<11/2/98 From: Tricia Re: teeth cleaning causing problems>

Hi Sharon,

I asked my allo boss about this, and he said that one of the more common kitty sedatives (ketamine--used before hooking them up to the gas anesthesia) is rather hard on the kidneys.  He felt that in Mahogany's case, her kidneys were probably already failing, and that the added stress from the sedative might have pushed her over the edge

I found this excerpt in an article I have on chemical restraint: Compendium for Continuing Education Restraint Methods for Radiography in Dogs and Cats Aug 1996

" The dissociogenic drugs ketamine and tiletamine induce excellent immobilization and provide superficial analgesia. Rigidity of the extremities is produced because of poor muscle relaxation. Such effects as hallucinations, confusion, agitation, and fear have been described by human  patients who have received these drugs; similar effects apparently occur in animals. Ketamine or tiletamine should be used only cautiously in patients with severe liver disease. Cats eliminate at least some ketamine  unchanged in urine. This agent should therefore be used cautiously if a cat has renal disease. "

Tricia

-----Original Message-----
From: <JeremiahMeow@>

I noticed that Sandy and Tricia both posted about cats that stopped eating after a dental cleaning.  Can you two give me more details about what happened and if anyone else knows any similar stories, I'd appreciate knowing about them.  It's kind of funny because something inside of me has kept me from getting my Kirby's teeth cleaned and maybe deep down inside I had a sense that something bad like that could happen. Sandy, did Tasha recover from it and if she did, how long did it take?

Hi guys,

Just stumbled onto this site which has some interesting info on protein and progression of kidney failure.  They say lo-protein diets don't help and only cause muscle wasting.  But one thing I can't figure out is this diet they are promoting for CRF cats doesn't restrict protein yet has lower Phos.  What gives? I thought meat is hi in Phos so the 2 go hand in hand, or am I missing something?  I'm assuming of course that the protein is from a meat source.

Here's the URL is anyone is interested in reading the whole article http://www.iams.com/new/renal.htm

Here's an interesting quote:

More than just higher protein levels, these experimental diets are based on Iams' unique Nitrogen Trap&trade;. This dietary management tool uses fermentable fiber to divert nitrogenous wastes away from the kidneys and into the feces. Essentially, it stocks the intestines with bacteria that feed on urea. It works because fermentable fiber in the diet promotes proliferation of intestinal bacteria. These flourishing bacteria hydrolyze urea to ammonia and incorporate it into their own protein.

When the bacteria are excreted in the feces, along with them go the nitrogenous wastes. Dr. Reinhart said the Nitrogen Trap&trade; works "without sacrificing nutrient availability or stool quality." The unique blend of fermentable fibers "allows feeding of higher protein levels without exacerbating uremia." He cautioned, however, against feeding high levels of fermentable fiber to cats until researchers know more about its effects on protein and fat digestibility in this species.

Anyone know what in the world is "fermentable fiber"?  I know of soluble and insoluble fiber - psyllium is an example of the former, and wheat/oat bran are examples of the latter.

And what is in fermentable fiber to make it essentially probiotic?  I wonder if i can get the same results from acidophilus.  Boo Boo currently gets Dr. Goodpet's enzymes and I only just started adding psyllium to his food.  I gotta get to the bottom of this b/c this seems pretty logical to me.  I know that psyllium lowers cholesterol and the risk of diabetes plus many other things b/c it removes a bunch of bad stuff from the system.  So if I can figure out what fermentable fiber is, I can add it to Boo's food.  Any feedback greatly appreciated:)

Sandy and Booey

A few days ago, there was a discussion here concerning Dr. Belfield's recommendations for high dosages of Vit. C for renal failure.  Below is a post that Lew Olson put on another list.  I try to stay away from posting info. that pertains to d**s, but this could just as well have been a cat under this condition, so I do think it's pertinent.  I don't normally like to post anecdotal evidence, as many of you are well aware.  However, in this case, this was posted by a person who has studied a great deal about naturopathic methods of healing (and in fact, is doing some graduate work in this area).  Although this was years ago, I think it still has some merit today.

<< However, I had a black and tan coonhound in 1985 that lay dying of renal failure. He could not get up, had uremic poisoning and had about 25% left of his kidneys. Upon Dr Belfield DVM's advise at a recent Vet conference lecture, my small
town vet gave him 25,000 mgs of vitamin C intravenously. At half way through the drip, he was wagging his tail, and at the end, was happy to hop up and trot out the door. He lived five more years. He needed two more treatments during those years, in time of renal crisis.

