off when I took my hand off her, but I think it's because she really had to pee - because that straight where she went. But if I had to guess, I'd say we got a good 125cc or so, so I was fine with that - especialy since it went off without a hitch to speak of.

I am going to push for the Lactated ringers, I just don't want to annoy this new vet with contradicting his prescriptions right off the bat. I think that's what blew my relatinship with my other one, I would question her treatments as to why and suggest "what do you think of this?" and she often didn't have an answer or would dismiss me. BUT, if the fluid isn't going to work - that's major. As long as it's balanced with elecrolytes (seems Norm-R and LRS both are) them I'm ok with that. He said that flushing out the cat with plain fluid, also flushes out electrolytes. So... onward.

I appreciate your support very much and do plan to keep at it, she does much bettter when she is getting them regularly. She was diagnosed with eraly stage CKD 5 yrs ago, and stayed stable with no treatment. Now, even though it will do me no good, if I had taken it more seriously then and things would be different... but we can't change the past.

The vet mentioned possible IBD, which I think could be an issue but I will talk to him more about that when the rest of the urine cultures come through. I wonder if there is a definitive test for that or if they just peek around via ultrasound (which I'm still leaning against, if I were a millionaire I'd say "no problem, go for it"... but I'm not). The only symptom she has is the varying emissions in the litter box, sometimes they are normal - sometimes loose. she rarely throws up, if she does it's usually caused by a hairball or a piece of grass. She eats most days, has maintained her weight - she actually looks really good for her age, and I swear that Nutrical vitamin gel does wonders for her coat. She is so soft and shiny. @That Guy  - your kitty looks like he has a really nice shiny coat too, especially for 19! I'm actually thinking Roni might make 19, too. If you'd asked me two months ago I would have said "no way". Her birthday is sometime in Jan, so was Len's (my recently departed Rainbow bridge boy), and so is mine... so I made us all the same day.

To warm my fluids, I usually just immerse it in warm/hot water with the ports out of the water and go by feel. I got a pretty good feel of what it should feel like (the new vets office has something like the opposite of a refrigerator, it's a warmer, and they store their bags of fluid in there. Nice touch I thought. So what I originally thought was too warm was the temp the vet used, so I'm kind of guessing at the moment.

Unfortunately little girl has fleas, not a terrible case - but a few here and there. I had to put Advantage on her last night, much to my chagrin. That gets applied to the back of their head/neck and supposedly eventually covers the cat. I applied it after the fluids. Since she gets sub-q'ed under her shoulderblades, I'm wondering if the presence of the advantage in the general area would be bad for when I inject. I doubt it, but I wouldn't want to inject it in through the needle poke and get those chemicals under her skin.

Oh so many worries.
 

micknsnicks2mom

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my snick gets sodium chloride 9% solution for her sub-q's. we started off with lactated ringers, but after snick's blood calcium level became and stayed elevated, we were switched over to sodium chloride. snick has been diagnosed with idiopathic hypercalcemia, and her calcium level moves up/down quite a bit. july's bloodwork was the first time in months (maybe a year?) that snick's calcium level was in the normal range. snick gets the sub-q's for her CKD (she's currently stage 2). she also has IBD.

fyi -- we had planned to have the ionized calcium test done in july, but we were unable to draw enough blood to have that test run (after the senior panel/thyroid and other tests) -- snick gets very, very upset and stressed when we do a blood draw.
 
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wasabipea

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Roni's calcium, potassium and phosphorus were all normal (surprisingly enough for her age and the CKD). I was worried giving her fluids with the added electrolytes, but he thinks that fluid therapy flushes them out - and he said that bloodwork for full-body potassium isn't always accurate. I know she had had weakness in her hind legs lately and her balance is off. I attributed that to her having too much fluid that she wasn't absorbing - but that's likely not the case.

The vet said preliminary reports are showing signs of eColi in her urine. I wonder how that would happen? Hopefuly it  will be of the treatable variety and not one of these superbugs that can't be treated.

I hope she doesn't have IBD as well. Poor thing.

Roni handles blood draws well, but the ultrasound... even with the cost - the last time she got one, about 5 yrs ago, when they shaved her belly they took off (or almost took off) one of her nipples. So tummy shaving is extremely stressful for her now, understandably.

