No one wants their pet to suffer, but understanding the signs of suffering - often caused by pain - requires careful observation. Animals instinctively hide signs of pain because, if you think about it, their wild ancestors were at a severe disadvantage if they showed weakness to their pack or their predators.
Learning to recognize pain in our pets becomes even more important as they grow older. Technically speaking, age is not a disease and age doesn't cause an animal to be less active or create changes their behavior, however age-related changes in their bodies can. Arthritis is very common in older animals and although it might start with Monday morning stiffness after a weekend of exercise, over the years it can become chronic (read: constant) pain in the hips, knees, back and neck. (sound familiar?) Very often the changes our pets go through are so gradual that we have trouble recognizing them.
Some signs are pretty straightforward, like crying, whimpering, growling in reaction to pain. Limping is always a clear sign of pain, even if your pet has been doing it for a while. But did you know that when a dog paces, it often means either it hurts to lie down or doing so may make it harder to breath. Another common situation is an older dog begins snapping at you or other family members. This often means she is afraid your touch will create more pain.
There are other, less obvious signs that should signal to us that your pet is saying, "I don't feel good!"
You've said you don't want your pet to suffer; there is no reason your pet should have to and no excuse for allowing the pain to continue.
Most people know that high blood pressure, or hypertension, in humans increases the risk of heart disease and stroke and can be present for long periods of time with no outward signs. Would you be surprised to know it is also “the silent killer” in cats?
Cats are notoriously good at hiding signs of illness anyway, and because high blood pressure by itself has no symptoms, it is that much more insidious. The condition is most frequently found in older cats, and often secondary to an already existing disease like kidney disease, heart disease, diabetes or hyperthyroidism.
Like in people, high blood pressure causes wear and tear on many parts of the body. Like a hose with abnormally high water pressure, it can cause damage, leaks and rupture in blood vessels. What are the effects of ongoing hypertension?
Blood pressure in cats is measured just as it is in humans, with an inflatable cuff and a Doppler, an ultrasonic listening device. To get an accurate reading, it helps if it is done in a quiet room, where your cat can relax a bit. The doctor will take several readings to be sure it’s not artificially elevated by stress. If blood pressure is consistently high and stress is ruled out as a cause, additional tests may be needed, including a complete blood count, blood chemistry, and urinalysis.
Treatment begins with controlling the underlying disease, taking into account any medications that can worsen hypertension, such as steroids, and an evaluation of diet. If additional treatment is indicated, it will depend on other diseases present. The goal is to reduce the blood pressure into a range that minimizes organ damage. Once controlled, blood pressure should be rechecked every three months.
I know it’s hard – on both you and your cat - to visit the veterinarian. But diseases like hypertension can only be diagnosed by a doctor, and your geriatric cat’s life may depend on it. The American Association of Feline Practitioners recommends blood pressure monitoring as part of a regular bi-annual senior cat exam for all cats.
In the final days of a cat’s life, people often try to get a few more days with their pets. But early detection and control of hypertension and other geriatric diseases can extend a cat’s life for years!
There are so many treatment options in veterinary medicine these days - we can choose cancer radiation treatments, joint replacements, kidney transplants for our pets - all quite successfully in the right cases.
But we as pet owners almost always outlive our pets, so we are repeatedly faced with making difficult decisions about their care and the lengths we will go to treat them.
So what do you do if you are facing a terminal disease for your pet, you have chosen not try to "cure" the disease and now you are seeing declining quality of life. The decision on whether and when to choose euthanasia is a difficult and personal one. You may be thinking you need to postpone it. Maybe you feel your pet still has more good days than bad. Maybe you want to make it until the next college break, or the end of a deployment. Maybe it's not a decision you are emotionally prepared to make. Veterinary hospice may be something you are considering.
I've written about veterinary hospice in the past, and while more and more veterinarians are offering hospice care programs, the truth is many pet owners have been providing basic hospice care for some time - home cooking, help getting outside, cleaning up after daily accidents. Doctors can prescribe pain control, appetite stimulants, fluids, etc., but whether your veterinarian gets involved or not, when you are providing end of life care for your pet, you need to think about three different budgets:
When any one of the three runs out, it’s important to acknowledge it's time to do something differently. As difficult as it will be to ask, find some help from a veterinarian, extra helping hands at home and/or a mental health professional.
You've got to balance the budget.
Mary Craig, DVM, MBA
Dr Craig is a mobile veterinarian with a house call practice focused on end-of-life care.