I had a bitch who was dying of a closed pyrometra in 1987, and I decided as a last ditch effort, to use it on her. A very skeptical traditional vet administered it for me (made me sign a bunch of releases...) and again, she lifted her head half way through, and hopped off the table and was fine at the end.

I have seen vitamin C work very well in dogs with allergies, autoimmune problems, parvo and pain. While it may not be necessary to survive and live day to day, it definitely have healing properties, relieves pain and encourages collagen growth. >>

If you care to ask Lew further questions, she gave me permission to post and her e-mail addy is lewolson@

Leah
lknipp@

<<I have seen vitamin C work very well in dogs with allergies,  autoimmune problems, parvo and pain. While it may not be necessary to survive and live day to day, it definitely has healing properties, relieves pain and encourages collagen growth. >>

Thanks for posting this, Leah. I don't disagree w/ the above statement at all.  And I know how fantastic Vit C is w/ healing scarring etc.  Of the 2 examples Lew wrote about, the pyometra makes sense cuz isn't it a major bacterial infection of some sort..i can see how Vit C would help w/ that, even cure it.

Problem is that the kidneys (as per allo medicine's current knowledge) cannot rebuild and heal the way the liver can.  So once the kidney tissue is gone, it ain't gonna function again, as far as I know:(  Giving a 25g Vit C shot might help in acute renal failure but chronic? I still have doubts.  Not to say that if I could find an open-minded vet, I might not try it..I most definitely would..after all, Vit C can't hurt esp short-term like that.

I'm willing to give Dr. Belfield the benefit of the doubt in some instances, but in others, his claims defy logic and/or science.  Still,
it's nice to hear it helped Lew's d*gs; that's what I like to read - first-hand experience.  U've definitely given me something to mull
over..will ask Booey's vet about it..she's rather negative about most things so may not go for it:(  Can one get Vit C in injectable form from a pharmacy?  How about Vit B12?

Sandy, owned and operated by the mountain rascals who get Vit C in their food and don't even know it

At 12:43 AM 11/25/98 -0500, you wrote:
<<i wrote to the vetmed list to see if anyone knows what the heck "fermentable fiber" is....>>

I know part of the answer to this one.  "Fermentable" fiber doesn't pass unchanged through the body; it is fermented in the large intestine by the flora.  This process yields some energy and some gas.  (The amount of gas varies depending on whether the enzymes earlier in the digestive process have been able to remove most of the carbohydrates from the fiber matrix; that's why an enzyme supplement like "Beano" helps reduce gas formation.) Beans and peas contain fermentable (also called soluble) fiber for the human digestive system.  Fermentability will vary depending on species, and how the whole business works out will depend on the individual's enzymes and flora.

I think of it in an oversimplified but helpful way:  Sugar is simple carbohydrate that breaks down fairly easily, starch is complex carbohydrate that requires the right enzymes to break down, soluble fiber is very complex carbohydrate that requires enzymes and flora to break down, and insoluble fiber is indigestible carbohydrate.

Does anyone know how much amylase, if any, is present in cats?  If you don't have amylase, then starch becomes an unwieldy and unuseful carbohydrate.

Leslie

Hi all,

A while back we were talking about using Vit C in mega doses for various ailments.  Dr. Belfield, among others, is an advocate of this therapy.

I asked Stephanie Meyer, a professor at Harvard (who holds a PhD in chemistry), from the CRF list for permission to post her reply to this.  And she said to go right ahead so here's what she wrote about using Vit C.

Begin quote:

Just a cautionary caveat -- I'm not sure how significant in practice it is:  excess Vitamin C is metabolized by going through the intermediate oxalic acid.  In theory, if you produced large amounts, it could precipitate as calcium oxalate in the kidneys.  (And, btw, production of oxalate is the mechanism by which antifreeze poisoning causes kidney damage; the ethylene glycol is oxidized by the enzyme alcohol dehydrogenase to make oxalic acid.  The reason why alcohol is an antidote for antifreeze poisoning is that it keeps the enzyme busy long enough for the ethylene glycol to be excreted before it can be oxidized and do
damage.)

Dear Vick,

Thanks *so* much for asking about this on Vetmed and also thanks to Chris for his reply.  It really clarifies it all for me b/c I haven't
been able to find any other websites that really lay it out properly.

