When it comes to quality of life at the end of life for our cats, pain, and suffering are always foremost in our minds, but it is good to begin with a few definitions.
“Physical pain is a physiological process. Mental pain comes from an agitated and disturbed mind. Suffering is our mental and emotional response to the pain.” —Hayagriva Buddhist Center
“Suffering is an emotional experience. Suffering may or may not be connected to physical pain.” —Catherine Carrigan, Medical Intuitive Healer
How do we translate or interpret physical pain and suffering in our cats and then in the individual cat itself in order to maintain a good quality of life at end of life and get the right comfort care on board?
Assessing the Quality of Life Scale in Cats at End of Life
Is there pain and how can it be identified? Cats sometimes do not show pain, so the first priority is to identify its presence and degree as accurately as possible. The evaluation of BEAM (behavior, energy, appetite, and mood) plus reactivity to touch in affected areas, dilated pupils, mobility and physiologic changes can all be helpful. This is a helpful quality of life scale that can be used often and it can be helpful to record your findings on paper for future reference.
Have you noticed any changes in behavior like not wanting to engage in normal activity, or being reclusive?
Has your feline friend slowed down? Do you see them resting more and not greeting guests as they normally would? Are they no longer able to jump on the couch, bed, or kitchen counter?
With some pets, their appetite will rarely wane but in a large majority, it will be a good indicator if something is off, particularly in a pet who has always been a good eater. This could indicate a variety of things, but it is a clear sign that something needs addressing.
So much of the care of our cats is done through observation and mood is definitely one of those things that we can observe when we know the animal well. Is your cat as interactive with you as usual or have their preferences changed? Have their facial expressions diminished, or has the light in their eyes dimmed somewhat? Do they seem annoyed or frustrated at their diminished physical abilities?
How Can the Level of Pain be Determined?
Perhaps the best way to evaluate pain levels is to look at the symptom as expressed. For example, some expressions of these changes could be:
- inability to jump or walk well
- open-mouthed breathing
Referring to the quality of life scale in as many instances as possible will help the family determine where the cat’s quality of life is at and reporting that information to your hospice veterinarian to help determine if any modifications in the hospice care plan are warranted. One can never do too many assessments at the end of life. They are our best indicator as to modifications in the care plan.
Does Pain Always Need Managing?
Sometimes it may not need managing or will be temporary. However, an in-home hospice appointment with your veterinarian would be the best way to help determine what is needed and where the pet is at on the quality of life scale. Cats and their owners will always benefit from more support not less.
Does Untreated Pain Affect the Quality of Life?
Yes, it does, and that is why owners must become proactive in their pet’s care at all stages of life, particularly end of life.
The HHHHHMM scale
The HHHHHMM scale is also a very effective way to rate where your feline friend is on the quality of life scale. Dr. Alice Villalobos, a veterinary oncologist, has developed a quality of life scale for cats so that owners can become proactive in their end-of-life care. The quality of life scale provides guidelines that help owners and veterinarians work together to maintain a healthy human-animal bond.
The scale provides a tool with which to measure the success of palliative care or hospice plan for a cat with life-limiting disease and to fine-tune that care/plan. Dr. Villalobos’ quality-of-life scale looks at seven different categories and scores each parameter from 1 to 10, with 10 being the best. A score above 5 in each category, or an overall score greater than 35, suggests that the cat’s quality of life is acceptable and that it is reasonable to continue end-of-life care and support.
The categories to be measured can be remembered as ‘HHHHHMM’. This list of letters stands for Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, and More good days than bad.
Adequate pain control, including the ability to breathe properly, is an absolute necessity. Most pet owners do not know that being able to breathe is ranked as an important pain management strategy. Cats hide their pain extremely well. They will become very still if breathing is a problem.
Pain control may include oral or injectable medication. Knowing how to recognize pain in your cat is paramount. An abnormal gait, reluctance to move, hissing, not wanting to be touched, dropping food, excessive grooming of one area, frequent visits to the litter box, stiff, squinty eyes, and compact posture can all be indicators of pain in cats.
Often cats are able to hide their weight loss amongst all that glorious fur so one might have to be more diligent in checking for weight loss. If a cat cannot eat properly or willingly, first try hand-feeding.
If this is not successful, it may be appropriate to consider appetite stimulants or a blended or liquid diet, particularly if oral medication must be given. A feeding tube at the end of life might not be appropriate but at the beginning stages might work well.
Fluid under the skin is generally an easy and well-tolerated way to supplement what an ailing cat is drinking. This is not a heroic measure but can really help an older cat feel better in the early stages of the end of life but in the end, it may have the opposite effect. This is always an area to consult with your veterinarian and to observe your cat’s tolerance to treatment eg. if fluid is not being absorbed.
Can your cat be brushed, combed, and kept clean? Is the coat matted? Cats are very good about keeping themselves clean. If they have an oral tumor or back pain, they may not be able to groom and may need help. Waterless shampoo works well to keep the coat clean and a regular ‘lion cut’ can keep the coat short and easy to manage. At the end of life, appearance is hardly a priority but hygiene is always a concern, particularly in a cat that lacks mobility and is incontinent.
Is your cat experiencing joy or mental stimulation? Cats communicate with their eyes, as well as by purring. Is the ailing cat still interacting with family members and with the environment? Placing comfortable beds near family activities helps a cat remain engaged in life.
Bringing toys to them if they can no longer run after them and offering new sounds and smells – music, aromatherapy, and other modalities of care like reiki, acupuncture or massage could bring a measurable degree of comfort.
If your cat can no longer move around on its own, it may be time to consider a mobility device. Cats are quite accepting of two- and four-wheel carts as long as any pain is well managed. Mobility and hygiene go together when a cat is bedridden. Your veterinarian is an important resource when working through mobility issues.
More Good Days than Bad
What determines a bad day for your cat? Owners who are bonded have a deep connection to their cats and generally know what the quality of their days are and what consists of a good day for that particular cat versus a good day for cats in general. One must take into account so many factors for seniors and end of life.
Whereas one cat might be quite happy to sleep away the day and experience some level of discomfort while enjoying some evening socializing, another cat might not. Bad days, in general, may mean nausea, vomiting, diarrhea, seizures, frustration, unrelenting pain/discomfort, or inability to breathe.
When to Euthanize a Cat
Using the quality of life scale as one of the primary tools, observing the cat’s behavior, and honoring the relationship between you both should be very helpful when it comes to the high-stake decisions of end of life. It might help minimize regrets and gently guide the owner into a softer bereavement. Making this decision as a team is the best way possible to share the burden of the end of life and the sadness that comes along with it.