So much new info... I only have a little brain and there is lots in it right now!
 
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that guy

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I don't find anything wrong with questioning what the vet does and is there any other comparable products or what is the purpose of this proposed treatment. My vet answers all of my questions and more without a problem because she is as concerned about his health as I am. It is not often that vets treat a lot of 17 year old plus cats which can be hard as well as rewarding. A few years ago I didn't think my cat had more than a few weeks left in him but he is still around and going fairly strong.

As we age our bodies start to stiffen up and things that were easy when they are young are a lot harder now. I can see my cats back end is very stiff and before he was getting pain meds it was hard for him to lie down and I could see it in the way he walks. My guy is old, he is wobbly now and has fallen a few times and he sleeps a lot more than usual and he no longer does a lot of the things now that he did when he was young. As their care givers it is up to us to try and find all of these additional issues that come with age and try to help them.

Watch how she walks and see if she has any stiffness that may cause her pain or discomfort. My cat rarely goes in my lap anymore and it is not because he doesn't want to it is because he can't do it easily. He tries here and there but I can see by how he lies that it is not easy and at most I may see him like that for a few minutes. This could be the same with your cat, it may be the she wants to hang in your lap but it is really hard for her. Does she still walk on the tips of her toes like she did when she was young or is she walking flat footed where he wrists are almost touching the ground? When she is eating does she shift around or stand in any odd position or is this easy for her? Have you raised her dishes to make it easier for her to eat and drink or are they all on ground? Cats are great at hiding signs of pain so you may have to look closely to find them.

I hope she surprises you with her final age because if things settle out and get on top of her issues she may still have a few years left in her. All you can do is support her as much as possible and do the best you can for her now that you know more. If you have any medical questions then make a clean thread for them and ask here because there is a lot of people that know a lot here. Sorry to hear about the fleas, I have only had to deal with that once. I thought he had fleas and then I found he had found a rat nest outside and was going in there shoulder deep trying to kill them. Once the rats were gone the fleas were gone and it has never been an issue since.
 
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wasabipea

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I dont see anything wrong with asking questions to a vet, epsecially with our older model cats. But I can tell that my vet old vet just thought she should be put down because of her age and her symptoms that I'm attributing a lot to grief. I really don't see the stomach cancer diagnosis... if it was the squamulous cell variety, I think she'd be gone by now since it's aggressive, but if it's the small cell - the vet said he's seen cats live for years with small cell intestinal cancer. So... who knows?

Now whe is eating very well for the most part, and happily accepting the slow changeover to grain-free canned. Last night I gave her a bowl of half "good stuff" grain free, no veggies - and half some of the older junkier canned that she was used to. She went right for the good stuff, I was proud of her!

She is walking relatively mormally - now it's a walk, she used to "trot" everywhere. She still jumps on my lap no problem, and jumps from the end table to her bed (2-3 feet with little hesitation or mishaps). She is actually looking really good these days, and she is getting spoiled rotten. Her case of fleas isn't bad, only a few here and there, so I'm hoping one round of advantage will take care of that. A few tears ago, we had a flea crisis - both cats were covered (I think I had a colony under the deck which diatomaceous earth took care of) - but now she wanders into my neighbors year a little for the grass (I dont have any at the moment) - so she may have gotten them there.

I gave her some Norm-R last night without the added potassium, they injected a bunch into the first bag, and when she had the plain bag she sat there no problems, no bolting at the end. No purring, but no problems. Then I pilled her and then dinner. I think she was a little bent at all the intrusiveness at once, but if we can do that s a routine, she'll grow to accept it. At least she got dinner at the end, which made her happy.

So... onward. The vet was talking about giving her an oral potassium supplement, but I forgot to mention that she gets a fair amount of Nutrical which has not only potassium, but calcium and other good stuff. It also has phosphorus which I have to heep an eye on. I'll have to bring that up and see what he says - whether the added minerals and vitamins are enough.

I guess once we get the eCoi situation treated, then we can investigate the possibility of IBD, which I"m hoping can be treated by diet - even though the vet said only a small percentage keep IBD under control via diet alone.

While it is at times frustrating, and time consuming - it's really rewarding to see your beloved pet bounce back and improve with the right treatments


Glad your Scratchy is doing well, sounds like you are dedicated to taking very good care of him.
 
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