Zoom Recap: End of Life & Hospice Care—Call #8

No one wants to think about the end of their cat’s life or hospice care, but if you plan for it ahead of time, you’ll be more prepared to make decisions down the road. During this Zoom call, small animal veterinarian and My Lovely Feline content contributor Dr. Leslie Brooks explores the topic of end of life care and making decisions around euthanasia. The call was also co-hosted by My Lovely Feline content contributor and fostering and behavior specialist Liz Italia.

Recorded: August 10th, 2020.

Disclaimer: The opinions expressed in this call are those of the guest(s) and/or host(s) and may or may not reflect the views or opinions of My Lovely Feline.

Assessing Quality of Life

Feline leukemia, cancer, feline infectious peritonitis (FIP aka feline coronavirus) are just some of the illnesses a cat can face at a young age, but really, there are many reasons end of life or hospice care are discussed. These include financial reasons (which we’ll discuss more), quality of life, or a lack of other treatment options.

The main thing to focus on is keeping your cat as comfortable as possible, and what that looks like is different for every cat. For example, if your cat loves to lay in their bed, make it as easy as possible for them to get to their food and water and keeping a litter box close. You may have to put puppy pads outside of their box or even add pet steps near furniture.

Sometimes you may not take them to the vet as frequently as you normally would because the stress isn’t worth it. In these cases, you can try to find a mobile vet or veterinary nurse who can come to your house to help you. Some vets offer hospice call ins, where they call you every day to see how you and your cat are doing.

Suffering means something different from cat to cat. When it’s time to make a decision if euthanasia or allowing them to pass on their own, look at their behaviors:

• Are they doing the things they usually like to do?
• Are they breathing easily?
• Are they yowling in pain?
• Are they open mouth breathing?
• Are they still eating? Or are they turning their nose up even at things they love?
• Are they vomiting a lot?
• Are they having a hard time keeping their bowels in?

The answers to these questions can help you determine next steps.

If your goal is to make your cat more comfortable and get a little more time with them, your vet may recommend the following medications:

• Pain meds - Buprenorphine is an opiate that can be squirted into a cat’s mouth and absorbed through their gums. If they have an oral tumor, they can receive an injection.
• Appetite Stimulant - You can get a transdermal ointment that you rub in their ear to help them eat.
• Antibiotics
• Anti-nausea meds

If it’s too difficult to medicate a cat at home and they’re hiding all the time or trying to bite their owner, Dr. Brooks recommends forgoing the medication to keep the cat happy.

Keep in mind, if your cat bites you or someone else and you decide you need to euthanize them or they pass before 10 days, your vet is required by law to send them in for rabies testing. The last thing you want is for your cat to pass and then have their body sent for testing.

There is nothing wrong with letting your pet pass on their own. Sometimes cats will pass on their own, either in their sleep or all of a sudden. If they are in a lot of pain or having problems breathing, Dr. Brooks recommends euthanaisa to end suffering.

Liz spoke about how she feels death is part of a cat’s life too, and that there’s something beautiful about providing peace at a moment when your cat needs you most. If there is no better outcome possible, then you have to put some feelings aside and do what’s best for them. It’s still part of their journey and part of their story.

One of the callers also shared that she has a 13-year-old Bombay with early kidney disease. She had to euthanize her littermate a few years ago because he ingested the stamen of a lily which fell on the floor without the owner noticing.

He started having viral symptoms and they progressed quickly and he ended up in the ICU. His owner made the decision that if his levels didn’t improve after a few days, she’d euthanize him. He was in acute renal failure, so she made the difficult decision to put him to sleep. She’s now a cat adoption counselor and educates adopters on toxins.

Financial Component

Liz also shared that it’s okay you can’t commit to giving the best care for financial reasons. Very few people have access to endless wealth, so most of us have limitations on what we can spend. You have a responsibility to yourself, your home, your family, and your cat that you can cover basics like food and shelter.

You’ll have to look at what you can afford and how much extra time your cat will have and be honest with yourself about what works for you. Sometimes all of the care in the world isn’t going to change the outcome. Weigh how much time you’ll get with treatment, the quality of life your pet will likely have, plus the cost. If any one of those things doesn’t work for you, it’s okay to opt not to treat.

