learning to give subQs at home: I failed, now probable cancer diagnosis

:doh3:
I'm starting a new thread since the euthanasia thread morphed into this topic. I went with the kitty last night, all set to learn to do subQs at home - and while determined, still iffy - I couldn't do the actual poke. I was so scared of hurting her, and her skin is thin and she is so small. I feel pathetic and wimpy.

I don't think she stabilized as I was hoping for. Waiting for the docs phonecall on the results of her blood work, but I have a feeling she is going to need every other day fluids. While a good traveler and an incredibly docile patient - that's too much to put her thru and I have to do it.

They use 18 gauge needles there, it's huge.

Any tips or tricks that people used to get over their fear of the first few pokes would be so appreciated. Halp!

Taking her in every other day is not only costly, but stressful on both of us.

Thanks in advance

Well the doc called and things have changed, her creatinine is normal (2.2) but white cell count is higher and that's after much antibiotic treatment. She is thinking intestinal cancer. At 18, I'm not going to aggressively treat it, but an ultrasound might give a better idea what's going on. Do I spend the $550 just to know? Even if I can't treat it, I want to look for signs that it's her time... because I missed the lung cancer in Len and hate to think he may have suffered at all. Not Roni too. It appears to be slow growing, but I don't want her to hurt.

My Sebastian gets fluids every other day for his chronic pancreatitis. I also use 18 gauge needles. The good thing about the larger needles is that the fluids flow faster and you get done quicker, which is especially helpful for a kitty who gets antsy and doesn't want to stay still for too long. The first few times I was very hesitant, but just tried not to think about it too much. I had to put on this sort of mental block. Ugh, I know my advice is totally not helpful. I'm a terrible teacher. I remember others suggesting to me to practice on an orange to get the feel of the needle going in.

I'm sorry that her WBC is higher. Right now they are guessing on the cancer, right? It's a tough call about the ultrasound. I like having as much information as possible, but then there's the stress of having it done and her belly getting shaved.

I'm so sorry to hear the news.  One option would be to go with gentle treatments (steroids, supportive care etc) and just wait and watch.  If you aren't going to do hard core treatments (and I totally get that) regardless of diagnosis then why spend the money to work her up?

I was just about to say to use an orange!  It has a similar toughness of skin.  I used 18 gauge needles as well.  20 or 22 is fine, but I was already used to 18 so I stayed with them.  You can do this.  Search YouTube for videos on people giving cats subQ fluids.  It helps.  Once you do it a few times, you'll feel more confident.  I had to really talk to myself those first few times.  I had to tell myself that I was going to suck it up and help my cat.  Thankfully, Grey was a terrific patient and just gave me a stunned look when I first poked her  like, "hey, what was that for?" and I laughed through my tears and gave her fluids.  She rolled over and enjoyed the warmth.  That meant a lot to me.

The U/S...my opinion is, if you aren't going to treat it, leave her be.  Is nothing showing up on X-ray?  Me personally, I probably wouldn't do the U/S and would just treat symptoms.  I would do the fluids, and anything else that ultimately would make her feel better.  I would do crazy diet changes, or medicate her trying to cure her if the treatment is stressful.  Again, this is only my opinion.

Wasabipea said:

They use 18 gauge needles there, it's huge.

Any tips or tricks that people used to get over their fear of the first few pokes would be so appreciated. Halp!
 

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Definitely track down some finer gauge needles. I alternated between the Terumo UTW 22g 1" and 21g 1 1/2" needles with my guy, but you might want to experiment with a few different sizes to see what works best for your kitty. The flow-rate will slow down a bit with the smaller ones, so if you have a fidgety cat or you're giving a lot of fluids, sometimes the fatter needles are a better option. But ya, 18 gauge is harpoon and I'd never use those on a wee kitty. 

Some things that might help: I would initially numb the area I was injecting into with an ice-cube wrapped in paper towel. If your cat tolerates it, just apply it for a few minutes. If it makes your cat antsy, if may not be worth the effort. Warming the bag of fluids is essential. I put the whole shebang (bag and venoset) in a large Ziploc and immersed it in a sink-full of very warm water for up to half an hour (depends on how full the bag is). When inserting the needle, pull up a nice tight tent of skin and make sure the bevel of the needle is facing up. Be firm and swift with the insertion (just make sure you don't go through the other side - but  hey, it happens to the best of us, so no need to freak out if you do. Just keep calm and carry on. )

Give lots of treats! Especially afterwards, but even during if it helps distract her. Some people feed their cats while they get fluids. I preferred to "do" my cat when he was sleepy, which was usually after he ate.

