May or may not interest you

[Elaine]

Just been reading through some old emails and came across this one from the woman who runs the felinecrf.org.
I had emailed her about the use of subq fluids, being pro-active with a crf cat and dealing with vets.
As it seems CRF is on the increase, I thought some of you might be interested to read what she had to say to me.

Hi Elaine

thanks for your kind words about my site, though of course I wish you'd
never needed it in the first place.

I appreciate your concerns about the way British vets appear to be less than
proactive about treating CRF. This is partly a cultural thing. Firstly, UK
vets tend to focus more on what's best for the cat rather than the owner
(hence declawing being illegal), and therefore they worry about sub-Qs being
uncomfortable for the cat. In this regard, it doesn't help that the RCVS,
their governing body, does not advocate sub-Qs, claiming they are "painful".

But secondly, based on what I've seen over the last 6.5 years, it is not
solely the vets who are at fault - the demand from the consumer is not
really there. You could argue that this is because they are not aware of the
options such as sub-Qs, but I'm not actually sure that the demand for
proactive treatment is that massive in the USA either; there are not really
that many people on the CRF Support list when you think that around 30% of
15 year old cats have CRF. Perhaps they are just given the fluids in USA and
just get on with it, I sure hope so.

I do know that most of the UK people who write to me are not looking to get
fluids, in fact I probably hear from only around 4 a year who are. Most of
the UK people who write to me (and the vast majority are not British) have
read my site, yet still seem satisfied with the Fortekor and
presciption diet which they are invariably given. They also (unsurprisingly)
use The Final Hours page often too <sigh> So those who want to do sub-Qs are
in the minority from what I can see. I still believe sub-Qs should be made
routinely available, but the demand from clients has to be there as well as
the supply. My own UK vet has offered sub-Qs to every single CRF cat she
thought suitable for them over the last 6.5 years. She offers to show the
client how to do them, how easy it is. Not a single client has taken her up
on the suggestion, saying it's "too much".

My site does have some ideas on winning over a vet's support for sub-Qs:

http://www.felinecrf.org/fluid_therapy.htm#winning_vet_support (http://www.felinecrf.org/fluid_therapy.htm#winning_vet_support)

You will see I do not advocate a confrontational approach. I think a
partnership with the vet is the ideal. I think one thing that swung it for
us in obtaining sub-Qs (apart from the fact that my vet is very
kind-hearted) was that my vet knew me. Whereas quite often people turn up at
the surgery with a crashing CRF cat, and they don't even know their vet's
name. It can only help if you build up a relationship with a vet *before* a
crisis. In my case, my vet had seen me lose Tanya, she'd rehomed George to
us only for him to die a few weeks later, and I think she felt it would help
me to know I'd done all I could for Thomas, so that's why she let me try
sub-Qs, even though she felt they wouldn't help. She told me three months
after Thomas's diagnosis that she owed me an apology. She said when Thomas
was first diagnosed and I wanted to try sub-Qs, the entire practice (six
vets at that time) thought I was... She paused to find a word, so I said
helpfully "mad", and she laughed and said "no, misguided". They did change
their opinion thanks to Thomas. Others have had the same success.

I think a set of guidelines from the RCVS would be ideal, but it isn't going
to happen anytime soon. Several of us have written to the RCVS over the last
6.5 years, and we've never got anywhere; on the contrary, we are usually fed
the line that sub-Qs are "painful" to the cat. Besides, the RCVS is busy
working on the ethics of kidney transplants, which only a handful of people
could ever afford, but which presumably are far less "painful" than getting
stuck with a very fine needle.

Helen

[angieh]

Although I do not have personal experience of a cat with CRF, I do find Helen's email to you interesting on many different levels; perhaps the most pressing of which is why on earth are the RCVS spending so much time on the ethics of kidney transplants if, as she says, only a handful of people could ever afford - and what criteria are they using when they say that subQs (with a very fine needle) is too painful for cats? IMO there is something else going on with RCVS and it has nothing to do with helping cats with CRF.

[Elaine]

I am inclined to agree with you Angie.

[farthing]

That's interesting. I lost a cat a couple of years ago to renal failure, we'd only had her 6 months so she was really too badly damaged to help. Thing it with lots of elderly cats, I know it is something I am likely to have to deal with.
Have you read or heard anything about using laculose for CRF cats. While researching to try and help Chokki, I found info about it being used, intially to help with constipation, but it was also thought to help with binding onto urea, thus stopping it getting into the bloods. I would be interested to know if you've heard anything one way or another about this.

[Elaine]

There are studies looking into this, I dont have any experience of it myself nor have I spoken to any one who has but its very interesting.
http://www.felinecrf.org/treatments.htm#constipation