Sharing Stories

Liz shared a story about a foster kitten named Jalapeno she had to have euthanized. Most kittens with birth defects will display them at less than 6 weeks of age. He started breathing funny at 5 weeks old, so Liz rushed him to the ER where X-rays showed he had an enlarged heart and fluid in his lungs.

They asked Liz what she wanted to do, and she understood he was born with a heart that was too big, and told them she thought putting him to sleep would be the best thing. The vet offered to let her take him home, but he agreed the inevitable would happen.

Although it was difficult since she had known him since 10 days old and bottle fed him, she just couldn’t watch him suffer. She asked to see Jalapeno one last time to say good-bye. When he started to cry, she could see that his gums were losing their color, so she knew he wasn’t getting the oxygen he needed.

She grabbed a vet tech immediately and asked them to euthanize him right away because he was suffering. Although it was completely devastating, Liz knew he was in heart failure and there was no way to undo that. She was grateful she noticed something was wrong and could ease his passing.

A listener also shared her stories about three cats that had to be euthanized. Two of the cats were older, and were getting fluid in their lungs. Each time the fluid was removed, the question was posed if she should euthanize them.

Eventually the vet explained she could allow them to pass on their own, but it might not be peaceful, which is what helped her make the decision. For the 3rd cat she euthanized, she had made an appointment for him, and he almost didn’t make it through the night. After having gone through it so many times, she’s better prepared.

This helps her make decisions on which vets she works with, as well as selecting vets who will have the same view she does on putting quality of life first. Her current vet treats cats without going to the extreme, which mirrors her views.

Dr. Brooks then reminded all the callers that your opinion is important because you know how your animal is supposed to behave.

Bringing them into the vet can result in a jolt of adrenaline and they may seem fine, but you know how your cat was behaving before the visit. It’s not wrong to make the decision even if they aren’t overtly suffering (too early is better than too late). It’s really impossible to tell the exact right moment when a cat should be euthanized.

Then, Dr. Brooks also shared a personal story. Her mom had a 16-year-old cat that was peeing all over the house. She wasn’t able to get diagnostics for the cat, but given the age, Dr. Brooks was certain there was an underlying issue.

It was ruining her mother’s relationship with the cat and causing stress, but still, her mom felt guilty deciding to euthanize the cat. Dr. Brooks kindly explained to her mother that euthanasia was the right decision, and her mother eventually agreed.

 

Q&A

I have a senior cat with renal disease who’s on special food and has trauma in her past. When she’s ill, she reverts back to how she was after being rescued, where she doesn’t want to be held and wants to be alone. How do I deal with this trauma component?

Liz: Dr. Brooks, can a cat with renal disease have gabapentin?

Dr. Brooks: That may help her, and would be okay in small doses. It would relieve any pain she’s feeling and help her be more comfortable. Buprenorphine is an option too. You could also give her Pepcid (generic is famotidine) to combat stomach acidity that’s common in cats with kidney disease.

Liz: I also want to mention that a cat that’s suffered drama and gets pulled back into it will need time to cool off. They aren’t even recognizing you. Your cat probably wants to feel safe and is being protective of herself.

What do you do to catch an injured feral cat?

Liz: I’d reach out to a local rescue or animal shelter ahead of time to see if they can help you. You could also reach out to people who TNR (trap neuter return) on a regular basis and see if they would agree to help you or at the least give you some tips.

My cat with renal disease sometimes poops outside of the box?

Dr. Brooks: If your cat has kidney disease, it could be from that. They can also be uncomfortable with the litter you’re using.

Liz: If the cat had muscle wasting on the back half, the cat may not have enough muscle to hold in a bowel movement. So she might not be able to hold it long enough to get to the box.

 

Early Preparation Is Best

Cat owners aren’t the only ones who avoid talking about end of life care ahead of time. Many vets also don’t bring up the topic, which is why Dr. Brooks wanted to talk about it. Although it’s hard and emotional to talk about, it’s better to discuss when you are thinking clearly and aren’t being pressured to make those decisions.

Then when the time comes, although it isn’t easy, at least you have a plan in place, or at least know your options.