<<If you want to adjust the gut flora, then fermentablility is desired and fermentable fibers like soybean fiber, psyllium, pectin,>>

hmm..i add psyllium to Booey's food now and hopefully the next CBC will show whether it has helped w/ the BUN.  I doubt it would lower Creatinine cuz that's more an indicator of kidney function.  It seems reasonable to expect psyllium to absorb a lot of the bad stuff such as nitrogen in the system; his poops smell funky enough w/o excess nitrogen in 'em..p.u! <g>

This will be so cool if it helps cat in kidney failure..woo hoo!!

<<Without commenting on Iams material directly, the concept of a  "nitrogen trap" is a valid one that does have support in the
literature.  The only question to ask is is there enough data to support the concept in practice, and is there enough of the     fermentable fiber present to actually work.> >

Wonder if I can find more literature on this; if anyone comes across anything, would u mail me the journal reference, etc.?  Course there's a limit to how much psyllium one can give a tiny 7 lb kitty cat but I'll report back if anyone is interested as to whether this helps Boo or not. At the very least psyllium is so good for cholesterol, diabetes, etc. that it feel comfortable giving it to him..can't hurt as long as I don't overdo it and make him gassy.

Thanks again, Vick!:)

Sandy, owned and operated by the mountain cats

Hi all, esp those w/ an interest in renal failure,

Here's the URL plus the abstract for the article I referred to earlier on Omega 3 fatty acids, and d*gs.  I had my research assistant get it for me thru interlibrary loan; hey, what can I say - she was bored and begged me for work! <g>.  Given that Omega 3 needs for cats might be quite different, I really dunno what implications this has for our CRF  kitties. FWIW, here it is:
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m_d

"Beneficial effects of chronic administration of dietary omega-3 polyunsaturated fatty acids in dogs with renal insufficiency"
Brown SA, Brown CA, Crowell WA, Barsanti JA, Allen T, Cowell C, Finco DR

Department of Physiology and Pharmacology, College of Veterinary Medicine, University of Georgia, Athens 30602, USA.

Dietary supplementation with polyunsaturated fatty acids (PUFA) alters the course of experimental renal disease in rats. However, chronic renal disease in other laboratory animals and in human beings frequently responds differently to experimental manipulations. We investigated the effects of variations in dietary PUFA composition on the chronic course of induced renal disease in dogs. Two months after 15/16 nephrectomy, dogs were randomly divided into three groups of seven animals each. For the next 20 months, each group of dogs was fed a low-fat basal diet supplemented with one of three sources of lipid to achieve a final concentration of 15% added fat. Fat sources provided omega-3 PUFA (menhaden fish oil, group FO), omega-6 PUFA (safflower oil, group SO), or  saturated fatty acids (beef tallow, group BT). Throughout the dietary trial, the magnitude of proteinuria and the plasma concentrations of creatinine, cholesterol, and triglyceride were lower in group FO. The mean overall glomerular filtration rate was 0.89+/-0.18 ml/min per kilogram of body weight in group SO, a value that was significantly less
(p < 0.05) than the corresponding values for  groups BT and FO (1.21+/-0.18 and 1.43+/-0.20 ml/min/kg, respectively). Renal interstitial fibrosis also was significantly elevated in group SO. The extents of mesangial matrix expansion, glomerulosclerosis, and renal interstitial cellular infiltrate were similar in groups BT and SO, but lower (p < 0.05) in group FO. We conclude that supplementation with omega-6 PUFA enhanced renal injury; supplementation with omega-3 PUFA was renoprotective.

Oops, I was too quick w/ the send button.  Not that this is relevant to my cat anymore but figured since so many of you on the list have CRF cats, this might be interesting.  It's also from PubMed (same URL I gave earlier).

Very interesting results, and something this momcat's been saying for a long time.  Nice to see some scientific support.  Course this begs the question - if not protein, then what contributes to progression of renal disease?  And more importantly, in the research methodology - just what type of hi or lo protein food was used?  if commercial, it could be the junk in that food that could confounds matters.  A real test would be a hi quality home-made diet vs. commercial, and of course in that we could include cooked vs. raw.  Wish some holistic vets could take up the mantle.  I'm too busy doing research in the area of my doctoral studies to be writing papers in vet journals!:)

Anyway, here is the abstract.  Curious what others think.
____________
Am J Vet Res 1998 May;59(5):575-82

Protein and calorie effects on progression of induced chronic renal failure in cats.

