Q-button

RE: Q-button

Martin Atkinson — Tue, 15 Sep 2015 09:44:36 GMT

[quote user="Iain Richards"]I'm finding more people reluctant to accept mortality even when it is overwhelmingly obvious[/quote]One of my own cats has IRIS stage 3 CKD and last Christmas caught a virulent form of PCV from a new stray kitten (all 4 of my cats went down with it despite full vaccination status) at the same time as I had extracted an upper canine tooth with a FORL which was very painful so he was not in best condition. I kept him going with SC fluids and syringe feeding. He got over that after a week but come the summer he really suffered with the heat as he does every year and needed a lot of encouragement to eat and appetite stimulants just to keep him going. Now the cooler weather has come he has blossomed, his appetite has come back and his coat is glossy again. Should I have let him fade away or euthanased him at Christmas?

RE: Q-button

Iain Richards — Tue, 15 Sep 2015 00:32:50 GMT

No offense taken. I've gone several rounds with the beast of Basingstoke and emerged unscathed.....

It's a good question "Where do you draw the line?" I'm finding more people reluctant to accept mortality even when it is overwhelmingly obvious. It's a debate beyond e-mail exchanges and it's case by case.

RE: Q-button

Martin Atkinson — Mon, 14 Sep 2015 09:21:58 GMT

[quote user="Iain Richards"]"I would ask you why you became a vet Iain with that attitude?" was your question.[/quote] OK that was a rhetorical question you were not meant to answer (apologies if you found it offensive, you will learn with time when I'm serious or not). The question was, following a description of possible other scenarios, 'Where do you draw the line'?

RE: Q-button

james herriot lied — Sat, 12 Sep 2015 15:00:40 GMT

That was a commendably restrained response, Iain. I hope that you're not feeling discouraged from posting on the site - many, many experienced practitioners are keen to share experience without making snide little comments like the one directed at you.

If it hasn't been said already, welcome to the forum.

RE: Q-button

Iain Richards — Sat, 12 Sep 2015 14:18:22 GMT

"I would ask you why you became a vet Iain with that attitude?" was your question. My answer was in my last post: "If I've got this wrong, then my apologies and I'm keen to learn more".

My only experience with s/c fluids in conscious cats is that it appeared painful,so I wanted to know more. I think that's a vital characteristic of a being a vet.

Stunning is an acceptable method of euthanasia if you consistently get it right.

Iain

RE: Q-button

Robin Grimmer — Sat, 12 Sep 2015 11:25:03 GMT

[quote user="Iain Richards"]

Some interesting answers, thanks. I suppose that if the cat is in no pain then it's acceptable from the welfare angle. And you could get philosophical and argue that it is a treatment and therefore no different to fortekor.

Iain

[/quote]

Probably a lot more effective than Fortekor! ;-)

RE: Q-button

Martin Atkinson — Sat, 12 Sep 2015 10:39:38 GMT

[quote user="Iain Richards"]And you could get philosophical and argue that it is a treatment and therefore no different to fortekor.[/quote]I don't see where philosophy comes in here, we are doing our best to treat the animals under our care. Clearly we all have differing views on at what point we intervene and at what point we say that our intervention is no longer in the best interest of the animal.

But I would be interested to hear your replies to the questions I posed directly to you in my previous post. I've been criticised for my views on methods of euthanasia in another thread and have justified them. Equally I've been told off for asking someone to justify their views so it works both ways.

RE: Q-button

Iain Richards — Fri, 11 Sep 2015 22:50:24 GMT

Iain

RE: Q-button

Miriam Lodewyks — Fri, 11 Sep 2015 18:51:27 GMT

Iain, the whole point is that my patient is feeling generally well, but feels even better when he is rehydrated subcutaneously. His urine is isosthenuric and he cannot maintain hydration just from drinking. He is borderline uraemic (12-14), and I am trying to keep the uraemia minimised with daily sc fluids. My client is fully aware that PTS is inevitable, but is willing to invest time, effort and money to buy some more time with her dearly beloved pet. Is that unethical? This is NOT one of those horrific, emaciated, dying-slowly cats with a urea of >35... that's when PTS is quite clearly the only reasonable, ethical option... obviously!