You will eventually get used to it. And so will your kitty, especially once she starts to realize that the fluids make her feel better. Remember, cats don't have needle-phobias (that's strictly a human affliction). They might experience a bit of a pinch at first, but once they get used to the sensation of fluids under their skin, they really don't tend to mind. More often than not, it's having to hold still for the duration that is the biggest challenge. If you have anyone that can help you at first (like controlling the on-off valve and keeping an eye on how much fluids you're giving), that can be super useful. Eventually you'll be able to do it in your sleep though. 

Originally Posted by Sugarcatmom  

When inserting the needle, pull up a nice tight tent of skin and make sure the bevel of the needle is facing up. Be firm and swift with the insertion (just make sure you don't go through the other side - but  hey, it happens to the best of us, so no need to freak out if you do. Just keep calm and carry on.

)

I preferred to "do" my cat when he was sleepy, which was usually after he ate.

You will eventually get used to it.

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Wasabipea, we had a similar situation with our senior cat (we think she was about 17) where it was unclear what was wrong but turned out to be intestinal cancer. We didn't do an ultrasound. I'm very, very sorry you're most likely going through the same thing.

We gave our cat fluids, too, and I've quoted Sugarcatmom's post to show what worked best for us. It was also very helpful that we have beams on one of our ceilings and could screw in a hook from which to hang the bag with the fluids. We put a fluffy towel on a table so the cat would have a comfortable place to sit/lie while she got the fluids. I was horribly nervous the first time -- I think my husband thought I wouldn't be able to do it. But I did, though it did take a bit of time for me to get the gumption. In the end, I think I also made a sort of mental block, like GoHolistic. It does get easier, particularly because you'll likely see that your cat is more comfortable after the fluids. If your cat is fairly dehydrated and doesn't seem more comfortable, you might want to ask about giving fluids more often. (We did.)

Since peaches08 mentioned diet, I'll also say that, despite being very sick, our cat's symptoms did ease a little in her last months when I put her on a no-grain, no-fish diet.

I wish i knew how to do multiple quotes, much I want to address. I hadn't heard of the orange trick, I was practicing with a loosely balled up hand towel. If she does indeed have intestinal cancer, I refuse to drag her to the vets office every other day, and even though her creatinine stabilized at normal (her kidneys respond well to fluid therapy) - I'm going to have to do the fluids at home. She does appear better afterwards.

LisaHE, how did you find out in the end that it was indeed intestinal cancer? Part of me wants to do the U/S just to know what to look for - but the last time she had her belly shaved, they took off one of her nipples with the shaver, so that has now been filed under Traumatic Events. Was your Kitty's slow progressing, or rather quick? Roni has been battling multiple maladies for some time now, and I may have a hard time determining when is time to say when, esp if I'm not sure its cancer. She has amazing bounce back capabilities, but if I know she is terminal - then that's that.

StephenQ, what would steroid treatments address? I think my vet thinks I'm insane for keeping her around, but she's not bad right now.

I will try for a smaller needle, she is very good about sitting still and doest get much fluid with her size and I will try no fish, no grain diet. She snubbed her food tonight, but I did get an entire bottle of beef baby food into her. This might end sooner than I thought.

She cries during the night, which I took as mourning a sibling recently lost. Now I'm wondering if it is pain? From what I understand cats hide their pain, and she doesn't appear in pain, but now I'm wondering.

Here's a thought: what about having the vet tech guide you through "the poke" - i.e. you put your left hand on the cat as if you are about to tent, and you hold the needle in your right hand; then the tech puts her hand on yours and between the two of you create the tent, then the tech puts her other hand on your needle hand and guides you in.

A 20-gauge needle is fine if you feel more comfortable with a smaller needle. 

My thoughts go out to both of you.

Wasabipea, there was no absolute diagnosis but in the end the vet could feel a mass and she said she was certain. (I didn't trust all the vets we saw at that practice but did trust this one.) It's all a long story but the cat had IBD symptoms, on and off, over the years but had never been diagnosed properly. We first brought her in for her digestive and litter box problems in the early 2000s, before there was much online information about IBD or general discussion of how to feed a cat. The vets at that practice weren't knowledgeable at all about cat nutrition (they still aren't so we've switched vets for our new cats) and essentially said she had idiopathic colitis. I still feel horribly guilty that I never figured things out in time for the cat to live longer (she was a wonderful cat!) but at least I learned how to feed our new cats.