Finco DR, Brown SA, Brown CA, Crowell WA, Sunvold G, Cooper TL

Department of Physiology, College of Veterinary Medicine, University of  Georgia, Athens 30602, USA.

OBJECTIVE: To determine effects of dietary protein and calories on progression of induced chronic renal failure in cats.

ANIMALS: 28 young  adult female cats.

PROCEDURE: Renal mass was reduced surgically, and glomerular filtration rate (GFR) was determined. Cats were alloted to 4
groups of 7 with similar mean GFR (1.52 to 1.55 ml/min/kg of body weight). Diets were formulated to provide: low protein and calorie (diet A), low protein and high calorie (diet B), high protein and low calorie (diet C), and high protein and calorie (diet D) intakes. Cats were fed their prescribed diet for 12 months, then blood and urine biochemical variables were measured, after which kidney specimens were examined microscopically.

RESULTS: Protein intake by cats of groups C and D (9.0 g/d/kg) was substantially greater than that by cats of groups A and
B (5.3 and 5.2 g/d/kg, respectively). Caloric intake by cats of groups B and D (73 and 71 calories/d/kg, respectively) was greater than that by cats of groups A and C (58 and 55 calories/d/kg, respectively). Renal glomerular lesions were mild and not affected by protein, calories or their interactions.

Nonglomerular lesions, though mild, were significantly influenced by calorie intake, but not by protein or calorie-protein interactions. The GFR did not decrease in any group. Urine protein-to-creatinine ratio increased significantly in all groups after reduction of renal mass, but values from all groups remained within the reference range (0 to 0.3).

CONCLUSIONS AND CLINICAL RELEVANCE: Diets replete in protein were not associated with increased severity of glomerular or nonglomerular renal lesions, increased proteinuria, or decreased GFR. Diets replete in calories were not associated with increased severity of glomerular lesions, but were associated with mild increase of nonglomerular lesions. Factors other than protein and calorie intake must be considered potential causes of progression of renal failure in cats. Results raise questions about the practice of restricting quantity of protein in the diet of cats with chronic renal failure, with the intention of ameliorating development of further renal damage.

Sherry -- I could write a book about the so-called prescription diets.   They are low in some of the essential building blocks of nutrients and thus produce the dull, stringy coats.   Last year this time my little sealpoint baby was diagnosed and the vet said put all the cats on the K/D dry since three were 'older' anyway, it might do them good.

This was the first of Jan.   Gumby (crf) continued to lose weight and look sicker and sicker.  Henry (age 18) started having seizures in April,  Ichabod (age 17) went lame in his front leg and started having other problems in May. Henry died of a massive seizure in Oct.   Ichabod died in July of  'undisclosed' problems!   I lost Gumby in May.    I have nine cats.   I experienced weight gain in my heaviest one (to the point of being obese).  My skinniest got skinnier.   My cat with border-line IBD had terrible  stomach trouble, mostly gas and diahhrea that took months to cure.   My cat that has skin problems (allergies, they think) got in an awful mess and is just now back to his full soft coat.    The cat with slight dandruff was so flakey I thought his skin was
molting -- what a mess that was.

This was all in the course of 5 months of eating Hills K/D  and Purina CNM NF dryfood.

I have done a lot of nutritional research into cat foods and there is a big controversy in whether low protein is really good for a cat in crf.   Protein is the bulding block for muscle developement and cats NEED protein to stay healthy.   Phosphorus is the big killer of kidneys as far as diet is concerned.   Unfortunately meat (which cats need) contains phosphorus.

What I believe to be the best route is a high quality protein source.   I am feeding my cats a combination of dry, canned and raw meat and their coats are absoluetly gorgeous.   They have more desire to play, are getting along better and are the picture of health again after I threw out that low-protein crap.

Gumby's brother has beginning stage crf.  BUN at 45 and creatinine at 3.65 at last check.   So I have decided this time around not to go with the prescription  diets.   I feed mostly PetGuard canned food with a little Nature's Recipe and MaxCat Senior.   The dry I feed is BacktoBasics.  I have mail-order this, but it is higher in fat and I need this with my slim siamese.   My fatso gets Nutro Natural mixed with Sensible Choice Reduced Calorie, and the others eat any of the three.   Three meals every two weeks, I feed raw chicken strips mixed with raw chicken livers and Gerbers baby food veggies for about 3-4 meals to all the cats that will eat it (5 out of 6).