RE: Q-button

Martin Atkinson — Fri, 11 Sep 2015 14:57:18 GMT

[quote user="Stephanie Fursland"]Exactly - so it shouldn't be regarded as giving the cat "cycle of uraemic episode after uraemic episode"[/quote] Sorry I misunderstood that you were countering Iain I thought you were on his side.

[quote user="Stephanie Fursland"]don't know how to do the quote in the box thing[/quote]You click on reply, highlight the line you want to quote in the post , click quote and it will magically appear then type your reply. Or if you want to quote the whole post just click quote without any highlighting. If you want to quote multiple lines from a post like I just have just repeat the process on a new line.

RE: Q-button

Stephanie Wellings — Fri, 11 Sep 2015 13:23:00 GMT

Exactly - so it shouldn't be regarded as giving the cat "cycle of uraemic episode after uraemic episode" (don't know how to do the quote in the box thing) because it wouldn't be used in those patients.

RE: Q-button

Martin Atkinson — Fri, 11 Sep 2015 12:58:44 GMT

[quote user="Stephanie Fursland"]I wouldn't do sub cut fluids in a cat that was clinically uraemic, because my understanding was that it's very poorly absorbed from under the skin at that point[/quote]Not at all. IV fluids are necessary for rapid recovery in a uraemic, clinically dehydrated animal that needs diuresing but we're talking about long-term supplementary fluids because even a polydypsic CKD cat is not taking enough fluid on board to maintain normal hydration status due to is hyposthenuria.

RE: Q-button

Stephanie Wellings — Fri, 11 Sep 2015 11:13:24 GMT

I wouldn't do sub cut fluids in a cat that was clinically uraemic, because my understanding was that it's very poorly absorbed from under the skin at that point; but in a slowly progressive CKD case it's surely along the same lines as a symptomatic treatment like an anti-emetic (i.e. it doesn't fix the problem but it lessens the symptoms).

RE: Q-button

Martin Atkinson — Fri, 11 Sep 2015 10:47:22 GMT

[quote user="Iain Richards"]Without wishing to be rude, and in now way disrespectful to the OP, but is this in any way ethical? Who is the beneficiary? [/quote]You could apply this to everything we do if you want, in the final analysis the beneficiary of pet keeping is the pet keeper not the pet. I agree that some people go too far and have unreasonable expectations but a cat that has quality of life extended for several months and doesn't object to SC fluids doesn't fall in that category any more than giving chemotherapy for lymphoma or long term pain relief for dogs with severe OA. Where do you draw the line?

Anyway half the point of the skin button is that it allows fluids to be given with no discomfort.

I would ask you why you became a vet Iain with that attitude?

RE: Q-button

Kate Richardson — Fri, 11 Sep 2015 07:35:08 GMT

Iain, the point is you get in with the sc fluids before they reach end stage to maintain good quality of life and delay the onset of end stage.

RE: Q-button

Evelyn Barbour-Hill — Fri, 11 Sep 2015 00:48:13 GMT

I had one on over three years of twice-weekly subcutaneous normal saline injection (offered the buttons, owner found that she and cat were fine with a needle, with a giving set and a bag, of course).

The cat was comfortable and happy all the time .

RE: Q-button

Iain Richards — Fri, 11 Sep 2015 00:32:17 GMT

Without wishing to be rude, and in now way disrespectful to the OP, but is this in any way ethical? Who is the beneficiary? The cat that has end stage renal failure and won't drink? Or the owner? I can see the cat would get temporary relief (assuming the kidneys are able to create some urine) but as all this is doing is giving them a cycle of uraemic episode after uraemic episode. What of the pain of s/c injection? I can see some merit in short term s/c fluids while the owner comes to term with PTS, but this surely cannot be a viable, humane treatment.

If I've got this wrong, then my apologies and I'm keen to learn more.

Iain

RE: Q-button

Miriam Lodewyks — Wed, 09 Sep 2015 19:50:27 GMT

Fankooo Martin. Most helpful!

RE: Q-button

Martin Atkinson — Wed, 09 Sep 2015 15:47:45 GMT

[quote user="GrooveJet"]not sure how easy they are to insert (under local?) or how long one might last? How many should I order? [/quote]I place them under sedation and a bit of local. There are two suggested sites: between the shoulder blades and on the flank. There are pros and cons to each. The logic is that you are less likely to get fibrous adhesions on the flank which would restrict the volume you could give and this was an issue with the cat that survived more than 3 months. I tried once on the flank but I think it was more difficult to access and the cat was able to interfere with it and got an abscess so the implant failed and I replaced it in the scruff.