Brooksie also had a very arthritic leg, mild-to-moderate kidney disease and low-level thyroid issues, which complicated everything and make it more difficult to say how quickly the cancer progressed. About five years ago she also developed an arrhythmia that nobody thought she would or could survive -- the good vet was shocked each year when we brought her back for yet another annual exam. Like your cat, Brooksie had amazing bounce-back capabilities and she had some pretty lively moments even in her last days, insisting on walking down stairs or trying to jump on tables, even when she didn't have much strength. I'd say her decline was gradual, over months, though it was very clear in the last week that she was nearing the end, and even clearer on her last morning that we needed to have her put to sleep. Looking back, the decline was fairly easy to track through her interest (or lack of interest) in food, though that could have been a combination of the kidney disease and the cancer.

One other thing that might be helpful: in Brooksie's last weeks, I gave her back rubs that she and I both enjoyed. (They might have been more therapeutic for me than for her!) I would lie on the bed, holding her on my chest, and rub, fairly firmly, up and down her spine. She loved it! I started doing it one day right after giving her the fluids then began doing it several times a day. Like your cat, Brooksie was very good at hiding pain: the back rubs seemed to relax her.

My thoughts are with you, Wasabipea. Those were difficult months for us and I'm sure this time is difficult for you, too.

I meant to say I WOULDN'T do crazy diet changes...man I can't type lately!  Did she snub a meal that she normally loves? 

I've been doing a rotation of brands and flavors that she likes she she doesn't get bored, but as LisaHE says - she has so many other issues that it's hard to determine which one is giving her trouble. And the vet couldn't feel anything in her abdominal region as of two days ago, but a few weeks ago the same vet felt an area inside her (but she was in a really gassy phase and the vet couldn't tell if it was a mass or a gas pocket). Two days ago, she didn't feel the mass - so it must have been a gassy pocket. The x-rays show nothing and I'm just going by her behavior and appetite and what's in the box. It's hard to determine from her behavior since she lost her brother of 18 yrs not too long ago - after that is when her health "fell apart". So she is sad, along with being unwell.

Now that her kidneys seem to have stabilized (2.2 creatinine after 4 days with no fluids), she still seemed much perkier after receiving 200cc subQ. The vet (whom I'm not 100% certain I trust - she is the one that made the remark about some clients she wished would just euthanize, Im not sure if she is being objective or not) consulted with an internal veterinary specialsit and they both seem to agree that even though nothing can be felt, and the x-rays are inconclusive - I'd rather not do an ultrasound since the only thing it will tell me is whether or not there is a thickening of the bowel, nothing that is going on inside. I'm just at such a loss and so confused. she has good days and bad days, as 18 year old cats do - what if I mistake a simple "bad day" as the end and have her put down when she would have been running around the house the next day, or purring on my lap.

As far as the rubs, around her shoulders I try to be very delicate with since the subQs probably make her sore - and some days she seems to like to be stroked, while others... she kind of wants to be left alone.

And with administering the subQs... I think I"m going to ask tonight is they have a smaller needled and the tech did sort of what you said, cocheezie, I held the needle while he poked. Maybe tonight I'll try to reverse it. I can poke and if he thinks I'm not doing it right then he can take over the poke. I'm actually so upset right now, tonight night not be a good idea.

If anyone responds to this and I don't get back right away, I"m just having a hard time and may not get to replies for a couple of days - so please if you offer help and you don't hear from me - I'm not being a jerk. Just taking a break from all my cat bad-things.

I wish my vet never made that stupid remark about wishing that some of her clients would just euthanize and get it over with. I don't trust her anymore, bottom line. What if she is exagerrating the situation just to get me to end it because she is tired of seeing my cat? My trust level is not good with her. It's not like the cat is suffering, or dragging herself around the house, or barely functioning. She's more or less fine for now, with the good day/bad day thing.

Thanks everyone, your help is appreciated.

I'm sorry your cat is having such a tough time.  I've been giving my cat sub-q's every other day (100ml) since October.  He has bladder cancer, high kidney values, and has hyperthyroidism.  We started out using the 18 gauge, 1" long needles (green), but as my cat has lost significant weight of late and he has become more fragile, we have switched to the 20 gauge, 3/4" long needles (pink).  It does take a bit longer, but he doesn't flinch (as much) when I insert the needle.  At his current stage, I also find it helps for the needle to be shorter.  With his skin more delicate now, I accidentally went through the other side of the "tent" with the longer needle.  That has not been a problem with the 20 gauge. 

