Sadly, your cat has recently been diagnosed with a fatal disease or is nearing the end of her ninth life. In the past, you could choose to treat the disease or to give your cat a peaceful death through euthanasia. Increasingly, however, pet owners and veterinarians are working together to find a third way toward a positive end-of-life experience: hospice, or Pawspice, the term coined by Alice Villalobos, DVM, a leader in the movement.
A growing number of pet owners now want to care for their terminally ill pets at home. They seek sophisticated supportive care until the cat dies at home or the time for euthanasia arrives.
The goal is to provide palliative care — which is essentially care that is designed to relieve symptoms, but not treat the underlying disease itself — and quality of life for animals in the advanced stages of disease. It may include pain management, infection control, nutritional support and complementary therapies such as acupuncture or massage.
How this can help
The approach may yield longer survival times for terminally ill pets, giving owners and their cat more good time together before the inevitable end. In one human study, for instance, lung cancer patients given palliative care in addition to standard treatment lived three months longer than people who went through standard care without the nurturing provided by palliative medicine, according to Dr. Villalobos.
Determining and managing quality of life are the first and most important steps. The ability to provide quality of life as death nears honors the human-animal bond, and is particularly important for animals, explains Dr. Villalobos. “Humans have goals. Animals live in the now. If animals suffer, they’re suffering now, and now is every minute. They’re not looking forward to getting well or to a special occasion or for someone.”
What is quality of life?
Quality of life encompasses physical, mental and social well- being. According to Dr. Villalobos’s scale, the seven components of quality of life are hurt, hunger, hydration, hygiene, happiness, mobility, and more good days than bad days.
Pain management is at the top of the list. If pain can’t be controlled, nothing else is as important. Unfortunately, many diseases are associated with pain, says Alicia Karas, DVM, a pain specialist at Tufts Cummings School of Veterinary Medicine. These include oral cavity or dental diseases, cancers, chronic kidney disease, osteoarthritis, inflammatory bowel disease, chronic bladder inflammation and diabetes mellitus.
Determining a cat’s level of pain can often be difficult. Cats are reluctant to show pain and many owners — and even veterinarians — may be unaware that a cat is in pain at all.
“Behavioral changes with chronic pain can develop so slowly that the owner doesn’t realize that it isn’t just ‘aging,'” Dr. Karas explains. “In a cat with arthritic pain, for example, an owner might see impaired mobility — reluctance to jump up or down, a halting, step-by-step gait on stairways, clicking of nails on the floor, or general stiffness. The cat may be more likely to sleep or be inactive, may seek different places to hide, or may have difficulty chewing with oral pain.
“Cats will often play until an advanced age, so if the cat seems to lose its willingness to play, that is significant. These are things to consider when wondering whether a cat has moderate to severe pain.”
Pain management in animals is a relatively new area of focus in veterinary medicine, and more can be done for cats than in the past, although treatment options for cats are still more limited than for dogs. One option is combining more than one type of pain medication.
When pain is moderate to severe, one drug may not be enough to effectively counter the pain. Adding a drug from a different class allows the veterinarian to use lower doses of each drug and minimize side effects. And medication isn’t the only weapon against pain.
“It is hugely important to consider the effects of diet, body weight, supplements such as essential fatty acids and glucosamine, hands-on therapies such as acupuncture, and home modifications to permit more comfortable access to daily activity,” explains Dr. Karas.
The simplest and most important first step is to let your veterinarian know that it’s important to you to recognize and prevent pain in your older cat.
Assessing Quality of Life
According to Dr. Villabolos, there are seven factors that, together, determine quality of life. This list may be useful to you in assessing the quality of life of your cat.
Hurt: Does your veterinarian feel that your cat’s pain can be managed with medication, supplements, weight loss and modifications to his environment?
Hunger: Does your cat eat well? If not, can his appetite be improved with appetite stimulants, hand-feeding, or dietary adjustments? Warming food makes it more aromatic, which stimulates appetite, and scratching your cat’s head and neck may encourage him to eat.
Hydration: Does your cat drink enough water? Dehydration can make cats feel sick. Consider providing a fountain (some cats prefer running water) to encourage your cat to drink, or learning to administer subcutaneous fluids at home with the guidance of your vet.
Hygiene: Can your cat clean himself? Loss of interest in grooming in cats often indicates significant illness. Oral pain, or stiffness resulting from arthritis, may limit a cat’s ability to groom. Keeping him brushed, clean and dry may help his overall attitude.
Happiness: Does your cat greet you and enjoy petting and other interactions? If he seems depressed, anxious or isolated, can you make environmental changes such as keeping him in a quieter area — or a more active one if he is a social cat?
Mobility: Can your cat get around without assistance? If necessary, can he be helped in and out of the litter box?
More good days than bad: If your cat has a terminal disease and his bad days begin to outnumber his good days, it may be time to discuss euthanasia with your veterinarian. — Kim Campbell Thornton