This way I feel I am hedging my bets with types and manufacturers.   What isn't in one, may be in another and the raw food is the tops.   I have put my food analysis spreadsheet on the web at http://personalweb.edge.net/~boles/canfood.htm   and also  dryfood.htm

It is ordered by amount of phosphorus in foods and all calcuations are done on dry matter basis (not the label analysis).   Try to stay near the top of the  lists as this is the lower phosphorus foods.    Read labels and try to feed the highest quality you can afford, avoiding unnatural preservatives, colorants, and by-products if possible.   This way there is less non-nutrient stuff that the
kidneys have to deal with.

Hope this helps.............

Sherry B wrote:

<< I was wondering if anyone has any answers to a few questions:  I have an 11 year old cat who has Kidney problems, the vet put  him on KD (science diet cat food for Kidney problems). He gained  about 5 lbs on this cat food, but his stomach feels and looks funny.  If you never saw him before, you would think he was a she and pregnant.  His coat has also changed from soft & shinny too dull & greasy looking.  He doesn't seem to be in any pain.............any ideas?

I also have a geriatric (16 years old) cat. She has lost weight. I have tried giving her baby food, she eats very little. The vet says she's fine. I know  by looking at her she is NOT fine. She stares out into space, loses her  balance.  She also has this un-dying need to wake me up at 3:30 every morning to eat,  she crys VERY loudly until I get up. I try feeding her right before I retire for  the evening,  but she still wakes me up at 3:30 every morning. What can I feed her to make  her  gain some weight? and what can I do, so she doesn't wake me up so early every morning ?>>

Noreen      >^,,^<
mailto:boles@

For your 16 yr old:  Has your vet done blood work to rule out the possibility of hyperthyroidism?  Older cats with substantial wt loss often have an overactive thyroid- other signs include rapid heart rate, but the only way to know for sure is a blood test.  Hyperthyroidism can be treated with daily meds, radioactive iodine or surgery if a growth is present.  I have had several cats who had the radioactive iodine treatment (just like humans) and did well.  I know this is not a traditional medical list, but I don't know of any alternative approaches. Bloodwork should be the starting point for anything else.

I have an older cat , Heidi, who howls and stares off into space too (she's 18 and has also kidney problems and kidney surgery).  She howls in the middle of the night-she sleeps on the rocking chair next to the bed-seems to just want to make sure I'm there.  Sometimes it's once an hour or so, other times it's not at all.    She also howls when I talk on the phone.  She has a 6th sense-the more important the phone call, the louder she howls.  If I put her out of the room while I'm on the phone she's even worse-howls
louder.  I had a long-distance phone interview for a job several months ago and she started wailing in the middle of it.  The more I tried to hush her up, the worse it got-she knew the call was important.  My vet couldn't find anything wrong- said vet medicine now suspects that animals get something similar to Alzheimers.  We've decided she must have Mouseheimers.

As far as kidney problems go, I have several older cats, including Heidi, on KD and I've noticed the same things you've mentioned.  With one of my cats, her grooming has gotten poorer as she's grown older, so I have to groom her more frequently.  I also give subQ fluids at home to several of my older cats with kidney problems.  I freaked out when the vet was trying to teach
me how to give the fluids, but once I got the hang of it, it's easy.  The best part is that my kitties feel sooo much better without having to pay a visit to the vet.  I have well water with high levels of calcium.  Several cats developed calcium oxalate stones which I had to have removed at Purdue Vet School.  One cat had surgery to remove stones, the other had lithotripsy-both are on distilled water now to prevent the formation of new stones.  As a side note, shortly after my kitties developed stones, I developed a vision problem which was traced to calcium deposits behind my retina.  The doctors wouldn't admit a connection between the high levels of calcium in the water and the calcium deposits in my eyes, but the vets at Purdue were suspicious of a link.

If anyone has info on supplements I can give to my kidney kitties, I'd be interested.

Thanks!
Linda M & Heidi Mouseheimer

Just a brief note on kidney disease in cats.  The MOST important thing you can do is learn to give subcutaneous fluids at home.  No kidding - this will save your cat's life (at least for awhile, but could be on the order of years), and keep you out of the vet's office.  I tell my clients to increase fluids if the appetite falls - appetite and general attitude are their indicators of how often fluids should be give.  If they really need fluids, they will probably be getting them anywhere from twice daily to once weekly, and *this is for life*.