Our "fluids station" is a bench sitting next to a doorway that has a pull-up bar at the top of the door that is the perfect height for hanging fluids.  I don't give the fluids by myself.  Someone else helps keep the cat stationary and calm (petting him) while I handle the needle and fluid flow.  I suppose I could do it all myself, but my cat seems happier with someone giving him full attention, and this way all family members share in caring for the cat.  I have found it more comfortable for my cat if I pinch the skin a few times before inserting the needle.  Inserting faster is better.  I also have found he prefers it, and I think the fluids flow a bit better, if I insert the needle in the skin behind the shoulder area.  There seems to be more room for the needle and fluid away from all his shoulder bones.  I rotate from left to right side.

Practice helps calm your nerves.  Remember that even if you or your cat don't like to do it, giving fluids helps the cat!

I read some of the euthanizing thread.  These last few weeks, as my cat is eating less and less and clearly not as happy/vibrant as he once was, I keep thinking the end is near.  But then he greets me at the door when I get home or trots down the hall when my husband calls to take him outside for 5 minutes (something we recently started doing and he loves it), and I know it's not his time.  Don't let the vet make that decision, it has to be between you and your cat. 

Best wishes to both of you!

Your cat's kidney numbers aren't bad.  And it's common for kidney cats to go off food. 

Your vet is human, and she made a mistake.  And your feelings are hurt, on top of the stress of trying to learn to be a cat nurse all of the sudden.  Would it help to have a concrete answer from her what she thinks you should do, even if you think her answer is wrong?  What I mean is, would it help to just flat out ask her what she would do if this were her cat, listen carefully to her response, then make a decision from there as to whether to keep her or get a different vet?  Sometimes if I let something like this fester in my head, it eats me alive and causes me way more stress than if I had just confronted it to begin with. 

peaches08 said:

 
Your cat's kidney numbers aren't bad.  And it's common for kidney cats to go off food.

Your vet is human, and she made a mistake.  And your feelings are hurt, on top of the stress of trying to learn to be a cat nurse all of the sudden.  Would it help to have a concrete answer from her what she thinks you should do, even if you think her answer is wrong?  What I mean is, would it help to just flat out ask her what she would do if this were her cat, listen carefully to her response, then make a decision from there as to whether to keep her or get a different vet?  Sometimes if I let something like this fester in my head, it eats me alive and causes me way more stress than if I had just confronted it to begin with.

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That's exactly what's going on. She won't tell me what to do except that it would be "kind" to put her to sleep, and when I said that I don't think she is suffering too badly, she said to mark the calendar days of good and bad, eat vs. no eat, etc. Everyone tells me that I'll know. I don't even know if she had the intestinal cancer that the vet is hinting at.

I'm so confused and I really don't trust her now, I'm not about to start looking for a new vet - I used to really like their office.

Yea, I feel like there are no right answers. I just had to put Len down less than two months ago - I'm not ready to lose another, she's all I have. but of course, I don't want her hurting and with cats its hard to tell. *sad*

OK, sounds like you have an answer.  A hurtful answer, and one that just by looking at creatinine numbers (around 2 to 2.2, right?), I don't know where she's coming from about it being kinder to euthanize your cat.  Here's a page you've probably already seen, but I'm putting it out there anyway http://www.felinecrf.org/how_bad_is_it.htm. 

Maybe your vet needs a vacation or something. 

My vet originally gave me 18 gauge needles that were 1.5" long and each insertion really got him to flinch so I changed him to 20 gauge needles that were 1" long. I don't run it full out and he gets 100ml every day which can be a challenge if he is not feeling well. I find that getting the needle in is the hard part and once the fluid is going in it is usually a matter of waiting. Cat's don't really feel much where the needle is going in so even if it stings it is usually short lived and while they are getting the fluid they are usually good. I heat my sub-q fluid to about 97 degrees so it is comfortable and he usually falls asleep towards the end of the sub-q or just after.

There are a lot of videos on Youtube on how to do this so watch them and learn as much as you can. I would try practising making the tent and use your finger to do a light poke to get the angle and the method down so you are comfortable with it. Go back to the vet and then have them show you how to do it and then you try it while they are there and give a sub-q. With many cats this is the difference between life and death so it needs to be done and the best person to do it is the person the cat trusts the most, you. If your cat has thin skin with little body fat then a smaller needle would be fine. You really need to work on the sub-q's because once you have done it a few times it gets a lot easier and if you get the vet to walk you through it then they can help you with your fear of hurting the cat.

peaches08 said:

OK, sounds like you have an answer.  A hurtful answer, and one that just by looking at creatinine numbers (around 2 to 2.2, right?), I don't know where she's coming from about it being kinder to euthanize your cat.  Here's a page you've probably already seen, but I'm putting it out there anyway http://www.felinecrf.org/how_bad_is_it.htm. 