As said the kit comes with a punch to make a hole which you wiggle the implant through then secure it with a few sutures, although you may need to enlarge the incision slightly. You get a bit of leakage of injected fluid to start with but this soon seals.The sutures come out after 7-10 days and the button has magically been integrated permanently into skin.

As also said the longest I've had a cat survive is 3 months but the implant as still secure and there are reports in the internet of them being OK for a year or more.

They cost about £100 now, I usually have one in stock and order another as I use it.

A question you didn't ask was how much fluid to give at a time and that depends on the cat but 40ml is easily achievable and I advise a daily volume equal to maintenance requirement, on top of whatever the cat drinks.

Hope that helps.

RE: Q-button

Miriam Lodewyks — Wed, 09 Sep 2015 15:13:29 GMT

My patient has been closely monitored for the past couple years and is essentially feeling fine, but his Urea/creat started creeping up recently so decided to start in sc fluids now. Problem is that he's wriggley, and likes to crocodile roll! Thought the qbutton might make it easier, but not sure how easy they are to insert (under local?) or how long one might last? How many should I order?

RE: Q-button

Kate Richardson — Wed, 09 Sep 2015 11:53:51 GMT

[quote user="Anthony Dennison"]How easy is it to get fluid in this way? Giving s/c fluids always involves a degree of pressure on the syringe in my experience[/quote]

Initially the fluid goes in slowly, I usually use a 21 gauge needle minimum but find a 20g better. Once you have some fluid under the skin it flows pretty quickly by gravity as mentioned above. Sometimes you have to twist the needle a little to get the flow going (I assume the bevel is sitting against the skin in this case, so twisting it just moves the bevel). It probably does take a bit longer than injecting, but boy do the cats prefer it! I believe its the pressure of injecting that hurts so when it flows in slowly, they tolerate it really really well. Try it if you haven't already, you will be converted. You can often sit them in a top opening cat box and place the needle and they will just sit there without even needing holding.

[quote user="Martin Atkinson"]Maybe we should be encouraging owners to give fluids at home at an earlier stage.[/quote]

I think you are absolutely right

RE: Q-button

Stephanie Wellings — Wed, 09 Sep 2015 09:38:15 GMT

You need to elevate the bag, but it seems to go in just under gravity (I have the giving set dial fully open) - I guess there isn't much resistance under the loose skin of an older cat.

RE: Q-button

Martin Atkinson — Wed, 09 Sep 2015 09:36:25 GMT

[quote user="GrooveJet"]does anyone have any experience placing a subcutaneous "button" for owners to infuse sc fluids in cats?[/quote]

[quote user="Kate Richardson"]No personal experience of these buttons, Martin Atkinson is the one to message as he has more experience with these. [/quote]Kate has hit the button (pun intentional). You order them from DMS telephone number 08448888387, best to call as you can't order them off the website. They usually have to order them in from the States so it takes a few days. They come with full instructions, a skin punch and small supply of access needles. You will also need box of additional access needles if its for the long term although they are re-usable so long as hygienic precautions are taken.

I have used them in a number of cats with success. The problem is that by the time owners accept that additional fluids are necessary the cats are in end stage CRF and only last a few weeks but that is a few weeks more than they would have done without. In the end it is little different from giving S/C fluid by injection it just makes it easier at home. The longest I have a cat survive was three months but there are reports of a year or more in the States. Maybe we should be encouraging owners to give fluids at home at an earlier stage.

RE: Q-button

Anthony Dennison — Wed, 09 Sep 2015 09:10:13 GMT

[quote user="Stephanie Fursland"]

How are they currently giving the sub cut fluids? Many of our cats seem to tolerate it better if it is run from a warmed fluid bag via a giving set/butterfly needle rather than injecting from syringes - possibly because it's under less pressure and feels less weird going in?

[/quote]

How easy is it to get fluid in this way? Giving s/c fluids always involves a degree of pressure on the syringe in my experience

RE: Q-button

Stephanie Wellings — Wed, 09 Sep 2015 09:03:38 GMT