Make sure they are getting B-vitamins (in the fluids, and maybe 1/2 of a B-50 2-3 times weekly), as they lose B vitamins in their increased urination, and Bs make them feel much better.

K/D is NOT always appropriate for cats with kidney failure, as I believe you guys may have discussed.  It is low protein, and many cats  lose protein in the urine, so they need to have more normal levels of dietary protein.  This is certainly being question in the veterinary literature right now, and you should always question your vet if they make this recommendation.  If the urinalysis shows protein loss, I would seriously consider a more normal diet, and real food is, of course, a good idea.

I use fish oil and a number of other unproven supplements, depending on the individual, and this is something you should bring up with your holistic vet.
 

Susan G. Wynn, DVM

Kaylen,

prayers are being sent to you and Baranof. Don't worry about giving sub q fluids at home; only us humans are terrified of it. I'm terrified of needles and have passed out on several occasions from the sight of them, but I putthat aside and did what I had to do for Wiley.

<<I have to take him in every day for fluids.  I can manage this for about a week and a half and then I'm going to have to do it myself for financial reasons>>

if you warm the bag in hot tap water up to about cat body temp, it actually feels good going in. hang the bag high enough so gravity helps you out. Have the vet or vet tech show you how to do it. a smaller needle will take a little longer, but be more comfortable for him. A bigger needle is better if you want to get it over with more quickly, or if he's squirmy and won't sit still. They barely feel it if you inject them in the scruff. I had a special pillow set up under a lamp so it was a safe comfort zone for him. He even napped there when fluids were not scheduled. But he knew that when I put him up there, it was fluids time.

You must not be scared. Baranof will pick up on that. What you are doing here is providing him with the best care available; have that confidence when you administer the fluids. He loves you, and will forgive you being nervous, but calm yourself down, and remember, vets and techs do this all the time. So can you. He's your baby, and who else but you could administer them with the love and tenderness that you can? So make it a therapeutic experience for both of you. Repeat to yourself over and over that this is helping him get healthy and strong. Make it a prayer. Thank God for the strength that he is giving you to be able to care for Baranof in this way. Praise B. for being so brave. In my case, wiley was brave for both of us. It does get easier after you've done it for a while.

Oh, and welcome to the list!!

Sue

Here are some links that may help

• CRF support  http://www.best.com/%7Elynxpt/recep2.htm
• sub Q info: http://members.aol.com/aquila111/subq/   (the most helpful for me)
• http://www.best.com/~lynxpt/managb.htm
• http://pricemd.com/felinediabetes/inject.htm

<<When he was handing me my bulk order, he said he saw potassium on my list, and told me that cream of tartar is just
about pure potassium.  Does anyone know about this?  How much should I use?>>

Debbie,

I don't know about the potassium content of cream of tartar, but a booklet I have says caution is advised if the person/animal has kidney or heart problems.

That information was taken from "Food Additives: A Shopper's Guide to What's Safe & What's Not" by Christine Farlow, D.C.

Leah
lknipp@

At 11:08 AM 1/8/99 +0000, you wrote:
<<Thanks Leah! >>

You're welcome; I've got more info. on how PMGs compare to glandulars if you have additional questions.

<<She is on Renatrophin PMG by Standard Process-Bovine Kidney PMG Extract. >>

Hmmm - my kitty's is called Renafood. He's also taking Hepatrophin for his liver; at first he would eat these out of my hand, now I have to crush them and put them in his mouth.  The other thing I learned is that these should be given 15-30 minutes before/after eating.  I've seen some positive changes for the better since he's been on it as prescribed by our holistic vet; we've been able to maintain his Creat. and BUN at decent levels, in addition to using homeopathic remedies.

Leah
lknipp@

Kaylen,

Before you inject the needle, you can let the bubbles run out.  Tiny bubbles won't hurt your kitty- I was scared about that at first too.  I was confused thinking it would cause an embolism, etc, but it won't.  I think someone on one of the other postings said it will help your comfort and confidence to visualize how much better your kitty will feel and to visualize yourself doing it with confidence and compassion.  that approach helped me too.  I was very nervous at first, too--my hands shook, but it does really get easier.  You can do it--hang in there!

Linda M