Maybe your vet needs a vacation or something. 

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peaches08 said:

OK, sounds like you have an answer.  A hurtful answer, and one that just by looking at creatinine numbers (around 2 to 2.2, right?), I don't know where she's coming from about it being kinder to euthanize your cat.  Here's a page you've probably already seen, but I'm putting it out there anyway http://www.felinecrf.org/how_bad_is_it.htm. 

Maybe your vet needs a vacation or something. 

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Granted, when she made that remark, it was a couple of years go when euthanasia wasn't on the map for either of my cats - we were having a general conversation about euthanasia, I might have said something to the effect of how hard it must be to do that everyday, and I'll give her the benefit of the doubt that she was probably trying to lighten the mood a bit or whatever, so that particular comment wasn't directed at this situation. But even said in jest, it forever changed my view of her.

Now, even tho Roni's kidney values are in a good range, she has been on antibiotics for 3 weeks and if it was an infection - they definitely would have gone down instead of up. The vet consulted with an internal specialist, and they both are thinking intestinal cancer. A lot of the symptoms fit and she appears to be on a quick decline. I made an appt to have her put down Friday evening, she looks miserable. And I've been doing so much to help her recover, I don't know if its that she doesnt feel well, or she resents my efforts... but she won't even let me pet her. She used to love me so much, and was so affectionate... no more. I guess our last days together aren't going to be of the heartwarming variety. Hopefully tomorrow will be better.

So I guess learning subQs at home is a moot point, but thank you to everyone that responded.

She doesn't resent you, a cats instinct is to avoid everything and hide when they are sick to hide weakness in nature and it is hard wired. That is so sad that things have gone so bad but in the end you are doing for her so you have to do what is best for her. Keeping trying to make her feel good and hopefully things turn around.

That Guy said:

She doesn't resent you, a cats instinct is to avoid everything and hide when they are sick to hide weakness in nature and it is hard wired. That is so sad that things have gone so bad but in the end you are doing for her so you have to do what is best for her. Keeping trying to make her feel good and hopefully things turn around.

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Thank you. i know that is most likely the case, and I'm just feeling sorry for myself and being selfish (such attractive qualities - lol). I just hope she remembers how much I love her. I guess I waited too long, hoping for one of her miracle bounce backs.

Apologies for the self pity, won't happen again. I just hate seeing her this way. My poor girl.

It is a sad fact of life that everything passes at one time or another and sadly we usually outlive most pets and it is very hard to deal with. Some people create strong bonds with their animals and things like this are very hard to deal with in general. You now have to be a medical practitioner to your pet and you are forced to do things you know that she doesn't want done to it but you must. You did the best as you could which is saying a lot when you see the treatment other pets get and you can't live life in retrospect. Keeping trying to support her by gently stroking her on the head very lightly and give her some time relax. As long as she is not getting stressed out try to stay with her even if you don't pet her. Just having you there will make a big difference to her ut it is hard to fight instinct. My cat is the same, he is over 19 with IBD, renal failure, and has pancreatic issues but when he is feeling really bad he wants nothing to do with me and he just wants to be alone. When he is like that I just visit him for short periods of time and talk gently with him and try to make him feel as happy and secure as possible. So far I have been lucky and he has been able to snap out of them but one day he may not so I just try to make feel as good as I can and let him know he is not alone. Like you there are some treatments I put off hoping that the current one may make the difference but so far most have done nothing or made it worse. I look at his quality of life and what changes there would be for him and I either say no such as biopsies or consider it one of those options down the list somewhere.

Keep as positive as you can and just remember the good times and help her as much as possible in what may be her last few days unless she can pull out of it. If things don't change then as hard as it will be you are doing the best thing for both of you. In all of the treatments my cat has had I thought about each one and I always thought of the cat first and how he will deal with it rather than just fixing him at any cost. There is no shame in feeling bad for yourself either because it is a huge bond and the situation which she is in is basically out of your control. I have had to put pets down in the past and some have just never come back but each of them still lives because I remember each one and hopefully never forget. I wish both of you the best and hopefully she will relax a bit and let you stay close to her no matter what happens.