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Quality of Life Considerations

Happiness/Mental Status
General Behavior Patterns
Owner Perceptions

The decision to pursue additional medical treatments or consider euthanasia for a sick or chronically ill cat is a hard decision to make for many cat owners. This handout has been designed to help you consider the quality of life of your cat and to help make you aware of some of the additional options that exist if it is not the right time for euthanasia. Answer each of the questions in each section with a yes or no.

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Pain control is essential. Many animals do not complain in obvious, visible ways when they hurt. Many animals will hide their discomfort. Consider the following:
____My cat hurts.
____My cat limps. (If it didn't hurt, they wouldn't limp.)
____My cat's respirations are forced, exaggerated, or otherwise not normal.
____My cat licks repeatedly at one site on his/her body or at a site of a cancer/tumor.
____My cat guards or protects and area of his/her body and may snap if that area is approached or touched.
____My cat's posture is abnormal or different than normal.
____My cat shakes or trembles sometimes during rest.
____My cat is on pain medication and it doesn't work.
____My cat rests with his eyes open all the time, as if uncomfortable.
____My cat is resting more than usual and/or is noticeably less interactive with the family than before.

Possible interventions for yes answers: start pain medication, change pain medications, combinations of pain medications from different drug classes, surgical intervention, non-traditional medicine (acupuncture, cold laser treatments, etc.), treat the underlying disease/condition.

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Appetite is one of the most obvious signs of wellness. Most animals are normally vigorous eaters. Consider the following:
____My cat doesn't eat his/her normal food anymore.
____My cat picks at his/her food now but never used to do this.
____My cat walks over to his/her food and looks at it but won't eat or walks away from the food.
____My cat doesn't even want "good stuff" (treats, human foods, snacks) anymore.
____My cat acts nauseated or vomits. (Many cats that are nauseated will not necessarily vomit, they just eat less.)
____My cat is losing weight.

Possible interventions for yes answers: hand feeding, heating food, adding moisture by soaking food or using canned varieties, careful addition of human foods (baby food), veterinary prescription diets, syringe feeding, stomach tube placement, medications for appetite stimulation, or medications for nausea.

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Hydration status is equally important as appetite. Without adequate water consumption, your cat can become dehydrated, especially if his appetite is down and/or if there is any vomiting or diarrhea. Dehydration can contribute to weakness and not feeling well. Consider the following:
____My cat doesn't drink as much as he/she used to.
____My cat frequently has dry, sticky gums.
____My cat is vomiting or has diarrhea (fluid loss can also contribute to dehydration).

Possible interventions for yes answers: add moisture to the diet, subcutaneous (under the skin) fluid administration, medications to control vomiting or diarrhea. Place additional water bowls throughout the house (so your cat never has to go far for water). Freshen the water in the bowls twice daily. Offer water bowl options that are not located near food bowls.

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Animals that don't feel well, especially cats, do not have the energy to maintain normal hair and skin. Consider the following:
____My cat doesn't groom herself anymore or as effectively as before.
____My cat's hair is matted, greasy, rough looking, dull, or foul smelling.
____My cat has stool pasted around his/her rectum or in his/her hair.
____My cat smells like urine or has skin irritation from urine.
____My cat has pressure sores/wounds that won't heal.

Possible interventions for yes answers: regular brushing and grooming, frequent bedding changes, adequate padding for areas where the cat spends a lot of time, appropriate wound care, treat the underlying disease/condition, bathing when appropriate.

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Changes in normal activity can be due to mobility problems, pain, illness, or aging (arthritis). Consider the following:
____My cat cannot get up without assistance.
____My cat had a hard time getting around and/or limps.
____My cat lies in one place all day long.
____My cat does not want to play ball, go for walks, or do the things he/she used to do.
____My cat falls frequently.
____My cat's gait is stiff or laborious.
____My cat is wobbly when walking.
____My cat is unable to jump at all and/or as high as previously.

Possible interventions for yes answers: pain medication addition or adjustment, physical therapy, pet steps, heating pad on low setting with thick towel over the heating pad.

Happiness/Mental Status
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Another important area of consideration is the cat's mental status and happiness. Consider the following:
____My cat does not express joy and interest in life.
____My cat does not respond to the people that he/she used to respond to.
____My cat does not want to play with toys or do other things that he/she used to enjoy.
____My cat seems dull, not alert, or depressed.

General Behavior Patterns
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Changes in normal behavioral patterns are often a key indicator of how well and animal feels. Consider the following:
____My cat is hiding or sleeping in odd places.
____My cat doesn't greet me when I come home and he/she used to.
____My cat is overly clingy and is following me around and he/she never used to do this.
____My other cats are treating this cat differently - they are overly attentive or ignoring him/her completely.
____My cat doesn't care about what is going on around him/her.

Owner Perceptions
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Many times an owner is aware that their cat is suffering but does not want to give up on their cat. Consider the following:
____I wouldn't want to live if I were in a similar situation.
____I would be painful if I were in a similar situation.
____I have made appointments for euthanasia for this cat cancelled or didn't show up.
____I am holding onto this cat for some sentimental reason. (Examples: the cat belonged to a now deceased family member, the cat helped me through a hard time in my life, etc.)
____ My cat is having more bad days than good days.
____I have had to redefine a "good day" compared to weeks or months ago.

Unfortunately, there isn't a simple point system or scale that will tell you exactly what do for your cat. However, the more yes answers you have, the more likely it is that your cat has a compromised or poor quality of life. Cat owners may also find helpful a "Quality of Life Scale," written by Dr. Alice Villalobos (http://www.veterinarypracticenews.com/images/pdfs/Quality_of_Life.pdf).

It is always painful for cat owners to watch their beloved feline friends suffer and physically decline. A decision to euthanize a cat is very painful and heart-breaking for all of us as cat owners. If changes to improve quality of life, such as some of those mentioned above, are not possible or not helping in making your cat feel better, humane euthanasia is likely a loving and appropriate decision. People often prefer that their cat die naturally in the comfort of their own home, this is fine as long as the cat is not suffering. Unfortunately, this is not often the case. Home euthanasia by a housecall veterinarian may be elected, sometimes one of your own Cat Hospital of Chicago veterinarians is able to make a home visit for this purpose. Please do not hesitate to contact one of our hospital technicians or nurses or your Cat Hospital of Chicago veterinarian if you need help in making your decision of what is best for your cat.

Please do not hesitate to contact us to further discuss this handout and your cat's specific situation.

As veterinarians at Cat Hospital of Chicago, we have a responsibility to provide guidance on end of life issues on behalf of our patients. Our goal is to maintain and enhance the quality of life of our patients. This includes all of the welfare concepts defined in the Five Freedoms, i.e., freedom from physical discomfort, freedom from hunger, thirst and malnutrition, freedom from fear and distress, freedom from pain, injury and disease, and freedom to express normal patterns of behavior. Quantity of life may be an important consideration in human medicine, but we recognize that cats are constitutionally incapable of conceptualizing quantity of life. Cats do, however, have an incredible ability to appreciate quality of life. It is centered on this principle alone that the veterinarians at Cat Hospital of Chicago focus on being passionate and compassionate patient advocates.

The information provided is for educational purposes only and is not intended to take the place of your regular veterinarian. Please do not hesitate to contact your regular veterinarian if you have questions regarding your cat.

Very loosely adapted from Quality of Life Scale, Veterinary Practice News, June 2006, pg. 24.

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