What Is Quality of Life For Pets? - Part 1
On the surface, quality of life sounds like a nebulous concept. How do you determine if your pet is having a good quality of life? This can vary from pet to pet, and there is no one-size-fits-all answer. However, every time we discuss hospice and palliative care we will discuss “quality of life”. Quality of life is a very broad term that encompasses everything that determines if your pet is living a life with minimal pain and suffering. I think that we can all tell the difference between suffering and a really good quality of life. But what about the gray areas? Those times when we know our pet has a terminal disease but is not yet obviously suffering? How do we determine the quality of life then?
Because this is a big factor in most people’s decision whether to euthanize, emotions play a huge role when we are evaluating quality of life. There are ways to make this process more rational, but in the end, it often comes down to a feeling or intuition. There are numerous quality of life scales available on the internet, but all of them focus on similar issues. A good quality of life encompasses many categories, including:
Pain
Appetite
Energy
Mobility
Ability to participate in things they enjoy
Oftentimes, pets will cycle between good days and bad days. Some days, they don’t eat, but other days, they will. It can be hard on the good days to remember that the last week has been full of bad days, and vice versa. It is helpful to keep track of the good days and the bad days on a calendar. It’s easy to put a “B” for bad days and a “G” for good days. When the bad days outnumber the good days, or the bad days become unbearable, it is time to stop. Another option is to make a list of 5 things that your pet likes to do – this may include taking a walk outside, playing with a favorite toy, and eating. When your pet can’t do four out of five of their favorite activities, their quality of life is most likely poor.
Pain control is the number one determinant of quality of life. If we cannot control your pet’s pain, they are definitely suffering. Signs of pain include limping, not moving, inability to get up, grunting or groaning when being touched, or growling. There are many different options for pain management, including oral medications, patches, injections, acupuncture, herbs, and environmental changes. It is vital that you work closely with your veterinarian to find the right combination for your pet – do not be afraid to keep trying different combinations and different dosages. Our goal is to control pain but not to make your pet so sedated that they can’t interact with you. Some days may be worse than others, and so it is important to have a contingency plan for the bad days – either adding in new medications or increasing the dosage of chronic medications on those days. Veterinarians, especially those who focus on palliative care, understand the need for contingency plans for the bad days. Signs of pain include limping, not moving, inability to get up, grunting or groaning when being touched, or growling.
Appetite and the ability to eat are two different things. Your pet may want to eat but can’t, or they may be able to eat but have no appetite. The first thing to do when your pet is not eating is to try new foods. You can try changing from dry food to canned (which is easier to chew and swallow), or adding water to the dry food. You can also try feeding a home cooked diet (under the advice of a veterinarian). Some people will force feed their pets – we recommend avoiding this if possible, as when a pet is forced to take in food, they could aspirate (the food goes down into the lungs), or they can struggle so much that they end up hating the person giving them the food. If you get to this point, try hand feeding your pet first – don’t force them, but offer them the food in your hand or on a spoon. You can give small amounts of food via syringe, but you want to make sure that you go only as quickly as your pet can swallow the food. If you cannot get your pet to eat consistently, there are medications that can stimulate the appetite, including mirtazapine, cyproheptadine, and entyce. If your pet is not eating due to nausea (signs of nausea include hypersalivating, vomiting, licking their lips, and hard swallowing), anti-nausea medication may help.
If these medications and diet changes don’t work, or if your pet is not able to eat for various reasons (such as they can’t chew), a feeding tube may be recommended. There are many different types of feeding tubes, including nasogastric tubes (tubes that go from the nose to the stomach), esophageal feeding tubes (tubes that go into the esophagus and hang out the side of the neck), and gastric feeding tubes (tubes that go directly into the stomach from the outside). Depending on where the problem is located, the reason behind the inability to eat or the lack of appetite, and the size of the pet, your veterinarian can recommend which one is most preferable. There is a lot of negative feelings surrounding feeding tubes – some people believe that they are cruel or that living with a feeding tube is too stressful for your pet. Most dogs and cats tolerate feeding tubes very well – they don’t have the negative emotional feelings that people do. If your pet has a good quality of life other than their lack of appetite/inability to eat, a feeding tube will help them feel better. It is important to remember that not eating can be the body’s way of shutting down, especially close to death. However, maintaining optimal nutrition and hydration prior to this time period can prolong their quality of life. Feeding tubes also provide us a way to give medications and fluids. Feeding tubes do take a lot of time and effort at home to manage. If this is not something you are comfortable doing, or you feel that it will be detrimental to your pet’s psychological well-being, it is reasonable not to pursue this option after discussing it with your veterinarian.
If you have any questions or concerns, you should always visit or call your veterinarian – they are your best resource to ensure the health and well-being of your pets, and to help you during these final stages.